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Article ; Online: Maternal-fetal outcomes of pregnant women with type 1 diabetes treated with continuous subcutaneous insulin infusion or multiple daily injections during pregnancy - A Brazilian health care referral center cohort study.

Ogassavara, Juliana / Dualib, Patricia Medici / Mattar, Rosiane / Dib, Sérgio Atala / de Almeida-Pititto, Bianca

Archives of endocrinology and metabolism

2023 Volume 67, Issue 6, Page(s) e220483

Abstract: Objective: Pregnant women with type 1 diabetes (T1D) have an increased risk of maternal-fetal complications. Regarding treatment, continuous subcutaneous insulin infusion (CSII) has advantages compared to multiple daily injections (MDI), but data about ... ...

Abstract	Objective: Pregnant women with type 1 diabetes (T1D) have an increased risk of maternal-fetal complications. Regarding treatment, continuous subcutaneous insulin infusion (CSII) has advantages compared to multiple daily injections (MDI), but data about the best option during pregnancy are limited. This study's aim was to compare maternal-fetal outcomes among T1D patients treated with CSII or MDI during pregnancy. Subjects and methods: This study evaluated 174 pregnancies of T1D patients. Variables of interest were compared between the groups (CSII versus MDI), and logistic regression analysis was performed (p < 0.05). Results: Of the 174 included pregnancies, CSII was used in 21.3% (37) and MDI were used in 78.7% (137). HbA1c values improved throughout gestation in both groups, with no difference in the first and third trimesters. The frequency of cesarean section was significantly higher in the CSII group [94.1 Conclusion: In this study, we observed a higher frequency of cesarean section and a lower occurrence of congenital malformations in the CSII group, but the adjusted results might indicate that these associations are influenced by glycemic control.
MeSH term(s)	Infant, Newborn ; Pregnancy ; Humans ; Female ; Diabetes Mellitus, Type 1/drug therapy ; Hypoglycemic Agents/therapeutic use ; Cohort Studies ; Pregnant Women ; Glycated Hemoglobin ; Brazil ; Cesarean Section ; Pregnancy in Diabetics/drug therapy ; Pregnancy in Diabetics/chemically induced ; Insulin/therapeutic use ; Delivery of Health Care ; Insulin Infusion Systems
Chemical Substances	Hypoglycemic Agents ; Glycated Hemoglobin ; Insulin
Language	English
Publishing date	2023-06-24
Publishing country	Brazil
Document type	Journal Article
ISSN	2359-4292
ISSN (online)	2359-4292
DOI	10.20945/2359-4292-2022-0483
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Article ; Online: BrazIliaN Type 1 & 2 DiabetEs Disease Registry (BINDER): longitudinal, real-world study of diabetes mellitus control in Brazil.

de Almeida-Pititto, Bianca / Eliaschewitz, Freddy G / de Paula, Mauricio A / Ferreira, Graziela C

Frontiers in clinical diabetes and healthcare

2022 Volume 3, Page(s) 934629

Abstract: Introduction: This study aimed at assessing the patterns of care and glycemic control of patients with diabetes (DM) in real life during a follow-up of 2 years in the public and private health sectors in Brazil.: Methods: BINDER was an observational ... ...

