Introduction: The increasing burden of diabetes poses a great challenge to healthcare systems and... more Introduction: The increasing burden of diabetes poses a great challenge to healthcare systems and economy worldwide. Although modern therapeutic strategies for diabetes are widely available, most patients still fail to achieve optimal clinical targets and well-being. The primary objective of this study was to assess and explore potential drivers and successful management of diabetes among people with diabetes, family members and healthcare professionals in Portugal, by applying the protocol of the multinational study “Diabetes, Attitudes, Wishes and Needs (DAWN2)”.Material and Methods: A total of 767 adults, including 417 people with diabetes, 123 family members and 227 healthcare professionals, participated in the study. Surveys assessed health-related quality of life, self-management, attitudes/beliefs, social support and priorities for improvement areas in diabetes care.Results: Diabetes has a negative impact on the physical health and emotional well-being of patients in Portugal...
ObjectiveIn the last years, changes in dietary habits have contributed to the increasing prevalen... more ObjectiveIn the last years, changes in dietary habits have contributed to the increasing prevalence of metabolic disorders, such as non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). The differential burden of lipids and fructose on distinct organs needs to be unveiled. Herein, we hypothesized that high-fat and high-fructose diets differentially affect the metabolome of insulin-sensitive organs such as the liver, muscle, and different adipose tissue depots.MethodsWe have studied the impact of 12 weeks of a control (11.50% calories from fat, 26.93% from protein, and 61.57% from carbohydrates), high-fat/sucrose (HFat), or high-fructose (HFruct) feeding on C57Bl/6J male mice. Besides glucose homeostasis, we analyzed the hepatic levels of glucose and lipid-metabolism-related genes and the metabolome of the liver, the muscle, and white (WAT) and brown adipose tissue (BAT) depots.ResultsHFat diet led to a more profound impact on hepatic glucose and lipid metabo...
Heart diseases and stroke are the number one cause of death and disability among people with type... more Heart diseases and stroke are the number one cause of death and disability among people with type 2 diabetes (T2D). Clinicians and health authorities for many years have expressed interest in identifying individuals at increased risk of coronary heart disease (CHD). Our main objective is to develop a prognostic workflow of CHD in T2D patients using a Holter dataset. This workflow development will be based on machine learning techniques by testing a variety of classifiers and subsequent selection of the best performing system. It will also assess the impact of feature selection and bootstrapping techniques over these systems. Among a variety of classifiers such as Naive Bayes (NB), Random Forest (RF), Support Vector Machine (SVM), Alternating Decision Tree (ADT), Random Tree (RT) and K-Nearest Neighbour (KNN), the best performing classifier is NB. We achieved an area under receiver operating characteristics curve (AUC) of 68,06% and 74,33% for a prognosis of 3 and 4 years, respectively.
Consultation costs were found to be 21% lower for T1DM and 38% lower for T2DM patients in the int... more Consultation costs were found to be 21% lower for T1DM and 38% lower for T2DM patients in the integrated model clinic than the same services provided in the Portuguese National Health System. This is explained mainly by delayed diabetes complications. The final comparison was based on consultation costs because interventional treatments are provided by the PNHS regardless of the organization where the patients are being followed. The model is however prepared to consider these costs. Highlights: This highlights the need for more detail into segmentation of patient needs, to better adapt healthcare services but also to allow the estimation of financial impact. Sustainability of the integrated diabetes healthcare model, and the referral of diabetes patients from the NHS to private specialized units, must be explored if we intend to have effective initiatives towards wider transferability. Conclusion: The present study supports the implementation of organizational models that tackle integrally chronic diseases like diabetes, for having the potential to impact on the long term onset of the illness generating significant increases in quality of life for patients and cost savings to Health Systems worldwide.
Having a proper understanding of the impact of influenza is a fundamental step towards improved p... more Having a proper understanding of the impact of influenza is a fundamental step towards improved preventive action. This paper reviews findings from the Burden of Acute Respiratory Infections study on the burden of influenza in Iberia, and its potential underestimation, and proposes specific measures to lessen influenza’s impact.
Background Influenza can have a domino effect, triggering severe conditions and leading to hospit... more Background Influenza can have a domino effect, triggering severe conditions and leading to hospitalization or even death. Since influenza testing is not routinely performed, statistical modeling techniques are increasingly being used to estimate annual hospitalizations and deaths associated with influenza, to overcome the known underestimation from registers coded with influenza-specific diagnosis. The aim of this study was to estimate the clinical and economic burden of severe influenza in Portugal. Methods The study comprised ten epidemic seasons (2008/09–2017/18) and used two approaches: (i) a direct method of estimating the seasonal influenza hospitalization incidence, based on the number of National Health Service hospitalizations with influenza-specific International Classification of Diseases (ICD) codes (ICD-9: 487–488; ICD-10: J09-J11), as primary or secondary diagnosis; (ii) an indirect method of estimating excess hospitalizations and deaths using broader groups of ICD cod...
