Resumo Introdução: As complicações micro e macrovasculares da diabetes são resultado de um processo de caráter longo sobre a falta dos cuidados da diabetes, de que resultam problemas cardiovasculares, oftalmológicos e neuropáticos, requerendo por essas questões elevada atenção no tratamento. Descrição do caso: Apresenta-se o relato de caso de um paciente adulto de meia-idade, ex-fumador, com diagnóstico de diabetes mellitus, além da hipertensão e obesidade. A sua alimentação não saudável ao longo dos anos, sedentarismo e altos níveis de estresse resultou num quadro de isquemia vascular periférica, que intensificou as complicações da diabetes, ou seja, problemas micro e macrovasculares, entre eles, a retinopatia e a neuropatia. Por esse histórico, a farmacoterapia do paciente resultou entre as insulinas (regular e NPH), antiagregante plaquetátio, estatina, fibratos, psicotrópicos e os anti-hipertensores. Além disso, detetou-se que seus níveis glicémicos e hemoglobina glicada estão elevados. Ainda se verificaram alterações na lipoproteína de alta densidade (HDL) e triglicéridos. Algumas queixas do paciente no período noturno, como boca seca, tontura e sonolência, são problemas que podem estar relacionados com a terapia concomitante de venlafaxina, gabapentina e amitriptilina. Comentários: De forma geral, recomenda-se a este paciente a prática de exercício físico, como caminhada, por exemplo, diminuição do consumo de hidratos de carbono e sódio, além de algumas alterações na farmacoterapia do paciente.

Abstract Introduction: The micro and macrovascular complications of diabetes are the result of a long process of the lack of diabetes care, which results in cardiovascular, ophthalmological, and neuropathic problems, and for these reasons requires high attention in treatment. Case description: This article presents a case report of a middle-aged adult patient, ex-smoker, diagnosed with diabetes mellitus, in addition to hypertension and obesity. Their unhealthy diet over the years, sedentary lifestyle, and high levels of stress resulted in peripheral vascular ischemia, which intensified the complications of diabetes, that is, micro and macrovascular problems, including retinopathy and neuropathy. Due to this history, the patient’s pharmacotherapy resulted in insulins (regular and NPH), antiplatelet agents, statins, fibrates, psychotropics, and antihypertensives. In addition, his blood glucose levels and glycated hemoglobin were found to be elevated. Furthermore, alterations were observed in high-density lipoprotein (HDL) and triglycerides. Some patient complaints at night, such as dry mouth, dizziness, and drowsiness, are problems that may be related to concomitant therapy with venlafaxine, gabapentin, and amitriptyline. Comments: In general, this patient is recommended to practice physical exercises, such as walking, for example, reducing the consumption of carbohydrates and sodium, in addition to some changes in the patient’s pharmacotherapy.

RESUMEN Introducción: la diabetes mellitus es una enfermedad crónica que, al no ser controlada, puede desencadenar en complicaciones macro y microvasculares. Uno de los indicadores de un adecuado control glucémico es la hemoglobina glicosilada. Objetivos: determinar la frecuencia de complicaciones macro y microvasculares en pacientes diabéticos tipo 2 con hemoglobina glicosilada alterada internados en el Hospital Nacional de Itauguá periodo 2022 - 2023 Metodología: estudio observacional, descriptivo de corte transversal que incluyó a 170 pacientes adultos internados en el servicio de clínica médica del Hospital Nacional (Itauguá, Paraguay) durante los años 2022 y 2023. Resultados: la edad media fue de 58 ± 12 años, con predominio del sexo femenino (51 %). La complicación más frecuentemente diagnosticada fue la enfermedad del pie relacionada a la diabetes con 83 pacientes (49 %), seguido por retinopatía diabética 23 (14 %). El valor promedio de hemoglobina glicosilada fue de 10 ± 2 %. Solamente 6 (4 %) del total de pacientes presentó un valor de HbA1C≥ 7,1 %. La comorbilidad asociada más frecuente fue la hipertensión arterial 87 (51 %). El 91 % de los pacientes conocía ser portador de la enfermedad, el 80 % recibía algún tipo de tratamiento. Conclusiones: el pie diabético fue la complicación vascular diagnosticada con mayor ,frecuencia, especialmente en pacientes con HbA1C≥ 7,1 %.

ABSTRACT Introduction: diabetes mellitus is a chronic disease that, if not controlled, can lead to macro- and microvascular complications. One of the indicators of adequate glycemic control is glycosylated hemoglobin. Objectives: to determine the frequency of macro and microvascular complications in type 2 diabetic patients with altered glycosylated hemoglobin admitted to the Hospital Nacional from 2022 to 2023 Methodology: this was an observational, descriptive, cross-sectional study that included 170 adult patients admitted to the Internal Medicine service of the Hospital Nacional (Itauguá, Paraguay) during the years 2022 and 2023. Results: the mean age was 58 ± 12 years, with a predominance of the female sex (51 %). The most frequently diagnosed complication was foot disease related to diabetes with 83 patients (49 %), followed by diabetic retinopathy 23 (14 %). The average value of glycosylated hemoglobin was 10 ± 2 %. Only 6 (4 %) of the total patients had an HbA1C value ≤7 %. The most frequent associated comorbidity was arterial hypertension 87 (51 %). 91 % of the patients knew they were carriers of the disease, 80 % received some type of treatment. Conclusions: diabetic foot was the most frequently diagnosed vascular complication, especially in patients with HbA1C ≥7.1 %.

