Abstract Introduction: Vascular and neuropathic complications of diabetes cause diabetic foot, being the main risk factor for non-traumatic amputations. Objective: To analyze the available scientific evidence on lifestyle and self-care of patients at risk of diabetic foot. Methodology: Literature review using the preferred reporting items for systematic reviews and meta-analyses methodology; published in EBSCO host, Google academic, PubMed, Scielo and Elsevier; in English and Spanish from 2016 to 2022. Nursing articles were included, mentioning two or more variables of interest: diabetes mellitus, lifestyle, diabetic foot, and self-care; duplicates, no access, and gray literature were eliminated. From a total of 1,080 articles, 14 were included that met the inclusion criteria. Checklists were used to assess the quality of the manuscripts used. Results: Systematic reviews, observational, experimental and qualitative studies showed evidence that self-care can be influenced by culture, context and knowledge deficit, being this a risk factor for the development of diabetic foot. An association was found between the risk of diabetic foot with years of diagnosis, inadequate self-care of the feet and advanced age. Conclusion: The association between the self-care deficit and the risk of diabetic foot in the elderly was evidenced. It is recommended to broaden the search and include people under 40 years of age in order to establish effective preventive measures and reduce the risk of diabetic foot.

Abstrato Introdução: As complicações vasculares e neuropáticas da diabetes causam o pé diabético, sendo o principal fator de risco para amputações não traumáticas. Objetivo: Analisar a evidência científica disponível sobre o estilo de vida e o autocuidado dos doentes em risco de pé diabético. Metodologia: Revisão da literatura utilizando a metodologia preferred reporting items for systematic reviews and meta-analyses; publicada no EBSCO host, Google Scholar, PubMed, Scielo e Elsevier; em inglês e espanhol de 2016 a 2022. Foram incluídos artigos de enfermagem que mencionavam duas ou mais variáveis de interesse: diabetes mellitus, estilo de vida, pé diabético e autocuidado; foram removidos os duplicados, sem acesso e literatura cinzenta. De um total de 1.080 artigos, 14 que preencheram os critérios de inclusão foram incluídos. Foram utilizadas listas de verificação para avaliar a qualidade dos manuscritos utilizados. Resultados: Revisões sistemáticas, estudos observacionais, experimentais e qualitativos mostraram evidências de que o autocuidado pode ser influenciado pela cultura, contexto e défices de conhecimento, que são factores de risco para o desenvolvimento da doença do pé diabético. Foram encontradas associações entre o risco de pé diabético e os anos de diagnóstico, o autocuidado inadequado dos pés e a idade avançada. Conclusão: Verificou-se a associação entre défices de autocuidado e o risco de doença do pé diabético em idosos. Recomendamos o alargamento da pesquisa a pessoas com menos de 40 anos de idade, de forma a estabelecer medidas preventivas eficazes e reduzir o risco de doença do pé diabético.

Resumen Introducción: Las complicaciones vasculares y neuropáticas de la diabetes causan el pie diabético, siendo el principal factor de riesgo para amputaciones no traumáticas. Objetivo: Analizar la evidencia científica disponible sobre el estilo de vida y autocuidado de los pacientes con riesgo de pie diabético. Metodología: Revisión de la literatura mediante la metodología preferred reporting items for systematic reviews and meta-analyses; publicada en EBSCO host, Google académico, PubMed, Scielo y Elsevier; en inglés y español desde 2016 a 2022. Se incluyeron artículos de enfermería, que mencionaran dos o más variables de interés: diabetes mellitus, estilo de vida, pie diabético y autocuidado; se eliminaron duplicados, sin acceso abierto y literatura gris. De un total de 1,080 artículos se incluyeron 14 que reunieron los criterios de inclusión. Se emplearon listas de verificación para evaluar la calidad de los manuscritos utilizados. Resultados: Las revisiones sistemáticas, estudios observacionales, experimentales y cualitativos mostraron evidencias de que el autocuidado puede verse influenciado por la cultura, contexto y déficit de conocimientos, siendo este factor de riesgo para el desarrollo de pie diabético. Se encontró asociación entre el riesgo de pie diabético con años de diagnóstico, autocuidado inadecuado de los pies y edad avanzada. Conclusión: Se evidenció asociación entre déficit de autocuidado y riesgo de pie diabético en el adulto mayor. Se recomienda ampliar la búsqueda e incluir personas menores de 40 años para establecer medidas preventivas eficaces y reducir el riesgo de pie diabético.

