Papers by Davide Carvalho
Diabetology & Metabolic Syndrome
Background The management of antidiabetic therapy in people with type 2 diabetes (T2D) has evolve... more Background The management of antidiabetic therapy in people with type 2 diabetes (T2D) has evolved beyond glycemic control. In this context, Brazil and Portugal defined a joint panel of four leading diabetes societies to update the guideline published in 2020. Methods The panelists searched MEDLINE (via PubMed) for the best evidence from clinical studies on treating T2D and its cardiorenal complications. The panel searched for evidence on antidiabetic therapy in people with T2D without cardiorenal disease and in patients with T2D and atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), or diabetic kidney disease (DKD). The degree of recommendation and the level of evidence were determined using predefined criteria. Results and conclusions All people with T2D need to have their cardiovascular (CV) risk status stratified and HbA1c, BMI, and eGFR assessed before defining therapy. An HbA1c target of less than 7% is adequate for most adults, and a more flexible target (up ...
Purpose Hyperglycemia is associated with abnormalities of lipoproteins. The aim of this study was... more Purpose Hyperglycemia is associated with abnormalities of lipoproteins. The aim of this study was to analyze, in patients with Type 1 Diabetes (T1D), the association of glycemic control with lipid profile, focusing on glycemic variability and time in range obtained from Continuous Glucose Monitoring (CGM). Methods We performed a retrospective cohort in patients with T1D. We analyzed clinical parameters, HbA1c, CGM and lipid profile in two moments 6 to 18 months apart. We evaluated the association of HbA1c and CGM metrics with lipid profile in cross-sectional (n = 242) and longitudinal (n = 90) analyses. Results The mean age of the study population was 36.6 ± 12.6 years, 51.7% were male, and the mean diabetes duration was 16.8 ± 10.3 years. In the cross-sectional analysis, higher HbA1c, higher glucose management indicator (GMI), higher time above range and lower time in range were associated with higher triglyceride levels. In the longitudinal analysis, an increase in time below rang...
Revista Portuguesa de Endocrinologia, Diabetes e Metabolismo, 2022
Introduction: Using a multinational database of de-identified FreeStyle Libre sensor readings, we... more Introduction: Using a multinational database of de-identified FreeStyle Libre sensor readings, we analysed the subgroup of data for Portugal with the aim of understanding the daily scanning behaviour for FreeStyle Libre users in Portugal and the association with performance against internationally agreed measures of glycaemic control. Methods: De-identified data from FreeStyle Libre readers was collected between September 2014 and December 2020. Data for Portugal was extracted and analysed to determine the relationship between glucose scanning frequency and accepted measures of glycaemic control, including: estimated HbA1c, time in range 70-180 mg/dL, time with glucose <70 mg/dL, time with glucose <54 mg/dL, and time with glucose >180 mg/dL. Results: The Portugal dataset included 13 323 readers representing 171 million individual glucose readings. Users were rank-ordered by daily scan rate and separated into 10 equal-sized bins groups, ranging from the lowest (mean scan rate of 3.70 scans/day) to highest (mean scan rate of 35.77 scans/day). Users in Portugal performed an average of 13.2 daily glucose scans (median 10.7, IQR 6.6-16.4). Estimated HbA1c decreased from 8.59% to 7.26% as scan rates increased from lowest to highest (p < 0.05). Time in range 70-180 mg/dL improved from 44.51% to 61.31% with increasing scan rates (p < 0.05) and time with glucose >180 mg/dL fell from 50.18% to 33.80% (p < 0.05). Time with glucose <54 mg/dL fell from a median of 1.28% to 0.52% as mean daily scans increased from 8.14 to 35.77 (p < 0.05). Our study shows that, under real-life conditions, flash glucose monitoring enables users in Portugal to regularly monitor their glucose, and higher frequencies of monitoring are associated with improvements in accepted measures of glucose control, including lower estimated HbA1c and increased time in range, as well as less time in hyperglycaemia and clinically significant hypoglycaemia. These results are aligned with those observed world-wide.
Biomedicines
Non-alcoholic fatty liver disease (NAFLD) is associated with several other metabolic disorders, w... more Non-alcoholic fatty liver disease (NAFLD) is associated with several other metabolic disorders, which are typically pro-inflammatory states. Body fat content is an important marker of metabolic health and abdominal fat is associated with harmful cardiometabolic outcomes. We aimed to evaluate the association between the risk of NAFLD (through Fatty Liver Index (FLI), and BMI, AST/ALT ratio, and presence of diabetes (BARD)), and anthropometric parameters, predictors of metabolic status, in patients with morbid obesity, and to evaluate the association of FLI and BARD scores with pro-inflammatory markers. We have retrospectively studied patients with morbid obesity followed in our center. In total, 2184 participants were included, with an average age of 42.8 ± 10.6 years, 84.5% being females. We report a positive association of FLI with waist circumference (β = 0.10 [0.09 to 0.11], p < 0.01) and waist-to-hip ratio (β = 8.68 [6.85 to 10.52, p < 0.01]), even after adjusting for age,...