Abstract: Hypertriglyceridemia (HTG)-induced acute pancreatitis (AP) secondary to insulin deficiency following the onset of type 1 diabetes mellitus (T1DM) is a rare but serious complication in children. Objective: To describe the diagnosis and treatment of severe HTG and to emphasize the need for timely diagnosis of T1DM. Clinical Case: A 15-year-old female adolescent with a history of overweight presented with a two-weeks history of fever, anorexia, and diffuse abdominal pain. Laboratory tests revealed triglycerides of 17,580 mg/dL, lipase of 723 U/L, and blood glucose of 200 mg/dL. An abdominal CT scan showed an enlarged and edematous pancreas. She was hospitalized with a diagnosis of AP and severe HTG, which progressed to acute necro-hemorrhagic pancreatitis. Treatment included continuous intravenous insulin infusion until triglyceride levels decreased. Upon discontinuation of insulin, fasting hyperglycemia (206 mg/dL) and metabolic acidosis recurred, therefore DM was suspected. Upon targeted questioning, a history of polydipsia, polyuria, and weight loss during the last 3 months stood out. Glycated hemoglobin was markedly elevated (14.7%). Insulin therapy was optimized, achieving stabilization of laboratory parameters after 15 days of treatment and complete anatomical resolution of pancreatic involvement at one year of follow-up. Conclusions: The presence of severe HTG in pediatrics compels us to consider its secondary causes, such as the onset of T1DM. It is crucial to improve the ability to diagnose T1DM early, as it may present with infrequent and high-risk presentations for the patient.

Resumen: La pancreatitis aguda (PA) inducida por hipertrigliceridemia (HTG) secundaria a déficit de insulina en el contexto de un debut de diabetes mellitus tipo 1 (DM1) es una complicación infrecuente pero grave en niños. Objetivo: describir el diagnóstico y tratamiento de la HTG grave y destacar la necesidad del diagnóstico oportuno de la DM1. Caso Clínico: Adolescente de sexo femenino de 15 años con sobrepeso, consultó por fiebre, anorexia y dolor abdominal difuso de dos semanas de evolución. Las pruebas de laboratorio destacaron HTG 17.580 mg/dL, lipasa 723 U/L, glicemia 200 mg/dL. Tomografia computarizada abdominal mostró páncreas aumentado de tamaño y edematoso. Se hospitalizó con diagnóstico de PA e HTG grave, que evolucionó con PA necro-hemorrágica. Fue tratada con infusión continua de insulina intravenosa hasta lograr descenso de los niveles de triglicéridos. Al suspender la insulina presentó nuevamente aumento de la glicemia en ayunas (206 mg/dL) y acidosis metabólica, por lo que se sospechó DM. Preguntando dirigidamente, destacaba historia de polidipsia, poliuria y pérdida de peso durante los últimos 3 meses. La Hemoglobina glicosilada (HbA1c) resultó muy elevada (14,7%). Se optimizó el tratamiento insulínico, consiguiendo, a los 15 días de tratamiento, estabilización de los parámetros de laboratorio y resolución anatómica completa del compromiso pancreático al año de seguimiento. Conclusiones: La HTG grave en pediatría obliga a considerar sus causas secundarias, como el debut de DM1. Es crucial mejorar la habilidad de diagnóstico precoz de la DM, que puede presentarse con formas de debut infrecuentes y de alto riesgo para el paciente.

ABSTRACT Foundation: Non-compliance with treatment by diabetic people not only worsens the prognosis, but also their quality of life. Objective: To characterize therapeutic adherence in type 2 diabetic patients belonging to four health areas, from two municipalities in Cuba. Methods: A descriptive and cross-sectional study was carried out in two health areas of the municipalities of Cárdenas and Santiago de Cuba, in the period January - August 2019. The universe was represented by 1091 diabetic people who recovered from a previous study carried out between 2015 and 2016 in the same health areas. They underwent anthropometric measurements, blood pressure, glycated hemoglobin and a questionnaire was applied. Variables were studied: sociodemographic (age, sex, skin color, occupation, level of education, cohabitation), risk factors and comorbidities, pharmacological and non-pharmacological treatment and their relationship with adherence. Categorical variables were presented as frequencies and percentages. Results: Adherence was 70.7 %, statistically related to white skin color, high level of education, control of glycated hemoglobin according to age and value less than 7 %, as well as not suffering from comorbidities such as cardiovascular diseases, chronic respiratory diseases, dyslipidemia, no consumption of alcoholic or sugary beverages. Conclusions: The non-availability of medications in the pharmacy, forgetting to take them and at the established times were the main barriers reported by patients, this must be taken into account to have a favorable impact on the control of diabetes mellitus.

RESUMEN Fundamento: El incumplimiento del tratamiento por las personas diabéticas, no solo empeora el pronóstico, sino su calidad de vida. Objetivo: Caracterizar la adherencia terapéutica en pacientes diabéticos tipo 2 pertenecientes a cuatro áreas de salud, de dos municipios de Cuba. Métodos: Se realizó un estudio descriptivo y transversal en dos áreas de salud de los municipios de Cárdenas y Santiago de Cuba, en el periodo enero - agosto de 2019. El universo estuvo representado por 1091 personas diabéticas que se recuperaron de un estudio previo efectuado entre el 2015 y 2016 en las mismas áreas de salud. A estas se les realizó mediciones antropométricas, de la presión arterial, hemoglobina glicada y se aplicó un cuestionario. Se estudiaron variables: sociodemográficas (edad, sexo, color de la piel, ocupación, nivel de escolaridad, convivencia), factores de riesgo y comorbilidades, tratamiento farmacológico y no farmacológico y su relación con la adherencia. Las variables categóricas fueron presentadas como frecuencias y porcentajes. Resultados: La adherencia fue de 70,7 %, relacionada estadísticamente con color de piel blanca, nivel de escolaridad alto, control de la hemoglobina glicada según edad y valor inferior a 7 %, así como, el no padecimiento de comorbilidades como enfermedades cardiovasculares, respiratorias crónicas, dislipidemia, no consumo de bebidas alcohólicas, ni azucaradas. Conclusiones: La no disponibilidad de medicamentos en farmacia, el olvido en tomarlos y en los horarios establecidos resultaron las principales barreras referidas por los pacientes, esto debe tenerse en cuenta para incidir de forma favorable en el control de la diabetes mellitus.