Abstract We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm (SCORE2 and SCORE-OP) is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50-69, ≥ 70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.

Resumen Presentamos la adaptación española de las guías europeas de prevención cardiovascular de 2021. En esta actualización, además del abordaje individual, se pone mucho más énfasis en las políticas sanitarias como estrategia de prevención poblacional. Se recomienda el cálculo del riesgo vascular de manera sistemática a todas las personas adultas con algún factor de riesgo vascular. Los objetivos terapéuticos para el colesterol LDL, la presión arterial y la glucemia no han cambiado respecto a las anteriores guías, pero se recomienda alcanzar estos objetivos de forma escalonada (etapas 1 y 2). Se recomienda llegar siempre hasta la etapa 2. La intensificación del tratamiento dependerá del riesgo a los 10 años y de por vida, del beneficio del tratamiento, de las comorbilidades, de la fragilidad y de las preferencias de los pacientes. Las guías presentan por primera vez un nuevo modelo (SCORE2 y SCORE2-OP) para calcular el riesgo de morbimortalidad vascular en 10 años (infarto de miocardio, ictus y mortalidad vascular) en hombres y mujeres de entre 40 y 89 años. Otra de las novedades sustanciales es el establecimiento de diferentes umbrales de riesgo dependiendo de la edad (< 50, 50-69 y ≥ 70 años). Se presentan diferentes algoritmos de cálculo del riesgo vascular y del tratamiento de los factores de riesgo vascular para personas aparentemente sanas, pacientes con diabetes y pacientes con enfermedad vascular aterosclerótica. Los pacientes con enfermedad renal crónica se considerarán de riesgo alto o muy alto, según la tasa del filtrado glomerular y el cociente albúmina/creatinina. Se incluyen innovaciones en las recomendaciones sobre los estilos de vida, adaptadas a las recomendaciones del Ministerio de Sanidad, así como aspectos novedosos relacionados con el control de los lípidos, la presión arterial, la diabetes y la insuficiencia renal crónica.

ABSTRACT Introduction: Diabetes is still the leading cause of non-traumatic amputation in most Western countries, epidemiological reports indicate that more than a million amputations are performed in people with diabetes each year, this is equivalent to an amputation for diabetes somewhere in the world every 30 seconds, most of these amputations are preceded by ulcers. Clinical Case: We present a case of a 39-year-old male patient suffering from diabetes mellitus and uncontrolled hypertension, with late complications, chronic kidney disease, anemia, retinopathy, and ischemic and neuropathic diabetic foot, with indication for amputation. Healthy lifestyles are used, controlling glycemia, hypertension, without requiring medication and reducing proteinuria. There were no adverse effects. With favorable evolution since then. Conclusion: A healthy lifestyle is an intervention that the earlier it is used, the greater its benefits, without the risk of adverse effects or unnecessary costs, but even in late stages it has shown benefits in glycemic, hypertensive and renal control.

RESUMEN Introducción: La diabetes sigue siendo la principal causa de amputación no traumática en la mayoría de los países occidentales1, informes epidemiológicos indican que más de un millón de amputaciones se realizan en personas con diabetes cada año, esto equivale a una amputación por diabetes en algún lugar del mundo cada 30 segundos, la mayoría de estas amputaciones son precedidas por úlceras2. Caso Clínico: Presentamos un caso de un paciente varón de 39 años pluripatológico que padece de Diabetes Mellitus e Hipertensión no controlada, con complicaciones tardías, renal, anemia, retinopatía, y pie diabético isquémico y neuropático, con indicación de amputación. Se emplea estilos de vida saludables6, controlando glicemias, hipertensión, sin requerir medicación y disminuyendo la proteinuria. No se presentaron efectos adversos. Con evolución favorable desde entonces. Conclusión: El estilo de vida saludables es una intervención que entre más tempranamente sea empleada serán mayores sus beneficios, sin el riesgo de efectos adversos, ni costos innecesarios, pero aun en etapas tardías ha mostrado beneficios en el control glicémico, hipertensivo y renal.

