Complicações macrovasculares do diabetes melito: peculiaridades clínicas, de diagnóstico e manejo

Triches, Cristina Bergmann; Schaan, Beatriz D’Agord; Gross, Jorge Luiz; Azevedo, Mirela Jobim de

doi:10.1590/s0004-27302009000600002

Cited by 20 publications

(18 citation statements)

References 62 publications

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“…We found that increased age of patients with type 2 diabetes, as well as a diagnosis for more than 10 years, were considered risk factors 17,18 . Therefore, the history of neuropathic pain and vascular insufficiency, which can be evaluated by the Doppler method measuring the ABI, allows the International Working Group on the Diabetic Foot Guidelines to be interpreted such that persons with peripheral arterial disease symptoms and ABI scores < 0.9 should be assessed for possible revascularization 13,14,17 . Although ABI scores > 1.3 have no correlation with an accurate evaluation of ischemia, they are associated with high cardiovascular risk, as calcification may occur with normal ABI scores in the absence of clinical signs of peripheral arterial disease.…”

Section: Discussionmentioning

confidence: 99%

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Ankle-brachial index and diabetic neuropathy: study of 225 patients

Chevtchouk

Silva²,

Nascimento

2017

Arq. Neuro-Psiquiatr.

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Objective To evaluate neuropathic pain and peripheral vascular disease in diabetics and compare this with the length of time since diagnosis in type 1, and type 2 diabetes. Methods A cross-sectional study with 225 diabetics chosen from their responses on the DN4 questionnaire, who were then evaluated with the ankle-brachial index (ABI), separating type 1 diabetes from type 2 diabetes. Results A higher incidence of neuropathic pain in those over 60 years of age showed an ABI > 1.3. Neuropathic pain was related to an abnormal ABI in 144 patients (64.2%). A statistically significant value was obtained in type 2 diabetes patients with more than 10 years from disease onset, 69 with altered ABI and 25 with normal ABI. There was an altered ABI (< 0.9) observed in 33% of type 1 diabetes patients and in 67% of type 2 diabetes patients. Conclusion The ABI test in type 1 diabetes and type 2 diabetes patients is important even in those who are asymptomatic. A diagnosis of more than 10 years prior, regardless of the presence of neuropathic pain or ischemic signs, altered the ABI.

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Section: Discussionmentioning

confidence: 99%

“…In the non-diabetic population, the incidence of ABI changes varied about 8.7%, and the prevalence of 62.2% artery disease was very likely among patients with chronic kidney failure, tobacco use and cardiovascular disease 14 …”

mentioning

confidence: 99%

Ankle-brachial index and diabetic neuropathy: study of 225 patients

Chevtchouk

Silva²,

Nascimento

2017

Arq. Neuro-Psiquiatr.

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“…Contudo, um aspecto que vem sendo debatido intensamente é a validade de realizar rastreamento para a presença de DAC em pacientes com DM sem sintomas de cardiopatia isquêmica, visto que o diabetes já é considerado um equivalente à presença de DAC prévia. Porém, a American Diabetes Association (ADA, 2008) não recomenda o rastreamento de DAC apenas com base na presença de outros fatores de risco cardiovasculares e a American Heart Association (AHA, 2007) recomenda o rastreamento apenas ao iniciar um programa de exercícios vigorosos (19) . Salienta-se a importância de uma rede de apoio possibilitando um processo educativo ao paciente com diabetes ampliando seus conhecimentos a fim de prevenir complicações cardiovasculares, possibilitando maior compreensão da doença e aquisição de hábitos saudáveis.…”

Section: Presença E Característica Da Dorunclassified

Dor torácica no infarto agudo do miocárdio entre pacientes diabéticos e não diabéticos

Paim

Azzolin²,

Moraes³

2012

Rev. Bras. Enferm.

