THAIS DELLA MANNA
Projetos de Pesquisa
Unidades Organizacionais
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
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- Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group(2012) GOMES, Marilia B.; COBAS, Roberta A.; MATHEUS, Alessandra S.; TANNUS, Lucianne R.; NEGRATO, Carlos Antonio; RODACKI, Melanie; BRAGA, Neuza; CORDEIRO, Marilena M.; LUESCHER, Jorge L.; BERARDO, Renata S.; NERY, Marcia; MARQUES, MariadoCarmo A.; CALLIARI, Luiz E.; NORONHA, Renata M.; MANNA, Thais D.; ZAJDENVERG, Lenita; SALVODELLI, Roberta; PENHA, Fernanda G.; FOSS, Milton C.; FOSS-FREITAS, Maria C.; PIRES, Antonio C.; ROBLES, Fernando C.; GUEDES, Maria de Fatima S.; DIB, Sergio A.; DUALIB, Patricia; SILVA, Saulo C.; SEPULVIDA, Janice; ALMEIDA, Henriqueta G.; SAMPAIO, Emerson; REA, Rosangela; FARIA, Ana Cristina R.; TSCHIEDEL, Balduino; LAVIGNE, Suzana; CARDOZO, Gustavo A.; AZEVEDO, Mirela J.; CANANI, Luis Henrique; ZUCATTI, Alessandra T.; CORAL, Marisa Helena C.; PEREIRA, Daniela Aline; ARAUJO, Luiz Antonio; TOLENTINO, Monica; PEDROSA, Hermelinda C.; PRADO, Flaviane A.; RASSI, Nelson; ARAUJO, Leticia B.; FONSECA, Reine Marie C.; GUEDES, Alexis D.; MATOS, Odelissa S.; FARIA, Manuel; AZULAY, Rossana; FORTI, Adriana C.; FACANHA, Cristina; MONTENEGRO, Ana Paula; MONTENEGRO JR., Renan; MELO, Naira H.; REZENDE, Karla F.; RAMOS, Alberto; FELICIO, Joao Sooares; SANTOS, Flavia M.; JEZINI, Deborah L.; CORDEIRO, Marilena M.Background: To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated. Methods: This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 +/- 11.7 years with a disease duration of 9.6 +/- 8.1 years (< 1 to 50 years). Results: Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels >= 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001). Conclusions: A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.
- Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil: data from the Brazilian Type 1 Diabetes Study Group(2015) FELICIO, Joao Soares; SOUZA, Ana Carolina Contente Braga de; KOURY, Camila Cavalcante; ABRAHAO NETO, Joao Felicio; MILEO, Karem Barbosa; SANTOS, Flavia Marques; MOTTA, Ana Regina Bastos; SILVA, Denisson Dias; ARBAGE, Thais Pontes; CARVALHO, Carolina Tavares; BRITO, Hana Andrade de Rider; YAMADA, Elizabeth Sumi; COBAS, Roberta Arnoldi; MATHEUS, Alessandra; TANNUS, Lucianne; PALMA, Catia Cristina Sousa; JAPIASSU, Leticia; CARNEIRO, Joao Regis Ivar; RODACKI, Melanie; ZAJDENVERG, Lenita; ARAUJO, Neuza Braga Campos de; CORDEIRO, Marilena de Menezes; LUESCHER, Jorge Luiz; BERARDO, Renata Szundy; NERY, Marcia; CANI, Catarina; MARQUES, Maria do Carmo Arruda; CALLIARI, Luiz Eduardo; NORONHA, Renata Maria de; MANNA, Thais Della; SAVOLDELLI, Roberta; PENHA, Fernanda Garcia; FOSS, Milton Cesar; FOSS-FREITAS, Maria Cristina; PIRES, Antonio Carlos; ROBLES, Fernando Cesar; NEGRATO, Carlos Antonio; GUEDES, Maria de Fatima; DIB, Sergio Atala; DUALIB, Patricia; SILVA, Saulo Cavalcanti da; SEPULVEDA, Janice; SAMPAIO, Emerson; REA, Rosangela Roginski; FARIA, Ana Cristina Ravazzani de Almeida; TSCHIEDEL, Balduino; LAVIGNE, Suzana; CARDOZO, Gustavo Adolfo; AZEVEDO, Mirela; CANANI, Luis Henrique; ZUCATTI, Alessandra Teixeira; CORAL, Marisa Helena Cesar; PEREIRA, Daniela Aline; ARAUJO, Luiz Antonio de; PEDROSA, Hermelinda Cordeiro; TOLENTINO, Monica; PRADO, Flaviene Alves; RASSI, Nelson; ARAUJO, Leticia Bretones de; FONSECA, Reine Marie Chaves; GUEDES, Alexis Dourado; MATTOS, Odelisa Silva de; FARIA, Manuel; AZULAY, Rossana; FORTI, Adriana Costa e; FACANHA, Cristina Figueiredo Sampaio; MONTENEGRO JUNIOR, Renan; MONTENEGRO, Ana Paula; MELO, Naira Horta; REZENDE, Karla Freire; RAMOS, Alberto; JEZINI, Deborah Laredo; GOMES, Marilia BritoBackground: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 +/- 30 and 70.4 +/- 19, respectively; p < 0.05). In addition, North-Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 +/- 0.6; Southeast: 1.65 +/- 0.7; South: 1.72 +/- 0.7; Midwest: 1.67 +/- 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities.