Resumen Antecedentes La medición de la hemoglobina glucosilada A1c (HbA1c) con un valor por debajo del 7% indica un adecuado control glucémico. Los esquemas farmacológicos están basados en cinco clases terapéuticas. Objetivo Describir los esquemas de tratamiento utilizados y hacer una comparación indirecta de ellos, con respecto al control de la glucosa determinada por la HbA1c, en pacientes con diabetes mellitus tipo 2 (DM2). Material y métodos Estudio descriptivo, transversal y retrospectivo, con muestreo sistemático. Fue aprobado con número de registro R-2022-2402-046. Información basada en expedientes entre enero de 2019 y diciembre de 2022. Se incluyeron pacientes con DM2, mayores de 18 años, de ambos sexos, con Hb1Ac reciente, parámetro de control 7% o menos, y con el mismo tratamiento farmacológico por lo menos 3 meses. Se excluyeron pacientes con diabetes mellitus tipo 1 y con diabetes gestacional. Análisis con estadística descriptiva. Resultados Se incluyeron 180 mujeres (64.1%) y 101 hombres (35.9%). Se utilizaron 58 esquemas farmacológicos diferentes. Porcentajes de control de HbA1c: monoterapia 50%, terapia dual 45%, terapia triple 48% y esquema cuádruple 28%. Conclusiones El porcentaje de control glucémico varía según el tipo de tratamiento farmacológico y existe poco uso de fármacos nuevos. El gran número de esquemas utilizados revela que no se estandarizan tratamientos, sino que se considera la individualidad del paciente.

Abstract Background The glicated hemoglobin A1c(HbA1c) measurement, whose value is below 7% indicates adequate glycemic control. The pharmacological regimens are based on five therapeutic classes. Objective Describe the treatment schemes used and make an indirectly compare them concerning glucose control, determined by HbA1c, in patients with type 2 diabetes mellitus (DM2). Materials and methods Descriptive, cross-sectional and retrospective study, with systematic sampling. Registration number R-2022-2402-046 was approved. Information based on records between January 2019 and December 2022. Patients with DM2, over 18 years of age, both sexes, with recent Hb1Ac, control parameter 7% or less and with the same pharmacological treatment for at least 3 months were included. Type 1 and gestational diabetes were excluded. Analysis with descriptive statistics. Results 180 women (64.1%) and 101 men (35.9%) were included. 58 pharmacological regimens were used (58). HbA1c control percentages: monotherapy 50%, dual therapy 45%, triple therapy 48% and quadruple regimen 28% were used. Conclusions The percentage of glucose control varies about the type of pharmacological treatment and there is little use of new drugs. The large number of schemes used reveals not standardizing treatments, but rather considering the individuality of the patient.

Abstract: Hypertriglyceridemia (HTG)-induced acute pancreatitis (AP) secondary to insulin deficiency following the onset of type 1 diabetes mellitus (T1DM) is a rare but serious complication in children. Objective: To describe the diagnosis and treatment of severe HTG and to emphasize the need for timely diagnosis of T1DM. Clinical Case: A 15-year-old female adolescent with a history of overweight presented with a two-weeks history of fever, anorexia, and diffuse abdominal pain. Laboratory tests revealed triglycerides of 17,580 mg/dL, lipase of 723 U/L, and blood glucose of 200 mg/dL. An abdominal CT scan showed an enlarged and edematous pancreas. She was hospitalized with a diagnosis of AP and severe HTG, which progressed to acute necro-hemorrhagic pancreatitis. Treatment included continuous intravenous insulin infusion until triglyceride levels decreased. Upon discontinuation of insulin, fasting hyperglycemia (206 mg/dL) and metabolic acidosis recurred, therefore DM was suspected. Upon targeted questioning, a history of polydipsia, polyuria, and weight loss during the last 3 months stood out. Glycated hemoglobin was markedly elevated (14.7%). Insulin therapy was optimized, achieving stabilization of laboratory parameters after 15 days of treatment and complete anatomical resolution of pancreatic involvement at one year of follow-up. Conclusions: The presence of severe HTG in pediatrics compels us to consider its secondary causes, such as the onset of T1DM. It is crucial to improve the ability to diagnose T1DM early, as it may present with infrequent and high-risk presentations for the patient.