Bariatric Surgical Practice and Patient Care, 2022
Endocrine, 2021
Purpose Insulin pump therapy has become the preferential treatment for type 1 diabetes (T1D) as i... more Purpose Insulin pump therapy has become the preferential treatment for type 1 diabetes (T1D) as it mimics the physiological secretion of insulin better than multiple daily injections. However, not all patients improve with insulin pump therapy. This study aims to determine the predictors of the effectiveness of insulin pumps in T1D. Methods We conducted a retrospective observational study of patients who started insulin pumps. Data from four timepoints (before, at 6, 12, and 36 months) were evaluated for outcomes of glycemic control and safety. The association of baseline predictors with outcomes was analyzed using linear and logistic regression models. Results We evaluated 136 patients (57.4% females, age 36 ± 12 years, duration of T1D 14 ± 9 years). During the follow-up, there was a mean decrease of HbA1c of 0.9 ± 1.2%. The improvement in HbA1c was independent of sex, age, and duration of T1D. Higher baseline HbA1c, family history of diabetes, and not being treated with statins were predictors of improvement in HbA1c. Not being treated with statins and higher baseline HbA1c predicted improvement in HbA1c without worsening hypoglycemia. History of hypoglycemia was a predictor of severe hypoglycemia. Family history, higher baseline HbA1c, and psychological/psychiatric disorders were predictors of ketoacidosis. Conclusion Benefits of insulin pump were independent of sex, age, and duration of T1D. Baseline HbA1c, family history of diabetes, treatment with statins, history of hypoglycemia, and psychological/psychiatric disorders were predictors of outcomes, and may allow the identification of patients who benefit most from insulin pump therapy or who are at increased risk of complications.
Revista Portuguesa de Endocrinologia, Diabetes e Metabolismo, 2021
A 60-year-old woman with diabetes mellitus was followed in endocrinology consultations since 2018... more A 60-year-old woman with diabetes mellitus was followed in endocrinology consultations since 2018, due to uncontrolled diabetes (HbA1c on 09/2018 -9.3%). She was medicated with metformin/ dapagliflozin 1000/5 mg bid and with a pre-mixed suspension (30% aspart insulin/70% NPH insulin, 16 IU before breakfast, 24 IU before lunch, and 24 IU before dinner. Her past medical history comprises hypertension, dyslipidemia, and morbid obesity (BMI 40.6 kg/m 2 ), as well as a proliferative diabetic retinopathy. She was submitted for bariatric surgery and was discharged with metformin/ dapagliflozin 1000/5 mg bid, the insulin being abruptly stopped. She was later admitted to the emergency department due to a diabetic ketoacidosis. After aggressive fluid therapy with insulin and the correction of electrolytic disturbances, there was a regression of this pathological presentation. This clinical case stresses the importance of a correct and multidisciplinary approach for antidiabetic therapy during the pre, peri, and post-surgical period among bariatric patients. Doente do sexo feminino, 60 anos, diabetes mellitus diagnosticada há 20 anos em análises de rotina. Seguida em consulta de endocrinologia desde 2018 por diabetes descompensada (HbA1c em 09/2018 -9,3%). Encontrava-se medicada com metformina/dapagliflozina 1000/5 mg bid e com uma pré-mistura (30% insulina aspart e 70% insulina isofânica) com 16UI antes do pequenoalmoço, 24UI antes do almoço e 24UI antes do jantar. Apresentava antecedentes de hipertensão, dislipidemia, obesidade mórbida (BMI 40,6 kg/m 2 ) e retinopatia diabética proliferativa. A doente foi submetida a cirurgia bariátrica e teve alta com metformina/dapagliflozina 1000/5 mg bid, tendo a insulinoterapia sido suspensa abruptamente. Posteriomente, foi admitida no serviço de urgência por cetoacidose diabética. Após fluidoterapia agressiva e correção dos distúrbios hidroelectrolíticos, verificou-se uma regressão do quadro patológico. Este caso reforça a importância de uma abordagem correta e multidisciplinar para a terapêutica antidiabética nestes doentes durante o período pré, peri e pós-operatório de doentes submetidos a cirurgia. cetoacidose diabética após cirurgia bariátrica: a Propósito de um caso clínico