ABSTRACT Introduction: Diabetes mellitus is the main cause of progression of chronic kidney disease and dialysis. The therapeutic intervention considers an HbA1C level that avoids adverse effects associated with hypoglycemic therapy, as occurs in patients with chronic kidney disease, despite not reaching normoglycemia. Clinical Case: The present case describes an intervention based on Lifestyle Medicine in a patient with diabetic nephropathy and chronic kidney disease, whose biomarkers showed improvement in kidney damage due to reduction of proteinuria or reduction of HbA1C, LDL and triglycerides in its metabolic control. Conclusion: The intervention with lifestyle medicine requires a multidisciplinary approach and the time of intervention does not discriminate a degree of chronic kidney disease that limits its intervention

RESUMEN Introducción: La diabetes mellitus es la principal causa de progresión de la enfermedad renal crónica y diálisis. La intervención terapéutica considera un nivel de HbA1C que evite efectos adversos asociados a la terapia hipoglicemiante como ocurre en el paciente con enfermedad renal crónica, pese a no se alcance la normoglicemia. Caso Clínico: El presente caso describe una intervención basada en Medicina de Estilos de Vida en un paciente con nefropatía diabética y enfermedad renal crónica, cuyos biomarcadores mostraron mejoría en daño renal por reducción de la proteinuria o reducción de HbA1C, LDL y triglicéridos en su control metabólico. Conclusión: La intervención con medicina de estilos de vida requiere un enfoque multidisciplinario y su momento de intervención no discrimina un grado de enfermedad renal crónica que limite su intervención.

Abstract Chronic kidney disease (CKD) in the diabetic patient is mainly a consequence of long-term diabetes mellitus itself. In Mexico approximately 50% of patients on dialysis are diabetics and this will could increase in the coming years. New therapeutic options available, combined with lifestyle changes, have improved glycemic control and may contribute to delay the onset as well as the progression of CKD. International scientific societies have developed clinical guidelines for the diagnosis and management of CKD in diabetics, although in some points, these recommendations are not adapted to the Mexican reality. We hereby present the conclusions of the consensus reached by Mexican specialists on diabetic nephropathy.

Resumen La enfermedad renal crónica (ERC) del paciente diabético es frecuentemente una consecuencia directa de la diabetes mellitus (DM) de larga evolución y se la conoce como nefropatía diabética. En México cerca del 50% de los pacientes en terapia sustitutiva de la función renal tienen ERC por DM, y este porcentaje podría aumentar en los próximos años. Nuevas opciones terapéuticas, combinadas con cambios en el estilo de vida, han mejorado el control de la glucemia y pueden contribuir sustancialmente a retrasar la aparición o la progresión a estadios avanzados de la ERC. Las sociedades científicas internacionales han elaborado guías clínicas para el diagnóstico y manejo de la nefropatía diabética, sin embargo, en algunos puntos estas recomendaciones no se adaptan a la realidad mexicana. Se presentan las conclusiones de un consenso realizado por especialistas mexicanos sobre diabetes y ERC, con especial énfasis en el uso de los inhibidores del cotransportador de sodio-glucosa.

