[AF] Tramadol e hipoglucemia

Lun Abr 23 18:21:21 CEST 2007

Hola,Otón!!
  No comentas cúal es la razón de la prescripción de tramadol.
  Suponiendo que se trate de un dolor crónico de cualquier etilogía, incluso relacionado con su diabetes,se me ha ocurrido que  la razón de la mejora en el control glucémico no se deba al tanto a que el  tramadol pueda ser hipoglucemiante o contribuir o potenciar la acción de la insulina, sino a su efecto analgésico, es decir, al control del dolor.
  Si el dolor desaparece, es posible que la paciente se encuentre más capacitada para afrontar el autocuidado de su diabetes. 
  Es una idea.
  Te mando un artículo en relación a esto.

  Salu2

  NINA

Letters: Observations
  Bodily Pain, Poor Physical Functioning, and Poor Glycemic Control in Adults With Diabetes 
  Cathy Sinnott, RN, MA1, Mary A.M. Rogers, PHD1, David Lehmann, MD, PHARMD1 and Ruth S. Weinstock, MD, PHD1,2 
  1 Department of Medicine, SUNY Upstate Medical University, Syracuse, New York
2 Department of Veterans Affairs Medical Center, Syracuse, New York   
Address correspondence to Ruth S. Weinstock, MD, PhD, SUNY Upstate Medical University, 750 East Adams St. (CWB 353), Syracuse, NY 13210. E-mail: weinstor en upstate.edu      
In the January issue of Diabetes Care, Krein et al. (1)  reported that the presence of chronic pain was associated with poor diabetes self-management. Their study was performed in a primarily male veteran population, and glycemic control was not addressed. We examined psychosocial factors associated with poor glycemic control in a largely female population followed in an urban, underserved, primary care medical clinic and found that the presence of pain and poor physical functioning were associated with poor glycemic control.   
Medical records of adults with diabetes (n = 236, 76% female, mean age 62 years) were reviewed. Mean HbA1c was 8.1%, and 52.5% had HbA1c levels of <8%. Patients were asked to complete the SF-36 Short Form Survey (2), the Appraisal of Diabetes Scale  (ADS) (3), the Diabetes Quality of Life (DQOL) Measure (4), the Problem Areas in Diabetes (PAID) Scale (5), and the patient survey used by the American Diabetes Association for provider recognition. Bivariate analyses were conducted using correlation coefficients for continuous variables and one-way ANOVA to assess differences in means across groups. Alpha was set at 0.05, two-tailed. Odds ratios, 95% CIs, and 2 tests for trend were used to compare patients with HbA1c <8% versus 8% for  various psychosocial measures. This project was approved by the Institutional Review Board for the Protection of Human Subjects at SUNY Upstate Medical University.   
HbA1c was negatively associated with the SF-36 Bodily Pain subscale score (P = 0.012). Those patients with HbA1c 8.0% were 5.6 times (95% CI 1.3?26.1) as likely to have more pain (as indicated by a low bodily pain subscore <30) compared with patients with less pain (high scores >70). HbA1c was also negatively correlated with physical functioning (SF-36 subscale, P = 0.002), with those having HbA1c 8% being 4.5 times (95% CI 1.1?20.3) as likely to have a low physical  functioning subscale score (<30) as patients with high scores (>70). Patients with HbA1c 8.0% were 3.6 times (95% CI 0.8?18.8) as likely to report poor or fair overall health (American Diabetes Association Provider Recognition Patient Survey, Question 1). HbA1c was not associated with the Mental Health subscales of SF-36, ADS, or DQOL, but those with HbA1c 8.0% had higher mean PAID scores (P = 0.034). As previously reported (6), as age increased, several psychosocial indicators improved (PAID total score, P = 0.001; PAID "worry," P < 0.001; PAID "impact," P = 0.026; Mental  Composite Score from SF-36, P = 0.005; Mental Health Subscore from SF-36, P = 0.017).   
Krein et al. (1) demonstrated that chronic pain limited the ability of patients with diabetes to self-manage their disease. We found that patients who reported more bodily pain, poorer physical functioning, and poorer self-assessment of overall health were more likely to have elevated HbA1c levels. Whether measures to decrease pain and improve physical functioning would help to improve glycemic control is an area for future study.   
Acknowledgments  
This study was supported through funding from the New York State Department of Health and was presented at the 60th annual meeting of the American Diabetes  Association, San Antonio, Texas, 9?13 June 2000.   
Footnotes  
M.A.M.R. is currently affiliated with the Division of General Medicine, University of Michigan, Ann Arbor, Michigan.   
References

  Krein SL, Heisler M, Piette JD, Makki F, Kerr EA: The effect of chronic pain on diabetes patients? self-management. Diabetes Care 28:65?70, 2005[Abstract/Free Full Text]
  McHorney CA, Ware JE, Lu JFR, Sherbourne CD: The MOS 36-item Short Form Health Survey (SF-36), III: tests of data quality, scaling  assumptions, and reliability across diverse patient groups. Med Care 32:40?66, 1994[Medline]
  Carey MP, Jorgensen RS, Weinstock RS, Sprafkin RP, Lantinga LJ, Carnrike CL Jr, Baker MT, Meisler AW: Reliability and validity of the Appraisal of Diabetes Scale. J Behav Med 14:43?51, 1991[Medline]
  Jacobson AM, Barofsky I, Cleary P, Rand L, The DCCT Research Group: Reliability and validity of a diabetes quality-of-life measure for the Diabetes Control and Complications Trial (DCCT). Diabetes Care 11:725?732, 1988[Abstract]
  Welch GW, Jacobson AM, Polonsky WH: The problem areas in diabetes scale: an evaluation of its clinical utility. Diabetes Care 20:760?766, 1997[Abstract]
  Trief PM, Wade MJ, Pine D, Weinstock RS: A comparison of health-related quality of life of elderly and younger insulin-treated adults with diabetes. Age Ageing 32:613?618, 2003[Abstract/Free Full Text]