Volume 6, Issue 3, September 2018, Page: 98-107
Brazilian Primary Care of T2D with Reactive-Homeostatic and Lifestyle Changing- Allostatic Approaches: A Cost-Effectiveness Data
Mariana Santoro Nakagaki, Center for Nutritional and Physical Exercise Metabolism, Department of Public Health, Sao Paulo State University, School of Medicine, Botucatu, Brazil; Physical Exercise Graduate Joint Program, Londrina and Maringa State Universities, Londrina, Brazil
Hugo Tadashi Kano, Center for Nutritional and Physical Exercise Metabolism, Department of Public Health, Sao Paulo State University, School of Medicine, Botucatu, Brazil; Pathology Graduate Program, School of Medicine, São Paulo State University, Botucatu, Brazil
Roberto Carlos Burini, Center for Nutritional and Physical Exercise Metabolism, Department of Public Health, Sao Paulo State University, School of Medicine, Botucatu, Brazil
Received: May 1, 2018;       Accepted: May 22, 2018;       Published: Jun. 13, 2018
DOI: 10.11648/j.ajss.20180603.15      View  1466      Downloads  120
The Brazilian Health System is committed to offer free of charge medications for Diabetes, with the expenditure with prescription drug being the increasingly large component of overall health care costs of the Ministry of Health. The program for Hypertension and Diabetes (HiperDia) provides distribution of more than 15 medications for those two diseases. However, besides this onerous pharmaceutical care, Brazil is facing a greater burden of T2D. The lack of discontinuing the soaring T2D might be due to the lack of knowledge of underlying epigenetics of insulin resistance and, consequently the principles for its treatment. The homeostasis model adopted by physicians in restoring the “low level” of plasma glucose probably has been inappropriate because if one signal is suppressed by a drug, the brain compensates by driving all the others harder. By adding more drugs to a complex system increases the frequency of iatrogenesis and costs. Alternatively, the allostasis model can explain insulin resistance without postulating any true defect because blood glucose fluctuates according to match the ever-shifting prediction of what might be needed. Insulin resistance would be caused by prolonged exposure to high glucose level that reduces its receptor number and sensitivity. Additionally, insulin and other hormones that regulate fuel supply are modulated rigorously from the brain by standard signals for vigilance such as cortisol. Cortisol related signals are elevated during states of hypervigilance and of hyposatisfaction. For people of lower socioeconomic status potential sources of satisfaction are less available, but food is abundant and cheap. Elevated cortisol raises appetite for carbohydrate and fat and shifts the distribution of fat deposits toward the viscera and reduces insulin sensitivity. The allostasis model suggests that the brain overrides local negative feedback (metabolic satiety signals) and people eat. Obesity contributes to T2D as well as to metabolic syndrome and atherosclerosis creating a profoundly lethal cascade, and all follow the familiar epidemiological pattern of disrupted communities. The guiding principle for rational treatment of T2D, would be to reduce the need for vigilance and to restore small satisfactions. Among population-based strategies, diet and physical exercise are the pillars of T2D treatment. In our community-based dynamic cohort, the lifestyle change protocol with dietary counseling and supervised walking-jogging exercises, reduced T2D by four exercise protocols such as high intensity (75%), Academy (71.3%), Mixed (78.6%) and Hydro-gymnastic (34.3%). Besides effective, this allostatic model experience showed to be also a money-saving alternative to be implemented by the government.
Type 2 Diabetes, Homeostatic Treatment, Allostatic Treatment, Cost-Effectiveness of Treatments
To cite this article
Mariana Santoro Nakagaki, Hugo Tadashi Kano, Roberto Carlos Burini, Brazilian Primary Care of T2D with Reactive-Homeostatic and Lifestyle Changing- Allostatic Approaches: A Cost-Effectiveness Data, American Journal of Sports Science. Vol. 6, No. 3, 2018, pp. 98-107. doi: 10.11648/j.ajss.20180603.15
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
International Diabetes Federation (IDF). Diabetes atlas. 6th ed. International Diabetes Federation; 2013.
Hu FB. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care. 2011;34:1249–1257.
American Diabetes Association (ADA). “Economic costs of diabetes in the US in 2007,” Diabetes Care. 2008; 31:596–615.
Arredondo A, Zúñiga A, Parada I. Health care costs and financial consequences of epidemiological changes in chronic diseases in Latin America: evidence from Mexico. Public Health. 2005; 119:711–720.