RESUMEN Se presenta la adaptación española de las Guías Europeas de Prevención Cardiovascular 2021. En esta actualización, además del abordaje individual, se pone mucho más énfasis en las políticas sanitarias como estrategia de prevención poblacional. Se recomienda el cálculo del riesgo vascular de manera sistemática a todas las personas adultas con algún factor de riesgo vascular. Los objetivos terapéuticos para el colesterol LDL, la presión arterial y la glucemia no han cambiado respecto a las anteriores guías, pero se recomienda alcanzar estos objetivos de forma escalonada (etapas 1 y 2). Se recomienda llegar siempre hasta la etapa 2, y la intensificación del tratamiento dependerá del riesgo a los 10 años y de por vida, del beneficio del tratamiento, de las comorbilidades, de la fragilidad y de las preferencias de los pacientes. Las guías presentan por primera vez un nuevo modelo para calcular el riesgo -SCORE2 y SCORE2-OP- de morbimortalidad vascular en los próximos 10 años (infarto de miocardio, ictus y mortalidad vascular) en hombres y mujeres entre 40 y 89 años. Otra de las novedades sustanciales es el establecimiento de diferentes umbrales de riesgo dependiendo de la edad (< 50, 50-69, ≥ 70 años). Se presentan diferentes algoritmos de cálculo del riesgo vascular y tratamiento de los factores de riesgo vascular para personas aparentemente sanas, pacientes con diabetes y aquellos con enfermedad vascular aterosclerótica. Los pacientes con enfermedad renal crónica se considerarán de riesgo alto o muy alto, según la tasa del filtrado glomerular y el cociente albúmina/creatinina. Se incluyen innovaciones en las recomendaciones sobre los estilos de vida, adaptadas a las recomendaciones del Ministerio de Sanidad, así como aspectos novedosos relacionados con el control de los lípidos, la presión arterial, la diabetes y la insuficiencia renal crónica.

ABSTRACT We report the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. In addition to the individual approach this update greatly emphasizes the importance of population level approaches to the prevention of cardiovascular diseases. Systematic CVD risk assessment is recommended for all adults with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure and glycaemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, a new, stepwise approach (Steps 1 and 2) to treatment intensification is proposed as a tool to help physicians and patients attain these targets in a way that fits the patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities, frailty and patient preferences. The updated SCORE algorithm-SCORE2, SCORE-OP- is recommended in these guidelines, which estimates an individual’s 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different risk categories according to different age groups (< 50, 50-69, ≥ 70 years). Different flowcharts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to those published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.

RESUMO Com melhorias nas exigências estéticas dentárias um número crescente de adultos está em busca de tratamento ortodôntico que, juntamente com estilo de vida atual e hábitos alimentares da população adulta, torna os ortodontistas mais propensos a encontrar pacientes com distúrbios metabólicos como a diabetes mellitus. Especula-se que o paciente diabético durante o tratamento ortodôntico pode não experimentar um processo fisiológico de cura como um paciente saudável. Portanto, o objetivo deste trabalho é apresentar uma revisão atual e contextualizada dos mecanismos pelos quais a diabetes mellitus descontrolada impacta na remodelação óssea e no movimento dentário ortodôntico durante a aplicação de forças ortodônticas. Foram pesquisadas as seguintes bases de dados MEDLINE (via PubMed), Scopus, Web of Science, SciELO, LILACS e open grey com os termos MeSH: “remodelação óssea”, “diabetes mellitus”, “ortodontia” e “movimento dentário”. Cinco artigos permaneceram após a estratégia de busca e foram analisados. Em suma, não foram encontrados estudos clínicos, as evidências foram limitadas a estudos em animais (ratos). Os resultados sugerem que existem diferenças na remodelação óssea e na movimentação dentária durante a aplicação de forças ortodônticas em animais com diabetes mellitus quando comparados a animais saudáveis, especialmente quando a doença está associada à doença periodontal. No entanto, os resultados ainda são controversos e podem ser devido a diferentes protocolos de estudo.