The activity of glutathione peroxidase (GSH-Px), serum selenium (Se), and thiobarbituric acid rea... more The activity of glutathione peroxidase (GSH-Px), serum selenium (Se), and thiobarbituric acid reactive substances (TBARS) were measured in the whole blood of 148 healthy adults aged 20-60 yr from the fishing and rural communities of "Rabo de Peixe," The Azores, Portugal. The subjects did not live in the same household and had different socioeconomic profiles and dietary habits. The serum lipid profile and selected life habits were also considered in this study. No significant differences in the activity of GSH-Px were found in the interpopulation or intrapopulation analyses, classified by age or lipid profile.
Apesar de os efeitos positivos de um estilo de vida saudável na prevenção e terapêutica da diabet... more Apesar de os efeitos positivos de um estilo de vida saudável na prevenção e terapêutica da diabetes mellitus tipo 2, a mudança comportamental é percecionada pelos profissionais de saúde como um processo difícil e complexo. Juntos é Mais Fácil é um programa de educação em grupo para a adoção de estilos de vida saudáveis em pessoas com diabetes, que decorreu entre 2011-2014 em 88 unidades de saúde em Portugal, com boa adesão dos participantes. O objetivo deste trabalho é apresentar os modelos teóricos e de intervenção que estiveram na base do seu desenvolvimento e aplicação (incluindo, entre outros, gestão de grupos, entrevista motivacional e modelo transteórico da mudança) e avaliar o conjunto de cursos de formação de formadores que decorreu como meio de preparação de 416 profissionais de saúde para a implementação do programa Juntos é Mais Fácil. Os questionários de avaliação da formação foram respondidos por 350 profissionais (84,1%) participantes nos cursos. 98,0% dos participantes fez uma apreciação global Muito Boa ou Boa da formação, e mais de 95,0% teve uma equivalente apreciação dos conteúdos, dos formadores e da organização. este grande interesse manifestado encontra concordância com a menor satisfação expressa em relação à duração do curso e à vontade em prolongar o mesmo. estratégias futuras para obviar a limitação de tempo passarão pela utilização de novas metodologias, nomeadamente o e-learning. concluímos que vale a pena investir na capacitação de profissionais de saúde e de pessoas com diabetes, para fazer face ao enorme desafio que constitui a mudança comportamental. A obesidade, o sedentarismo e os hábitos alimentares menos saudáveis estão na origem da diabetes tipo 2 (dM2). A melhoria destes aspetos pode proporcionar uma melhor compensação da doença e a prevenção das complicações da diabetes. Há evidência de que, mesmo as pequenas mudanças nos estilos de vida saudáveis, podem ter efeitos significativos positivos na saúde a longo prazo, se forem mantidos 1 . A adoção de estilos de vida saudáveis, nomeadamente no que se refere a uma alimentação sau-
Coffee may protect against non-alcoholic fatty liver disease (NAFLD), but the roles of the caffei... more Coffee may protect against non-alcoholic fatty liver disease (NAFLD), but the roles of the caffeine and non-caffeine components are unclear. Coffee intake by 156 overweight subjects (87% with Type-2-Diabetes, T2D) was assessed via a questionnaire, with 98 subjects (all T2D) also providing a 24 h urine sample for quantification of coffee metabolites by LC–MS/MS. NAFLD was characterized by the fatty liver index (FLI) and by Fibroscan® assessment of fibrosis. No associations were found between self-reported coffee intake and NAFLD parameters; however, total urine caffeine metabolites, defined as Σcaffeine (caffeine + paraxanthine + theophylline), and adjusted for fat-free body mass, were significantly higher for subjects with no liver fibrosis than for those with fibrosis. Total non-caffeine metabolites, defined as Σncm (trigonelline + caffeic acid + p-coumaric acid), showed a significant negative association with the FLI. Multiple regression analyses for overweight/obese T2D subjects ...
Liraglutide is a long-acting glucagon-like peptide-1 receptor agonist prescribed to diabetic pati... more Liraglutide is a long-acting glucagon-like peptide-1 receptor agonist prescribed to diabetic patients for glycaemic control. To understand the impact of liraglutide in the real-world setting, this study analysed its effects in a Portuguese cohort of Type 2 diabetes patients. This was an observational, multicentric, and retrospective study that included 191 liraglutide-treated patients with at least 12 months of treatment. Patients’ data were collected and analysed during a 24-month follow-up period. Overall, liraglutide treatment effectively reduced HbA1c levels from 8.3% to around 7.5%, after 6, 12, and 24 months (p < 0.001). In fact, 38.2%, 37.2%, and 44.8% of patients at 6, 12, and 24 months, respectively, experienced an HbA1c reduction of at least 1%. Moreover, a persistent reduction in anthropometric features was also observed, with 44.0%, 47.6%, and 54.4% of patients achieving a weight reduction of at least 3% at 6, 12, and 24 months, respectively. Finally, significant impr...
