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AIM: We studied real-world performance of MiniMed (MM) 780G system users from Argentina, Brazil, Colombia and Chile (geographical analysis), and the effect of each technology iteration of the MM system on glycaemic control (technology iteration analysis). MATERIALS AND METHODS: CareLink data from August 2020 to September 2022 were extracted. Endpoints included continuous glucose monitoring metrics. For the geographical analysis, aggregated endpoints for MM780G system users were calculated. For the technology iteration analysis, MM780G system user outcomes were compared with outcomes when the same individuals were still using the MM640G or MM670G system. RESULTS: On average, 1025 MM780G system users from the geographical analysis were followed for 136 (SD 135) days, spent 91.5 (14.3)% in advanced hybrid closed loop, showed a glucose management indicator (GMI) of 6.7 (0.3)%, a time in range between 70 and 180 mg/dl (TIR) of 76.5 (9.0)%, and a time below range 70 mg/dl (TBR) of 2.7 (2.1)%. The percentage of users reaching targets of GMI <7%, TIR >70% and TBR <4% was 80.8%, 78.1% and 80.1%, respectively. The technology iteration analysis on users transitioning from MM640G to MM780G system (N = 381) showed 0.4% decrease in GMI (7.1% to 6.7%, p < .0001), 10.7% increase in TIR (65.9% to 76.6%, p < .0001), while TBR remained. The percentage of insulin delivered automatically increased as well (47.5%-57.7%, p < .0001). Users transitioning from MM670G system (N = 78) showed a similar but less pronounced pattern. CONCLUSIONS: Real-world Latin American MM780G users on average showed good glucose control, achieving international targets. Glycaemic control increased with every technology iteration of the MM system, providing more automation each time.
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Diabetes Mellitus Tipo 1 , Insulina , Humanos , Insulina/uso terapêutico , Hipoglicemiantes/uso terapêutico , Glicemia/análise , América Latina/epidemiologia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Automonitorização da Glicemia , Controle Glicêmico , Sistemas de Infusão de Insulina , Glucose/uso terapêutico , Insulina Regular Humana/uso terapêutico , TecnologiaRESUMO
O telessaúde é a utilização das Tecnologias de Informação e Comunicação (TIC) nas atividades relacionadas à saúde desenvolvidas à distância entre profissionais e/ou pacientes. Para que as ações do telessaúde proporcionem serviços de saúde resolutivos é fundamental que os ambientes de trabalho tenham infraestrutura disponível em relação as TIC. O objetivo principal foi comparar a infraestrutura de TIC, que favorece o desenvolvimento de ações de telessaúde, nas Unidades Básicas de Saúde (UBS) participantes do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) no Brasil e regiões brasileiras; além de organizar um curso de formação profissional para os profissionais de saúde bucal de Ouro Branco, Minas Gerais (MG). Este estudo longitudinal utilizou dados secundários do segundo e terceiro ciclos do PMAQ-AB, realizados respectivamente nos anos de 2013/2014 e 2017/2018. Apenas as UBS que participaram de ambos os ciclos foram incluídas e pareadas pelo Cadastro Nacional de Estabelecimentos de Saúde (CNES). A amostra final foi de 22.021 UBS. As variáveis selecionadas para o estudo foram obtidas do Módulo I - Observação em Unidades Básicas de Saúde, na subdimensão - Equipamentos de tecnologia da informação e telessaúde. Participaram apenas as variáveis comuns aos dois ciclos representadas por computador, câmera, caixa de som, microfone, impressora, televisão e internet suficiente. A presença de cada equipamento de TIC atribuiu uma pontuação a cada UBS, sendo a pontuação final a soma do número de equipamentos identificados no serviço de saúde (de 0 a 7 pontos). Os dados foram analisados descritivamente e por meio do teste de Wilcoxon (p≤0,05) para comparar os escores das UBS no Brasil e nas regiões brasileiras, utilizando o programa SPSS, v. 25.0. Houve um aumento no número de UBS para todos os equipamentos de TIC analisados e aumento significativo da mediana de equipamentos de TIC do segundo para o terceiro ciclo no Brasil (3;4) e nas regiões brasileiras (p<0,001): Sul (4,5;5), Centro-Oeste (3,5;4), Norte (2;3) e Nordeste (1;3). Apenas a região Sudeste manteve o valor mediano de equipamentos (4) em ambos os ciclos. As regiões Sul, Sudeste e Centro-Oeste apresentaram as maiores medianas de pontuação em ambos os ciclos, mostrando melhores estruturas de TIC. A disponibilidade de equipamentos de TIC para ações do telessaúde nas UBS aumentou ao longo dos ciclos do PMAQ-AB com diferenças entre as regiões brasileiras. Em relação ao produto técnico foi realizado um Curso de Formação Profissional para as equipes de saúde bucal da Atenção Primária à Saúde, do Centro de Especialidades Odontológicas e da coordenação de saúde bucal da Prefeitura Municipal de Ouro Branco/ MG. O curso foi ministrado em dois dias, com uma carga horária de 3 horas/dia. O conteúdo teórico abordou normatizações, vantagens e modalidades de ações do telessaúde, além de um momento prático para que os participantes executassem uma simulação de um telemonitoramento. Durante a realização deste produto foram criados 5 roteiros de telemonitoramento que juntos podem contribuir para melhoria da qualidade de atenção na prestação de serviços do telessaúde à população do município.
