Abstract Neuromuscular electrical stimulation (NMES) can be an alternative to conventional exercising. This randomized clinical trial evaluated the effect of NMES in type 2 diabetes patients. Twenty-eight individuals with type 2 diabetes were assigned to NMES (n=14) or NMES-placebo (n=14) applied to knee extensor muscles for 60 minutes. Glucose variability, microvascular function and endothelial function were evaluated through continuous glucose monitoring system, near infrared spectroscopy and flow-mediated dilatation, respectively. Glucose levels (mg/dl) decreased 2h (184 ± 11 vs 223 ±15), 3h (179 ± 12 vs 219 ±14) and 4h (177 ± 12 vs 212 ±12) after NMES, in comparison to NMES-placebo. No differences in glucose variability were found: coefficient of variation (%) at 0-6h (11.4±1.3 vs 11.4±1.2), 6-12h (9.8±1.0 vs 11.6±1.6), 12-18h (15.5±2.0 vs 11.4±2.1), 18-24h (12.8±2.3 vs 10.0±1.6); standard deviation (mg/dl) at 0-6h (21.6±2 vs 24.6±3.5), 6-12h (19.5±1.8 vs 20.3±2.8), 12-18h (29.9±3.5 vs 21.3±2.8),18-24h (22.8±4.1 vs 16.6±2.0) and mean amplitude of glycemic excursions (mg/dl) 54.9±25.0 vs 70.3±35.7. Endothelial and microvascular functions did not change. In conclusion, one acute NMES session was strong enough to trigger glucose reduction in individuals with type 2 DM, but it failed to induce any significant change in glucose variability, endothelial and microvascular functions.

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.

The publication Cardiovascular Statistics – Brazil aims to provide an annual compilation of data and research on the epidemiology of CVDs in Brazil.&nbsp; The report integrates official statistics from the Brazilian Ministry of Health and other governmental entities alongside data from the GBD project, coordinated by the IHME at the University of Washington. Additionally, it incorporates data derived from various sources and scientific studies, including cohorts and registries, that relate to CVDs and their associated risk factors. This publication is intended for a wide range of individuals, including researchers, clinicians, patients, healthcare policymakers, media professionals, the general public, and other interested parties seeking extensive national data about heart disease and stroke.&nbsp; Volunteer researchers from various Brazilian universities and research institutions carry out the project. The group is led by a five-member steering committee (ALPR, CAP, DCM, GMMO, and LCCB). The Brazilian Society of Cardiology fully supports this initiative, and the project receives collaborative support from the GBD Brazil Network and an International Committee (GAR, PP, and TAG) from both the IHME/University of Washington (GAR) and the World Heart Federation (PP and TAG).&nbsp;

A publicação Estatística Cardiovascular – Brasil tem por objetivo fornecer uma compilação anual dos dados e das pesquisas sobre a epidemiologia das DCV no Brasil.&nbsp; Este documento integra as estatísticas oficiais do Ministério da Saúde do Brasil e outras entidades governamentais ao lado de dados do projeto GBD, coordenado pelo IHME da Universidade de Washington. Além disso, incorpora dados derivados de várias fontes e estudos científicos, inclusive coortes e registros, relacionados às DCV e fatores de risco associados. Esta publicação destina-se a um público variado, incluindo pesquisadores, clínicos, pacientes, formuladores de políticas de saúde, profissionais da mídia, o público em geral e todos aqueles que buscam dados nacionais abrangentes sobre DCV e acidente vascular cerebral. Pesquisadores voluntários de várias universidades e instituições de pesquisa brasileiros realizaram este projeto. O grupo é liderado por um comitê diretivo com cinco membros (ALPR, CAP, DCM, GMMO e LCCB). A Sociedade Brasileira de Cardiologia apoia integralmente esta iniciativa e o projeto recebe colaboração da Rede GBD Brasil1 e do GBD International Committee (GAR, PP e TAG) do IHME/Universidade de Washington (GAR) e da World Heart Federation (PP e TAG).&nbsp;