Este estudo permitiu partilhar as perceções, opiniões e sentimentos dos jovens adultos. Os result... more Este estudo permitiu partilhar as perceções, opiniões e sentimentos dos jovens adultos. Os resultados são similares entre género. Os jovens consideram as atividades de lazer e o apoio social da família, colegas e amigos muito importantes, no que se refere ao apoio emocional e ao apoio na diabetes. Consideram as atividades de lazer e a atividade física similar aos amigos sem diabetes, desde que tenham cuidados com o tratamento da diabetes. Abordaram as dificuldades que sentem em relação à alimentação, atividade física, insulinoterapia e controlo metabólico. Conversaram sobre as crenças e perceções em relação à vida com a diabetes, nomeadamente em relação às dificuldades com o autocontrolo. Referiram os benefícios das atividades de educação em grupo e dos campos de férias com outros jovens com diabetes relativamente à aceitação, adaptação à diabetes e bem-estar, assim como ao bom apoio da equipa de saúde
Study question Is the adoption of high-fat diet from childhood associated with sperm small RNA co... more Study question Is the adoption of high-fat diet from childhood associated with sperm small RNA content in mice? Are those changes inherited by the offspring and grand-offspring? Summary answer The adoption of high-fat diet during childhood changes sperm small RNA content up to the grand-offspring even after dietary correction. What is known already The prevalence of childhood obesity is increasing worldwide. The adoption of high-fat diet (HFD) from early age is a major factor for this trend. However, the long-lasting health effects of childhood obesity associated to HFD is unknown, particularly after dietary reversion. Multiple studies demonstrated that sperm small non-coding RNA (sncRNA) content changes in response to acute and chronic dietary factors. Also, sperm sncRNAs can transmit acquired traits such as metabolic syndrome. However, it is not known how the HFD-related sperm sncRNA fingerprints varies across generations, and how it relates with the phenotypes of the progeny. Stu...
Aims/hypothesis Imbalances in glucose metabolism are hallmarks of clinically silent prediabetes (... more Aims/hypothesis Imbalances in glucose metabolism are hallmarks of clinically silent prediabetes (defined as impaired fasting glucose and/or impaired glucose tolerance) representing dysmetabolism trajectories leading to type 2 diabetes. CD26/dipeptidyl peptidase 4 (DPP4) is a clinically proven molecular target of diabetes-controlling drugs but the DPP4 gene control of dysglycaemia is not proven. Methods We dissected the genetic control of post-OGTT and insulin release responses by the DPP4 gene in a Portuguese population-based cohort of mainly European ancestry that comprised individuals with normoglycaemia and prediabetes, and in mouse experimental models of Dpp4 deficiency and hyperenergetic diet. Results In individuals with normoglycaemia, DPP4 single-nucleotide variants governed glycaemic excursions (rs4664446, p=1.63x10−7) and C-peptide release responses (rs2300757, p=6.86x10−5) upon OGTT. Association with blood glucose levels was stronger at 30 min OGTT, but a higher associatio...
Diabetes is a major public health problem in Portugal, with a estimated prevalence of 13,1% in th... more Diabetes is a major public health problem in Portugal, with a estimated prevalence of 13,1% in the population aged between 20 and 79 years old, which corresponds to more than 1 million individuals who suffer from this disease. Diabetes has an overwhelmingly high social, economic and human cost. Indeed, costs associated with diabetes represent in Portugal approximately 10% of the total expenditure in Health and 0,9% of the country’s GDP. In particular, costs with antidiabetic medication have been steadily increasing in the past years, as new and more expensive therapeutic classes are launched into the market. For these reasons diabetes represents a serious threat to the sustainability of health care systems. “Diabetes in Portugal” was the subject of a reflection meeting which aimed to promote a debate on the contribution of oral antidiabetic medicines to a comprehensive approach to diabetes management, current guidelines and their applicability in clinical practice while taking into ...