Telehealth is the use of Information and Communication Technologies (ICT) in healthrelated activities carried out remotely among professionals and patients. For telehealth actions to provide resolutive health services, it is essential that work environments have ICT infrastructure available. The main objective was to compare the ICT infrastructure that favors the development of telehealth actions in the Basic Health Units (BHU) participating in the National Program for Improving Access and Quality in Primary Care (PMAQ-AB) in Brazil and Brazilian regions; in addition to organizing a professional training course for oral health professionals in Ouro Branco, Minas Gerais (MG). This longitudinal study used secondary data from the second and third cycles of PMAQ-AB, carried out in 2013/2014 and 2017/2018 respectively. Only BHU that participated in both cycles were included and matched by the National Register of Health Establishments. The final sample consisted of 22,021 BHU. The variables selected for the study were obtained from module I - Observation in Basic Health Units in the subdimension - Information technology and telehealth equipment. Only the variables common to both cycles, represented by computer, camera, speaker, microphone, printer, television and sufficient internet, took part. The presence of each piece of ICT equipment gave each BHU a score, with the final score being the sum of the number of pieces of equipment identified in the health service (from 0 to 7 points). The data was analyzed descriptively and using the Wilcoxon test (p≤0.05) to compare the scores of the BHUs in Brazil and in the Brazilian regions, using the SPSS program, v. 25.0. There was an increase in the number of BHU for all the ICT equipment analyzed and a significant increase in the median number of ICT equipment from the second to the third cycle in Brazil (3;4) and in the Brazilian regions (p<0.001): South (4.5;5), Midwest(3.5;4), North (2;3) and Northeast (1;3). Only the Southeast maintained the median value of equipment (4) in both cycles. The South, Southeast and CentralWest regions had the highest median scores in both cycles, showing better ICT structures. The availability of ICT equipment for telehealth actions in the UBS increased over the PMAQ-AB cycles, with differences between the Brazilian regions. With regard to the technical product, a Professional Training Course was held for the oral health teams of the Primary Health Care, the Dental Specialties Center and the oral health coordination of the Ouro Branco/MG city hall. The course was given over two days, with a workload of 3 hours/day. The theoretical content covered standards, advantages and types of telehealth actions, as well as a practical moment for participants to carry out a simulation of telemonitoring. During the course of this product, 5 telemonitoring scripts were created, which together can contribute to improving the quality of care in the provision of telehealth services to the municipality's population.
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Atenção Primária à Saúde , Avaliação em Saúde , Centros de Saúde , TelemedicinaRESUMO
PURPOSE OF REVIEW: To discuss evidence supporting the use of glucagon-like peptide 1 receptor agonists (GLP-1RA) to treat obesity and their role as a cardioprotective drug. Obesity is not just a hypertrophy of the adipose tissue because it may become dysfunctional and inflamed resulting in increased insulin resistance. Being overweight is associated with increased incidence of cardiovascular events and weight loss achieved through lifestyle changes lowers risk factors, but has no clear effect on cardiovascular outcomes. In contrast, treating obesity with GLP-1RA decreases cardiovascular risk and the possible mechanisms of cardioprotection achieved by this class of drugs are discussed. GLP-1RA were initially developed to treat type 2 diabetes patients, in whom the effects upon glycemia and, moreover, weight loss, especially with long-acting GLP-1RA, were evident. However, cardiovascular safety trials in type 2 diabetes patients, the majority presenting cardiovascular disease and excess weight, showed that GLP-1 receptor agonists were indeed capable of decreasing cardiovascular risk. RECENT FINDINGS: Type 2 diabetes treatment with GLP-1RA liraglutide and semaglutide paved way to a ground-breaking therapy specific for obesity, as shown with the SCALE 3 mg/day liraglutide program and the STEP 2.4 mg/week semaglutide program. A novel molecule with superior performance is tirzepatide, a GLP-1 and GIP (Gastric Inhibitory Peptide) receptor agonist and recent results from the SURPASS and SURMOUNT programs are briefly described. Liraglutide was approved without a CVOT (Cardiovascular Outcome Trial) because authorities accepted the results from the LEADER study, designed for superiority. The SELECT study with semaglutide will report results only in 2023 and tirzepatide is being tested in patients with diabetes in the SURPASS-CVOT. Clinical studies highlight that GLP-1RA to treat obesity, alongside their concomitant cardioprotective effects, have become a hallmark in clinical science.
