[Early-onset type 2 diabetes mellitus. The experience from a third level medical institution]. / Diabetes tipo 2 de inicio temprano. Experiencia en una institución de tercer nivel de atención médica.

OBJECTIVE: Describe the clinical, metabolic and psychosocial characteristics observed among patients with early onset type 2 diabetes (T2DM). METHODS: We included 80 consecutive patients with early onset T2DM. All had a medical record, completed a battery of questionnaires and had blood and urine tests. RESULTS: Mean age was 49 +/- 12 years, 57.5% were women, 76.2% had a family history of diabetes and 68.8% a personal history of obesity. Diabetes was diagnosed at the mean age of 32 +/- 6 years with a mean duration of 17 +/- 11 years. Most patients (66.2%) were on poor glycemic control (Alc > 9.0%) and 30% were depressed. Insulin was commonly needed (80% of the patients) and started on average 9 years after diagnosis Significant diabetes related complications were common (71.3% of patients). A longer diabetes duration was the variable most significantly associated with developing complications (p < 0.00001). CONCLUSIONS: Patients with early onset T2DM constitute 27.8% of the total number of diabetic patients attending our clinic; they are characterized by a stronger family history of diabetes, a personal history of obesity and co-morbidities associated with metabolic syndrome. Longer disease course and poor glycemic control contribute to a high prevalence of diabetes related complications and high rates of mortality.

[Pilot study of two different strategies to reinforce self care behaviors and treatment compliance among type 2 diabetes patients from low income strata]. / Estudio piloto de dos diferentes estrategias para reforzar conductas de autocuidado y adherencia al tratamiento en pacientes de bajos recursos económicos con diabetes tipo 2.

UNLABELLED: Long term diabetes self-management behaviors, and strict glycemic control are difficult to achieve in clinical practice. OBJECTIVE: Asesss two different reinforcement strategies for diabetes selfcare management, psychological distress and glycemic control in a one year follow up study. METHODS: 70 consecutive type 2 diabetic patients, were recruited and randomly assigned to three study groups. Subjects in the control group (CG) continued with their normal treatment schedule. The second group received a reinforcement course at 6 months (RCG) and in the third group, patients were contacted monthly by phone (PHCG) to promote self-management attitudes and address problems as they arose. A battery of questions and laboratory work-up were obtained at baseline and at one year follow-up. RESULTS: At one year follow-up, the three groups significantly increased their diabetes-related knowledge. Both experimental groups displayed improved treatment compliance and had better adherence to the recommended meal plan (p=0.06 and 0.003). In addition, the PHCG significantly increased (p<0.0001) their adherence to pharmacological treatment. No significant differences were observed in glycemic control, prevalence of depression or diabetes related distress. CONCLUSIONS: Follow-up patient reinforcement strategies improve strategic diabetes self-care management behaviors. Further studies are needed to demonstrate the positive impact of these benefits on diabetes related outcomes.

Estudio piloto de dos diferentes estrategias para reforzar conductas de autocuidado y adherencia al tratamiento en pacientes de bajos recursos económicos con diabetes tipo 2 / Pilot study of two different strategies to reinforce self care behaviors and treatment compliance among type 2 diabetes patients from low income strata

Antecedentes: Es difícil establecer conductas apropiadas de autocuidado y cumplir los objetivos terapéuticos en pacientes con diabetes tipo 2. El objetivo de esta investigación fue evaluar el impacto de dos estrategias de reforzamiento en el autocuidado de la diabetes, variables psicosociales y control glucémico a un año de seguimiento. Métodos: Se incluyeron 70 pacientes con diabetes tipo 2 asignados en forma aleatoria a tres grupos de estudio: grupo control (GC) que continuó con el programa habitual de tratamiento; un segundo grupo (GCR), que recibió un curso educativo después de seis meses; un tercer grupo (GRT), asignado a recibir llamadas telefónicas mensuales para promover conductas de autocuidado e intentar detectar y solucionar problemas. Se practicaron diversos cuestionarios y análisis de laboratorio al inicio y un año después. Resultados: Al año de seguimiento, los tres grupos mejoraron en forma significativa sus conocimientos en diabetes. Ambos grupos experimentales mejoraron su adherencia al plan de alimentación (p=0.06 y 0.003). El GRT también mejoró su adherencia al tratamiento farmacológico (p<0.0001). No se observaron cambios significativos en el control glucémico, prevalencia de depresión o disfunción emocional asociada a la diabetes. Conclusiones: Las estrategias de reforzamiento mejoran el autocuidado de la diabetes. Se requieren estudios a largo plazo para demostrar el impacto de estos beneficios en la calidad de vida y el logro de los objetivos terapéuticos.

