Evaluation of diabetic patients after three month use of continuous subcutaneous insulin infusion, dispensed by a protocolled form at outpatient reference clinic of Taguatinga Regional Hospital

Abstract

Objective: To evaluate the data of continuous subcutaneous insulin infusion protocol (CSII) for diabetics waived by the Health State Secretariat of Distrito Federal (HSSDF) and therapeutic responses three months after the transfer of multiple daily injections regimen for CSII. Subjects and methods: Eighty patients (49 female) took part in this experimental study, mean age and disease duration were 27.9 years and 13 years, respectively; 96% patients had type 1 diabetes mellitus. Results: The entire sample (ECO) and 3 subgroups (group 1 -A1c decrease, group 2 -A1c stable, and group 3 -A1c increase), stratified according to a ≥ 0.5% change in A1c, were analyzed. Group 1 involved 64% of the patients. The ECO showed a significant A1c decrease: MDI 8.1 ± 1.4% vs. CSII 7.3 ± 0.9%, p < 0.0001 (0.8% difference pro CSII therapy). Group 1 demonstrated an A1c decrease from 8.7% to 7.3% (1.4% difference). Group 2 mean A1c was 7.1%. Rate of hypoglycemia (< 50 mg/dL) decreased 61% in the ECO and 79% in Group 2. Conclusion: This study reinforces the safety and efficacy of CSII with a robust A1c reduction and hypoglycemia. The pioneer care HSSDF ambulatory attests to be achievable the free dispensing by Unified Health System (UHS) following a protocol, and this approach results in less wastage to the patient and represents a rational policy of therapy with CSII for UHS. Arch Endocrinol Metab. 2015;59(1):23-8

Vascular Inflammation and Genetic Predisposition as Risk Factors for Cardiovascular Diseases

“…Unlike CRP, MPO is more involved in different stages of atherosclerosis such as foam cells, endothelial dysfunction and apoptosis, the activation of matrix metalloproteinases, and the expression of tissue factor which could address the patients with vulnerable plaques, and the potential burden of such plaques in clinical practice [47]. The members of the inflammatory cytokine family IL-6 and tumor necrosis factor (TNF)-α, released from the main cells of the plaque, vascular smooth muscle cells, endothelial cells, monocytes, and macrophages, are highly involved in atherosclerosis [48]. Ridker and colleagues reported from 14,916 healthy male; blood IL-6 concentrations were significantly elevated in individuals who had myocardial infarction as compared with those who did not [49].…”