Introdução: A insulinoterapia intensiva constitui, atualmente, o tratamento de eleição na diabete... more Introdução: A insulinoterapia intensiva constitui, atualmente, o tratamento de eleição na diabetes mellitus (DM) tipo 1, a qual inclui as múltiplas injeções diárias de insulina (MIDI) e a infusão subcutânea contínua de insulina (ISCI). Esta última, tem vindo a tornar-se o modo terapêutico preferencial, visto mimetizar melhor a ação pancreática fi siológica, sendo, contudo, limitada a evidência que suporta a sua superioridade relativamente à MIDI. Neste contexto, o objetivo do nosso estudo foi avaliar os efeitos da transição de MIDI para ISCI no tratamento intensivo da DM tipo 1. Material e Métodos: Estudo longitudinal retrospetivo em doentes previamente sob MIDI que transitaram para ISCI entre 2006 e 2014. Foram recolhidos dados referentes ao peso, HbA1c, glicemia plasmática, perfi l lipídico, creatinina, frequência semanal de episódios de hipoglicemia e de hiperglicemia e presença de complicações microvasculares. Os efeitos da transição para ISCI foram também comparados de acordo com os seguintes subgrupos: HbA1c pré-ISCI (≤ 7,0% vs > 7,0%); idade (≤ 35 anos vs > 35 anos); sexo (masculino versus feminino); IMC (≤ 25 vs > 25 kg/m2); duração da doença (≤ 15 anos vs > 15 anos); dose diária total (DDT) de insulina (≤ 45 e > 45 unidades de insulina); FSI (≤ 40 e > 40) e complicações microvasculares (presença versus ausência). Resultados: A amostra incluiu 85 doentes, com média de idades de 38 ± 11 anos, 50 (58,8%) do sexo feminino, com duração média de doença de 21 ± 9 anos. Verifi cou-se uma redução signifi cativa na frequência de eventos de hipo e hiperglicemia após transição para ISCI (3,0 ± 5,0 vs 2,0 ± 2,2 por semana, p = 0,001; e 5,5 ± 6,1 vs 2,5 ± 2,6 por semana, p = 0,05, respetivamente). Observou-se ainda um maior benefício glicémico no subgrupo de doentes com pior controlo metabólico (HbA1c > 7%) relativamente ao grupo de doentes com HbA1c ≤ 7% (Δ HbA1c = -0,55% vs 0,20%, respetivamente, p < 0,05), para os 6 primeiros meses após ISCI, constatando-se, adicionalmente, um aumento signifi cativo nos níveis de HDL-C (2,81 ± 10,34 mg/dL, p = 0,039). Conclusão: Neste estudo, a terapêutica com ISCI demonstrou ser mais efi caz comparativamente à MIDI nos doentes com pior controlo metabólico, verifi cando-se ainda uma redução signifi cativa da frequência semanal de eventos de hipo e hiperglicemia. Não obstante os resultados animadores associados à ISCI, no futuro, torna-se imperativo a realização de estudos longitudinais mais alargados para avaliar a real efi cácia relativa da ISCI no tratamento da DM tipo 1.
Journal of Medical Case Reports, 2021
Background The clinical characteristics and complications of Cushing syndrome (CS) are well known... more Background The clinical characteristics and complications of Cushing syndrome (CS) are well known and described in the literature. Nevertheless, rare, atypical presentations may go unnoticed. Osteonecrosis is a well-documented complication of glucocorticoid therapy. However, endogenous hypercortisolism is a rare, but relevant, cause of bone avascular necrosis. We describe the case of a woman with CS undiagnosed for 2 years after presenting with femoral avascular necrosis. Case presentation A 38-year-old Caucasian woman was referred for evaluation of secondary amenorrhea, associated with oral contraception withdrawal in the context of deep venous thrombosis (DVT). She had a previous right hip arthroplasty for treatment of avascular necrosis of the femoral head, diagnosed after 3 years of progressive right hip pain and limited mobility. She also had high blood pressure (HBP) of 5 years’ duration, and reported weight gain (4 kg in 2 years). There was no history of infertility (gravida ...