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Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/prevenção & controle , Ensaios Clínicos como Assunto , Diabetes Mellitus Tipo 2/induzido quimicamente , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Peptídeo 1 Semelhante ao Glucagon/uso terapêutico , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Receptor do Peptídeo Semelhante ao Glucagon 1/uso terapêutico , Humanos , Hipoglicemiantes/uso terapêutico , Liraglutida/uso terapêutico , Obesidade/complicações , Obesidade/tratamento farmacológico , Redução de PesoRESUMO
Cardiovascular events related to atherosclerosis are responsible for high morbidity and mortality among patients with type 2 diabetes. Improvement in care, especially in early stages, is crucial. Oral semaglutide, a glucagon-like peptide 1 analogue, controls blood glucose and results in significant body weight loss in patients with type 2 diabetes. Beyond these well-known effects, an interesting aspect of this drug is its antiatherogenic activity, which should be further explored in clinical practice. This paper reviews the evidence related to oral semaglutide decreasing cardiovascular risk in patients with type 2 diabetes, focusing on the drug's antiatherosclerotic properties. The glucagon-like peptide 1 analogue restores endothelial dysfunction, induces vasodilatation, and reduces plasma lipids. Oral semaglutide showed cardiovascular safety profile, with significant reduced risk of death from cardiovascular events. Based on current data, clinicians should consider oral semaglutide for type 2 diabetes management.
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Aterosclerose/tratamento farmacológico , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Peptídeos Semelhantes ao Glucagon/administração & dosagem , Controle Glicêmico , Hipoglicemiantes/administração & dosagem , Incretinas/administração & dosagem , Administração Oral , Animais , Aterosclerose/diagnóstico , Aterosclerose/mortalidade , Biomarcadores/sangue , Glicemia/metabolismo , Causas de Morte , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Peptídeos Semelhantes ao Glucagon/efeitos adversos , Controle Glicêmico/efeitos adversos , Humanos , Hipoglicemiantes/efeitos adversos , Incretinas/efeitos adversos , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND AND AIMS: COVID-19 severity and mortality are elevated in individuals with diabetes. During the pandemic, interventions recommended globally for people with diabetes were to keep blood glucose on target whilst staying at home to curb the spread of the virus. In Brazil, similar measures were proposed. The aim of our observational study was to assess whether these measures achieved their objectives. METHODS: An anonymous and untraceable survey was shared from April 22nd to May 4th. States with more than 30 respondents were included in the analysis and Fisher's exact test was performed to identify associations, with p < 0.05 considered significant. RESULTS: Type 1 diabetes and female participants were prevalent, 60.76% and 76.12% respectively. 10 out of 26 states were included, in addition to the Federal District (1562 responses). Only in three states (Bahia, Goiás and Pernambuco) less than 50% of the respondents experienced higher glycemia or higher variability during the pandemic. Goiás state, where almost half of the respondents (49.12%) have private insurance, presented the highest percentage of individuals receiving medicines for three months (35.48%) and one of the lowest percentages of blood glucose deterioration (47.17%). In the large states of Minas Gerais, Rio de Janeiro and São Paulo, consultations and/or lab exams were postponed by 37.14%, 34.33% and 40.88%, respectively. CONCLUSIONS: The decentralized measures implemented by states in Brazil left most people with diabetes unprotected. Many were forced to venture outside to collect or to purchase their medical supplies monthly and reported increased glycemic levels and/or variability.