ABSTRACT With improvements in dental aesthetic requirements an increasing number of adults are seeking orthodontic treatment that, along with current lifestyle and eating habits of the adult population, makes orthodontists more likely to encounter patients with metabolic disorders such as diabetes mellitus. Speculated that the diabetic patient during orthodontic treatment may not experience a physiological healing process as a healthy patient. Therefore, the objective of this work is to present a current and contextualized review of the mechanisms by which uncontrolled diabetes mellitus impacts on bone remodeling and orthodontic tooth movement during the application of orthodontic forces. The following databases were searched MEDLINE (via PubMed), Scopus, Web of Science, SciELO, LILACS and open grey with these MeSH “bone remodeling”, “diabetes mellitus”, “orthodontic” and “tooth movement”. Five articles remained after search strategy and were analyzed. In sum, no clinical studies were found, the evidence was limited to animal studies (rats). The results suggest that there are differences in bone remodeling and tooth movement during the application of orthodontic forces in animals with diabetes mellitus when compared to healthy animals, especially when the disease is associated with periodontal disease. However, the results are still controversial and may be due to different study protocols.

ABSTRACT Introduction: Diabetes Mellitus involves a serious Public Health problem, its control consists in getting the patient to keep their blood glucose levels controlled to prevent multiorgan complications, so adherence to treatment and lifestyle changes are fundamental pillars, where the family as maximum support to the immediate reach of the patient plays a transcendental role. Objetive: To determine the relationship between family support and glycemic control in Type II diabetic patients who attend a Hospital of III Level in Paraguay during July and August 2019. Methods: This was an observational, descriptive study with an analytical component Transversal, the “instrument to measure family support in Type 2 Diabetic” of Valadez Figueroa et al., Validated in 2003 was applied. Patients with Diabetes were questioned about sociodemographic variables and the value in the last HbA1c control. Results: Of the 284 diabetes patients surveyed 82 % (202) were women, 46 % (131) were under five years of diagnosis. 67 % (190) had inadequate glucose control. Regarding global family support, 82 % (233) had average family support. A positive association of glycemic decontrol was found in relation to the average family support. Conclusion: There is an association between average family support in patients with diabetes and glycemic lack of control, which demonstrated the importance of the family for the patient to adhere to the treatment agreed upon by the health personnel.

RESUMEN Introducción: La diabetes mellitus comprende un grave problema de Salud Pública, su control consiste en conseguir que el paciente mantenga sus cifras de glicemia controladas para prevenir complicaciones multiorgánicas, por lo cual la adherencia al tratamiento y cambios en el estilo de vida son pilares fundamentales, en donde la familia como máximo apoyo al alcance inmediato del paciente juega un papel trascendental. Objetivo: determinar la relación entre el apoyo familiar y el control de la glucemia en pacientes diabéticos Tipo II que acuden a un Hospital III Nivel de atención de Paraguay durante julio y agosto del 2019. Metodología: Estudio observacional, descriptivo con componentes analíticos, de corte transversal, se aplicó el “instrumento para medir apoyo familiar en el diabético Tipo II” de Valadez Figueroa et al., validado en el 2003. A los pacientes con diabetes se les interrogó sobre variables sociodemográficas y el valor en el último control de la prueba hemoglobina glicosilada. Resultados: De los 284 pacientes con diabetes encuestados 82 % (202) fueron mujeres, el 46 % (131) tenían menos de cinco años de diagnóstico. El 67 % (190) tenían un control de glucosa inadecuado. Respecto al apoyo familiar global, 82 % (233) tenían apoyo familiar medio. Se encontró una asociación positiva de descontrol glucémico en relación con el apoyo familiar medio. Conclusión: Existe asociación entre el apoyo familiar medio en pacientes con diabetes y el descontrol glucémico, que demostró la importancia de la familia para que el paciente se adhiera al tratamiento acordado con el personal sanitario.

Abstract Diabetes mellitus type 2 (DM2) is a chronic and multifactorial disease that requires an integral treatment throughout the life of the patient and in need of constant adjustments according to specific requirements of each patient. It is well established that weight loss in diabetic patients may delay the progression of the disease or even delay its onset. In addition to being a beneficial factor in the treatment goals of diabetic patients, weight reduction can achieve clinically significant changes in serum glucose, glycated hemoglobin (HbA1c) and triglyceride levels. Evidence-based recommendations are currently aimed at pharmacological, surgical and lifestyle changes in the management of obesity as part of the comprehensive treatment of patients with diabetes mellitus type 2. Traditional pharmacological treatments for diabetes mellitus type 2 may further increase weight and this may decrease the benefits of adequate glycemic control. It’s important to identify the interference of each drug group on weight.