Abstract	Introduction: This study aimed at assessing the patterns of care and glycemic control of patients with diabetes (DM) in real life during a follow-up of 2 years in the public and private health sectors in Brazil. Methods: BINDER was an observational study of patients >18 years old, with type-1 (T1DM) and type-2 DM (T2DM), followed at 250 sites from 40 cities across the five regions of Brazil. The results for the 1,266 participants who were followed for 2 years are presented. Main results: Most patients were Caucasians (75%), male (56.7%) and from the private health sector (71%). Of the 1,266 patients who entered the analysis, 104 (8.2%) had T1DM and 1162 (91.8%) had T2DM. Patients followed in the private sector represented 48% of the patients with T1DM and 73% of those with T2DM. For T1DM, in addition to insulins (NPH in 24%, regular in 11%, long-acting analogues in 58%, fast-acting analogues in 53%, and others in 12%), the patients received biguanide (20%), SGLT2-I (4%), and GLP-1Ra (<1%). After 2 years, 13% of T1DM patients were using biguanide, 9% SGLT2-I, 1% GLP-1Ra, and 1% pioglitazone; the use of NPH and regular insulins decreased to 13% and 8%, respectively, while 72% were receiving long-acting insulin analogues, and 78% fast-acting insulin analogues. Treatment for T2DM consisted of biguanide (77%), sulfonylureas (33%), DPP4 inhibitors (24%), SGLT2-I (13%), GLP-1Ra (2.5%), and insulin (27%), with percentages not changing during follow-up. Regarding glucose control, mean HbA1c at baseline and after 2 years of follow-up was 8.2 (1.6)% and 7.5 (1.6)% for T1DM, and 8.4 (1.9)% and 7.2 (1.3)% for T2DM, respectively. After 2 years, HbA1c<7% was reached in 25% of T1DM and 55% of T2DM patients from private institutions and in 20.5% of T1DM and 47% of T2DM from public institutions. Conclusion: Most patients did not reach the HbA1c target in private or public health systems. At the 2-year follow-up, there were no significant improvements in HbA1c in either T1DM or T2DM, which suggests an important clinical inertia.
Language	English
Publishing date	2022-08-16
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-6616
ISSN (online)	2673-6616
DOI	10.3389/fcdhc.2022.934629
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Article ; Online: Father's weight could contribute to large babies in overweight and obese mothers with and without gestational diabetes.

Bedani, Caio Rodrigues / Dualib, Patricia M / Carvalho, Camila C R / Oliveira, Julia M / Mattar, Rosiane / Dib, Sergio A / de Almeida-Pititto, Bianca

Archives de pediatrie : organe officiel de la Societe francaise de pediatrie

2023 Volume 30, Issue 3, Page(s) 192–194

Abstract: We evaluated whether there was an association between fathers' nutritional status and children's birth weight (BW) considering weight-matched mothers with and without gestational diabetes mellitus (GDM). In total, 86 trios of women, infants, and fathers ... ...

Abstract	We evaluated whether there was an association between fathers' nutritional status and children's birth weight (BW) considering weight-matched mothers with and without gestational diabetes mellitus (GDM). In total, 86 trios of women, infants, and fathers were evaluated. BW was not different between the groups of obese and non-obese parents, frequency of maternal obesity, or GDM. The percentage of infants who were large for gestational age (LGA) was 25% in the obese group and 14% in the non-obese group (p = 0.44). There was a borderline significance for higher body mass index (p = 0.09) of the father in the LGA group compared with the adequate for gestational age group. These results corroborate the hypothesis that the father's weight can also be relevant for the occurrence of LGA.
MeSH term(s)	Infant ; Child ; Female ; Humans ; Pregnancy ; Male ; Diabetes, Gestational/epidemiology ; Overweight/complications ; Overweight/epidemiology ; Birth Weight ; Fetal Macrosomia/etiology ; Fetal Macrosomia/epidemiology ; Obesity/complications ; Obesity/epidemiology ; Weight Gain ; Body Mass Index ; Fathers
Language	English
Publishing date	2023-03-10
Publishing country	France
Document type	Journal Article
ZDB-ID	1181947-9
ISSN	1769-664X ; 0929-693X
ISSN (online)	1769-664X
ISSN	0929-693X
DOI	10.1016/j.arcped.2023.01.003
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Article ; Online: Maternal-fetal outcomes of pregnant women with type 1 diabetes treated with continuous subcutaneous insulin infusion or multiple daily injections during pregnancy – A Brazilian health care referral center cohort study

Juliana Ogassavara / Patricia Medici Dualib / Rosiane Mattar / Sérgio Atala Dib / Bianca de Almeida-Pititto

Archives of Endocrinology and Metabolism, Vol 67, Iss

2023 Volume 6

Abstract: ABSTRACT Objective: Pregnant women with type 1 diabetes (T1D) have an increased risk of maternal-fetal complications. Regarding treatment, continuous subcutaneous insulin infusion (CSII) has advantages compared to multiple daily injections (MDI), but ... ...