Dietary fructose overshadows glucose in promoting metabolic complications. Intestinal fructose me... more Dietary fructose overshadows glucose in promoting metabolic complications. Intestinal fructose metabolism (IFM) protects against these effects in rodents, by favoring gluconeogenesis, but the extent of IFM in humans is not known. We therefore aimed to infer the extent of IFM by comparing the contribution of dietary fructose to systemic glucose and hepatic glycogen appearance postprandially. Twelve fasting healthy subjects ingested two protein meals in random order, one supplemented with 50 g 5/95 fructose/glucose (LF) and the other with 50 g 55/45 fructose/glucose (HF). Sources of postprandial plasma glucose appearance and hepatic glycogen synthesis were determined with deuterated water. Plasma glucose excursions, as well as pre- and post-meal insulin, c-peptide, and triglyceride levels were nearly identical for both meals. The total gluconeogenic contribution to plasma glucose appearance was significantly higher for HF versus LF (65 ± 2% vs. 34 ± 3%, p < 0.001). For HF, Krebs cy...
This work has received funding from the European Union, in the framework of the Health Programme ... more This work has received funding from the European Union, in the framework of the Health Programme (2008-2013).
Aims In older adults with type 2 diabetes (T2D), overtreatment remains prevalent and undertreatme... more Aims In older adults with type 2 diabetes (T2D), overtreatment remains prevalent and undertreatment ignored. The main objective is to estimate the prevalence and examine factors associated with potential overtreatment and undertreatment Method Observational study conducted within an administrative database of older adults with T2D who registered in 2018 at the Portuguese Diabetes Association. Participants were categorized either as potentially overtreated (HbA1c[?]7.5%), appropriately on target (HbA1c[?]7.5-[?]9%), or potentially undertreated (HbA1c>9%). Results of 444 participants, potential overtreatment, and undertreatment were found in 60.5% and 12.6% of the study population. Taking the patients on target as a comparator, the group of potentially overtreated showed to be more males (61.3% vs.52.2%), less-obese (34.1% vs.39.2), higher cardiovascular diseases (13.7% vs.11%), peripheral vascular diseases (16.7% vs.12.8%), diabetic foot (10% vs.4.5%), and severe kidney disease (5.2% vs.4.5%). Conversely, the potentially undertreated participants were more females (64.2% vs.47.7%), obese (49% vs.39.2%), had more dyslipidemia (69% vs.63.1%), peripheral vascular disease (14.2% vs.12.8%), diabetic foot (8.9% vs.4.5%), and infections (14.2% vs.11.9%). The odds of potential overtreatment were mostly decreased by 59% of females, 73.5% in those with retinopathy, and 86.3% in insulin, 65.4% sulfonylureas, and 66.8% in SGLT2 inhibitors users. Contrariwise, an increase in the odds of potential undertreatment was more than 4.8times higher in insulin, and more than 3.1times higher in sulfonylureas users. Conclusion potential overtreatment and undertreatment in older adults with T2D in routine clinical practice should guide the clinicians to balance the use of newer oral antidiabetic agents considering its safety profile regarding hypoglycemia.
The adoption of high-fat diets (HFDs) is a major contributor to the increasing prevalence of obes... more The adoption of high-fat diets (HFDs) is a major contributor to the increasing prevalence of obesity worldwide. Herein, we study the impact of an HFD from early age in testicular physiology and sperm parameters in two generations of mice, with a focus on testicular oxidative status. Mice of the diet-challenged generation (F0; n = 36) were randomly fed after weaning with standard chow (CTRL), a high-fat diet (HFD) for 200 days, or a transient high-fat diet (HFDt) (60 days of HFD + 140 days of standard chow). The offspring generation (F1; n = 36) was obtained by mating normoponderal females with those fed a chow diet 120 days post-weaning. Mice fed an HFD for a lifetime presented impaired insulin tolerance, a trait inherited by their sons. The sons of mice fed HFD inherited decreased catalase activity and displayed lower activities of mitochondrial complexes I and IV. Similar to their progenitors, the sons of HFD mice had a higher prevalence of pinhead and bent neck defects than that ...
The consumption of energy-dense diets has contributed to an increase in the prevalence of obesity... more The consumption of energy-dense diets has contributed to an increase in the prevalence of obesity and its comorbidities worldwide. The adoption of unhealthy feeding habits often occurs at early age, prompting the early onset of metabolic disease with unknown consequences for reproductive function later in life. Recently, evidence has emerged regarding the intergenerational and transgenerational effects of high-fat diets (HFD) on sperm parameters and testicular metabolism. Hereby, we study the impact of high-fat feeding male mice (F0) on the testicular metabolome and function of their sons (F1) and grandsons (F2). Testicular content of metabolites related to insulin resistance, cell membrane remodeling, nutritional support and antioxidative stress (leucine, acetate, glycine, glutamine, inosine) were altered in sons and grandsons of mice fed with HFD, comparing to descendants of chow-fed mice. Sperm counts were lower in the grandsons of mice fed with HFD, even if transient. Sperm qual...
