No abstract

The aim of this study was to assess drug use and costs before and after bariatric surgery (BS). A systematic review of the literature was carried out using the MeSH terms obesity, bariatric surgery, and drug costs for searches of 10 electronic databases up to July 2014. Data were extracted from the 11 studies (37,720 patients) that fulfilled the inclusion criteria. Where applicable, data were pooled by meta-analysis. The average number of drugs per patient decreased from 3.9 ± 1.86 before surgery to 1.75 ± 1.85 after surgery. Mean reduction in total cost of drugs was 49.8 % over a follow-up duration of 6-72 months. BS is effective for the improvement or resolution of comorbidities and significantly reduces drug use and costs.

SummaryThe aims of this study were to investigate the contributions of the mitochondrial DNA m.4216T > C and m.4917A > G variants, and also of the European-specific mitochondrial cluster J/T, to the development of type 2 diabetes mellitus in Caucasian-Brazilian patients from Southern Brazil. We analyzed 347 type 2 diabetes patients and 350 control subjects. Variant frequencies in patients and control subjects were compared using χ 2 tests or odds ratio. We also compared clinical and laboratory characteristics among patients with and without the variants. We found that the frequencies of the m.4216T > C and m.4917A > G variants are higher in diabetic patients than in control subjects. Moreover, haplogroups J (partially defined by the presence of the m.4216T > C variant only) and T (partially defined by the presence of both m.4216T > C and m.4917A > G variants) are more frequent in the type 2 diabetic group than in the control group. Patients belonging to the cluster J/T are more insulin resistant than patients of other haplogroups. In conclusion, our results indicate the association of the cluster J/T (as suggested by analyses of the m.4216T > C and m.4917A > G variants) with insulin resistance and type 2 diabetes.

Weight loss after bariatric surgery increases exercise capacity and reduces peripheral metaboreflex, heart rate, and blood pressure. Further investigation on the role of metaboreflex regarding mechanisms of exercise capacity of individuals with obesity is warranted.

Catalase is a central antioxidant enzyme constituting the primary defense against oxidative stress. In this study, we investigated whether the functional –262C/T polymorphism in the promoter of catalase gene is associated with the presence of diabetic retinopathy (DR), diabetic nephropathy (DN) and ischemic heart disease (IHD) in 520 Caucasian-Brazilians with type 2 diabetes. The –262C/T polymorphism was also examined in 100 Caucasian blood donors. Patients underwent a clinical and laboratory evaluation consisting of a questionnaire, physical examination, assessment of diabetic complications and laboratory tests. Genotype analysis was performed using the polymerase chain reaction followed by digestion with restriction enzyme. The genotype and allele frequencies of the –262C/T polymorphism in patients with type 2 diabetes were very similar to those of blood donors (T allele frequency = 0.20 and 0.18, respectively). Likewise, there were no differences in either genotype or allele frequencies between type 2 diabetic patients with or without DR, DN or IHD. Thus, our results do not support the hypothesis that the –262C/T polymorphism is related to the development of DR, DN or IHD in patients with type 2 diabetes. Further studies are necessary to elucidate the role of catalase gene polymorphisms in the pathogenesis of diabetic complications.

The results suggest that the salivary levels of mutans streptococci increase following bariatric surgery in morbidly obese patients.