Abstract	ABSTRACT Objective: Pregnant women with type 1 diabetes (T1D) have an increased risk of maternal-fetal complications. Regarding treatment, continuous subcutaneous insulin infusion (CSII) has advantages compared to multiple daily injections (MDI), but data about the best option during pregnancy are limited. This study's aim was to compare maternal-fetal outcomes among T1D patients treated with CSII or MDI during pregnancy. Subjects and methods: This study evaluated 174 pregnancies of T1D patients. Variables of interest were compared between the groups (CSII versus MDI), and logistic regression analysis was performed (p < 0.05). Results: Of the 174 included pregnancies, CSII was used in 21.3% (37) and MDI were used in 78.7% (137). HbA1c values improved throughout gestation in both groups, with no difference in the first and third trimesters. The frequency of cesarean section was significantly higher in the CSII group [94.1 vs. 75.4%, p = 0.017], but there was no significant difference in the frequency of other complications, such as miscarriage, premature delivery and preeclampsia. The mean birth weight and occurrence of neonatal complications were also similar, except for the proportion of congenital malformations, which was significantly lower in the CSII group [2.9 vs. 15.6%, p = 0.048]. In regression analysis, the association of CSII with cesarean section and malformations lost significance after adjusting for HbA1c and other covariates of interest. Conclusion: In this study, we observed a higher frequency of cesarean section and a lower occurrence of congenital malformations in the CSII group, but the adjusted results might indicate that these associations are influenced by glycemic control.
Keywords	Continuous subcutaneous insulin infusion ; maternal-fetal outcomes ; multiple daily injections ; type 1 diabetes mellitus ; pregnancy in diabetics ; Medicine ; R ; Diseases of the endocrine glands. Clinical endocrinology ; RC648-665
Subject code	610
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	Brazilian Society of Endocrinology and Metabolism
Document type	Article ; Online
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Article ; Online: Gut bacterial markers involved in association of dietary inflammatory index with visceral adiposity.

Freitas, Renata G B O N / Vasques, Ana Carolina J / da Rocha Fernandes, Gabriel / Ribeiro, Francieli B / Solar, Isabela / Shivappa, Nitin / Hébert, James R / de Almeida-Pititto, Bianca / Geloneze, Bruno / Ferreira, Sandra Roberta G

Nutrition (Burbank, Los Angeles County, Calif.)

2024 Volume 122, Page(s) 112371

Abstract: Objective: To deepen the understanding of the influence of diet on weight gain and metabolic disturbances, we examined associations between diet-related inflammation and body composition and fecal bacteria abundances in participants of the Nutritionists' ...