Resumen: La pancreatitis aguda (PA) inducida por hipertrigliceridemia (HTG) secundaria a déficit de insulina en el contexto de un debut de diabetes mellitus tipo 1 (DM1) es una complicación infrecuente pero grave en niños. Objetivo: describir el diagnóstico y tratamiento de la HTG grave y destacar la necesidad del diagnóstico oportuno de la DM1. Caso Clínico: Adolescente de sexo femenino de 15 años con sobrepeso, consultó por fiebre, anorexia y dolor abdominal difuso de dos semanas de evolución. Las pruebas de laboratorio destacaron HTG 17.580 mg/dL, lipasa 723 U/L, glicemia 200 mg/dL. Tomografia computarizada abdominal mostró páncreas aumentado de tamaño y edematoso. Se hospitalizó con diagnóstico de PA e HTG grave, que evolucionó con PA necro-hemorrágica. Fue tratada con infusión continua de insulina intravenosa hasta lograr descenso de los niveles de triglicéridos. Al suspender la insulina presentó nuevamente aumento de la glicemia en ayunas (206 mg/dL) y acidosis metabólica, por lo que se sospechó DM. Preguntando dirigidamente, destacaba historia de polidipsia, poliuria y pérdida de peso durante los últimos 3 meses. La Hemoglobina glicosilada (HbA1c) resultó muy elevada (14,7%). Se optimizó el tratamiento insulínico, consiguiendo, a los 15 días de tratamiento, estabilización de los parámetros de laboratorio y resolución anatómica completa del compromiso pancreático al año de seguimiento. Conclusiones: La HTG grave en pediatría obliga a considerar sus causas secundarias, como el debut de DM1. Es crucial mejorar la habilidad de diagnóstico precoz de la DM, que puede presentarse con formas de debut infrecuentes y de alto riesgo para el paciente.

ABSTRACT FGF21 is a hormone produced primarily by the liver with several metabolic functions, such as induction of heat production, control of glucose homeostasis, and regulation of blood lipid levels. Due to these actions, several laboratories have developed FGF21 analogs to treat patients with metabolic disorders such as obesity and diabetes. Here, we performed a systematic review and meta-analysis of randomized controlled trials that used FGF21 analogs and analyzed metabolic outcomes. Our search yielded 236 articles, and we included eight randomized clinical trials in the meta-analysis. The use of FGF21 analogs exhibited no effect on fasting blood glucose, glycated hemoglobin, HOMA index, blood free fatty acids or systolic blood pressure. However, the treatment significantly reduced fasting insulinemia, body weight and total cholesterolemia. None of the included studies were at high risk of bias. The quality of the evidence ranged from moderate to very low, especially due to imprecision and indirection issues. These results indicate that FGF21 analogs can potentially treat metabolic syndrome. However, more clinical trials are needed to increase the quality of evidence and confirm the effects seen thus far. FGF FGF2 functions production homeostasis levels actions diabetes Here metaanalysis meta analysis outcomes 23 articles metaanalysis. analysis. hemoglobin index pressure However insulinemia cholesterolemia bias low issues syndrome far 2

Abstract Diabetes mellitus (DM) is a major cause of chronic kidney disease (CKD) and changes in lipoprotein. Literature data suggest that cholesterol associated with high-density lipoprotein (HDLc) plays a protective role against albuminuria and diabetic nephropathy. These factors are related with changes in serum apolipoproteins such Apo A-I. This work aims to evaluate the correlation of apolipoprotein A-I with renal function in diabetic outpatients. Samples were collected from 281 outpatients for analyses of glycated hemoglobin (HbA1c), serum creatinine (SCr), urea (BUN), cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDLc) and estimation of glomerular filtration rate (eGFR). Urinary samples were obtained to assess urine albumin creatinine ratio (UACR). Triglyceride-glucose index (TyG) was calculated to estimate insulin resistance. The mean age was 61,5 ± 16,4 years. Most patients were female, Afro-Mestizo and over 50 years of age. Pearson's revealed negative correlation of creatinine with HDLc and Apo A-I. There was a correlation of eGFR with HbA1c, TG and HDLc. TyG presented a negative correlation with Apo A-I and HDLc. The highest quartiles of UACR presented the highest TyG and the lowest Apo A-I. In conclusion, Apo A-I indicated an association with insulin resistance and changes in renal function parameters, especially as a factor associated with the onset of albuminuria, with a better predictive potential than the HDLc. DM (DM CKD (CKD highdensity high density (HDLc nephropathy AI. AI A I. I 28 HbA1c HbAc , HbA c (HbA1c) SCr, SCr (SCr) BUN, BUN (BUN) TC, TC (TC) TG, (TG) HDLcholesterol HDL eGFR. . (eGFR) UACR. (UACR) Triglycerideglucose Triglyceride glucose (TyG 615 61 5 61, 164 16 4 16, female AfroMestizo Afro Mestizo Pearsons Pearson s conclusion parameters 2 (HbA1c (SCr (BUN (TC (TG (eGFR (UACR 6 1