ABSTRACT Objective: To evaluate the association between knowledge about the disease, adherence to self-care, and glycemic control in people diagnosed with type 1 diabetes mellitus. Subjects and methods: A cross-sectional study of patients aged over 18 years diagnosed with type 1 diabetes mellitus, treated at an outpatient clinic of a Brazilian university hospital. Participants with other types of diabetes, cognitive impairment, pregnancy, and outpatient discharge were excluded. Data were collected from January to March 2021 (by telephone call), with questions about the participants’ profile, diabetes knowledge questionnaire (DKN-A), and self-care inventory revised (SCI-R) translated into and adapted for Brazilian Portuguese. Data analysis involved chi-square associations, Mann-Whitney U tests, and Poisson regression. Results: Among 198 adult participants, the mean age was 42 ± 12 years, 53.5% were women, the mean glycated hemoglobin was 8.6 ± 1.6%, 140 (70.8%) had satisfactory knowledge about diabetes, 65 (32.8%) had adherence to self-care, and 46 (23.2%) had adequate glycemic control. We found an association between knowledge and adherence to self-care (p < 0.001). Knowledge was not associated with glycemic control (p = 0.705). Conclusion: Knowledge about diabetes was associated with greater adherence to self-care in people with type 1 diabetes mellitus, but it did not reflect in better glycemic control. Objective disease selfcare, selfcare self care, care mellitus methods crosssectional cross sectional hospital impairment pregnancy excluded 202 by call, call , call) participants profile DKNA, DKNA DKN (DKN-A) SCIR SCI R (SCI-R Portuguese chisquare chi square associations MannWhitney Mann Whitney tests regression Results 19 4 535 53 5 53.5 women 86 8 6 8. 16 1.6% 14 70.8% 708 70 (70.8% 32.8% 328 32 (32.8% 23.2% 232 23 2 (23.2% p 0.001. 0001 0.001 . 0 001 0.001) 0.705. 0705 0.705 705 0.705) Conclusion 20 (DKN-A 53. 1.6 70.8 7 (70.8 32.8 3 (32.8 23.2 (23.2 000 0.00 00 070 0.70 1. 70. (70. 32. (32. 23. (23. 0.0 07 0.7 (70 (32 (23 0. (7 (3 (2 (

ABSTRACT Objective: To conduct a systematic review and meta-analysis assessing the cardiorespiratory fitness (CRF) among individuals with and without type 2 diabetes Materials and methods: The current review was registered in PROSPERO under the number CRD42018082718. MEDLINE, EMBASE, and Cochrane Library databases were searched from inception through February 2022. Eligibility criteria consisted of observational or interventional studies that evaluated CRF through cardiopulmonary exercise testing or six-minute walk test in individuals with type 2 diabetes compared with individuals without type 2 diabetes. For data extraction, we used baseline CRF assessments of randomized clinical trials or follow-up CRF assessments in observational studies. We performed a meta-analysis using maximal oxygen consumption (VO2max), and distance walked in the 6MWT as primary outcomes. They were extracted and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. The meta-analysis was conducted using Review Manager (RevMan) software. Results: Out of 8,347 studies retrieved, 77 were included. Compared with individuals without type 2 diabetes, individuals with diabetes achieved a lower VO2max (−5.84 mL.kg−1.min−1, 95% CI −6.93, −4.76 mL.kg−1.min−1, p = <0.0001; I2 = 91%, p for heterogeneity < 0.0001), and a smaller distance walked in 6MWT (−93.30 meters, 95% CI −141.2, −45.4 meters, p > 0.0001; I2: 94%, p for heterogeneity < 0.0001). Conclusion: Type 2 diabetes was associated with lower cardiorespiratory fitness, as observed by lower VO2max on maximal tests, and smaller distance walked in 6MWT, however the quality of studies was low. Objective metaanalysis meta analysis (CRF methods CRD42018082718 CRD MEDLINE EMBASE 2022 sixminute six minute extraction followup follow up VO2max, VOmax , VO max (VO2max) MWT outcomes MDs (MDs 95 groups RevMan (RevMan software Results 8347 8 347 8,34 retrieved 7 included −5.84 584 5 84 (−5.8 mLkg1min1 mLkgmin mL kg 1 min mL.kg−1.min−1 693 6 93 −6.93 476 4 76 −4.7 <0.0001 00001 0 0001 I 91 91% 0.0001, 0.0001 0.0001) −93.30 9330 30 (−93.3 meters 1412 141 −141.2 454 45 −45. 94 94% 0.0001. . Conclusion tests low CRD4201808271 202 (VO2max 9 834 34 8,3 −5.8 58 (−5. mLkg mLkg1min mL.kg−1.min− 69 −6.9 47 −4. <0.000 0000 000 0.000 −93.3 933 3 (−93. 14 −141. −45 CRD420180827 20 83 8, −5. (−5 mL.kg−1.min −6. −4 <0.00 00 0.00 −93. (−93 −141 CRD42018082 −5 (− −6 − <0.0 0.0 −93 (−9 −14 CRD4201808 ( <0. 0. −9 −1 CRD420180 <0 CRD42018 CRD4201 CRD420 CRD42 CRD4