Acta Médica Portuguesa, 2020
Introduction: Recently, vitamin D has gained importance as a diabetes risk modifier. Our aim was ... more Introduction: Recently, vitamin D has gained importance as a diabetes risk modifier. Our aim was to assess the association between serum vitamin D levels and the prevalence of diabetic retinopathy in patients with type 1 diabetes.Material and Methods: Retrospective review of a population of patients with type 1 diabetes followed in a Portuguese tertiary center. Patients were included if they had an ophthalmological evaluation and a serum 25-hydroxyvitamin D level determination within the same year. Logistic regression analysis was used to adjust for possible confounders.Results: We included 182 patients (47% male), and 57% (n = 103) had signs of diabetic retinopathy. We found a significant association between lower circulating levels of 25-hydroxyvitamin D levels and a greater prevalence of diabetic retinopathy after adjusting for confounders (duration of diabetes, estimated glomerular filtration rate, age, sex, metabolic control, season, dyslipidemia and hypertension) (OR = 0.94; 9...
Diabetology & Metabolic Syndrome, 2020
BackgroundIn current management of type 2 diabetes (T2DM), cardiovascular and renal prevention ha... more BackgroundIn current management of type 2 diabetes (T2DM), cardiovascular and renal prevention have become important targets to be achieved. In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for treatment of hyperglycemia in T2DM.MethodsMEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence were determined using predefined criteria.Results and conclusionsIn non-pregnant adults, the recommended HbA1ctarget is below 7%. Higher levels are recommended in frail older adults and patients at...
Case Reports in Endocrinology, 2019
Introduction. Adrenocorticotropic hormone (ACTH) ectopic production is a rare cause of Cushing sy... more Introduction. Adrenocorticotropic hormone (ACTH) ectopic production is a rare cause of Cushing syndrome (CS). The most commonly associated tumours are small-cell lung carcinoma along with bronchial and thymic carcinoids. To date, only 5 cases have been published in the literature featuring ectopic ACTH secretion from metastatic acinic cell carcinoma (ACC) of the parotid gland. We hereby describe a very uncommon case of ectopic CS (ECS) unveiling a metastatic parotid ACC. Case Presentation. A 46-year-old man with hypertension and dyslipidemia diagnosed 4-months before, as well as new-onset diabetes mellitus unveiled 1-month earlier, was referred to emergency department for hypokalemia. Hormonal study and dynamic biochemical tests performed indicated ECS. Imaging and cytological findings pointed toward a likely primary right parotid malignancy with liver metastases. Somatostatin receptor scintigraphy has shown an increased uptake in the parotid gland and mild expression in liver metas...
Endocrine Abstracts, 2019
Endocrine Abstracts, 2019
Revista Portuguesa de Cardiologia, 2019
Agonistas do recetor do peptídeo tipo 1 semelhante ao glucagon; Diabetes mellitus; Doenc ¸as card... more Agonistas do recetor do peptídeo tipo 1 semelhante ao glucagon; Diabetes mellitus; Doenc ¸as cardiovasculares; Fatores de risco; Inibidores do cotransportador sódio-glicose 2; Resumo A diabetes mellitus (DM) é uma das patologias crónicas mais prevalentes no século XXI, constituindo uma doenc ¸a metabólica com consequências vasculares por acelerac ¸ão dos processos ateroscleróticos. Caracterizada pela incapacidade de produc ¸ão ou utilizac ¸ão de insulina, e consequente hiperglicemia e insulinopenia, a DM ocasiona diversas complicac ¸ões microvasculares, tais como retinopatia e nefropatia, e macrovasculares, incluindo enfarte agudo do miocárdio e acidente vascular cerebral, as quais põem em causa a qualidade e expectativa de vida da pessoa com diabetes. Descrevemos a estreita relac ¸ão entre DM, fatores de risco cardiovascular e doenc ¸a cardiovascular e examinamos a abordagem multifatorial para o tratamento dessa doenc ¸a, incluindo a reduc ¸ão do risco cardiovascular na pessoa com DM tipo 2 (DM2). Por último, analisamos novas perspetivas para o tratamento da DM2, resultantes do desenvolvimento de novos fármacos antidiabéticos. Com esta revisão pretende-se que o clínico assuma o papel fundamental de orientar a pessoa com diabetes no controlo da sua doenc ¸a, com vista a melhorar a sua qualidade de vida e o seu prognóstico. Tendo em conta os dados disponíveis atualmente, o aparecimento de novas terapêuticas anti-hiperglicémicas
Revista Portuguesa de Endocrinologia, Diabetes e Metabolismo, 2016
