Objective: To investigate associations between physical activity, comorbidity severity, depressive symptoms, and health-related quality of life in type 2 diabetes mellitus. Subjects and methods: All individuals, 200 patients and 50 controls, aged from 40 to 60 years, were investigated by interview, and all variables were measured concurrently. Physical activity was evaluated by the International Physical Activity Questionnaire (IPAQ), Health-Related Quality of Life (HRQL) by the Short-Form Health Survey (SF-36), comorbidity severity by the Charlson Comorbidity Index (CCI), and depressive symptoms by the Beck Depression Inventory (BDI-II ≥ 16). Single and multiple regression analysis evaluated the effects of independent variables on physical activity. Results: The patients had more depressive symptoms and greater comorbidity severity (p < 0.005). Diabetic patients showed better activity levels (IPAQ) (p < 0.005). Functional Capacity, General State of Health, and Physical Limitation were the most affected subscales in the SF-36 evaluation of the HRQL. Sedentary diabetic patients had higher waist circumference, waist-to-hip ratios, more depressive symptoms, and worse HRQL. Functional capacity (p = 0.000), followed by General State of Health (p = 0.02), were the health status measure subscales independently associated with physical activity. Conclusions: The findings suggest that increasing patient independence and treating depressive symptoms can promote physical activity for type 2 diabetes mellitus patients. It is suggested that group activities and caregivers/family support might compensate for the patient dependence, and increase adherence to exercise programs in those that are less active. Arq Bras Endocrinol Metab. 2013;57(1):44-50 Keywords Type 2 diabetes; physical activity; quality of life; depressive symptoms; functional capacity RESUMO Objetivo: Investigar as associações entre atividade física, gravidade das comorbidades, sintomas depressivos e qualidade de vida relacionada à saúde em pacientes com diabetes mellitus tipo 2. Sujeitos e métodos: Todos os indivíduos, 200 pacientes e 50 controles, com idades entre 40 e 60 anos, foram analisados por entrevistas, e todas as variáveis foram medidas neste mesmo momento. A atividade física foi avaliada pelo International Physical Activity Questionnaire (IPAQ); a qualidade de vida relacionada à saúde (QVRS), pelo Short-Form Health Survey (SF-36); a gravidade das comorbidades, pelo Índice de Comorbidade de Charlson (CCI); e os sintomas depressivos foram avaliados pelo Inventário de Depressão de Beck (BDI-II ≥ 16). A análise de regressão simples e múltipla avaliou os efeitos das variáveis independentes sobre a atividade física. Resultados: Os pacientes apresentaram mais sintomas depressivos e maior gravidade das comorbidades (p < 0,005). Os pacientes diabéticos apresentaram melhores níveis de atividade (IPAQ) (p < 0,005). A Capacidade Funcional, a Condição Geral de Saúde e a Limitação Física foram as subescalas mais afetadas na avaliação da QVRS no SF-36. Os ...

To evaluate the relationship between physical activity with co morbidities and health-related quality of life in type 2 diabetic patients with and without restless legs syndrome (RLS). This is an observational study, set at tertiary care diabetic outpatient clinic, where 200 consecutive type 2 diabetic patients and 47 controls participated. Physical activity level was established by the International Physical Activity Questionnaire (IPAQ) and RLS diagnosis and RLS severity were established using the criteria defined by the International Restless Legs Syndrome Study Group; excessive daytime sleepiness was evaluated by the Epworth Sleepiness Scale, quality of sleep by the Pittsburgh Sleep Quality Index and Health-Related Quality of Life by the Short-Form Health Survey (SF-36). Depressive symptoms were investigated by Beck Depression Inventory (BDI- II). Among all diabetic patients (58 % women, mean age 52.7 ± 5.7), disease duration varied from 1 to 30 years (11.7 ± 7.5). Diabetic patients had more hypertension (76 %), peripheral neuropathy (65 %), and depressive symptoms (31 %) than controls; no gender differences were found between cases with and without depressive symptoms. RLS patients (72 % female) had worse quality of sleep. With regards to the quality of life domains, more active RLS diabetic patients had better perception of functional capacity, physical limitation, pain, and general health state (p < 0.05). RLS symptom severity did not vary according to physical activity (IPAQ level). This study shows that the physical activity is associated with a better perception of functional capacity, physical limitation, and pain in diabetic patients with RLS; thus a more active lifestyle should be encouraged.

W e would like to thank Dr. Dinc for the interest in our article suggesting that increasing patient independence and treating depressive symptoms can promote physical activity in type 2 diabetes mellitus patients. Initially, Dr. Dinc and cols. have reaffirmed that community-based studies are highly important. This particular study evaluated diabetic patients from a tertiary care center. We agree that it is important to use scales that have been validated and largely, used as it was done in our study (1). Also, despite the number of controls, data analysis was adequate; however, a greater number of patients and of controls would increase the power of our data. At present, we did not include metabolic status of the patients because this was mainly an analysis of physical activity status, comorbidities, depressive symptoms, and health-related quality of life. We considered that our results, showing a high number of diabetic patients performing physical activity, are valuable because they prove that educational programs are effective. Nevertheless, we know that a lot more needs to be done in order to achieve prevention of metabolic syndrome and diabetes.In this population, heart failure was not reported and myocardial ischemia and/or previous myocardial infarct were found in 39 (20%) of the cases. As described, these comorbidities were unrelated with physical activity (2). Of note, even low-intensity physical activity has been shown to improve health related measures, particularly cardiovascular function (3). Thus, after safeguarding patients with cardiovascular disorders, advising patients to perform physical activity seems warranted, as a general rule. We think that the need to classify patients according to their cardiac status in order to encourage occasional low-level physical activity could inhibit the encouragement of exercise practice. Of course, physical abilities and comorbidities must be considered for a safe implementation of exercises, and individuals with any indication of cardiovascular disease should be thoroughly evaluated. Recently, a study has shown that a universal strategy to promote physical activity in primary care has the potential to increase the number of years lived free from physical disease (4). The same study affirms that there is only weak evidence that this strategy is cost-effective.As it has been quoted, depressive symptoms are very frequently associated with diabetes. Interestingly, identified diabetes has been associated with 4-fold greater odds of depression, while undiagnosed diabetes has not been associated with depression (5). Depressive symptoms are frequent in hemodialysis (6), obstructive sleep apnea

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Introduction: Osteogenesis imperfecta (OI) is a heritable disorder of the connective tissue that mainly manifests as bone fragility. Other signs and symptoms may be present, such as sensorineural hearing loss, cardiac malformations, and teeth alterations. Case description: 72-year-old female patient presented with left abundant spontaneous hyaline rhinorrhea, history of several bone fractures since early childhood, and a blue grayish sclera was noted. Cerebrospinal fluid (CSF) leak was diagnosed. Neuroimaging revealed lowering of the sella turcica floor, platybasia, basilar impression, left middle fossa calcified meningioma, syringobulbia, ventricular dilatation, and left ethmoidal fistula. Due to the patient’s age and clinical status, a medical approach was chosen, and treatment with acetazolamide and furosemide in low dosages, which resulted in a decrease of the rhinorrhea. Discussion: Clinical features and imaging study are often sufficient for diagnosis of OI. The neurological and cranial features in OI are varied. CSF leak is not commonly reported and might have been a consequence of bone softening and hydrocephalus. Conclusions: This case represents a treatment challenge, as the surgical results were uncertain, once bone fragility could result in the development of new leaks. Clinical treatment was chosen and resulted in a significant improvement of the symptoms.