Background: With an estimated 74% of all deaths attributable to non-communicable diseases (NCDs) in 2010, NCDs have become a major health priority in Brazil. The objective of the study was to conduct a comprehensive literature review on diabetes in Brazil; specifically: the epidemiology of type 2 diabetes, the availability of national and regional sources of data (particularly in terms of direct and indirect costs) and health policies for the management of diabetes and its complications. Methods: A literature search was conducted using PubMed to identify articles containing information on diabetes in Brazil. Official documents from the Brazilian government and the World Health Organization, as well as other grey literature and official government websites were also reviewed. Results: From 2006 to 2010, an approximate 20% increase in the prevalence of self-reported diabetes was observed. In 2010, it was estimated that 6.3% of Brazilians aged 18 years or over had diabetes. Diabetes was estimated to be responsible for 278,778 years of potential life lost for every 100,000 people. In 2013, it is estimated that about 7% of patients with diabetes has had one or more of the following complications: diabetic foot ulcers, amputation, kidney disease, and fundus changes. The estimated annual direct cost of diabetes was USD $3.952 billion in 2000; the estimated annual indirect cost was USD $18.6 billion. The two main sources of data on diabetes are the information systems of the Ministry of Health and surveys. In the last few years, the Brazilian Ministry of Health has invested considerably in improving surveillance systems for NCDs as well as implementing specific programmes to improve diagnosis and access to treatment. Conclusions: Brazil has the capacity to address and respond to NCDs due to the leadership of the Ministry of Health in NCD prevention activities, including an integrated programme currently in place for diabetes. Strengthening the surveillance of NCDs is a national priority along with recognising the urgent need to invest in improving the coverage and quality of mortality data. It is also essential to conduct regular surveys of risk factors on a national scale in order to design effective preventive strategies.

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Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: a comprehensive literature review

Osteoporosis and sarcopenia are two age-related diseases that affect the quality of life in the elderly. Initially, they were thought to be two independent diseases; however, recently, increasing basic and clinical data suggest that skeletal muscle and bone are both spatially and metabolically connected. The term "osteosarcopenia" is used to define a condition of synergy of low bone mineral density with muscle atrophy and hypofunction. Bone and muscle cells secrete several factors, such as cytokines, myokines, and osteokines, into the circulation to influence the biological and pathological activities in local and distant organs and cells. Recent studies reveal that extracellular vesicles containing microRNAs derived from senescent skeletal muscle and bone cells can also be transported and aid in regulating bone-muscle crosstalk. In this review, we summarize the age-related changes in the secretome and extracellular vesicle-microRNAs secreted by the muscle and bone, and discuss their interactions between muscle and bone cells during aging.

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Bone and Muscle Crosstalk in Aging

PIMENTEL, A.V. The perception of the vulnerability to the disease among women with delayed diagnosis of uterine cervical cancer. Ribeirão Preto, 2010. 66p. Thesis (Master) – University of São Paulo at Ribeirão Preto College of Nursing. This cross-sectional, descriptive, exploratory and qualitative study aimed to identify and evaluate the perception of the vulnerability to the disease among women with delayed diagnosis of uterine cervical cancer. The theoretical framework used was the vulnerability, based in the concept proposed by Ayres et al. (2003). The subjects of the study were twelve women who were under follow-up at the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School, for treatment of advanced uterine cervical cancer, between April 08 and May 28 2009. Data were collected by interviews. The data analysis was done according to the presuppositions of content analysis, proposed by Bardin (2006). Two central categories emerged from the results: “Perceiving yourself vulnerable” and “Facing the disease and the treatment”. The vulnerability arose to the participants of this study through the emergence of the first signs and symptoms of the disease, increasing as the diagnosis was determined and treatment was needed, bringing difficulties and suffering. At the same time, women had the opportunity to find ways to face and overcome problems, to the extent possible. The individual, social and programmatic compounds of the vulnerability, included in the concept proposed by Ayres et al. (2003), were shown in the factors related to clients, professionals and services, among others, and made the women susceptible to the problems and damages of their health, related to the uterine cervical cancer, aggravating their vulnerability to the disease. The need to overcome some deficiencies in the model of care and in the humanization of care was evidenced, as well as in the level of commitment and in the quality of the institutions, resources, management, and monitoring of the programs of prevention and detection of uterine cervical cancer, in the different levels of care.