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77Rev Bras Enferm, Brasília 2012 jan-fev; 65 (1) ReSUmO Considerando-se que pacientes diabéticos acometidos de Infarto Agudo do Miocárdio (IAM) podem, ou não, apresentar dor torácica, objetivou-se neste estudo comparar a presença e intensidade de dor torácica no IAM entre pacientes diabéticos e não diabéticos. Realizou-se um estudo transversal, que incluiu pacientes com IAM, idade ≥18 anos, ambos os sexos. Utilizou-se uma escala numérica verbal para avaliar a presença e a intensidade da dor. Foram incluídos 88 pacientes no estudo, dentre os quais 77 (87,5%) não diabéticos e 11 (12,5%) diabéticos. A dor esteve presente em 11 (100%) dos diabéticos e 76 (98,7%) dos não diabéticos. A intensidade da dor nos diabéticos foi de 8,91 versus 8,23 nos não diabéticos. O estudo mostrou semelhança na presença e intensidade da dor torácica entre pacientes diabéticos e não diabéticos acometidos de IAM. descritores: Diabetes mellitus; Infarto do miocárdio; Escala analógica da dor. aBStRaCt Considering that diabetic patients suffering from Acute Myocardial Infarction (AMI) may or may not have chest pain, this study aimed to compare the presence and intensity of chest pain in AMI between diabetic and non-diabetic patients. We conducted a cross-sectional study that included patients with AMI, aged ≥ 18 years, both sexes. We used a verbal numeric scale for assessing the presence and intensity of pain. The study included 88 patients, of whom 77 (87.5%) non-diabetic patients and 11 (12.5%) diabetics. The pain was present in 11 (100%) of diabetics and in 76 (98.7%) of non-diabetics. The intensity of pain in diabetics was 8.91 versus 8.23 in non-diabetic patients. The study showed similarity in the presence and intensity of chest pain between diabetic and non diabetic patients suffering from AMI.

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“…Diabetes mellitus (DM) and obesity are well-defined risk factors for cardiovascular disease and mortality [1,2]. Both diseases have assumed epidemic proportions in the last few decades [1,3].…”

Section: Introductionmentioning

confidence: 99%

Contrasting effects of preexisting hyperglycemia and higher body size on hospital mortality in critically ill patients: a prospective cohort study

et al. 2014

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BackgroundObesity and diabetes mellitus are well-defined risk factors for cardiovascular mortality. The impact of antecedent hyperglycemia and body size on mortality in critical ill patients in intensive care units (ICUs) may vary across their range of values. Therefore, we prospectively analyzed the relationship between in-hospital mortality and preexisting hyperglycemia and body size in critically ill ICU patients to understand how mortality varied among normal, overweight, and obese patients and those with low, intermediate, and high glycated hemoglobin (HbA1c) levels.MethodsMedical history, weight, height, physiologic variables, and HbA1c were obtained during the first 24 h for patients who were consecutively admitted to the high complexity ICU of Hospital de Clínicas de Porto Alegre, Brazil, from April to August 2011. The relationships between mortality and obesity and antecedent hyperglycemia were prospectively analyzed by cubic spline analysis and a Cox proportional hazards model.ResultsThe study comprised 199 patients. The overall hospital mortality rate was 43.2% during a median 16 (8–28) days of follow-up. There was a progressive risk of in-hospital mortality with higher HbA1c levels, with the relationship becoming significant at HbA1c >9.3% compared with lower levels (hazard ratio 1.74; 95% confidence interval with Bonferroni correction 1.49–2.80). In contrast, mean body mass index (BMI) was higher in survivors than in nonsurvivors (27.2 kg/m2 ± 7.3 vs. 24.7 kg/m2 ± 5.0 P = 0.031, respectively). Cubic spline analysis showed that these relationships differed nonlinearly through the spectrum of BMI values. In a Cox proportional hazards model adjusted for Acute Physiology and Chronic Health Evaluation II score and HbA1c, the risk of in-hospital mortality progressively decreased with increasing BMI (BMI <20 vs. 20–23.9 kg/m2, P = 0.032; BMI <20 vs. 24–34.9 kg/m2, P = 0.010; BMI <20 vs. ≥35 kg/m2, P = 0.032).ConclusionsOur findings suggest that significant hyperglycemia prior to ICU admission is a risk factor for in-hospital mortality. Conversely, increasing BMI may confer an advantageous effect against mortality in critical illness independently of previous glycemic control.

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Complicações macrovasculares do diabetes melito: peculiaridades clínicas, de diagnóstico e manejo

Cited by 20 publications

References 62 publications

Ankle-brachial index and diabetic neuropathy: study of 225 patients

Ankle-brachial index and diabetic neuropathy: study of 225 patients

Dor torácica no infarto agudo do miocárdio entre pacientes diabéticos e não diabéticos

Contrasting effects of preexisting hyperglycemia and higher body size on hospital mortality in critically ill patients: a prospective cohort study

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