ABSTRACT Objective: To perform a systematic review of randomized controlled trials, evaluating the effect of probiotics, prebiotics or symbiotics supplementation on glycemic and inflammatory control in children with Type 1 Diabetes Mellitus (T1DM). Data source: The Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Clinical Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online (SciELO) databases were searched. Randomized clinical trials of pediatric patients with DM1 using probiotics, prebiotics or symbiotics were included, regardless of year or language of publication. Studies that did not evaluate glycated hemoglobin (HbA1c) were excluded. Metabolic results (HbA1c, total insulin dose and C-peptide) and inflammatory control [interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ)] during probiotic supplementation or similar, related to modification of the intestinal microbiota, were analyzed. PROSPERO ID: CRD42022384485. Data synthesis: Five studies were selected for a systematic review. Regarding metabolic markers, only one of the articles that analyzed HbA1c showed a significant decrease (p=0.03) in the intervention group. One study identified a reduction in the total dose of insulin and increased C-peptide levels. Regarding the evaluation of inflammatory parameters (IL-10, TNF-α, INF-γ), there were no statistical relevant modifications. Conclusions: Current data from the literature were not conclusive in identifying an improvement in glycemic control and did not observe changes in inflammatory parameters with the use of probiotics, prebiotics or symbiotics in pediatric patients with T1DM. Objective probiotics T1DM TDM . T DM (T1DM) source MEDLINE/PubMed, MEDLINEPubMed MEDLINE/PubMed , MEDLINE PubMed (MEDLINE/PubMed) Trials LatinoAmericana Latino Americana LILACS (LILACS SciELO (SciELO searched included publication HbAc HbA c (HbA1c excluded HbA1c, Cpeptide C peptide interleukin10 interleukin 10 [interleukin-1 IL10, IL10 IL (IL-10) factoralpha factor alpha TNFα TNF α (TNF-α interferongamma interferon gamma IFNγ IFN γ (IFN-γ) similar microbiota ID CRD42022384485 CRD synthesis markers p=0.03 p003 p 0 03 (p=0.03 group levels 10, (IL-10 TNFα, α, TNF-α INFγ, INFγ INF INF-γ) modifications Conclusions (T1DM (MEDLINE/PubMed interleukin1 [interleukin- IL1 (IFN-γ CRD4202238448 p=0.0 p00 (p=0.0 (IL-1 INF-γ [interleukin CRD420223844 p=0. p0 (p=0. (IL- CRD42022384 p=0 (p=0 (IL CRD4202238 p= (p= CRD420223 (p CRD42022 CRD4202 CRD420 CRD42 CRD4

RESUMO Objetivo: Realizar uma revisão sistemática de ensaios clínicos randomizados controlados avaliando o efeito da suplementação de probióticos, prebióticos ou simbióticos no controle glicêmico e inflamatório em crianças com diabetes mellitus tipo 1 (DM1). Fontes de dados: As bases Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Clinical Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SciELO) foram pesquisadas. Foram incluídos ensaios clínicos randomizados de pacientes pediátricos com DM1 em uso de probióticos, prebióticos ou simbióticos, independentemente de ano ou idioma de publicação. Foram excluídos os trabalhos que não avaliaram hemoglobina glicada (HbA1c). Os resultados metabólicos (HbA1c, dose de insulina total e peptídeo C) e o controle inflamatório [interleucina-10 — IL-10), fator de necrose tumoral-alfa (TNF-α) e interferon-gama (IFN-γ)] durante a suplementação de probióticos ou similares, relacionados à modificação da microbiota intestinal, foram analisados. ID PROSPERO: CRD42022384485. Síntese dos dados: Cinco estudos foram selecionados para revisão sistemática. Com relação aos marcadores metabólicos, apenas um dos artigos que analisaram a HbA1c apresentou diminuição significativa (p=0,03) no grupo intervenção. Um estudo identificou redução da dose total de insulina e aumento dos níveis de peptídeo C. Quanto à avaliação dos parâmetros inflamatórios (IL-10, TNF-α, INF-γ), não houve modificações de relevância estatística. Conclusões: Os dados atuais da literatura não foram conclusivos em identificar melhora no controle glicêmico e não observaram mudanças nos parâmetros inflamatórios com o uso de probióticos, prebióticos ou simbióticos em pacientes pediátricos com DM1. Objetivo DM . (DM1) MEDLINE/PubMed, MEDLINEPubMed MEDLINE/PubMed , MEDLINE PubMed (MEDLINE/PubMed) Trials LatinoAmericana Latino Americana LILACS (LILACS SciELO (SciELO pesquisadas publicação HbA1c. HbAc HbA c (HbA1c) HbA1c, (HbA1c C interleucina10 interleucina 10 [interleucina-1 IL10, IL10 IL IL-10) tumoralalfa tumoral alfa TNFα TNF α (TNF-α interferongama interferon gama IFNγ IFN γ (IFN-γ) similares intestinal analisados PROSPERO CRD42022384485 CRD p=0,03 p003 p 0 03 (p=0,03 intervenção 10, (IL-10 TNFα, α, TNF-α INFγ, INFγ INF INF-γ) estatística Conclusões (DM1 (MEDLINE/PubMed interleucina1 [interleucina- IL1 IL-10 (IFN-γ CRD4202238448 p=0,0 p00 (p=0,0 (IL-1 INF-γ (DM [interleucina IL-1 CRD420223844 p=0, p0 (p=0, (IL- IL- CRD42022384 p=0 (p=0 (IL CRD4202238 p= (p= CRD420223 (p CRD42022 CRD4202 CRD420 CRD42 CRD4

ABSTRACT Nonketotic hyperglycemia may occur as a cause of chorea in patients with chronic decompensated diabetes. Because it is rare and consequently poorly studied, diagnosis and treatment can be delayed. Therefore, our objective was to summarize clinical and radiological features, as well as treatments performed, from previously reported cases to facilitate adequate management in clinical practice. We searched MEDLINE/PubMed, EMBASE, Cochrane, CINAHL, Web of Science, Scopus, and LILACS databases for studies published before April 23, 2021. We included case reports and case series of adults (aged ≥ 18 years) that described hyperglycemic chorea with measurement of glycated hemoglobin (HbA1c) and cranial magnetic resonance imaging (MRI). Studies were excluded if participants were pregnant women, aged < 18 years, and had no description of chorea and/or physical examination. We found 121 studies that met the inclusion criteria, for a total of 214 cases. The majority of the included studies were published in Asia (67.3%). Most patients were women (65.3%) aged > 65 years (67.3%). Almost all patients had decompensated diabetes upon arrival at the emergency department (97.2%). The most common MRI finding was abnormalities of the basal ganglia (89.2%). There was no difference in patient recovery between treatment with insulin alone and in combination with other medications. Although rare, hyperglycemic chorea is a reversible cause of this syndrome; therefore, hyperglycemia should always be considered in these cases. studied delayed Therefore features performed practice MEDLINEPubMed MEDLINE PubMed MEDLINE/PubMed EMBASE Cochrane CINAHL Science Scopus 23 2021 1 HbA1c HbAc HbA c (HbA1c MRI. . (MRI) andor or examination 12 criteria 21 67.3%. 673 67.3% 67 3 (67.3%) 65.3% 653 (65.3% 6 97.2%. 972 97.2% 97 2 (97.2%) 89.2%. 892 89.2% 89 (89.2%) medications syndrome therefore 202 (MRI 67.3 (67.3% 65.3 (65.3 97.2 9 (97.2% 89.2 8 (89.2% 20 67. (67.3 65. (65. 97. (97.2 89. (89.2 (67. (65 (97. (89. (67 (6 (97 (89 ( (9 (8