Abstract	Objective: To deepen the understanding of the influence of diet on weight gain and metabolic disturbances, we examined associations between diet-related inflammation and body composition and fecal bacteria abundances in participants of the Nutritionists' Health Study. Methods: Early-life, dietary and clinical data were obtained from 114 women aged ≤45 years. A validated food frequency questionnaire was used to calculate the energy-adjusted dietary inflammatory index (E-DII). Participants' data were compared by E-DII quartiles using ANOVA or Kruskal-Wallis. Associations of DXA-determined body composition with the E-DII were tested by multiple linear regression using DAG-oriented adjustments. Fecal microbiota was analyzed targeting the V4 region of the 16S rRNA gene. Spearman correlation coefficients were used to test linear associations; differential abundance of genera across the E-DII quartiles was assessed by pair-wise comparisons. Results: E-DII score was associated with total fat (b=1.80, p<0.001), FMI (b=0.08, p<0.001) and visceral fat (b=1.19, p=0.02), independently of maternal BMI, birth type and breastfeeding. E-DII score was directly correlated to HOMA-IR (r=0.30; p=0.004), C-reactive protein (r=0.29; p=0.003) and to the abundance of Actinomyces, and inversely correlated to the abundance of Eubacterium.xylanophilum.group. Actinomyces were significantly more abundant in the highest (most proinflammatory) E-DII quartile. Conclusions: Association of E-DII with markers of insulin resistance, inflammation, body adiposity and certain gut bacteria are consistent with beneficial effects of anti-inflammatory diet on body composition and metabolic profile. Bacterial markers, such as Actinomyces, could be involved in the association between the dietary inflammation with visceral adiposity. Studies designed to explore how a pro-inflammatory diet affects both central fat deposition and gut microbiota are needed.
MeSH term(s)	Humans ; Female ; Adiposity ; Gastrointestinal Microbiome ; RNA, Ribosomal, 16S/metabolism ; Diet ; Inflammation/metabolism ; Obesity, Abdominal/complications ; Bacteria/metabolism
Chemical Substances	RNA, Ribosomal, 16S
Language	English
Publishing date	2024-01-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	639259-3
ISSN	1873-1244 ; 0899-9007
ISSN (online)	1873-1244
ISSN	0899-9007
DOI	10.1016/j.nut.2024.112371
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Article ; Online: Associations of prematurity and low birth weight with blood pressure and kidney function in middle-aged participants of the Brazilian Longitudinal Study of Adult Health: ELSA-Brasil.

Branda, Julia Ines F / de Almeida-Pititto, Bianca / Bensenor, Isabela / Lotufo, Paulo A / Ferreira, Sandra Roberta G

Journal of nephrology

2023 Volume 36, Issue 5, Page(s) 1373–1382

Abstract: Background: An adverse intrauterine environment reflected by low birth weight (LBW) and prematurity may induce fetal programming that favors kidney dysfunction in adulthood. We examined the association of LBW and prematurity with blood pressure (BP) and ...

Abstract	Background: An adverse intrauterine environment reflected by low birth weight (LBW) and prematurity may induce fetal programming that favors kidney dysfunction in adulthood. We examined the association of LBW and prematurity with blood pressure (BP) and kidney function markers in non-diabetic, middle-aged adults without kidney disease from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: A cross-sectional analysis of 768 subjects aged 35-54 years was conducted. Comparisons were performed according to self-reported birth weight: LBW (< 2.5 kg) or normal birth weight (2.5-4.0 kg). Associations of LBW and prematurity with BP levels and kidney function markers "(estimated glomerular filtration rate [eGFR], albumin-creatinine ratio [ACR] and serum cystatin-C) were tested by multiple linear regression using adjustments based on Directed Acyclic Graphs. Propensity score matching was applied to control imbalances. Results: Mean age of participants was 45.5 ± 4.6 years and 56.8% were female; 64 (8.3%) participants reported LBW and 39 (5.0%) prematurity. The LBW group had higher systolic (p = 0.015) and diastolic BP (p = 0.014) and ACR values (p = 0.031) and lower eGFR (p = 0.015) than the normal birth weight group, but no group difference for cystatin-C was found. The preterm group had higher mean levels of systolic and diastolic BP, but no difference in kidney function markers was evident. In a regression model adjusted for sex, skin color and family history of hypertension, both systolic and diastolic BP levels were associated with LBW, but this association disappeared after adding for prematurity, which remained associated with BP (p = 0.017). Having applied a propensity score matching, LBW was associated with ACR values (p = 0.003), but not with eGFR or BP levels. Conclusion: The study findings of independent associations of prematurity with higher BP levels, and of LBW with markers of kidney function in adulthood, support that early life events may predict risk for hypertension and kidney dysfunction in adulthood. The study design precluded the inferring of causality, and prospective studies are needed to further investigate this hypothesis.
MeSH term(s)	Infant, Newborn ; Middle Aged ; Humans ; Adult ; Female ; Male ; Blood Pressure/physiology ; Longitudinal Studies ; Birth Weight/physiology ; Brazil/epidemiology ; Cross-Sectional Studies ; Risk Factors ; Infant, Low Birth Weight ; Hypertension/diagnosis ; Hypertension/epidemiology ; Renal Insufficiency ; Kidney ; Cystatins
Chemical Substances	Cystatins
Language	English
Publishing date	2023-01-17
Publishing country	Italy
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1093991-x
ISSN	1724-6059 ; 1120-3625 ; 1121-8428
ISSN (online)	1724-6059
ISSN	1120-3625 ; 1121-8428
DOI	10.1007/s40620-022-01549-w
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Article ; Online: Diabetes and covid-19: more than the sum of two morbidities.