Universidade de são paulo escola de enfermagem de ribeirão preto

There is no consensus on the prevalence of sarcopenia or its impact on mortality in end‐stage renal disease patients undergoing dialysis. This review aimed to summarize the diagnostic criteria of sarcopenia and its prevalence and impact on the mortality of end‐stage renal disease patients undergoing dialysis. Embase, MEDLINE, PubMed, and Cochrane Library were searched from inception to 8 May 2021 to retrieve eligible studies that assessed muscle mass by commonly used instruments, such as dual‐energy X‐ray absorptiometry, bioelectrical impedance analysis, magnetic resonance imaging, and body composition monitor. Two assessment tools matched to study designs were employed to evaluate study quality. Pooled sarcopenia prevalence was calculated with 95% confidence interval (CI), and heterogeneity was estimated using the I2 test. Associations of sarcopenia with mortality were expressed as hazard ratio (HR) and 95% CI. The search identified 3272 studies, and 30 studies (6162 participants, mean age from 47.5 to 77.5 years) were analysed in this review. The risk of bias in the included studies was low to moderate. Twenty‐two studies defined sarcopenia based on low muscle mass (LMM) plus low muscle strength and/or low physical performance, while eight studies used LMM alone. Muscle mass was assessed by different instruments, and a wide range of cut‐off points were used to define LMM. Overall, sarcopenia prevalence was 28.5% (95% CI 22.9–34.1%) and varied from 25.9% (I2 = 94.9%, 95% CI 20.4–31.3%; combined criteria) to 34.6% (I2 = 98.1%, 95% CI 20.9–48.2%; LMM alone) (P = 0.247 between subgroups). The statistically significant differences were not found in the subgroups of diagnostic criteria (P > 0.05) and dialysis modality (P > 0.05). Additionally, the sarcopenia prevalence could not be affected by average age [regression coefficient 0.004 (95% CI: −0.005 to 0.012), P = 0.406] and dialysis duration [regression coefficient 0.002 (95% CI −0.002 to 0.005), P = 0.327] in the meta‐regression. The pooled analyses showed that combined criteria of sarcopenia were related to a higher mortality risk [HR 1.82 (I2 = 26.3%, 95% CI 1.38–2.39)], as was LMM [HR 1.61 (I2 = 26.0%, 95% CI 1.31–1.99)] and low muscle strength [HR 2.04 (I2 = 80.4%, 95% CI 1.19–3.5)]. Although there are substantial differences in diagnostic criteria, sarcopenia is highly prevalent in dialysis patients and is linked to increased mortality. The standardization of sarcopenia diagnostic criteria would be beneficial, and future longitudinal studies are needed to investigate the prevalence and prognostic value of sarcopenia in dialysis patients.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/jcsm.12890

Diagnosis, prevalence, and mortality of sarcopenia in dialysis patients: a systematic review and meta‐analysis

The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we have various reasons to believe that the hospital costs are underestimated, the estimated DFD burden is significant. As such, public health preventive strategies to reduce DFD related morbidity and mortality and costs are of utmost importance.

https://www.mdpi.com/1660-4601/15/1/89/pdf

Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study.

One of the most important chronic complications of diabetes mellitus is diabetic foot. Severe progression of diabetes can lead to lower limb amputations. However, since evolution of the disease is slow, it is possible to implement prevention and control measures. The scope of the Family Health Program (in terms of the possibility of early diagnosis of diabetes mellitus and diabetic foot) favors epidemiological studies to determine the problem's magnitude. This article aimed to identify the proportion of individuals with diabetic foot treated at family health units in the city of Recife, Pernambuco State, Brazil. An epidemiological survey was conducted with a probabilistic sample of medical charts of diabetic patients (N = 1,374) enrolled in six health districts in the city, analyzing relations between socioeconomic variables, health conditions, and the occurrence of amputation. Diabetic foot was observed in 9% of the sample. There was a positive and statistically significant association with the variables alcoholism and amputation (p < 0.001). The prevalence of lower limb amputations was 25.6% among individuals with complications and 2.3% of the total sample.

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Prevalência de pé diabético e fatores associados nas unidades de saúde da família da cidade do Recife, Pernambuco, Brasil, em 2005

OBJECTIVES: to analyze the complications associated with type 2 diabetes in patients seen by Family Health Units. METHODS: a study was conducted of the Family Health Units of the six health districts of the city of Recife, State of Pernambuco, Brazil, with a sample of 1374 records of diabetic patients registered on the Family Health Program. The variables used were: the occurrence of macro-and microvascular complications, age, sex, years of schooling, alcohol consumption, smoking, first and last glucose recorded. RESULTS: there was a higher rate of complications in women (71.5%) compared to men (29.5%). Of the total, 58.9% had at least one complication. The macrovascular complications corresponded to 95.6%. The peripheral vascular disease was responsible for 92.1%, when considered as a single complication. There was an association between the age of 66 years or more and macrovascular complications, with a prevalence of 37.8%. Microvascular complications were half as common among women as among men (3.6 x 6.4) and this represents a statistically significant difference (p=0.04). Smoking was shown to be associated with microvascular complications (p<0001). CONCLUSIONS: the results point to a need to strengthen, alongside basic health services, measures recommended by the Health department, aiming to reduce risk factors and the impact of complications.