ABSTRACT Objective: The aim of this study was to evaluate the glycated hemoglobin (HbA1c) levels before and after sustained virologic response (SVR) and investigate the baseline characteristics associated with improved glycemic control in patients with chronic hepatitis C (CHC) achieving SVR after direct-acting antivirals (DAA) therapy. Materials and methods: Consecutive adult patients with CHC who achieved SVR after DAA treatment between January 2016 and December 2017 at Hospital de Clínicas de Porto Alegre (RS, Brazil) were prospectively included. Levels of HbA1c were measured up to 24 weeks before DAA therapy and 12 weeks after SVR. Exclusion criteria were decompensated cirrhosis, HIV and/or hepatitis B virus, liver disease of other etiologies, and/or modification of prediabetes/type 2 diabetes mellitus (PDM/T2DM) management. The primary outcome was a comparison of HbA1c levels before and after SVR. Secondary outcomes were the baseline variables associated with improved glycemic control. Results: The study included 207 patients with a mean age of 60.6±10.7 years, of whom 51.7% were women, 56% had cirrhosis, 37.7% had HCV genotype 3, and 54.5% had baseline T2DM or PDM. The median HbA1c level reduced significantly after SVR (5.5%, interquartile range [IQR] 4.9%-6.3%) compared with baseline (5.7%, IQR 5.3%-6.7%; p = 0.01). The baseline characteristics associated with improved HbA1c after SVR were cirrhosis, genotype 3, and age ≤ 60 years. Conclusion: Among patients with CHC, SVR after DAA was associated with HbA1c reduction, particularly in those with cirrhosis, genotype 3, and age ≤ 60 years. Objective HbAc HbA c (HbA1c (SVR (CHC directacting direct acting (DAA methods 201 RS, RS (RS Brazil 1 cirrhosis andor virus etiologies prediabetestype prediabetes type PDM/T2DM PDMT2DM PDMTDM PDM T DM (PDM/T2DM management Results 20 606107 6 10 7 60.6±10. years 517 51 51.7 women 56 377 37 37.7 3 545 54 5 54.5 TDM 5.5%, 55 (5.5% [IQR 4.9%6.3% 4963 4.9% 6.3% 4 9 4.9%-6.3% 5.7%, 57 (5.7% 5.3%6.7% 5367 5.3% 6.7% 5.3%-6.7% 0.01. 001 0.01 . 0 01 0.01) Conclusion reduction PDMT 60610 60.6±10 51. 37. 54. 5.5% (5.5 4.9%6.3 496 49 4.9 63 6.3 4.9%-6.3 5.7% (5.7 5.3%6.7 536 53 5.3 67 6.7 5.3%-6.7 00 0.0 6061 60.6±1 5.5 (5. 4.9%6. 4. 6. 4.9%-6. 5.7 5.3%6. 5. 5.3%-6. 0. 606 60.6± (5 4.9%6 4.9%-6 5.3%6 5.3%-6 60.6 ( 4.9%- 5.3%- 60.