Condliffe S, Link CR, Parasuraman S, Pollack MF. The effects of hypertension and obesity on total health-care expenditures of diabetes patients in the United States. Appl Econ Lett. 2013; 20:649–652.
Seuring T, Archangelidi O, Suhrcke M. The Economic Costs of Type 2 Diabetes: A Global Systematic Review. Pharmacoeconomics. 2015; 33(8): 811–831.
Bertoldi AD, Kanavos P, França GVA, Carraro A, Tejada CA, Hallal PC, et al. Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: a comprehensive literature review. Globalization and Health. 2013 Dec 3;9(1):62.
Bahia LR, Araujo DV, Schaan BD et al. The costs of type 2 diabetes mellitus outpatient care in the Brazilian public health system. Value in Health, 2011;14 (5 Suppl 1):S137–S140.
Malerbi DA, Franco LJ. Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30-69 yr. The Brazilian Cooperative Group on the Study of Diabetes Prevalence. Diabetes care. 1992 Nov;15(11):1509–16.
Bertoldi AD, Helfer AP, Camargo AL, Tavares NUL, Kanavos P. Is the Brazilian pharmaceutical policy ensuring population access to essential medicines? Global Health. 2012;8:6.
International Diabetes Federation (IDF), Diabetes Atlas, International Diabetes Federation Diabetes Atlas, Brussels, Belgium, 3rd edition, 2006.
Vieira FS. Gasto do Ministério da Saúde com medicamentos: tendência dos programas de 2002 a 2007. Rev Saúde Pública. 2009;34(2):206–9.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Research and Clinical Practice. 2010;87(1):4–14.
Sterling P. Principles of Allostasis: Optimal Design, Predictive Regulation, Pathophysiology, and Rational Therapeutics. In: Jay Schulkin, editor. Allostasis, homeostasis, and the costs of physiological adaptation. 2004; p. 17.
Buchman TG. The community of the self. Nature. 2002 Nov 14;420(6912):246–51.
Sterling P, Eyer J. Biological basis of stress-related mortality. Social science & medicine Part E, Medical psychology. 1981;15(1):3–42.
Schwartz MW, Woods SC, Porte D, Seeley RJ, Baskin DG. Central nervous system control of food intake. Nature. 2000 Apr 6;404(6778):661–71.
Rahal A, Kumar A, Singh V, Yadav B, Tiwari R, Chakraborty S, et al. Oxidative stress, prooxidants, and antioxidants: the interplay. BioMed research international. 2014 Jan 23;2014:761264.
Saper CB, Chou TC, Elmquist JK. The need to feed: homeostatic and hedonic control of eating. Neuron. 2002 Oct 10;36(2):199–211.
Schulkin J, McEwen BS, Gold PW. Allostasis, amygdala, and anticipatory angst. Neuroscience and biobehavioral reviews. 1994;18(3):385–96.
McLellan KCP, Manda RM, Sloan LA, Burini RC. Epigenetics of Glucose Metabolism and the Basis for T2DM Interventions. In: Type 2 Diabetes. InTech; 2013.
Diamond J. The double puzzle of diabetes. Nature. 2003 Jun 5;423(6940):599–602. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 9th ed. 2013.
Burini RC, Kano HT, Burini FHP and McLellan KCP. Metabolic Syndrome - From the Mismatched Evolutionary Genome with the Current Obesogenic Environment to the Lifestyle Modification as a Primary Care of Free-Living Adults in a Brazilian Community. In: Morton Jody, editor. Metabolic Syndrome: Clinical Aspects, Management Options and Health Effects. 2016. p. 54.
Zimmet P, Alberti KGMM, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001 Dec 13;414(6865):782–7.
Saltiel AR, Kahn CR. Insulin signalling and the regulation of glucose and lipid metabolism. Nature. 2001 Dec 13;414(6865):799–806.
Popkin BM. Nutrition Transition and the Global Diabetes Epidemic. Curr Diab Rep. 2015; 15(9): 64.
Mota JF, Moreto F, Burini FHP, Medina WL, Rimm EB and Burini RC. Effect of Physical Conditioning with Lifestyle Intervention on A Community-Based Hyperglycemic-Overweight Adults. Journal of US-China Medical Science. 2011;8(No. 10 (Serial No. 83)):581–7.
Burini RC, Torezan GA, McLellan KCP. Behavioral risk factors and effects of lifestyle modification on adults with Diabetes: A Brazilian community-based study. Emerging Issues in Medical Diagnosis and Treatment. Concept Press Ltd. 2013; 1.