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COVID-19/epidemiologia , COVID-19/prevenção & controle , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Quarentena/tendências , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/metabolismo , Brasil , COVID-19/sangue , Diabetes Mellitus/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Most patients with cerebral palsy (CP) do not respond to physical therapy due to deterioration in their nutritional status, secondary to gastrointestinal disorders and the catabolic state of the disease itself. However, basic treatments only contemplate the energy requirements and do not consider supplementation with glutamine, zinc, selenium, colecalciferol, spirulina, omega 3 or even vegetal proteins. OBJECTIVE: In this study, we determined the effect of using a nutritional support system (NSS): diet and supplements, on the gross motor function in children with CP with spastic diparesic and Gross Motor Function Classification System III (GMFCS III). METHODS: An exploratory study was performed. Thirty patients (from 4 to 12 years old) were randomly assigned to: (1) dietary surveillance (FG), (2) deworming and WHO diet (CG), or (3) deworming and the NSS (IG). Gross motor function was evaluated using the gross motor function measure (GMFM) scale. RESULTS: The IG-treated group presented a significant improvement in standing and walking parameters analyzed in the GMFM compared with FG and CG groups. Fifty percent of the IG-treated patients managed to walk, while in the other groups, no patients were able to walk. CONCLUSIONS: The NSS used in the present work improves gross motor function and promotes walking in patients with CP.
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The present study aims at identifying main barriers faced by people living with diabetes in Brazil during the COVID-19 pandemic. METHODS: In a convenience sampling study, data were collected from 1701 individuals, aged 18 or above; 75.54% female participants; 60.73% T1D and 30.75% T2D, between April 22nd and May 4th, using an anonymous and untraceable survey containing 20 multiple choice questions (socio-demographic; health status and habits of life during COVID-19 pandemic). Relationship between variables was established using the multiple correspondence analysis technique. RESULTS: 95.1% of respondents reduced their frequency of going outside of their homes; among those who monitored blood glucose at home during the pandemic (91.5%), the majority (59.4%) experienced an increase, a decrease or a higher variability in glucose levels; 38.4% postponed their medical appointments and/or routine examinations; and 59.5% reduced their physical activity. T1D, the youngest group, was more susceptible to presenting COVID-19 symptoms despite not being testing; whilst the T2D group had higher frequency of comorbidities that are additional risk factors for COVID-19 severity. CONCLUSIONS: This study provides a first hand revelation of the severity of COVID-19 on individuals with diabetes in Brazil. Their habits were altered, which impacted their glycemia, potentially increasing the risk of poor outcomes and mortality if infected by SARS-CoV-2, and of acute and chronic diabetes complications.
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Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/psicologia , Diabetes Mellitus/fisiopatologia , Pneumonia Viral/complicações , Pneumonia Viral/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , COVID-19 , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Diabetes Mellitus/terapia , Diabetes Mellitus/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Fatores de Risco , SARS-CoV-2 , Inquéritos e Questionários , Adulto JovemRESUMO
The International Consensus in Time in Range (TIR) was recently released and defined the concept of the time spent in the target range between 70 and 180 mg/dL while reducing time in hypoglycemia, for patients using Continuous Glucose Monitoring (CGM). TIR was validated as an outcome measures for clinical Trials complementing other components of glycemic control like Blood glucose and HbA1c. The challenge is to implement this practice more widely in countries with a limited health public and private budget as it occurs in Brazil. Could CGM be used intermittently? Could self-monitoring blood glucose obtained at different times of the day, with the amount of data high enough be used? More studies should be done, especially cost-effective studies to help understand the possibility of having sensors and include TIR evaluation in clinical practice nationwide.
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OBJECTIVE: Real-world effectiveness of basal insulin therapy is affected by poor treatment persistence, often occurring soon after initiation. This analysis is part of an international cross-sectional study conducted in T2DM patients and is intended to describe the reasons behind non-persistence to insulin therapy in Brasil. METHODS: Responders to an online survey in seven countries were classified as continuers (no gap of ≥7 days), interrupters (interrupted therapy for ≥7 days within first 6 months, then restarted), and discontinuers (terminated therapy for ≥7 days within first 6 months, and did not start it again before the survey). We present the results from the Brazilian cohort. RESULTS: Of 942 global respondents, 156 were from Brasil, with a mean age of 34 years and a mean of 5.8 years since T2DM diagnosis. Reasons contributing to insulin continuation (n=50) were improved glycemic control (82%) and improved physical feeling (50%). Common reasons for interruption (n=51) or discontinuation (n=55) were, respectively, weight gain (47.1%, 43.6%), hypoglycemia (45.1%, 38.2%), and pain from injections (39.2%, 49.1%). However, not all patients who reported weight gain and hypoglycemia as a reason for interruption or discontinuation experienced these: 16/24 (66.7%) and 22/24 (91.7%) participants had weight gain, and 13/23 (56.5%) and 15/21 (71.4%) had hypoglycemia, respectively. The most important reason for possible re-initiation for interrupters and discontinuers, respectively, was persuasion by the physician/HCP (80.4%, 72.7%). CONCLUSION: The benefits of basal insulin therapy motivated continuers to persist with the treatment; experienced or anticipated side effects contributed to interruption and discontinuation. Physician and patient training is key in the treatment of diabetes.
