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Doctoral Thesis
DOI
https://doi.org/10.11606/T.17.2015.tde-23072020-131849
Document
Author
Full name
Carlos Gustavo de Melo Gonçalves de Lima
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2015
Supervisor
Committee
Cruz, Antonio Augusto Velasco e (President)
Dib, Sérgio Atala
Jorge, Rodrigo
Ruffino Netto, Antonio
Scarpi, Marinho Jorge
Title in Portuguese
Saúde ocular em índios Xavante portadores de diabetes mellitus tipo 2
Keywords in Portuguese
Complicações do diabetes
Diabetes mellitus
Hiperglicemia
Índios Sul-Americanos
Retinopatia diabética
Abstract in Portuguese
Objetivos: Analisar as condições da saúde ocular e a frequência de retinopatia, catarata, glaucoma, pterígio e outras doenças oculares entre os índios Xavante com diabetes mellitus. Relacionar a retinopatia diabética ao: tempo de diagnóstico do diabetes, hipertensão arterial, dislipidemia, obesidade e microalbuminúria. Métodos: Em um estudo de prevalência, realizado nos Territórios Indígenas de Sangradouro-Volta Grande e São Marcos, entre 2008 e 2011, com 948 índios Xavante adultos, foram diagnosticados 246 diabéticos. Dentre estes, foram examinados 143 indivíduos. O exame oftalmológico consistiu em medida da acuidade visual, exame ocular externo, biomicroscopia, tonometria de aplanação, oftalmoscopia direta e indireta. Amostras de sangue foram obtidas, através de punção venosa para testes laboratoriais de hemoglobina glicada (HbA1c); colesterol total, HDL e LDL; triglicérides; apolipoproteínas A-I e B e proteína C reativa (PCR). Amostras de urina foram obtidas para a dosagem da microalbuminúria. O estado nutricional foi avaliado usando medidas antropométricas, incluindo: peso, altura e circunferência abdominal. Resultados: os achados oftalmológicos mais frequentes foram: pterígio em 35%, catarata 28%, e atrofia coriorretiniana peripapilar 23,8%. A frequência da retinopatia diabética foi de 19,3%, distribuída da seguinte forma: retinopatia não proliferativa leve em nove indivíduos (33,3%), moderada em nove (33,3%), grave em seis (22,3%), muito grave em dois (7,4%), além de um caso de retinopatia diabética proliferativa com sinais de alto risco para perda visual (3,7%). Pelos resultados da análise multivariada (modelo de regressão de Poisson), observou-se associação entre a retinopatia diabética e as variáveis: tempo de diagnóstico do diabetes ≥60 meses (IC 95%: 1,68-7,12; p=0,001), escavação papilar ≥0,5 (IC 95%: 1,55-5,99; p=0,001); glicemia de jejum elevada (p<0,001); HbA1c elevada (p<0,001). Conclusões: a ocorrência de retinopatia diabética nos índios Xavante está associada ao maior tempo de doença e taxas elevadas de glicemia e HbA1c. A elevada prevalência de diabetes nessa população, aliada ao seu mau controle metabólico, aponta para a ocorrência de grande número de indivíduos com as complicações crônicas do diabetes, em especial a retinopatia.
Title in English
Eye health in Xavante indians with type 2 diabetes mellitus
Keywords in English
Diabetes complications
Diabetes mellitus
Diabetic retinopathy
Hyperglycemia
Indians
South American
Abstract in English
Purpose: To evaluate the impact of diabetes on the eye health conditions and frequency of retinopathy, cataracts, glaucoma, pterygium and other ocular diseases among the Xavante Indians with diabetes mellitus. To relate diabetic retinopathy with: time of diabetes diagnosis, hypertension, dyslipidemia, obesity and microalbuminuria. Methods: In a prevalence study conducted in Indigenous people from Sangradouro Volta Grande and San Marcos reservations in Mato Grosso, Brazil, between 2008 and 2011 with 948 adults Xavante Indians, 246 diabetic subjects were diagnosed. Of these, 143 subjects were examined. The ophthalmologic examination consisted of visual acuity, external eye examination, biomicroscopy, applanation tonometry, direct and indirect ophthalmoscopy. Blood samples were obtained by vein puncture for laboratory including glycated hemoglobin - HbA1c, total cholesterol, HDL and LDL, triglycerides, apolipoproteins AI and B and C-reactive protein (CRP). Urine samples were obtained for determination of microalbuminuria. Nutritional status was assessed using anthropometric measurements, including weight, height, waist circumference. Results: the most common ophthalmologic findings were: pterygium in 35%, cataract in 28% and peripapillary chorioretinal atrophy in 23.8%. The frequency of diabetic retinopathy was 19.3%, distributed as follows: mild nonproliferative retinopathy in 9 eyes (33.3%), moderate in (33.3 %), severe in 6 (22.3%), very severe in 2 (7.4%) and one case of proliferative diabetic retinopathy high risk (3.7%). By the results of the multivariate analysis (Poisson regression model), we observed an association between diabetic retinopathy and the variables: time of diabetes diagnosis ≥60 months (95% CI: 1.68-7.12, p=0.001), papillary excavation ≥0.5 (CI 95%: 1.55-5.99; p=0.001), high fasting glucose (p<0.001) and elevated glycosylated hemoglobin (p<0.001). Conclusions: The occurrence of diabetic retinopathy in Xavante Indians is associated with longer disease duration and higher rates of blood glucose and glycated hemoglobin. The high prevalence of diabetes in this population, combined with its poor metabolic control may result in large numbers of individuals with chronic complications of diabetes, especially retinopathy.
 
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Publishing Date
2020-10-20
 
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