Abstract Background Frailty is a biological syndrome suggested as a better predictor of morbimortality than chronological age. Objective To assess associations between frailty and morbimortality outcomes in postoperative cardiac surgery. Methods A retrospective cohort study was conducted with cardiac surgery patients. Frailty and maximal inspiratory pressure (MIP) were assessed before surgery. Postoperative outcomes were: extracorporeal circulation time; use of vasopressor; mean arterial pressure (MAP); red blood cell (RBC) transfusion; cardiac arrhythmia and/or heart arrest; presence of intra-aortic balloon pump; antibiotic use; extubation time; length of stay in the intensive care unit (ICU); length of postoperative stay; mortality. One-way ANOVA was used to compare postoperative variables between frailty categories; Spearman was used to evaluate the correlations between frailty and postoperative variables. Age, sex, and MIP were introduced into multiple regression models to find the independent association between postoperative variables and frailty. A significance level of p < 0.05 was adopted. Results The medical records of 200 patients were analyzed (65.7±7.2 years; 68.5% men; 63.5% non-frail, 22.5% pre-frail, 14% frail). Frailty was not a predictor of postoperative outcomes. Age was an independent predictor for alterations in MAP (PR: 1.028, 95% CI: 1.003-1.053, p=0.025), need for RBC transfusion (PR: 1.034, 95% CI: 1.007-1.062, p=0.014), longer extubation time (PR: 1.052, 95% CI: 1.023-1.083, p<0.001), length of stay in the ICU (ß: 0.031, 95% CI: 0.010-0.053, p=0.005), length of postoperative stay (ß: 0.017, 95% CI: 0.003-0.031, p=0.015). Conclusions Frailty was not a predictor of morbimortality following cardiac surgery in middle-aged and older adults; however, age did predict morbidities in this setting.

Abstract Background Obesity and overweight in childhood can increase the risk of developing cardiovascular disease throughout live. Objectives This study provides an update of a meta-analysis of randomized clinical trials (RCT) published in 2014, to assess the effects of physical activity interventions on preventing cardiovascular risk factors in childhood. Methods This update combines data from the previous search with new data obtained from June 2013 to June 2020. Searches were performed on PubMed, EMBASE and Cochrane CENTRAL. The RCTs enrolled used interventions with physical activity longer than six months in school children aged 6-12 years, and evaluated body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels. Data analysis was performed using a random-effects model and a P value <0.05 was considered statistically significant. Results A total of 28,603 articles were retrieved, and 17 RCTs (11,952 subjects) were included. Physical activity interventions were associated with reduction in SBP [−2.11mmHg (95%CI −3.67, −0.54), I243%], DBP [−2.08mmHg (95%CI −3.68, −0,49), I265%] and TG [-0.08mmol/L (95% CI -0.13, -0.03), I20%], and increase in TC [0.17mmol/L (95%CI 0.04, 0.30), I20%]. However, the interventions were not associated with reductions in BMI [−0.03 kg/m2 (95%CI −0.17, 0.10), I20%]. Conclusion This update confirms and reinforces the beneficial effects of physical activity intervention in reducing systolic and diastolic blood pressure and TG levels.

ABSTRACT Objective: To assess caregivers’ perception about the changes in the daily habits of children and adolescents with type 1 diabetes during the COVID-19 pandemic. Subjects and methods: Primary caregivers of youth aged ≤18 with or without type 1 diabetes were selected for the diabetes and the control groups. Caregivers estimated the youth's time (hours) of physical activity and screen time before and during the pandemic, and rated the quality of eating habits and medication adherence from 0 to 10. The primary outcome was the change in physical activity time, screen time, and eating habits scores during isolation. Between-group analyses and within-group comparisons were conducted. A post hoc analysis was performed using logistic regression to correct for confounding factors. Results: In total, 764 participants were included (381 diabetes group vs. 383 control group). Before the pandemic, the diabetes group presented a reduced median of physical activity (P < 0.001) and screen time (P < 0.001). During the pandemic, the difference between both groups remained similar (P = 0.58). Scores of quality of eating habits were similar in both groups before the pandemic [8.0 (7.0-9.0) vs. 8.0 (7.0-9.0), P = 0.31] but decreased during the pandemic [7.0 (5.1-8.1) vs. 8.0 (6.0-9.0), P < 0.001]. The diabetes group had a significantly worse change in eating habits scores (P < 0.01). Conclusion: During the pandemic, eating habits were significantly worse in youth with diabetes than in those without diabetes. Objective COVID19 COVID 19 COVID-1 methods 18 ≤1 youths s hours (hours 10 isolation Betweengroup Between withingroup within conducted factors Results total 76 381 (38 vs 38 group. . group) 0.001 0001 001 0.001. 0.58. 058 0.58 58 0.58) 80 8 [8. 7.09.0 7090 7.0 9.0 7 9 (7.0-9.0 8. 7.09.0, , 0.31 031 31 70 [7. 5.18.1 5181 5.1 8.1 5 (5.1-8.1 6.09.0, 6090 6.0 6 (6.0-9.0) 0.001] 0.01. 0.01 01 0.01) Conclusion COVID1 COVID- ≤ (3 3 0.00 000 00 05 0.5 [8 09 7.09. 709 7. 90 9. (7.0-9. 0.3 03 [7 5.18. 518 51 5. 81 (5.1-8. 6.09.0 609 60 6. (6.0-9.0 0.0 ( 0. [ 7.09 (7.0-9 5.18 (5.1-8 6.09. (6.0-9. (7.0- (5.1- 6.09 (6.0-9 (7.0 (5.1 (6.0- (7. (5. (6.0 (7 (5 (6. (6