Pititto, Bianca de Almeida / Ferreira, Sandra Roberta G

Revista de saude publica

2020 Volume 54, Page(s) 54

Abstract: The coronavirus disease 2019 (covid-19) pandemic has caused a public health emergency worldwide. Risk, severity and mortality of the disease have been associated with non-communicable chronic diseases, such as diabetes mellitus. Accumulated evidence has ... ...

Abstract	The coronavirus disease 2019 (covid-19) pandemic has caused a public health emergency worldwide. Risk, severity and mortality of the disease have been associated with non-communicable chronic diseases, such as diabetes mellitus. Accumulated evidence has caused great concern in countries with high prevalence of this morbidity, such as Brazil. This text shows the picture of diabetes in Brazil, followed by epidemiological data and explanatory hypothesis for the association between diabetes and covid-19. We emphasized how the burden of these two morbidities in a middle-income country has aggravated this pandemic scenario. The comprehension of this association and biological plausibility may help face this pandemic and future challenges.
MeSH term(s)	Adult ; Age Factors ; Aged ; Aged, 80 and over ; Betacoronavirus ; Brazil/epidemiology ; COVID-19 ; Cardiovascular Diseases/complications ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/physiopathology ; Comorbidity ; Coronavirus Infections/epidemiology ; Coronavirus Infections/physiopathology ; Diabetes Complications/epidemiology ; Diabetes Complications/physiopathology ; Diabetes Mellitus/epidemiology ; Diabetes Mellitus/physiopathology ; Female ; Humans ; Hypertension/complications ; Hypertension/epidemiology ; Hypertension/physiopathology ; Male ; Middle Aged ; Obesity/complications ; Obesity/epidemiology ; Obesity/physiopathology ; Pandemics ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/physiopathology ; Prevalence ; Risk Factors ; SARS-CoV-2 ; Severity of Illness Index
Keywords	covid19
Language	English
Publishing date	2020-05-29
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	732179-x
ISSN	1518-8787 ; 0034-8910
ISSN (online)	1518-8787
ISSN	0034-8910
DOI	10.11606/s1518-8787.2020054002577
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Article ; Online: Neck circumference as a predictor of gestational diabetes and risk of adverse outcomes in pregnancy of Brazilian woman with overweight and obesity.

de Souza Carvalho, Camila Rodrigues / Dualib, Patricia Medici / Mattar, Rosiane / Dib, Sérgio Atala / de Almeida-Pititto, Bianca

Archives of endocrinology and metabolism

2022 Volume 66, Issue 4, Page(s) 439–445

Abstract: Objective: To evaluate the association of neck circumference (NC) with gestational diabetes (GDM) and adverse outcomes in women with overweight and obesity.: Subjects and methods: This prospective study included 132 (BMI > 25 kg/m: Results: Women ... ...