Resumen La diabetes mellitus tipo 2 es una enfermedad multifactorial y de carácter crónico que requiere un tratamiento integral a lo largo de la vida del paciente y con necesidad de ajustes constantes de acuerdo con los requerimientos específicos de cada paciente. Se ha identificado que la disminución de peso en pacientes diabéticos puede retrasar la progresión de la enfermedad e incluso retrasar o evitar su aparición. Además de ser un factor benéfico en las metas de tratamiento de los pacientes diabéticos, la disminución del peso puede lograr cambios clínicamente significativos en las concentraciones totales de glucosa sérica, hemoglobina glucosilada (HbA1C) y en las concentraciones de triglicéridos. En la actualidad las recomendaciones basadas en evidencia están dirigidas a la intervención farmacológica, quirúrgica y cambios en el estilo de vida en el manejo de la obesidad como parte del tratamiento integral de los pacientes con diabetes mellitus tipo 2. Los tratamientos farmacológicos tradicionales contra la diabetes mellitus tipo 2 pueden aumentar aún más el peso y esto puede disminuir los beneficios del control glucémico adecuado. Es importante identificar la injerencia de cada grupo de fármacos en el peso.

The prevention and treatment of chronic kidney disease (CKD) in diabetes through diet and lifestyle have been a topic of much interest over the years. Consideration of the type and amount of carbohydrate, protein and fat is required for optimal blood glucose control, for clinical outcomes related to renal function and for consideration of risk reduction for cardiovascular disease. Depending on the CKD stage different dietary changes should be considered protein-calorie malnutrition is common in chronic kidney disease patients and is a powerful predictor of morbidity and mortality. We review the nutritional management of a diabetic patient throughout the progression of their CKD.

La prevención y el tratamiento de la enfermedad renal crónica (ERC) en pacientes con diabetes ha sido un tema de gran interés a lo largo de los años. Para conseguir un adecuado control glucémico, una función renal estable y una reducción del riesgo cardiovascular, es fundamental un correcto aporte de hidratos de carbono, lípidos y proteínas. Las medidas dietéticas realizadas se irán modificando a lo largo de la evolución de la ERC. La malnutrición energético-proteica es muy frecuente en pacientes con ERC y diabetes y es un importante predictor de morbimortalidad. Revisamos el manejo nutricional de un paciente diabético a lo largo de la progresión de su ERC.

OBJETIVO: determinar la prevalencia y los factores relacionados con la adherencia no farmacológica en pacientes con hipertensión arterial (HTA) y diabetes mellitus (DM). METODOLOGIA: estudio observacional transversal en pacientes adultos mayores de 35 años con diagnóstico de HTA o DM, atendidos en un programa de Renoprotección en cuidado primario en Cali, Colombia. Se excluyeron aquellos pacientes con enfermedad renal crónica en estadío KDOQI 4-5, los que presentaran comorbilidades adicionales que deterioraran la función renal o con trastornos neuropsiquiátricos diagnosticados previamente. La adherencia no farmacológica se determinó mediante un cuestionario de autoreporte y los factores asociados a la misma se determinaron mediante regresión de Poisson con varianza robusta. RESULTADOS : la prevalencia de la adherencia no farmacológica fue de 9,4%. La inactividad física estuvo presente en 75% de los pacientes, y más del 19% de la población consumía sal frecuentemente. Entre los diabéticos, 18% consumía carbohidratos con frecuencia. Los hombres mostraron ser menos adherentes que las mujeres (RP: 0,21; p = 0,002). Los factores asociados positivamente con la adherencia no farmacológica fueron: estar estudiando, desempleado o pensionado (RP: 4,42; p = 0,019), recibir apoyo del equipo de salud (RP: 3,17; p = 0,032), tener diagnóstico de diabetes (RP: 7,79; p = 0,000) y la función renal en KDOQI-3 (RP: 5,14; p = 0,008). CONCLUSION: la adherencia no farmacológica fue muy baja en la población de estudio, en particular en relación con la inactividad física. Los factores asociados positivamente a la adherencia fueron el sexo femenino, tener una ocupación diferente al hogar, diagnostico de diabetes, enfermedad renal en KDOQI-3 y contar con apoyo del equipo de salud.