ABSTRACT Objective: To evaluate the precipitating factors of diabetic ketoacidosis (DKA) in patients with type 1 diabetes hospitalized through the emergency department of a tertiary hospital. Materials and methods: Individuals with type 1 diabetes hospitalized for DKA from January 2005 to March 2010 (first period [P1], n = 75) and from April 2010 to January 2017 (second period [P2], n = 97) were identified through a query of electronic medical records. Data were collected by reviewing medical records. Only the first hospitalization of each participant in each period was included. Results: In P2, 44 patients (45.4%) were women, mean age was 26.2 ± 14.5 years, and 74 patients (76.3%) had a previous diagnosis of type 1 diabetes. Only 1 patient had glycated haemoglobin (HbA1c) below 64 mmol/mol (8.0%). Most patients (62.2%) had had a previous episode of DKA. In P1, non-adherence was the main cause of DKA (38.7%), followed by infection (24.0%). In P2, these rates were 34.0% and 24.7%, respectively; no statistical difference was observed between the two study periods (p = 0.790). Conclusion: Over time, non-adherence remained the main precipitating factor of DKA, followed by infection, and no significant difference was observed between the two study periods. Elevated HbA1c, outside the therapeutic range, indicates suboptimal diabetes care and may explain, at least in part, poor adherence as a precipitating factor of decompensation. Health strategies, such as improved self-management of type 1 diabetes, may contribute to a future reduction in DKA episodes. Objective (DKA hospital methods 200 201 P1 P , [P1] 75 second P2 [P2] 97 records included Results 4 45.4% 454 45 (45.4% women 262 26 2 26. 145 14 5 14. years 7 76.3% 763 76 3 (76.3% HbA1c HbAc HbA c (HbA1c 6 mmolmol mmol mol 8.0%. 80 8.0% . 8 0 (8.0%) 62.2% 622 62 (62.2% nonadherence non 38.7%, 387 38.7% 38 (38.7%) 24.0%. 240 24.0% 24 (24.0%) 340 34 34.0 247 24.7% respectively p 0.790. 0790 0.790 790 0.790) Conclusion time range explain part decompensation strategies selfmanagement self management episodes 20 [P1 [P2 9 45.4 (45.4 76.3 (76.3 8.0 (8.0% 62.2 (62.2 38.7 (38.7% 24.0 (24.0% 34. 24.7 079 0.79 79 [P 45. (45. 76. (76. 8. (8.0 62. (62. 38. (38.7 24. (24.0 07 0.7 (45 (76 (8. (62 (38. (24. 0. (4 (7 (8 (6 (38 (24 ( (3 (2