ABSTRACT The aim of this study was to assess the efficacy and safety of hybrid closed-loop (HCL) systems for insulin delivery in children and adolescents with type 1 diabetes (T1D). We searched Embase, PubMed, and Cochrane Library for randomized controlled trials (RCTs) published until March 2023 comparing the HCL therapy with control therapies for children and adolescents with T1D. We computed weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) with 95% confidence intervals (CIs) for binary endpoints. Four RCTs and 501 patients were included, of whom 323 were randomized to HCL therapy. Compared with control therapies, HCL significantly improved the period during which glucose level was 70-180 mg/dL (WMD 10.89%, 95% CI 8.22-13.56%) and the number of participants with glycated hemoglobin (HbA1c) level < 7% (RR 2.61, 95% CI 1.29-5.28). Also, HCL significantly reduced the time during which glucose level was > 180 mg/dL (WMD -10.46%, 95% CI -13.99 to -6.93%) and the mean levels of glucose (WMD -16.67 mg/dL, 95% CI -22.25 to -11.09 mg/dL) and HbA1c (WMD -0.50%, 95% CI -0.68 to -0.31). There were no significant differences between therapies regarding time during which glucose level was < 70 mg/dL or <54 mg/dL or number of episodes of ketoacidosis, hyperglycemia, and hypoglycemia. In this meta-analysis, HCL compared with control therapies was associated with improved time in range and HbA1c control in children and adolescents with T1D and a similar profile of side effects. These findings support the efficacy of HCL in the treatment of T1D in this population. closedloop closed loop (HCL TD . T D (T1D) Embase PubMed (RCTs 202 WMDs (WMDs RRs (RRs 95 CIs (CIs endpoints 50 included 32 70180 70-18 mgdL mg dL WMD 1089 10 89 10.89% 8.2213.56% 8221356 8.22 13.56% 8 22 13 56 8.22-13.56% HbAc HbA c (HbA1c 7 RR 261 2 61 2.61 1.295.28. 129528 1.29 5.28 29 5 28 1.29-5.28) Also 18 10.46%, 1046 46 -10.46% 13.99 1399 99 -13.9 6.93% 693 6 93 -6.93% 16.67 1667 16 67 -16.6 22.25 2225 25 -22.2 11.09 1109 11 09 -11.0 0.50%, 050 0 -0.50% 0.68 068 68 -0.6 0.31. 031 0.31 31 -0.31) 54 <5 ketoacidosis hyperglycemia hypoglycemia metaanalysis, metaanalysis meta analysis, analysis meta-analysis effects population (T1D 20 9 3 7018 70-1 108 10.89 2213 8.2213.56 822135 822 8.2 1356 13.56 8.22-13.56 26 2.6 295 1.295.28 12952 129 1.2 528 5.2 1.29-5.28 10.46% 104 4 -10.46 13.9 139 -13. 6.93 69 -6.93 16.6 166 -16. 22.2 222 -22. 11.0 110 -11. 0.50% 05 -0.50 0.6 06 -0. 03 0.3 -0.31 701 70- 10.8 221 8.2213.5 82213 82 8. 135 13.5 8.22-13.5 2. 1.295.2 1295 12 1. 52 5. 1.29-5.2 10.46 -10.4 13. -13 6.9 -6.9 16. -16 22. -22 11. -11 0.50 -0.5 0. -0 -0.3 10. 8.2213. 8221 8.22-13. 1.295. 1.29-5. 10.4 -10. -1 6. -6. -2 0.5 - 8.2213 8.22-13 1.295 1.29-5 -10 -6 8.221 8.22-1 1.29- 8.22-

ABSTRACT Objective: To evaluate the association between neck circumference (NC) measured during pregnancy and markers of glucose metabolism measured 2-6 months postpartum in women with overweight/obesity with and without gestational diabetes (GDM). Subjects and methods: This prospective study enrolled 100 pregnant women (including 50 with GDM) with pregestational body mass index (BMI) ≥ 25 kg and < 40 kg/m². The cohort was stratified according to NC tertiles during pregnancy. Glucose metabolism was assessed in the postpartum period. The association between NC during pregnancy and markers of glucose metabolism postpartum was tested using linear regression analysis. Results: Participants with NC in the third tertile, compared with those with NC in the second and first tertiles, had higher levels of glycated hemoglobin (HbA1c; 5.6 ± 0.4% versus 5.4 ± 0.3% versus 5.3 ± 0.2%, respectively, p = 0.006), fasting insulin (13.2 ± 6.6 µIU/mL versus 11.1 ± 5.8 µIU/mL versus 9.5 ± 4.9 µIU/mL, respectively, p = 0.035), homeostasis model for insulin resistance (HOMA-IR; 3.1 ± 1.7 versus 2.5 ± 1.3 versus 2.1 ± 1.2, respectively, p = 0.035) and triglyceride-glucose index (TyG; 4.6 ± 0.2 versus 4.5 ± 0.2 versus 4.5 ± 0.3, respectively, p = 0.010). In crude linear regression analysis, NC measured during pregnancy was significantly associated with levels of fasting plasma glucose, 2-hour glucose, HbA1c, log HOMA-IR, and TyG index. The association remained after adjustment for age, family history of diabetes, and number of pregnancies. When adjusted for pregestational BMI and gestational weight gain, NC remained independently associated with fasting plasma glucose and HbA1c levels. Conclusion: The NC measured during pregnancy was positively associated with worse glucose metabolic profile in the postpartum among women with obesity/overweight with and without GDM. The NC measurement may be a feasible tool for early identification of women at a higher risk of developing type 2 diabetes mellitus. Objective (NC 26 6 2- overweightobesity overweight obesity GDM . (GDM) methods 10 including 5 (BMI 4 kgm² kgm m² m kg/m² period analysis Results tertile HbAc HbA c (HbA1c 56 5. 04 0 0.4 54 03 3 0.3 53 02 0.2% respectively 0.006, 0006 0.006 , 006 0.006) 13.2 132 13 (13. 66 6. µIUmL µIU mL 111 11 1 11. 58 8 95 9 9. 49 4. 0.035, 0035 0.035 035 HOMAIR HOMA IR (HOMA-IR 31 3. 17 7 1. 2. 21 12 1.2 triglycerideglucose triglyceride (TyG 46 0. 45 0.010. 0010 0.010 010 0.010) 2hour hour HOMAIR, IR, HOMA-IR age pregnancies gain Conclusion obesityoverweight mellitus (GDM kg/m 000 0.00 00 13. (13 003 0.03 001 0.01 01 0.0 (1 (