Introduction: The increasing burden of diabetes poses a great challenge to healthcare systems and... more Introduction: The increasing burden of diabetes poses a great challenge to healthcare systems and economy worldwide. Although modern therapeutic strategies for diabetes are widely available, most patients still fail to achieve optimal clinical targets and well-being. The primary objective of this study was to assess and explore potential drivers and successful management of diabetes among people with diabetes, family members and healthcare professionals in Portugal, by applying the protocol of the multinational study “Diabetes, Attitudes, Wishes and Needs (DAWN2)”.Material and Methods: A total of 767 adults, including 417 people with diabetes, 123 family members and 227 healthcare professionals, participated in the study. Surveys assessed health-related quality of life, self-management, attitudes/beliefs, social support and priorities for improvement areas in diabetes care.Results: Diabetes has a negative impact on the physical health and emotional well-being of patients in Portugal...
ObjectiveIn the last years, changes in dietary habits have contributed to the increasing prevalen... more ObjectiveIn the last years, changes in dietary habits have contributed to the increasing prevalence of metabolic disorders, such as non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). The differential burden of lipids and fructose on distinct organs needs to be unveiled. Herein, we hypothesized that high-fat and high-fructose diets differentially affect the metabolome of insulin-sensitive organs such as the liver, muscle, and different adipose tissue depots.MethodsWe have studied the impact of 12 weeks of a control (11.50% calories from fat, 26.93% from protein, and 61.57% from carbohydrates), high-fat/sucrose (HFat), or high-fructose (HFruct) feeding on C57Bl/6J male mice. Besides glucose homeostasis, we analyzed the hepatic levels of glucose and lipid-metabolism-related genes and the metabolome of the liver, the muscle, and white (WAT) and brown adipose tissue (BAT) depots.ResultsHFat diet led to a more profound impact on hepatic glucose and lipid metabo...
Heart diseases and stroke are the number one cause of death and disability among people with type... more Heart diseases and stroke are the number one cause of death and disability among people with type 2 diabetes (T2D). Clinicians and health authorities for many years have expressed interest in identifying individuals at increased risk of coronary heart disease (CHD). Our main objective is to develop a prognostic workflow of CHD in T2D patients using a Holter dataset. This workflow development will be based on machine learning techniques by testing a variety of classifiers and subsequent selection of the best performing system. It will also assess the impact of feature selection and bootstrapping techniques over these systems. Among a variety of classifiers such as Naive Bayes (NB), Random Forest (RF), Support Vector Machine (SVM), Alternating Decision Tree (ADT), Random Tree (RT) and K-Nearest Neighbour (KNN), the best performing classifier is NB. We achieved an area under receiver operating characteristics curve (AUC) of 68,06% and 74,33% for a prognosis of 3 and 4 years, respectively.
Consultation costs were found to be 21% lower for T1DM and 38% lower for T2DM patients in the int... more Consultation costs were found to be 21% lower for T1DM and 38% lower for T2DM patients in the integrated model clinic than the same services provided in the Portuguese National Health System. This is explained mainly by delayed diabetes complications. The final comparison was based on consultation costs because interventional treatments are provided by the PNHS regardless of the organization where the patients are being followed. The model is however prepared to consider these costs. Highlights: This highlights the need for more detail into segmentation of patient needs, to better adapt healthcare services but also to allow the estimation of financial impact. Sustainability of the integrated diabetes healthcare model, and the referral of diabetes patients from the NHS to private specialized units, must be explored if we intend to have effective initiatives towards wider transferability. Conclusion: The present study supports the implementation of organizational models that tackle integrally chronic diseases like diabetes, for having the potential to impact on the long term onset of the illness generating significant increases in quality of life for patients and cost savings to Health Systems worldwide.
Having a proper understanding of the impact of influenza is a fundamental step towards improved p... more Having a proper understanding of the impact of influenza is a fundamental step towards improved preventive action. This paper reviews findings from the Burden of Acute Respiratory Infections study on the burden of influenza in Iberia, and its potential underestimation, and proposes specific measures to lessen influenza’s impact.
Background Influenza can have a domino effect, triggering severe conditions and leading to hospit... more Background Influenza can have a domino effect, triggering severe conditions and leading to hospitalization or even death. Since influenza testing is not routinely performed, statistical modeling techniques are increasingly being used to estimate annual hospitalizations and deaths associated with influenza, to overcome the known underestimation from registers coded with influenza-specific diagnosis. The aim of this study was to estimate the clinical and economic burden of severe influenza in Portugal. Methods The study comprised ten epidemic seasons (2008/09–2017/18) and used two approaches: (i) a direct method of estimating the seasonal influenza hospitalization incidence, based on the number of National Health Service hospitalizations with influenza-specific International Classification of Diseases (ICD) codes (ICD-9: 487–488; ICD-10: J09-J11), as primary or secondary diagnosis; (ii) an indirect method of estimating excess hospitalizations and deaths using broader groups of ICD cod...