OBJECTIVE: To determine the prevalence and factors associated with adherence to non-pharmacological treatment in patients with high blood pressure (HBP) and diabetes mellitus (DM). METHODOLOGY: A cross-sectional and observational study conducted with adult patients older than 35, diagnosed with HBP or DM and receiving health care in a primary care renal protection program in Cali, Colombia. Patients with chronic kidney disease at the KDOQI 4-5 stage, additional comorbidities which impair the renal function or with previously diagnosed neuropsychiatric disorders were excluded. Adherence to non-pharmacological treatment was determined using a self-report questionnaire. Factors associated with adherence were obtained through a Poisson regression with robust variance. RESULTS : The prevalence of patient adherence was 9.4%.Physical inactivity was present in 75% of the patients and 19% of the population often consumed salt. Among the diabetics, 18% often consumed carbohydrates. Men showed less adherence than women (RP: 0.21; p = 0.002). Factors positively associated with adherence to non-pharmacological treatment were: being a student, unemployed or retired(RP: 4.42; p = 0.019), getting help from the health care team (RP: 3.17; p = 0.032), being diagnosed with diabetes (RP: 7.79; p = 0.000) and having the renal function in the KDOQI-3 stage (RP: 5.14; p = 0.008). CONCLUSION: Adherence to non-pharmacological treatment was very low in the studied population, particularly in relation to physical inactivity. The factors positively associated with treatment adherence were being female, not being a housewife, having diabetes, having a renal disease at the KDOQI-3 stage and having the support of a health care team.

Objetivo: Determinar a prevalência e os fatores ligados à aderência não-farmacológica em pacientes com hipertensão arterial (HTA) e diabetes mellitus (DM). Metodologia: Estudo observacional transversal em pacientes adultos maiores de 35 anos com diagnóstico de HTA ou DM, atendidos em um programa de Renoproteção em cuidado primário em Cali, Colômbia.Foram excluídos aqueles pacientes com doença renal crônica em etapa KSOQI 4-5, aqueles com comorbilidades adicionais que deterioram a função renal ou com transtornos neuropsiquiátricos diagnosticados previamente.A aderência não farmacológica foi determinada por meio de um questionário de auto-relato e os fatores associados a ela foram determinados por meio de regressão de poisson com variância robusta. Resultados : A prevalência da aderência não farmacológica foi de 9.4%.A inatividade física esteve presente em 75% dos pacientes e mais de 19% da população consumia sal frequentemente.Entre os diabéticos 18% consumia frequentemente carboidratos. Os homens mostraram ser menos aderentes do que as mulheres (RP: 0,21; p = 0,002). Os fatores associados positivamente à aderência não farmacológica foram os fatos de estarem estudando, desempregados ou aposentados(RP: 4,42; p = 0,019), receber apoio da equipe de saúde (RP: 3,17; p = 0,032), ter diagnóstico de diabetes (RP: 7,79; p = 0,000) e a função renal em KDOQI-3 (RP: 5,14; p = 0,008). Conclusão: Aderência não farmacológica foi muito baixa na população analisada, em particular em relação com a atividade física.Os fatores associados positivamente à aderência foram o gênero feminino, ter uma ocupação diferente do lar, diagnóstico de diabetes, doença renal em KDOQI-3 e contar com apoio da equipe de saúde.