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Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Adulto , Glicemia/efeitos dos fármacos , Brasil , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hiperglicemia/tratamento farmacológico , Masculino , Relações Médico-PacienteRESUMO
SUMMARY OBJECTIVE Real-world effectiveness of basal insulin therapy is affected by poor treatment persistence, often occurring soon after initiation. This analysis is part of an international cross-sectional study conducted in T2DM patients and is intended to describe the reasons behind non-persistence to insulin therapy in Brasil. METHODS Responders to an online survey in seven countries were classified as continuers (no gap of ≥7 days), interrupters (interrupted therapy for ≥7 days within first 6 months, then restarted), and discontinuers (terminated therapy for ≥7 days within first 6 months, and did not start it again before the survey). We present the results from the Brazilian cohort. RESULTS Of 942 global respondents, 156 were from Brasil, with a mean age of 34 years and a mean of 5.8 years since T2DM diagnosis. Reasons contributing to insulin continuation (n=50) were improved glycemic control (82%) and improved physical feeling (50%). Common reasons for interruption (n=51) or discontinuation (n=55) were, respectively, weight gain (47.1%, 43.6%), hypoglycemia (45.1%, 38.2%), and pain from injections (39.2%, 49.1%). However, not all patients who reported weight gain and hypoglycemia as a reason for interruption or discontinuation experienced these: 16/24 (66.7%) and 22/24 (91.7%) participants had weight gain, and 13/23 (56.5%) and 15/21 (71.4%) had hypoglycemia, respectively. The most important reason for possible re-initiation for interrupters and discontinuers, respectively, was persuasion by the physician/HCP (80.4%, 72.7%). CONCLUSION The benefits of basal insulin therapy motivated continuers to persist with the treatment; experienced or anticipated side effects contributed to interruption and discontinuation. Physician and patient training is key in the treatment of diabetes.
RESUMO OBJETIVO Dados de vida real sobre como a eficácia da terapia com insulina é afetada pela baixa persistência ao tratamento que ocorre logo após o início da terapia. Esta análise é a parte brasileira de um estudo transversal internacional conduzido em pacientes com DM2 que teve como objetivo descrever as razões relacionadas à não persistência ao tratamento com insulina. METODOLOGIA O estudo realizado em sete países por meio de questionários on-line classificou como pacientes continuadores (aqueles que não apresentaram intervalo ≥7 dias sem uso da insulina), interrompedores (interromperam a terapia por ≥7 dias nos primeiros seis meses de uso, depois recomeçaram) e descontinuadores (interromperam a terapia por ≥7 dias nos primeiros seis meses de uso e não retornaram). Nesta análise descrevemos os dados da coorte brasileira. RESULTADOS Dos 942 pacientes incluídos, 156 eram do Brasil, com idade média de 34 anos e média de seis anos desde o diagnóstico de DM2. Razões que contribuíram para o uso contínuo da insulina (n=50) foram a melhora do controle glicêmico (82%) e a melhora no estado geral (50%). Razões para a interrupção (n=51) ou para a descontinuação (n=55) foram, respectivamente, ganho de peso (41,7%, 43,6%), hipoglicemia (45,1%, 38,2%) e dor à aplicação (39,2%, 49,1%). Entretanto, nem todos os pacientes que reportaram ganho de peso e hipoglicemia como possível razão para interrupção ou descontinuação realmente apresentaram esses eventos: 16/24 (66,7%) e 22/24 (91,4%) dos participantes apresentaram ganho de peso e 13/23 (56,6%) e 15/21 (71,4%) apresentaram hipoglicemia, respectivamente. A razão mais importante para o possível recomeço entre os interrompedores e descontinuadores foi a persuasão de médicos/profissionais de saúde (80,4% e 72,7%, respectivamente). CONCLUSÕES Os benefícios do tratamento com insulina basal motivaram continuadores a persistir com a terapia; a experiência ou a antecipação de eventos adversos contribuíram para a interrupção e descontinuação. O treinamento de médicos e pacientes é um dos pilares fundamentais do tratamento do diabetes.