The activity of glutathione peroxidase (GSH-Px), serum selenium (Se), and thiobarbituric acid rea... more The activity of glutathione peroxidase (GSH-Px), serum selenium (Se), and thiobarbituric acid reactive substances (TBARS) were measured in the whole blood of 148 healthy adults aged 20-60 yr from the fishing and rural communities of "Rabo de Peixe," The Azores, Portugal. The subjects did not live in the same household and had different socioeconomic profiles and dietary habits. The serum lipid profile and selected life habits were also considered in this study. No significant differences in the activity of GSH-Px were found in the interpopulation or intrapopulation analyses, classified by age or lipid profile.
Apesar de os efeitos positivos de um estilo de vida saudável na prevenção e terapêutica da diabet... more Apesar de os efeitos positivos de um estilo de vida saudável na prevenção e terapêutica da diabetes mellitus tipo 2, a mudança comportamental é percecionada pelos profissionais de saúde como um processo difícil e complexo. Juntos é Mais Fácil é um programa de educação em grupo para a adoção de estilos de vida saudáveis em pessoas com diabetes, que decorreu entre 2011-2014 em 88 unidades de saúde em Portugal, com boa adesão dos participantes. O objetivo deste trabalho é apresentar os modelos teóricos e de intervenção que estiveram na base do seu desenvolvimento e aplicação (incluindo, entre outros, gestão de grupos, entrevista motivacional e modelo transteórico da mudança) e avaliar o conjunto de cursos de formação de formadores que decorreu como meio de preparação de 416 profissionais de saúde para a implementação do programa Juntos é Mais Fácil. Os questionários de avaliação da formação foram respondidos por 350 profissionais (84,1%) participantes nos cursos. 98,0% dos participantes fez uma apreciação global Muito Boa ou Boa da formação, e mais de 95,0% teve uma equivalente apreciação dos conteúdos, dos formadores e da organização. este grande interesse manifestado encontra concordância com a menor satisfação expressa em relação à duração do curso e à vontade em prolongar o mesmo. estratégias futuras para obviar a limitação de tempo passarão pela utilização de novas metodologias, nomeadamente o e-learning. concluímos que vale a pena investir na capacitação de profissionais de saúde e de pessoas com diabetes, para fazer face ao enorme desafio que constitui a mudança comportamental. A obesidade, o sedentarismo e os hábitos alimentares menos saudáveis estão na origem da diabetes tipo 2 (dM2). A melhoria destes aspetos pode proporcionar uma melhor compensação da doença e a prevenção das complicações da diabetes. Há evidência de que, mesmo as pequenas mudanças nos estilos de vida saudáveis, podem ter efeitos significativos positivos na saúde a longo prazo, se forem mantidos 1 . A adoção de estilos de vida saudáveis, nomeadamente no que se refere a uma alimentação sau-
Coffee may protect against non-alcoholic fatty liver disease (NAFLD), but the roles of the caffei... more Coffee may protect against non-alcoholic fatty liver disease (NAFLD), but the roles of the caffeine and non-caffeine components are unclear. Coffee intake by 156 overweight subjects (87% with Type-2-Diabetes, T2D) was assessed via a questionnaire, with 98 subjects (all T2D) also providing a 24 h urine sample for quantification of coffee metabolites by LC–MS/MS. NAFLD was characterized by the fatty liver index (FLI) and by Fibroscan® assessment of fibrosis. No associations were found between self-reported coffee intake and NAFLD parameters; however, total urine caffeine metabolites, defined as Σcaffeine (caffeine + paraxanthine + theophylline), and adjusted for fat-free body mass, were significantly higher for subjects with no liver fibrosis than for those with fibrosis. Total non-caffeine metabolites, defined as Σncm (trigonelline + caffeic acid + p-coumaric acid), showed a significant negative association with the FLI. Multiple regression analyses for overweight/obese T2D subjects ...
Liraglutide is a long-acting glucagon-like peptide-1 receptor agonist prescribed to diabetic pati... more Liraglutide is a long-acting glucagon-like peptide-1 receptor agonist prescribed to diabetic patients for glycaemic control. To understand the impact of liraglutide in the real-world setting, this study analysed its effects in a Portuguese cohort of Type 2 diabetes patients. This was an observational, multicentric, and retrospective study that included 191 liraglutide-treated patients with at least 12 months of treatment. Patients’ data were collected and analysed during a 24-month follow-up period. Overall, liraglutide treatment effectively reduced HbA1c levels from 8.3% to around 7.5%, after 6, 12, and 24 months (p < 0.001). In fact, 38.2%, 37.2%, and 44.8% of patients at 6, 12, and 24 months, respectively, experienced an HbA1c reduction of at least 1%. Moreover, a persistent reduction in anthropometric features was also observed, with 44.0%, 47.6%, and 54.4% of patients achieving a weight reduction of at least 3% at 6, 12, and 24 months, respectively. Finally, significant impr...
