Navegando por Assunto "Insulina"

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Acesso aberto (Open Access)
Avaliação dos picos de hormônio do crescimento nos testes de estímulo com insulina e clonidina em pacientes com diagnóstico de baixa estatura
(Universidade Federal do Pará, 2016-12-28) PINTO, Carlliane Lima e Lins; YAMADA, Elizabeth Sumi; http://lattes.cnpq.br/7240314827308306; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863
Short stature (SS) is an important referral cause for evaluation in pediatric endocrinology. Growth hormone deficiency (GHD) needs to be considered when other causes of BE are excluded, but there are limitations in establishing its definitive diagnosis, being the subject of several debates and controversies. Although highly questioned, GH stimulation tests are still considered the standard for the diagnostic confirmation of GHD. The present study aimed to evaluate the sensitivity, specificity and accuracy of the different GH peak cut-off points for diagnosis of GHD, in response to stimulus by insulin tolerance test (ITT) and clonidine test, in addition to identifying the best GH peak level to confirm diagnosis using a Receiver Operating Characteristics (ROC) curve analysis. For this purpose, a retrospective and observational study was carried out. Clinical and laboratory data from 62 patients at the endocrinology department of the Hospital Universitário João de Barros Barreto (HUJBB) were collected. The gold standard considered for performance analysis of cut-off points in both GH stimulation tests was the therapeutic response. Thus, 26 patients who achieved a height increase of at least 0,3 standard-deviation at the end of one year of treatment with recombinant human GH (rhGH) were classified as GHD. The remaining patients who did not obtain this gain formed the group called non-GHD. Both groups had similar mean height (p = 0,8155) and gained height at the end of follow-up, but this gain was higher in the GHD group compared to the non-GHG group (20,5 ± 14,8 cm vs. 9,2 ± 6,7 cm, respectively, p = 0,0064). GHD group had a significantly lower meddle GH peak than the non-GHG group in both tests (p <0,0001). Sensitivity, specificity and accuracy of cut-off points 3, 5, 7 and 10 ng/mL were defined in the TTI and in the clonidine test, and there was no superiority of one test over the other. In addition, the cut-off points found were 7,92 ng/mL and 6,78 ng/mL in the TTI and clonidine test, respectively, based on the construction of the ROC curve, representing the most sensitive and specific GH peak levels for the diagnosis of GHD. We conclude that the cut-off points found in this study may represent an emerging tool in the selection of patients who would probably benefit from treatment with rhGH, both in cases of GHD for a known cause and in cases of IGHD.
Acesso aberto (Open Access)
Cartilha educativa sobre cuidados com o uso de insulina injetável no tratamento do Diabetes Mellitus
(Universidade Federal do Pará, 2022-08-25) GOMES, Adriana dos Santos Mendes; SANTOS, Márcia Costa dos; http://lattes.cnpq.br/5450061620179886
Introduction: Diabetes Mellitus (DM) is a hormonal disorder characterized by persistent hyperglycemia resulting from a deficiency in the production and/or action of insulin. Currently, for the drug treatment of DM, we have two classes of injectable drugs: insulin and Glucagon-like peptide 1 (GLP-1) analogues, with insulin being the most used injectable drug today. Objectives: To create educational material on care with the injectable drug insulin aimed at patients with DM. Methodology: A bibliographic research was carried out in the MEDLINE, Pubmed and Scielo portals, which resulted in 2.920 publications and 29 scientific articles were registered. After analyzing the texts, the Educational Booklet on care with the use of the injectable drug insulin in the treatment of diabetes mellitus was prepared as a final product. It is a methodological development study, which refers to the elaboration, validation and evaluation of an instrument and research technique that can later be used by other people (POLIT; BECK, 2011). The booklet was edited using Office Word software free version 2021 and CorelDraw Graphics Suite X8 2021 and configured for printing on A4 sheet (210mm x 297 mm) in ―portrait‖ format. After delimiting