RESUMO: Objetivo: analisar as condições de vida e saúde de indígenas Kaingang com Diabetes Mellitus tipo 2. Método: estudo transversal, realizado por meio de entrevista e consulta aos prontuários com indígenas da etnia Kaingang, residentes em uma terra indígena localizada na região norte do Paraná-Brasil. Para análise dos dados, utilizaram-se os testes t de Student e do qui-quadrado. Resultados: a idade média dos 45 participantes foi de 56,3 ± 12,4 anos. A maioria apresentou excesso de peso e a medida da circunferência da cintura das mulheres foi superior ao indicativo de risco. A média de hemoglobina glicada foi de 9,6 ± 2,7%; e de glicemia venosa foi de 189,1 ± 95,3 mg/dL. Conclusão: analisar as condições de vida e saúde de indígenas Kaingang gera subsídios para o planejamento de ações de rastreamento precoce, prevenção e acompanhamento das condições crônicas na população indígena. RESUMO Objetivo 2 Método transversal ParanáBrasil. ParanáBrasil Paraná Brasil. Brasil Paraná-Brasil dados utilizaramse utilizaram se quiquadrado. quiquadrado qui quadrado. quadrado qui-quadrado Resultados 4 563 56 3 56, 124 12 12, anos risco 96 9 6 9, 2,7% 27 7 1891 189 1 189, 953 95 95, mgdL mg dL mg/dL Conclusão precoce 5 2,7 18 2,

RESUMEN Objetivo: Analizar las condiciones de vida y la salud de los indígenas Kaingang con diabetes mellitus de tipo 2. Material y método: estudio transversal realizado mediante entrevistas y consulta de historias clínicas con indígenas de la etnia Kaingang que viven en una tierra indígena situada en la región norte de Paraná-Brasil. Para analizar los datos se utilizaron la prueba t de Student y la prueba chi-cuadrado. Resultados: La edad media de las 45 participantes era de 56,3 ± 12,4 años. La mayoría de las mujeres tenían sobrepeso y su perímetro de cintura era superior al indicador de riesgo. La hemoglobina glucosilada media fue de 9,6 ± 2,7% y la glucemia venosa de 189,1 ± 95,3 mg/dL. Conclusión: El análisis de las condiciones de vida y de salud de los indígenas kaingang ayuda a planificar acciones de detección precoz, prevención y seguimiento de las afecciones crónicas en la población indígena. Objetivo 2 método ParanáBrasil. ParanáBrasil Paraná Brasil. Brasil Paraná-Brasil chicuadrado. chicuadrado chi cuadrado. cuadrado chi-cuadrado Resultados 4 563 56 3 56, 124 12 12, años riesgo 96 9 6 9, 27 7 2,7 1891 189 1 189, 953 95 95, mgdL mg dL mg/dL Conclusión precoz 5 2, 18

ABSTRACT Objective: To analyze the living conditions and health of Kaingang indigenous people with type 2 Diabetes Mellitus. Method: A cross-sectional study carried out through interviews and consultation of medical records with indigenous people of the Kaingang ethnic group living in an indigenous land in the northern region of Paraná-Brazil. Student’s t-test and the chi-square test were used to analyze the data. Results: The average age of the 45 participants was 56.3 ± 12.4 years. Most women were overweight, and their waist circumference was higher than the risk indicator. The average glycated hemoglobin was 9.6 ± 2.7%, and venous glycemia was 189.1 ± 95.3 mg/dL. Conclusion: analyzing the living conditions and health of Kaingang indigenous people provides information for planning early screening, prevention, and monitoring of chronic conditions in the indigenous population. Objective Mellitus Method crosssectional cross sectional ParanáBrazil. ParanáBrazil Paraná Brazil. Brazil Paraná-Brazil Students Student s ttest t chisquare chi square data Results 4 563 56 3 56. 124 12 12. years overweight indicator 96 9 6 9. 27 7 2.7% 1891 189 1 189. 953 95 95. mgdL mg dL mg/dL Conclusion screening prevention population 5 2.7 18 2.

Abstract Objective Glycemic control is essential for reducing the risks of long-term complications in individuals living with type 1 diabetes mellitus. The study aimed to evaluate the relationship between glycemic control and demographic, economic, and clinical characteristics, and self-care behaviors for diabetes. Method A total of 107 people living with diabetes participated in the study. The participants completed an online self-report questionnaire containing clinical indicators and health care measures. Results The results showed that most participants did not have adequate glycemic control (based on glycated hemoglobin evaluation), especially due to difficulties in monitoring the disease and a lack of daily testing, as well as an increase in tobacco use. Low income, high body mass index, and low social class also predicted inadequate glycemic control. Conclusion It is recommended that health strategies sensitive to social inequalities and individual difficulties related to glycemic control be implemented to promote health. longterm long term mellitus demographic economic characteristics selfcare self 10 selfreport report measures based evaluation, evaluation , evaluation) testing use income index

Resumo Objetivo O controle glicêmico é essencial para diminuir os riscos de complicações em longo prazo de pessoas vivendo com diabetes mellitus tipo 1. O objetivo do estudo foi avaliar a relação entre controle glicêmico e características demográficas, econômicas, clínicas, e comportamentos de autocuidado para a diabetes. Método Participaram da pesquisa 107 pessoas vivendo com diabetes. Os participantes responderam um questionário de autorrelato online com indicadores clínicos e de cuidado com a saúde. Resultados Os resultados mostraram que a maioria dos participantes não possuía controle glicêmico adequado (baseado na avaliação de hemoglobina glicada), especialmente aqueles com dificuldade de monitorar a doença e pelas falhas em realizar a testagem diária e aumento do uso de tabaco. O controle glicêmico inadequado também foi predito pela baixa renda, índice de massa corporal elevado e baixa classe social. Conclusão Recomenda-se implementar estratégias em saúde sensíveis às desigualdades sociais e dificuldades individuais relacionadas ao controle glicêmico para promover a saúde. 1 demográficas econômicas clínicas 10 baseado glicada, glicada , glicada) tabaco renda social Recomendase Recomenda se