Este estudo permitiu partilhar as perceções, opiniões e sentimentos dos jovens adultos. Os result... more Este estudo permitiu partilhar as perceções, opiniões e sentimentos dos jovens adultos. Os resultados são similares entre género. Os jovens consideram as atividades de lazer e o apoio social da família, colegas e amigos muito importantes, no que se refere ao apoio emocional e ao apoio na diabetes. Consideram as atividades de lazer e a atividade física similar aos amigos sem diabetes, desde que tenham cuidados com o tratamento da diabetes. Abordaram as dificuldades que sentem em relação à alimentação, atividade física, insulinoterapia e controlo metabólico. Conversaram sobre as crenças e perceções em relação à vida com a diabetes, nomeadamente em relação às dificuldades com o autocontrolo. Referiram os benefícios das atividades de educação em grupo e dos campos de férias com outros jovens com diabetes relativamente à aceitação, adaptação à diabetes e bem-estar, assim como ao bom apoio da equipa de saúde
Study question Is the adoption of high-fat diet from childhood associated with sperm small RNA co... more Study question Is the adoption of high-fat diet from childhood associated with sperm small RNA content in mice? Are those changes inherited by the offspring and grand-offspring? Summary answer The adoption of high-fat diet during childhood changes sperm small RNA content up to the grand-offspring even after dietary correction. What is known already The prevalence of childhood obesity is increasing worldwide. The adoption of high-fat diet (HFD) from early age is a major factor for this trend. However, the long-lasting health effects of childhood obesity associated to HFD is unknown, particularly after dietary reversion. Multiple studies demonstrated that sperm small non-coding RNA (sncRNA) content changes in response to acute and chronic dietary factors. Also, sperm sncRNAs can transmit acquired traits such as metabolic syndrome. However, it is not known how the HFD-related sperm sncRNA fingerprints varies across generations, and how it relates with the phenotypes of the progeny. Stu...
Aims/hypothesis Imbalances in glucose metabolism are hallmarks of clinically silent prediabetes (... more Aims/hypothesis Imbalances in glucose metabolism are hallmarks of clinically silent prediabetes (defined as impaired fasting glucose and/or impaired glucose tolerance) representing dysmetabolism trajectories leading to type 2 diabetes. CD26/dipeptidyl peptidase 4 (DPP4) is a clinically proven molecular target of diabetes-controlling drugs but the DPP4 gene control of dysglycaemia is not proven. Methods We dissected the genetic control of post-OGTT and insulin release responses by the DPP4 gene in a Portuguese population-based cohort of mainly European ancestry that comprised individuals with normoglycaemia and prediabetes, and in mouse experimental models of Dpp4 deficiency and hyperenergetic diet. Results In individuals with normoglycaemia, DPP4 single-nucleotide variants governed glycaemic excursions (rs4664446, p=1.63x10−7) and C-peptide release responses (rs2300757, p=6.86x10−5) upon OGTT. Association with blood glucose levels was stronger at 30 min OGTT, but a higher associatio...
Diabetes is a major public health problem in Portugal, with a estimated prevalence of 13,1% in th... more Diabetes is a major public health problem in Portugal, with a estimated prevalence of 13,1% in the population aged between 20 and 79 years old, which corresponds to more than 1 million individuals who suffer from this disease. Diabetes has an overwhelmingly high social, economic and human cost. Indeed, costs associated with diabetes represent in Portugal approximately 10% of the total expenditure in Health and 0,9% of the country’s GDP. In particular, costs with antidiabetic medication have been steadily increasing in the past years, as new and more expensive therapeutic classes are launched into the market. For these reasons diabetes represents a serious threat to the sustainability of health care systems. “Diabetes in Portugal” was the subject of a reflection meeting which aimed to promote a debate on the contribution of oral antidiabetic medicines to a comprehensive approach to diabetes management, current guidelines and their applicability in clinical practice while taking into ...