- Clinical and molecular data from 61 Brazilian cases of Congenital Hyperinsulinemic Hypoglycemia(2015) LIBERATORE JR., Raphael Del Roio; RAMOS, Priscila Manzini; GUERRA JR., Gil; MANNA, Thais Della; SILVA, Ivani Novato; MARTINELLI JUNIOR, Carlos EduardoObjective: To study the clinical and molecular characteristics of a sample of Brazilian patients with Congenital Hyperinsulinemic Hypoglycemia (CHH). Methods: Electronic message was sent to members from Endocrinology Department-Brazilian Society of Pediatrics requesting clinical data for all cases of CHH. A whole blood sample from living patients was requested for DNA extraction followed by a search for mutations of the genes ABCC8, KCNJ11, GCK, GLUD1, HADH, SLC16A1 and HNF4A. Results: Of the 61 patients evaluated, 36 (59%) were boys, and only 16 (26%) were born by normal delivery. Gestational age ranged from 32 to 41 weeks (mean = 37 weeks and 6 days). Birth weight ranged from 1590 to 5250 g (mean = 3430 g). Macrossomia occurred in 14 cases (28%). Age at diagnosis ranged from 1 to 1080 days (mean = 75 days). DNA for molecular analysis was obtained from 53 of the 61 patients. Molecular changes in the ABCC8 gene were detected in 15 (28%) of these 53 cases, and mutations in the KCNJ11 gene were detected in 6 (11%). Mutations in the GLUD1 gene were detected in 9 cases (17%) of the total series. Mutations of the GCK gene in heterozygosis were detected in 3 cases. No mutations were detected in the sequencing of genes HADH, SLC16A1 and HNF4A. Conclusion: The present study conducted in Brazil permitted the collaborative compilation of an important number of CHH cases and showed that the present clinical and molecular data are similar to those of published global series.
- Translation and validation of diabetes self-management profile (DSMP) into Brazilian Portuguese language: first instrument to assess type 1 diabetes self-management in a pediatric population(2017) PASSONE, Caroline Gouveia Buff; ESTEVES, Lygia Spassapan Oliveira; SAVOLDELLI, Roberta Dias; HARRIS, Michael A.; DAMIANI, Durval; MANNA, Thais DellaObjective: To translate and validate the instrument Diabetes Self-Management Profile (DSMP)-Conventional and Flexible Regimens into Brazilian Portuguese language in order to evaluate the quality of diabetes self-management in children and adolescents with type 1 diabetes and their caregivers. Methods: DSMP was submitted to forward and back translation method and validated in a group of type 1 diabetes youths between 6 and 18 years (n = 102), and their families. Analysis of DSMP internal consistency, intra and interobserver reliability and concurrent correlation with HbA1c were done. Results: DSMP total scores demonstrated adequate internal consistency (Cronbach's alpha = 0.79), 3-month test-retest reliability (rho = 0.53; p < 0.001), inter-interviewer agreement (rho = 0.55; p < 0.001). DSMP total score was significantly correlated to HbA1c (rho = -0.54, p < 0.001). Conclusion: DSMP-translated version is a reliable and valid tool to assess diabetes self-management.