the content of the booklet, the Flesch Reading Ease Index (IFLF) was applied in order to assess the ease with which a text can be read. After that, it was necessary to validate it, through the evaluation of a committee composed of content professor judges (JDC) and professional health care judges (JPSA). Results: The booklet addressed the following points about care with the use of insulin: types of insulin currently available, how to obtain it from SUS, what supplies are needed, how to carry out its application and care in the disposal of materials used. In the analysis of the booklet, the IFLF test revealed an index of 79.94 (%), being within the range of 70-80, which classifies the material as reasonably Easy. The judges carried out the validation of the educational material based on the evaluation of 3 aspects of the content: clarity of language, practical relevance and theoretical relevance. The global CVI (average of all grades) was calculated for the educational booklet, with values of 0.9 for clarity of language, 0.97 for practical relevance and 0.96 for theoretical relevance, indicating an excellent level of agreement between the judges. Conclusion: The educational material is presented with reasonably easy reading and presented good content validation, indicating that it is material of good understanding and content. It is hoped that this material will be well accepted, encourage education in DM, and serve as a practical guide for patients with diabetes in their daily lives and that it will develop skills and favor the autonomy and self-care of these individuals.
Acesso aberto (Open Access)
Influência da suplementação de vitamina D na variabilidade glicêmica em pacientes com diabetes Mellitus tipo 1
(Universidade Federal do Pará, 2016-01-27) FELÍCIO, Karem Mileo; YAMADA, Elizabeth Sumi; http://lattes.cnpq.br/7240314827308306; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863
Recent studies suggest that glycemic variability (GV) could influence the risk of complications in diabetes, independently from glycemic control (GC). GV is the evaluation of the daily fluctuations of glycemia through specific calculations. The few studies that have assessed the effects of supplementation with vitamin D (VD) in patients with diabetes type 1(DM1) on GC are controversial and there is no data about a possible action of VD on GV in these patients. Our study aims to evaluate the effects of VD supplementation on GV in patients with DM1. We executed a prospective, controlled study with 22 patients with DM1. Doses of either 4.000 or 10.000 IU/day of cholecalciferol were administered for 12 weeks according to the patient’s previous vitamin D serum levels. All patients were submitted to continuous glucose monitoring system (CGMS) with the analysis of 41.000 glycemias, dosage of vitamin D and HbA1c before and after the treatment. When the pre and post treatment variables were compared, no differences were observed, except for the expected improvement of the levels and status of VD (26,1 ± 9,0 vs 44,4 ± 24,7 ng/mL ; p<0,01 e 1,00 ± 0,76 vs 0,36 ± 0,66 ; p<0,01), respectively. Correlations were found between the percentage variation (Δ) of the glycemia standard deviation (ΔGSD), calculated using the CGMS, with Δ of the basal (r= 0,6; p<0,01) and total insulin (r= 0,6; p<0,01). Our study also found a correlation between the VD status after supplementation and Δ of the prandial (r= 0,5; p<0,05) and total insulin (r= 0,4; p<0,05), indicating that the better the vitamin D status, lower the doses of insulin needed by the patients. To efficiently study the GV, patients were divided in two groups: Patients in which the ΔGSD improved (group 1; N= 12 (55%)) and those in which the ΔGSD worsened (group 2; N= 10 (45%)). Group 1 when compared to group 2 showed lower needs of insulin (Δbasal insulin = -8,0 vs 6,3%; (p<0,05)) and lower frequency of hypoglycemia (12/44 (27%) vs 21/33 (64%), hypoglycemias / days evaluated ; p<0,01). Our data suggests that supplementation of VD on patients with DM1 could improve the GV associated to a lower need of insulin in more than 50% of these patients. The improvement of GV was strongly associated with reduction in frequency of hypoglycaemia. However, it was not possible to demonstrate benefits of vitamin D on glycaemic control measured by the HbA1c.