Abstract	Objective: To evaluate the association of neck circumference (NC) with gestational diabetes (GDM) and adverse outcomes in women with overweight and obesity. Subjects and methods: This prospective study included 132 (BMI > 25 kg/m Results: Women with (n = 61) and without (n = 71) GDM had similar mean (SD) pre-gestational BMI [30.3 (4.0) Conclusion: In a group of pregnant women with overweight or obesity, NC can be a useful tool for identifying risk of GDM and obstetric adverse outcomes.
MeSH term(s)	Body Mass Index ; Brazil ; Diabetes, Gestational ; Female ; Humans ; Hypertension ; Infant, Newborn ; Obesity/complications ; Overweight/complications ; Pregnancy ; Prospective Studies
Language	English
Publishing date	2022-06-02
Publishing country	Brazil
Document type	Journal Article
ISSN	2359-4292
ISSN (online)	2359-4292
DOI	10.20945/2359-3997000000499
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Book ; Online: Diabetes and covid-19

Pititto, Bianca de Almeida / Ferreira, Sandra Roberta G.

Revista de Saúde Pública v.54 2020

more than the sum of two morbidities

2020

Abstract: ABSTRACT The coronavirus disease 2019 (covid-19) pandemic has caused a public health emergency worldwide. Risk, severity and mortality of the disease have been associated with non-communicable chronic diseases, such as diabetes mellitus. Accumulated ... ...

Abstract	ABSTRACT The coronavirus disease 2019 (covid-19) pandemic has caused a public health emergency worldwide. Risk, severity and mortality of the disease have been associated with non-communicable chronic diseases, such as diabetes mellitus. Accumulated evidence has caused great concern in countries with high prevalence of this morbidity, such as Brazil. This text shows the picture of diabetes in Brazil, followed by epidemiological data and explanatory hypothesis for the association between diabetes and covid-19. We emphasized how the burden of these two morbidities in a middle-income country has aggravated this pandemic scenario. The comprehension of this association and biological plausibility may help face this pandemic and future challenges.
Keywords	Diabetes Mellitus ; epidemiology ; Coronavirus Infections ; complications ; Comorbidity ; Developing Countries ; covid19
Language	English
Publishing date	2020-01-01
Publisher	Faculdade de Saúde Pública da Universidade de São Paulo
Publishing country	br
Document type	Book ; Online
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Article: Prolactin does not seem to mediate the improvement on insulin resistance markers and blood glucose levels related to breastfeeding.

de Oliveira, Julia Martins / Dualib, Patricia Medici / Ferraro, Alexandre Archanjo / Carvalho, Camila Rodrigues de Souza / Mattar, Rosiane / Dib, Sérgio Atala / de Almeida-Pititto, Bianca

Frontiers in endocrinology

2023 Volume 14, Page(s) 1219119

Abstract: Introduction: The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Strategies to decrease this risk should be strongly encouraged. Lactation has been associated, for the mother, with reduction in future T2DM risk in several studies. ...

Abstract	Introduction: The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Strategies to decrease this risk should be strongly encouraged. Lactation has been associated, for the mother, with reduction in future T2DM risk in several studies. The mechanisms behind this phenomenon, however, are poorly understood. The aims of this study were, first, to compare blood glucose levels and markers of insulin resistance (MIR) in early postpartum women with overweight/obesity according to their breastfeeding status and, second, to evaluate whether prolactin (PRL) levels could mediate improvements in these parameters. Methods: The prospective study followed 95 women older than 18 years from early pregnancy for up to 60 to 180 days postpartum. All participants had a BMI > 25 kg/m Results: Breastfeeding women ( Conclusion: Breastfeeding was associated with improvement in glucose metabolism and MIR 60 to 180 days after birth in overweight and obese women, even when adjusted for confounders. PRL levels were not found to mediate the association between breastfeeding and improvement in MIR.
MeSH term(s)	Pregnancy ; Humans ; Female ; Prolactin ; Blood Glucose ; Diabetes Mellitus, Type 2/epidemiology ; Insulin Resistance ; Overweight ; Prospective Studies
Chemical Substances	Prolactin (9002-62-4) ; Blood Glucose
Language	English
Publishing date	2023-08-30
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2592084-4
ISSN	1664-2392
ISSN	1664-2392
DOI	10.3389/fendo.2023.1219119
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