article 6 Citação(ões) na Scopus Síndrome de Berardinelli-Seip: descrição genética e metabólica de cinco pacientes(2011) BARRA, Cristiane B.; SAVOLDELLI, Roberta D.; MANNA, Thais D.; KIM, Chong A.; MAGRE, Jocelyn; PORTA, Gilda; SETIAN, Nuvarte; DAMIANI, DurvalObjecive:To report the genetic and metabolic profile of patients with Berardinelli-Seip syndrome (BSCL) followed at Instituto da Crianca, HC-FMUSP. Subjects and methods: Patients with clinical features of BSCL (n = 5), all female, were evaluated through serum levels of glucose, insulin, lipids, leptin, and liver enzymes. Abdominal sonography and DNA analysis were also performed. Results: Leptin deficiency and hypertriglyceridemia were found in all the patients. Three progressed to diabetes mellitus. Four patients have mutations in AGPAT2 gene and one have a mutation in CAV1 gene. Conclusion: The earliest metabolic abnormalities were hypertriglyceridemia and insulin resistance, culminating in the onset of diabetes at the time of puberty. Mutations in the AGPAT2 gene were the most frequent in our patients. Arq Bras Endocrinol Metab. 2011;55(1):54-9article 21 Citação(ões) na Scopus Novel mutation in MCT8 gene in a Brazilian boy with thyroid hormone resistance and severe neurologic abnormalities(2011) MENEZES FILHO, Hamilton Cabral de; MARUI, Suemi; MANNA, Thais Della; BRUST, Ester Saraiva; RADONSKY, Vanessa; KUPERMAN, Hilton; DICHTCHEKENIAN, Vae; SETIAN, Nuvarte; DAMIANI, DurvalMCT8 is a cellular transporter of thyroid hormones important in their action and metabolization. We report a male patient with the novel inactivating mutation 630insG in the coding region in exon 1 of MCT8. He was characterized clinically by severe neurologic impairment (initially with global hypotonia, later evolving with generalized hypertonia), normal growth during infancy, reduced weight gain, and absence of typical signs and symptoms of hypothyroidism, while the laboratory evaluation disclosed elevatedT3, low total and free T4, and mildly elevated TSH serum levels.Treatment with levothyroxine improved thyroid hormone profile but was not able to alter the clinical picture of the patient.These data reinforce the concept that the role of MCT8 is tissue-dependent: while neurons are highly dependent on MCT8, bone tissue, adipose tissue, muscle, and liver are less dependent on MCT8 and, therefore, may suffer the consequences of the exposition to high serum T3 levels. Arq Bras Endocrinol Metab. 2011;55(1).60-6- Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil(2014) GOMES, Marilia Brito; NEGRATO, Carlos Antonio; COBAS, Roberta; TANNUS, Lucianne Righeti Monteiro; GONCALVES, Paolla Ribeiro; SILVA, Pedro Carlos Barreto da; CARNEIRO, Joao Regis Ivar; MATHEUS, Alessandra Saldanha Mattos; DIB, Sergio Atala; AZEVEDO, Mirela Jobim; NERY, Marcia; RODACKI, Melanie; ZAJDENVERG, Lenita; MONTENEGRO JUNIOR, Renan Magalhaes; SEPULVEDA, Janice; CALLIARI, Luis Eduardo; JEZINI, Deborah; BRAGA, Neuza; LUESCHER, Jorge L.; BERARDO, Renata S.; ARRUDA-MARQUES, Maria Carmo; NORONHA, Renata M.; MANNA, Thais D.; SALVODELLI, Roberta; PENHA, Fernanda G.; FOSS, Milton C.; FOSS-FREITAS, Maria C.; PIRES, Antonio C.; ROBLES, Fernando C.; GUEDES, Maria de Fatima S.; DUALIB, Patricia; SILVA, Saulo C.; SAMPAIO, Emerson; REA, Rosangela; FARIA, Ana Cristina R.; TSCHIEDEL, Balduino; LAVIGNE, Suzana; CANANI, Luis Henrique; ZUCATTI, Alessandra T.; CORAL, Marisa Helena C.; PEREIRA, Daniela Aline; ARAUJO, Luiz Antonio; TOLENTINO, Monica; PEDROSA, Hermelinda C.; PRADO, Flaviane A.; RASSI, Nelson; ARAUJO, Leticia B.; FONSECA, Reine Marie C.; GUEDES, Alexis D.; MATOS, Odelissa S.; PALMA, Catia C.; AZULAY, Rossana; FORTI, Adriana C.; FACANHA, Cristina; MONTENEGRO, Ana Paula; MELO, Naira H.; REZENDE, Karla F.; RAMOS, Alberto; FELICIO, Joao Soares; SANTOS, Flavia M.Background: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D). Methods: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups. Results: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). The majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001). Conclusions: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.