The prevalence of diabetes mellitus (DM) is very high in Brazil and worldwide. It is estimated that there are now more than 12 million diabetics in Brazil, not counting those who already have the disease but have not yet been diagnosed. Since the introduction of insulin, the treatment of DM has been constantly changing, according to treatment guidelines proposed by diabetes societies, from the diagnosis to more advanced stages of the disease. More stable insulins, as well as incretin-based therapy for subcutaneous use, have been proposed in the treatment of type 2 DM patients. These therapies have not only contributed to the better treatment of the most prevalent type of diabetes, but also introduced the use of a parenteral medication other than insulin.

Infective endocarditis (IE) is a relatively rare, serious cardiovascular disease with a hospital mortality rate of 17-25%, despite all therapeutic advances. In an observational study by Bezerra et al., published in this issue of the IJCS, the association between the use of insulin and IE is discussed. In this retrospective study involving 211 patients, 17 with DM (nine insulin users), there was a higher proportion of S. aureus infection in diabetics using insulin. However, mortality rate was not higher among diabetics when compared to non-diabetics. There is a lack of studies on IE in DM and regarding the use of insulin and IE, data are even more scarce. So, the study by Bezerra et al., assumes an importance in this area of knowledge, since we are talking about a highly prevalent disease (DM) and a serious comorbidity (IE) with a still high risk of mortality.

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OBJECTIVE: To analyze the epidemiology, diagnosis, clinical aspects causes and evolution of infectious endocarditis. METHODS: The patients analyzed were treated at the University Hospital of the Faculdade de Medicina of Ribeirão Preto-USP and had a diagnosis of infectious endocarditis defined by Duke’s criteria, which classifies infectious endocarditis as native, prosthetic valve or that occurring in intravenous drug users. RESULTS: One hundred and eighty episodes of infectious endocarditis in 168 patients were observed. Echocardiograms in 132 (73.3%) provided a diagnosis of infectious endocarditis in 111 (84%) patients; mitral valves were affected in 55 (30.5%), tricuspid valves in 30 (16.6%) and the aortic valve in 28 (15.5%) patients. Hemocultures were performed in 148 (93.8%) episodes of IE. The most commonly isolated infectious organisms were Staphylococcus aureus in 46 (27.2%) patients and Streptococcus viridans in 27 (15.9%). Complications occurred in 116 (64.4%) patients and 73 (40.5%) of the patients died. CONCLUSION: The general profile of the observed infectious endocarditis was similar to that reported in studies performed in other countries and included users of intravenous drugs. The high degree of mortality observed is not compatible with progress in diagnosis and treatment of infectious endocarditis and is probably due to the absence of diagnostic suspicion. The high frequency of fatal cases of septicemia (45.1% of deaths) in the patients studied indicates that unnoticed cases of infectious endocarditis had only been diagnosed at necropsy.