Moreto F, Kano HT, Torezan GA, Oliveira EP, Manda RM, et al. Changes in malondialdehyde and C-reactive protein concentrations after lifestyle modification are related to different metabolic syndrome-associated pathophysiological processes, Diabetes and Metabolic Syndrome. 2015; 9: 218-222.
Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003; 35: 1381-1395.
Heyward VH. Avaliação da composição corporal aplicada (1st Edn.) São Paulo. 2000.
World Health Organization. OBESITY Preventing and managing the global epidemic: report of a WHO Consultation on Obesity. Geneva: World Health Organization. 1998.
Janssen I, Baumgartner RN, Ross R, Rosenberg IH, Roubenoff R. Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women. Am J Epidemiol. 2004; 159: 413-421.
Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998; 147: 755-763.
Bray G. An approach to the classification and evaluation of obesity. In: Bjorntorp P, Brodoff BN. Obesity. 1992; 294-308.
Balke B, Ware RW. An experimental study of Air Force personel. US Armed Forces Med J 1959; 10: 675-88.
Baumgartner TAJ, A. S. Measurement for evaluation in physical education and exercise science. 8th Edition ed1995.
American Diabetes Association (ADA). Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;32(S1): S62-S67.
Nakagaki MS, Michelin E, Teixeira O, Burini RC. Cardiorespiratory Fitness and Insulin Sensitivity Response to high-Intensity Interval Training in Overweight Post- menopausal Women. Diabetes Obes Int J 2017, 2(2): 000152.
ACSM’s Guidelines for Exercise Testing and Pescription. 9th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health, 2014.
Burini RC, Nakagaki MS, Michelin E, Burini FHP. Treating Blood Hypertension in a Brazilian Community: Moving from Reactive Homeostatic Model to Proactive Allostatic Healthcare. Ann Clin Hypertens. 2018; 2: 001-016.
Mota JF; Moreto F; Medina WL; Pereira ECL; Burini RC. Nutritional and metabolic risk factors for insulin resistance in adults. International Journal of Nutrition and Metabolism. 2011; 3(7): 90-96.
Burini RC, Torezan GA, Sloan LA, Corrente JE, McLellan KCP. Dietary Intake Association with IFG and Responses of a Lifestyle Changing Protocol in a Community-B based Adult Cohort. Endocrinol Metab Synd 2014; 3:125.
Burini FHP, Salatini R, Nakagaki MS, Corrente JC, Rimm EB, Burini RC. Medicated Non-controlled Wholesomely Non-communicable chronic disease Patients - A Costless Effective Outcome Under “exercise is Medicine” Program: 1445 Board #238 May 28, 9. Medicine and Science in Sports and Exercise. 2015 May 1;47(5S):389.
Tuomilehto J; Lindström J; Eriksson JG; Valle TT; Hämäläinen H; Ilanne-Parikka, P. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine, 2001; 344:1343-1350.
Knowler, W. C.; Barret-Connor, E.; Fowler, S. F.; Hamman, R. F.; Lachin, J. M.; Walker, E. A. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New Englanf Journal of Medicine. 2002; 346:393-403.
Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012; 380: 219-229.
Fiuza-Luces C, Garatachea N, Berger NA, Lucia A. Exercise is the real polypill. Physiology (Bethesda). 2013; 28: 330-358.
Ventura-Clapier R; Mettauer B; Bigard X. Beneficial effects of endurance training on cardiac and skeletal muscle energy metabolism in heart failure. Cardiovascular Research.2007;73: 10–18.
Ostrowski K, Rohde T, Asp S, Schjerling P, Pedersen BK. Pro- and anti-inflammatory cytokine balance in strenuous exercise in humans. J Physiol. 1999; 515: 287-291.
Huang SH; Czech MP. The GLUT4 glucose transporter. Cell Metabolism. 2007;5:237–252.
Chakravarthy MV; Booth FW. Eating, exercise, and “thrifty” genotypes: connecting the dots toward an evolutionary understanding of modern chronic diseases. Journal of Applied Physiology. 2004;96: 3-10.
Burini RC, Kano HT, Nakagaki MS, Nunes CNM, Burini FHP. The lifestyle modification effectiveness in reducing Hypertension in a Brazilian Community: From the epigenetic basis of Ancestral Survival to the Contemporary Lifestyle and Public Health Initiatives HUMAN HYPERTENSION. Heighpubs J Clin Hypertens. 2017;1:010–31.
Browse journals by subject