OBJECTIVE -The purpose of this study was to evaluate the effect of the single nucleotide polymorphism (SNP) Ϫ634GϾC at the 5Ј regulatory region of the vascular endothelial growth factor (VEGF) in the risk of proliferative diabetic retinopathy (PDR) in the Brazilian population of European ancestry with type 2 diabetes. RESEARCH DESIGN AND METHODS-A case-control study was conducted in 501 type 2 diabetic patients of European ancestry. Patients underwent a standardized clinical, ophthalmological, and laboratory evaluation. Of these, 167 patients had PDR (case patients), and 334 were considered as control subjects (patients without PDR) for PDR. A reference population (110 individuals of European ancestry) was also evaluated.RESULTS -No evidence of association between Ϫ634GϾC/VEGF and the presence of diabetic retinopathy or type 2 diabetes was observed (P Ͼ 0.05). However, CC homozygous for the SNP Ϫ634GϾC was significantly more frequent in patients with PDR (37 of 167; 22.2%) than in the corresponding control group (40 of 334; 12%) in accordance with a recessive model (P ϭ 0.003). This effect was further observed when creatinine, BMI, sex, duration of type 2 diabetes, HDL cholesterol, and systolic blood pressure were taken into account (odds ratio 1.9 [95% CI 1.01-3.79], P ϭ 0.04).CONCLUSIONS -The presence of the allele Ϫ634C/VEGF in homozygosity is an independent risk factor for the development of PDR in type 2 diabetic patients of European ancestry. Diabetes Care 30:275-279, 2007D iabetic retinopathy is a common microvascular complication in patients with diabetes, constituting a major cause of blindness in this group. Although the risk of development of this complication increases with poor glycemic control, there are several indications suggesting that the occurrence or progression of diabetic retinopathy also depends on genetic factors (1-3).Proliferative diabetic retinopathy (PDR), characterized by increased vascular permeability, tissue ischemia, and neovascularization, affects 10 -20% of diabetic patients (4). This process depends on the local production of angiogenic factors and components of the extracellular matrix, which will be substrates for endothelial migration. Vascular endothelial growth factor (VEGF), a potent activator of angiogenesis, enhances collateral vessel formation and increases the permeability of the microvasculature (5,6). VEGF expression is induced by high glucose levels and hypoxia and plays an important role in normal and abnormal angiogenesis (7-9). Its levels have been found to be markedly increased in the vitreous and aqueous fluids in the eyes of patients with PDR (10 -12).Several polymorphisms at the VEGF 5Ј regulatory region have been characterized and evaluated as risk alleles for the susceptibility or progression of both diabetic retinopathy and diabetic nephropathy through case-control studies (13-16). The single nucleotide polymorphism (SNP) Ϫ634GϾC was found to be associated with nonproliferative diabetic retinopathy (NPDR) and diabetic macular edema in type 2 diabetic pa...

Objective: To investigate the presence of maternal and paternal history of type 2 diabetes mellitus (DM) in relatives of 644 type 2 diabetic patients from Southern Brazil, and also to evaluate its influence on the clinical characteristics of this disease. Patients and Methods: Familial history of type 2 DM was investigated by a questionnaire. The maternal and paternal history was investigated over two generations. Complete data sets on familial history were obtained from 396 patients. Results: In general, 76.6% of the patients reported at least one first-degree affected relative. Besides, 31.6% of the patients reported a maternal history of type 2 DM and 12.6% reported a paternal history. Patients with maternal and/or paternal history presented a lower age at type 2 DM diagnosis when compared to patients without familial history. In addition, patients with only paternal history presented a higher frequency of hypertension than patients with no familial history. Conclusions: This study suggests that there is a significant maternal effect in the transmission of type 2 DM in Southern Brazil, and that most of the clinical characteristics of this disease do not differ between patients with or without familial history of type 2 DM. Some studies have shown that the adult offspring of diabetic parents are more obese than those of non-diabetic parents and display higher fasting plasma levels of glucose, insulin, triglycerides, total cholesterol and LDL cholesterol (13). Similarly, in Pima Indians, maternal DM is associated with higher blood pressure (BP) in the offspring (14). Recently, a study reported that the offspring of diabetic mothers displayed higher body mass index (BMI) and triglycerides when compared to the offspring of diabetic fathers (15). However, there are still few studies regarding the influence of familial history on the clinical characteristics of type 2 DM, in particular concerning the role of the paternal history on these characteristics.The aims of this study were to compare the prevalence of maternal and paternal history of type 2 DM in patients from Southern Brazil with type 2 DM, and to evaluate the roles of familial histories of DM on the clinical and laboratory characteristics of this disease. PATIENTS AND METHODSThe study group consisted of 644 unrelated type 2 diabetic patients (514 Caucasian-and 130 AfricanBrazilians) participating in a multicenter study in the Brazilian State of Rio Grande do Sul. Diagnosis of type 2 DM was based on the World Health Organization criteria (16). Patients over 30 years old and who had been treated with oral glucose lowering agents for over two years with no history of ketoacidosis were included in the study. Ethnic definition was based on self-report. The Caucasian-Brazilians were descendents from Europeans, mainly from Portugal, Spain, Italy and Germany, whereas the African-Brazilians were descendents from people brought to Brazil, between the 17 th and 18 th centuries, mainly from the west coast of Africa, Angola and Mozambique. Written informed con...