ABSTRACT Objective: The present study aimed to evaluate glucose variability and hormonal responses during and after an aerobic exercise session performed after breakfast in type 2 diabetes patients treated with metformin. Materials and methods: In this quasi-experimental study individuals underwent clinical and laboratory evaluations and maximal exercise test. After two weeks an aerobic exercise session (30 minutes at 60%-70% of the peak heart rate) was performed. At rest, during and after the exercise session, glucose variability (mean amplitude glucose excursions, glucose coefficient of variation, and glucose standard deviation) and levels of plasma glucose, insulin, glucagon, and glucagon-like-peptide-1 were evaluated. Results: Thirteen patients were enrolled in the study. Plasma glucose increased at 15 minutes during the exercise session (244.6 ± 61.9 mg/dL), and decreased at 60 min after exercise (195.6 ± 50.0 mg/dL). Glucose variability did not show any difference before and after exercise. Insulin levels at 15 min [27.1 µU/mL (14.2-42.1)] and 30 min [26.3 µU/mL (14.6-37.4)] during the exercise were higher than those at fasting [11.2 µU/mL (6.7-14.9)] but decreased 60 minutes after exercise (90 minutes) [16.6 µU/mL (8.7-31.7)]. Glucagon levels did not show any difference. GLP-1 levels increased at 30 min [7.9 pmol/L (7.1-9.2)] during exercise and decreased 60 min after exercise (90 minutes) [7.7 pmol/L (6.8-8.5)]. Conclusion: Subjects with type 2 diabetes presented expected changes in insulin, glucagon and GLP-1 levels after breakfast and a single aerobic exercise session, not accompanied by glycemic variability changes. Objective metformin methods quasiexperimental quasi experimental test (3 60%70% 6070 60% 70% 70 60%-70 rate rest mean excursions variation deviation insulin glucagonlikepeptide1 glucagonlikepeptide like peptide 1 glucagon-like-peptide- evaluated Results 244.6 2446 244 6 (244. 619 61 9 61. mg/dL, mgdL mg/dL , mg dL mg/dL) 195.6 1956 195 (195. 500 50 0 50. mg/dL. . 27.1 271 27 [27. µUmL µU mL 14.242.1 142421 14.2 42.1 14 42 (14.2-42.1) 3 26.3 263 26 [26. 14.637.4 146374 14.6 37.4 37 4 (14.6-37.4) 11.2 112 11 [11. 6.714.9 67149 6.7 14.9 7 (6.7-14.9) 90 (9 16.6 166 16 [16. 8.731.7. 87317 8.7 31.7 8 31 (8.7-31.7)] GLP1 GLP GLP- 7.9 79 [7. pmolL pmol L 7.19.2 7192 7.1 9.2 (7.1-9.2) 7.7 77 6.88.5. 6885 6.8 8.5 5 (6.8-8.5)] Conclusion ( 60%70 607 60%-7 glucagon-like-peptide 244. 24 (244 195. 19 (195 27. [27 242 14.242. 14242 142 14. 421 42. (14.2-42.1 26. [26 637 14.637. 14637 146 374 37. (14.6-37.4 11. [11 714 6.714. 6714 67 6. 149 (6.7-14.9 16. [16 731 8.731.7 8731 87 8. 317 31. (8.7-31.7) 7. [7 7.19. 719 71 92 9. (7.1-9.2 88 6.88.5 688 68 85 (6.8-8.5) 60%7 60%- (24 (19 [2 14.242 1424 (14.2-42. 63 14.637 1463 (14.6-37. [1 6.714 671 (6.7-14. 73 8.731. 873 (8.7-31.7 [ 7.19 (7.1-9. 6.88. (6.8-8.5 (2 (1 14.24 (14.2-42 14.63 (14.6-37 6.71 (6.7-14 8.731 (8.7-31. (7.1-9 6.88 (6.8-8. (14.2-4 (14.6-3 (6.7-1 8.73 (8.7-31 (7.1- (6.8-8 (14.2- (14.6- (6.7- (8.7-3 (7.1 (6.8- (14.2 (14.6 (6.7 (8.7- (7. (6.8 (14. (6. (8.7 (7 (14 (6 (8. (8

ABSTRACT Objectives: To describe the oral health profile and evaluate the impact of tooth loss on diet quality and glycemic control among 66 patients with type 2 diabetes (T2DM) treated in an endocrinology outpatient clinic at a teaching hospital. Materials and methods: Questionnaires about diabetes self-care (SDSCA), masticatory ability, diet quality, anxiety level about dental treatment, and oral health were applied. Laboratory tests were retrieved from medical records or newly collected samples. Results: The presence of fewer than 21 teeth was associated with an unsatisfactory self-perceived masticatory ability (r = 0.44; p = 0.007). Most participants reported not having received guidance on oral health from their endocrinologists (81.8%) and having had the last visit to the dentist 2 years or more before the study (36.8%). The mean HbA1c level in the group with fewer than 21 teeth was comparable to that in the group with functional dentition (8.9 ± 1.5 and 8.7 ± 1.6%, respectively; p = 0.60). Conclusion: Adults with T2DM have a high prevalence of tooth loss and lack of information about oral hygiene care. Our results reinforce the need for more effective communication between medical and dental care teams.