Diabetes do tipo II: avaliação de diferentes desfechos relacionados a saúde em pacientes de UTI e ambulatório

Abstract

Contextualization: Type 2 diabetes (T2D) is a complex disease that affects millions of people worldwide. T2D may be responsible for significant cardiometabolic dysfunction and reduced quality of life (QOL) due to its negative impact on functional exercise capacity. T2D can lead to reduced cardiac autonomic activity accompanied by impaired endothelial function. In addition, prolonged T2D hyperglycemia appears to be one of the most important causes for complications, as well as the need for cardiovascular surgeries (CC) and hospitalizations in the Intensive Care Unit (ICU). Exercise seems to be able to increase cardiorespiratory fitness and improve glycemic control, thus playing a key role in the prevention, management and treatment of T2D and its associated complications. Objectives: Article 1. To compare the incidence of postoperative complications (PC) between diabetic and non-diabetic patients undergoing CC. Article 2. To undertake a systematic review and meta-analysis of randomized controlled trials publications within the T2D population that investigates the overall effect on glycemic control and physical fitness changes resulting from high intensive interval training (HIIT) or combined training (CT) versus continuous aerobic training (CAT). Article 3. Preparation of a study protocol to investigate the effects of different modes of physical training (HIIT and CT) associated with Light-Emitting Diode (LED) therapy on cardiometabolic status, functional capacity and QOL in T2D patients. Article 4. To investigate the association between physical fitness, heart rate variability and endothelial function in T2D patients. Methods: Article 1. This is a retrospective cross-sectional study, based on the analysis of 288 medical records. Patients aged ≥18 years, admitted to the ICU undergoing coronary artery bypass grafting or vascular surgeries were included. The population was divided into those with and without T2DM and then was evaluated the incidence of postoperative complications (PC) between groups. Article 2. Searches were performed in MEDLINE and PEDro databases. The PICO search strategy was adopted: P(patient) = T2D patients; I(intervention) = CT and HIIT; C(control) = CAT; O(outcome) = VO2 peak (peak oxygen consumption) and HbA1c% (glycosylated hemoglobin). Article 3. The participants will be randomly allocated to one of four groups: 1) LED therapy followed by physical training with HIIT; 2) LED therapy simulation (sham) followed by HIIT; 3) LED therapy followed by combined training (aerobic and resistance training); and 4) LED therapy simulation (sham) followed by combined training. The training protocol should be performed for 12 weeks, 3 times/week on alternate days, totaling 36 training sessions. Article 4. Physical function assessment were performed by Shuttle Walking Test (SWT), cardiac autonomic modulation by heart rate variability (HRV), and the endothelial function was evaluated by flow-mediated dilation (FMD) of the brachial artery via ultrasound imaging. Results: Article 1. No significant difference in relation to PC (bleeding, atrial fibrillation, cardiorespiratory arrest and respiratory complications) between the groups was observed (p>0.05). Article 2. A total of 10 studies enrolling 578 participants were included. CT was more effective than CAT in improving HbA1c levels (-0.58 [-0.78, -0.38]; Chi2=45.79; Z=5.76 (p<0.00001) and I2=91%, 5 trials/435 participants). HIIT was more effective than CAT in increasing VO2 peak (2.56 [1.44, 3.68]; Chi2=12.27; Z=4.49 (p<0.00001) and I2=67%, 5 trials/143 participants). Article 4. The main finding of this study is that some HRV indices (SDNN, RMSSD and HF) correlated significantly with the endothelial function across T2D subjects, with r-values within 0.51–0.57, p<0.05, for all relations. Additionally, it was found association between the walked distance on SWT and the basal diameter of brachial artery, with R=0.59, p<0.05. Conclusion: Article. T2D has a high incidence rate in the population of critically ill patients submitted to cardiovascular surgeries (CS), especially in the elderly. However, in this small retrospectively analyzed study, there was no significant increase in PC related to diabetes for patients undergoing CS. Article 2. The present data suggests that CT and HIIT might be the most efficient exercise modalities to improve glycemic control and physical fitness, respectively, in T2D patients. Article 3. The findings of this trial have the potential to provide important insights regarding the effects of different modes of physical training associated with LED therapy and may support the use of this therapy combination in T2D patients, improving their general health. Article 4. Our data demonstrate that some HRV indices related to FMD, indicating interaction between these two systems. In addition, our findings suggest a correlation between physical fitness and endothelial function across T2D subjects.