Este artigo revisa as evidências clínicas e farmacológicas para o uso da repaglinida, um regulador da glicose prandial. Repaglinida tem um início rápido de ação e curta duração - um perfil farmacocinético que permite sua administração em esquemas flexíveis no horário das alimentações limitando as flutuações pós-prandiais da glicemia, típicas do diabetes mellitus do tipo 2 (DM2). Estudos comparativos com repaglinida controlados por placebo demonstram que seu uso também controla os níveis médios da glicemia, conforme indicado por parâmetros essenciais de glicemia, como a glicemia de jejum e os níveis de hemoglobina A1c (HbA1c). O controle da glicemia pós-prandial é de grande importância clínica, uma vez que ela é um importante fator de risco independente para as complicações do DM. O controle glicêmico melhorou ainda mais em pacientes com DM2 resistente a drogas quando a repaglinida foi incorporada ao esquema terapêutico combinado com agentes sensibilizadores de insulina, como a metformina ou o troglitazone. Existem, também, dados sugerindo que o esquema de repaglinida durante as alimentações pode reduzir a possibilidade de hipoglicemia quando comparado com esquemas tradicionais baseados nas sulfoniluréias. Isto pode ser particularmente benéfico para deixar o paciente livre para adotar padrões alimentares variados. Enquanto as sulfoniluréias podem efetivamente melhorar o controle glicêmico global, sua ação prolongada pode resultar em estimulação inapropriada das células beta durante períodos de glicemia relativamente baixa, incorrendo em risco aumentado para hipogicemia. Embora este risco possa ser reduzido se as alimentações forem consumidas em espaços regulares, este esquema impõe restrições à rotina dos pacientes e à liberdade para implementar melhorias no estilo de vida, como a restrição calórica. A repaglinida é metabolizada no fígado produzindo metabólitos inativos e excretada na bile, uma vantagem potencial para pacientes com comprometimento da função renal. Em conclusão, razões óbvias para se considerar um esquema prandial para controle da glicemia incluem a redução dos riscos de complicações diabéticas e de hipoglicemia, e uma maior flexibilidade por o paciente. Dados já disponíveis sobre a repaglinida sugerem que muitos benefícios teóricos deste esquema prandial para regulação da glicemia pode ser obtido na prática clínica.

This article reviews the clinical evidence and pharmacological rationale for repaglinide, a prandial glucose regulator. Repaglinide has a rapid onset and short duration of action - a pharmacokinetic profile that allows administration in a flexible schedule at mealtimes to limit the postprandial blood glucose excursions typical of type 2 diabetes mellitus. Placebo-controlled and comparative studies of repaglinide have demonstrated that prandial repaglinide also achieves overall glycaemic control, indicated by essential blood glucose parameters such as fasting blood glucose and hemoglobin A1c (HbA1c) levels. Regulation of postprandial glucose is of clinical importance, as this is an important independent risk factor for diabetic complications. Glycaemic control has been further improved in patients with drug-resistant type 2 diabetes when repaglinide is incorporated into combination therapy regimens with insulin-sensitizing agents such as metformin or troglitazone. There are also data to suggest that a mealtime regimen of repaglinide can reduce the likelihood of hypoglycemia compared with traditional sulphonylurea-based regimens. This benefit may be particularly marked when the patient is free to adopt a varying meal pattern. While sulphonylureas can effectively improve overall glycaemic control, their prolonged action may result in inappropriate stimulation of beta-cells during periods of relatively low blood glucose, thereby incurring the risk of hypoglycemia. Although this risk can be reduced if meals are consumed at regular intervals, such an approach places restrictions on the patient's routine and freedom to implement lifestyle measures such as caloric restriction. Repaglinide is metabolized in the liver to inactive metabolites and excreted in bile, a potential advantage for patients with renal dysfunction. In conclusion, compelling reasons for considering a prandial approach to glycaemic management include risk reductions for diabetic complications and hypoglycemia, and greater flexibility for the patient. Available data concerning repaglinide suggest that many theoretical benefits of the prandial approach to glucose regulation may be achievable in clinical practice.