/pdf/complicacoes-cronicas-dos-diabeticos-tipo-2-atendidos-nas-2dwb9rlyoy.pdf

Complicações crônicas dos diabéticos tipo 2 atendidos nas Unidades de Saúde da Família, Recife, Pernambuco, Brasil

Sclerostin (Scl) is an osteoblast-inhibiting glycoprotein that is secreted mainly by osteocytes and is regulated by hormonal changes and skeletal loading. Decreased physical function and high serum Scl concentrations have been reported in chronic renal failure patients but little is known to date about the differences between diabetic and non-diabetic patients on hemodialysis who are susceptible to both sarcopenia and bone fragility. Objective.To determine the prevalence of sarcopenia and its association with serum Scl concentrations and metabolic parameters in 92 patients on hemodialysis. Anthropometric data and physical performance were evaluated in this study. Blood samples were collected for Scl, glucose, cholesterol, triglycerides, calcium, phosphate, PTH, and 25 OH-vitamin D measurements. Lean mass was evaluated using multifrequency electro-bioimpedance after dialysis session. Results. Mean age was 63.3 ± 13.6 years, 63% of patients were male, and 44.6% had diabetes. Mean body mass index (BMI) was higher in diabetics (26.6 ± 5.2 vs. 24.1 ± 3.7; p=0.01) and there were no differences in gait speed and handgrip strength between diabetic and non-diabetic subjects. A low skeletal muscle mass index (SMI) was identified in 65.2% of the participants, and among them 76.7% were men and 36.7% were diabetics. Mean serum Scl was 86.9 ± 39.0 pmol/L, which was higher in men (94.6 ± 41.7; p=0.017), in those individuals with low SMI (94.9 ± 40.7; p < 0.001), and in diabetics (97.2 ± 46.6; p < 0.003). After multivariate analysis and adjustments for potential confounders, high serum Scl was independently associated with low SMI and with the presence of diabetes. The following variables correlated positively with diabetes: blood pressure; BMI; waist circumference; waist/hip ratio; plasma glucose; serum Scl; and fat mass. Conclusions. We found higher serum Scl concentrations in hemodialysis patients with diabetes and these were inversely related to muscle mass.

https://downloads.hindawi.com/journals/ijn/2020/4596920.pdf

Serum Sclerostin, Body Composition, and Sarcopenia in Hemodialysis Patients with Diabetes.

Sclerostin (Scl) is an osteoblast inhibiting glycoprotein secreted mainly by osteocytes which is regulated by hormonal changes and skeletal loading. Decreased physical function and high serum Scl concentrations have been reported in chronic renal failure patients but little is known about the differences among diabetic and nondiabetic patients on hemodyalisis who are susceptible to both sarcopenia and bone fragility. Objective: To determine the prevalence of sarcopenia and its association with serum sclerostin concentrations and metabolic parameters in 92 patients on hemodyalisis. Anthropometric data and physical performance were evaluated. Blood sample were collected for sclerostin, glucose, cholesterol, triglycerides, calcium, phosphate, PTH e 25OH-vitamin D measurements. Lean mass was evaluated using multifrequency electro-bioimpedance at a “dry weight” time (after dialysis session). Results: Mean age was 63.3±13.6 years, 63% were male and 44.6% had diabetes. Mean BMI was higher in diabetics (26.6±5.2 vs. 24.1±3.7; p=0.01) and there were no differences in gait speed and hand grip strength between diabetic and nondiabetic subjects. A low skeletal muscle mass index (SMI) was identified in 65.2% of the participants, and among them 76.7% were men and 36.7% diabetics. Mean serum sclerostin was 86.9 ± 39.0 pmol/L, which was higher in men (94.6 ± 41.7; p = 0.017), in individuals with low SMI (94.9 ± 40.7; p Conclusions: We found higher serum sclerostin concentrations in hemodialysis patients with diabetes which were inversely related to muscle mass. Disclosure F. Bandeira: None. M.W. Medeiros: None. M.H. Junior: None. N.R. Silva: None. M. Bandeira Farias: None. L. Farias: None. Funding Arab Society for Paediatric Endocrinology and Diabetes

Maria Carolina Wanderley Costa de Medeiros

Papers

Prevalência de pé diabético e fatores associados nas unidades de saúde da família da cidade do Recife, Pernambuco, Brasil, em 2005

Complicações crônicas dos diabéticos tipo 2 atendidos nas Unidades de Saúde da Família, Recife, Pernambuco, Brasil

Serum Sclerostin, Body Composition, and Sarcopenia in Hemodialysis Patients with Diabetes.

534-P: Serum Sclerostin, Body Composition, and Sarcopenia in Hemodialysis Patients with Diabetes