Dietary fructose overshadows glucose in promoting metabolic complications. Intestinal fructose me... more Dietary fructose overshadows glucose in promoting metabolic complications. Intestinal fructose metabolism (IFM) protects against these effects in rodents, by favoring gluconeogenesis, but the extent of IFM in humans is not known. We therefore aimed to infer the extent of IFM by comparing the contribution of dietary fructose to systemic glucose and hepatic glycogen appearance postprandially. Twelve fasting healthy subjects ingested two protein meals in random order, one supplemented with 50 g 5/95 fructose/glucose (LF) and the other with 50 g 55/45 fructose/glucose (HF). Sources of postprandial plasma glucose appearance and hepatic glycogen synthesis were determined with deuterated water. Plasma glucose excursions, as well as pre- and post-meal insulin, c-peptide, and triglyceride levels were nearly identical for both meals. The total gluconeogenic contribution to plasma glucose appearance was significantly higher for HF versus LF (65 ± 2% vs. 34 ± 3%, p < 0.001). For HF, Krebs cy...
This work has received funding from the European Union, in the framework of the Health Programme ... more This work has received funding from the European Union, in the framework of the Health Programme (2008-2013).
Aims In older adults with type 2 diabetes (T2D), overtreatment remains prevalent and undertreatme... more Aims In older adults with type 2 diabetes (T2D), overtreatment remains prevalent and undertreatment ignored. The main objective is to estimate the prevalence and examine factors associated with potential overtreatment and undertreatment Method Observational study conducted within an administrative database of older adults with T2D who registered in 2018 at the Portuguese Diabetes Association. Participants were categorized either as potentially overtreated (HbA1c[?]7.5%), appropriately on target (HbA1c[?]7.5-[?]9%), or potentially undertreated (HbA1c>9%). Results of 444 participants, potential overtreatment, and undertreatment were found in 60.5% and 12.6% of the study population. Taking the patients on target as a comparator, the group of potentially overtreated showed to be more males (61.3% vs.52.2%), less-obese (34.1% vs.39.2), higher cardiovascular diseases (13.7% vs.11%), peripheral vascular diseases (16.7% vs.12.8%), diabetic foot (10% vs.4.5%), and severe kidney disease (5.2% vs.4.5%). Conversely, the potentially undertreated participants were more females (64.2% vs.47.7%), obese (49% vs.39.2%), had more dyslipidemia (69% vs.63.1%), peripheral vascular disease (14.2% vs.12.8%), diabetic foot (8.9% vs.4.5%), and infections (14.2% vs.11.9%). The odds of potential overtreatment were mostly decreased by 59% of females, 73.5% in those with retinopathy, and 86.3% in insulin, 65.4% sulfonylureas, and 66.8% in SGLT2 inhibitors users. Contrariwise, an increase in the odds of potential undertreatment was more than 4.8times higher in insulin, and more than 3.1times higher in sulfonylureas users. Conclusion potential overtreatment and undertreatment in older adults with T2D in routine clinical practice should guide the clinicians to balance the use of newer oral antidiabetic agents considering its safety profile regarding hypoglycemia.
The adoption of high-fat diets (HFDs) is a major contributor to the increasing prevalence of obes... more The adoption of high-fat diets (HFDs) is a major contributor to the increasing prevalence of obesity worldwide. Herein, we study the impact of an HFD from early age in testicular physiology and sperm parameters in two generations of mice, with a focus on testicular oxidative status. Mice of the diet-challenged generation (F0; n = 36) were randomly fed after weaning with standard chow (CTRL), a high-fat diet (HFD) for 200 days, or a transient high-fat diet (HFDt) (60 days of HFD + 140 days of standard chow). The offspring generation (F1; n = 36) was obtained by mating normoponderal females with those fed a chow diet 120 days post-weaning. Mice fed an HFD for a lifetime presented impaired insulin tolerance, a trait inherited by their sons. The sons of mice fed HFD inherited decreased catalase activity and displayed lower activities of mitochondrial complexes I and IV. Similar to their progenitors, the sons of HFD mice had a higher prevalence of pinhead and bent neck defects than that ...
The consumption of energy-dense diets has contributed to an increase in the prevalence of obesity... more The consumption of energy-dense diets has contributed to an increase in the prevalence of obesity and its comorbidities worldwide. The adoption of unhealthy feeding habits often occurs at early age, prompting the early onset of metabolic disease with unknown consequences for reproductive function later in life. Recently, evidence has emerged regarding the intergenerational and transgenerational effects of high-fat diets (HFD) on sperm parameters and testicular metabolism. Hereby, we study the impact of high-fat feeding male mice (F0) on the testicular metabolome and function of their sons (F1) and grandsons (F2). Testicular content of metabolites related to insulin resistance, cell membrane remodeling, nutritional support and antioxidative stress (leucine, acetate, glycine, glutamine, inosine) were altered in sons and grandsons of mice fed with HFD, comparing to descendants of chow-fed mice. Sperm counts were lower in the grandsons of mice fed with HFD, even if transient. Sperm qual...
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Papers by Joao Raposo