Vírus da imunodeficiência humana Terapêutica antirretrovírica Tiroide Lipodistrofia r e s u m o I... more Vírus da imunodeficiência humana Terapêutica antirretrovírica Tiroide Lipodistrofia r e s u m o Introduc ¸ ão: As alterac ¸ ões da func ¸ ão tiroideia são comuns nos doentes infetados pelo vírus da imunodeficiência humana (VIH). A prevalência de condic ¸ ões geralmente assintomáticas (como o hipotiroidismo subclínico) está aumentada e a doenc ¸ a de Graves pode ocorrer durante a reconstituic ¸ ão imune associada à terapêutica antirretrovírica combinada (TARC). Objetivo: O objetivo deste estudo é avaliar a presenc ¸ a de doenc ¸ a tiroideia em doentes infetados pelo VIH-1 sob TARC numa consulta cardiometabólica de endocrinologia associada ao VIH. Métodos: Estudo transversal de 377 doentes infetados pelo VIH-1 sob TARC. Resultados: Trezentos e trinta e oito doentes (89,66%) eram eutiroideus. Encontrámos alterac ¸ ões da glândula tiroideia em 10,34% (39/377): 1,33% (5/377) doenc ¸ a de Graves; 1,06% (4/377) tiroidite de Hashimoto; 0,80% (3/377) microcarcinoma papilar da tiroide; 0,53% (2/377) bócio multinodular tóxico; 2,12% (8/377) hipotiroidismo subclínico; 0,265% (1/377) hipotiroidismo pós-cirúrgico; 0,53% (2/377) hipertiroidismo subclínico; 1,59% (6/377) deficiência isolada de T4L e 2,12% (8/377) síndrome do eutiroideu doente. Conclusões: Nesta populac ¸ ão de doentes do ambulatório a prevalência de alterac ¸ ões da func ¸ ão tiroideia foi baixa quando comparada com outros estudos em doentes com VIH sob TARC (com prevalência de disfunc ¸ ão até 35%), aproximando-se da prevalência estimada na populac ¸ ão geral. As alterac ¸ ões mais frequentes foram o hipotiroidismo subclínico e a doenc ¸ a de Graves.
Revista Portuguesa de Endocrinologia, Diabetes e Metabolismo, 2012
Current Perspectives in HIV Infection, 2013
Please use Adobe Acrobat Reader to read this book chapter for free. Just open this same document ... more Please use Adobe Acrobat Reader to read this book chapter for free. Just open this same document with Adobe Reader. If you do not have it, you can download it here. You can freely access the chapter at the Web Viewer here. Current Perspectives in HIV Infection 262 Please use Adobe Acrobat Reader to read this book chapter for free. Just open this same document with Adobe Reader. If you do not have it, you can download it here. You can freely access the chapter at the Web Viewer here.
Nutrients, 2019
Gut microbiota dysbiosis has been recognized as having key importance in obesity- and metabolic-r... more Gut microbiota dysbiosis has been recognized as having key importance in obesity- and metabolic-related diseases. Although there is increasing evidence of the potential benefits induced by probiotics in metabolic disturbances, there is a lack of large cross-sectional studies to assess population-based prevalence of probiotic intake and metabolic diseases. Our aim was to evaluate the association of probiotic ingestion with obesity, type 2 diabetes, hypertension, and dyslipidemia. A cross-sectional study was designed using data from the National Health and Nutrition Examination Survey (NHANES), 1999–2014. Probiotic ingestion was considered when a subject reported consumption of yogurt or a probiotic supplement during the 24-hour dietary recall or during the Dietary Supplement Use 30-Day questionnaire. We included 38,802 adults and 13.1% reported probiotic ingestion. The prevalence of obesity and hypertension was lower in the probiotic group (obesity-adjusted Odds Ratio (OR): 0.84, 95%...
Acta Médica Portuguesa, 2020
Cerca de 28% dos doentes com dislipidemia apresentam na sua etiologia causas secundárias. A resol... more Cerca de 28% dos doentes com dislipidemia apresentam na sua etiologia causas secundárias. A resolução de algumas destas causas pode levar à correção total da dislipidemia. Descreve-se o caso de uma doente do sexo feminino, 50 anos, com obesidade grau II e cirrose biliar primária referenciada por dislipidemia mista com mau controlo (sob estatina e fibrato) e com alterações analíticas hepáticas. No estudo efetuado constatou-se hipotiroidismo primário auto-imune. Após normalização da função tiroideia pelo tratamento com levotiroxina, além da suspensão da estatina e fibrato, verificou-se melhoria do perfil lipídico, embora mantendo hipercolesterolemia. Neste período de tempo foi-lhe diagnosticada diabetes mellitus pelo que se instituiu de novo terapêutica com estatina (atorvastatina 10 mg), com normalização do perfil lipídico. Com este caso pretende-se salientar a importância da exclusão de causas secundárias de dislipidemia, nomeadamente o hipotiroidismo, bem como discutir aspectos par...
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Papers by Davide Carvalho