Long term diabetes self-management behaviors, and strict glycemic control are difficult to achieve in clinical practice. OBJECTIVE: Asesss two different reinforcement strategies for diabetes selfcare management, psychological distress and glycemic control in a one year follow up study. METHODS: 70 consecutive type 2 diabetic patients, were recruited and randomly assigned to three study groups. Subjects in the control group (CG) continued with their normal treatment schedule. The second group received a reinforcement course at 6 months (RCG) and in the third group, patients were contacted monthly by phone (PHCG) to promote self-management attitudes and address problems as they arose. A battery of questions and laboratory work-up were obtained at baseline and at one year follow-up. RESULTS: At one year follow-up, the three groups significantly increased their diabetes-related knowledge. Both experimental groups displayed improved treatment compliance and had better adherence to the recommended meal plan (p=0.06 and 0.003). In addition, the PHCG significantly increased (p<0.0001) their adherence to pharmacological treatment. No significant differences were observed in glycemic control, prevalence of depression or diabetes related distress. CONCLUSIONS: Follow-up patient reinforcement strategies improve strategic diabetes self-care management behaviors. Further studies are needed to demonstrate the positive impact of these benefits on diabetes related outcomes.

[Low galectin-3 capacity to discriminate thyroid lesions]. / Baja capacidad de galectina-3 para discriminar lesiones tiroideas.

UNLABELLED: Galectin-3 is considered useful in identifying lesions included in the term follicular tumour. OBJECTIVE: To evaluate galectin-3's power to discriminate among diverse thyroid lesions and to identify a set point of expression at which there is the least possible false positive results. METHODS: 26 follicular carcinomas and 104 assorted thyroid lesions were analysed (8 Hashimoto's thyroiditis, 18 goiter, 44 adenoma, 27 papillary carcinoma and 7 normal glands). Immunohistochemistry for galectin-3 was performed way (NCL-GAL-3, 1:100, Novocastra, UK). In a blinded manner intensity and percentage of expression were evaluated, as was its capacity to identify the previously mentioned thyroid entities with 2 x 2 tables. Minimum reactivity set point values were identified and the one which presented the least false positive cases was selected. RESULTS: A reaction was considered positive when 25% of the cells were marked, in which case neither the Hashimoto's thyroiditis, goiter, nor the residual tissue were positive for galectin-3. A positive galectin-3 reaction was identified in 4/44 adenomas, 5/26 follicular carcinomas and 18/27 papillary carcinomas. From a total of 53 carcinomas, 23 showed positive and 30 a negative reaction to galectin-3. Thus, galectin-3's sensitivity to discriminate between benign and malignant lesions was 94% while its specificity was 43%. When comparing follicular carcinoma with adenoma, sensibility was 19% while specificity was 91%. The positive predictive value was 56% and the negative predictive value 66%. Galectin-3 was most useful for identifying papillary thyroid carcinoma. CONCLUSIONS: Galectin-3 has limited value to distinguish benign from malignant thyroid lesions. The reaction must be considered positive when at least 25% of cells are marked.

Characteristics of patients with type 2 diabetes in México: Results from a large population-based nationwide survey.

OBJECTIVE: To describe the clinical characteristics of the diabetic population that formed part of a population-based survey conducted in México. RESEARCH DESIGN AND METHODS: In 2000, information was obtained from 42,886 subjects aged > or =20 years using a multistage sampling procedure. Standardized questionnaires were used. Anthropometric measurements, blood pressure, and capillary glucose concentrations were taken. RESULTS: Type 2 diabetes was found in 3,597 subjects (age-adjusted prevalence 8.18%), of which 2,878 (80%) had previously been diagnosed. The average age of the diabetic participants was 55.2 +/- 13.5 years; 13% were <40 years of age. Nine percent had been diagnosed for >10 years. The average BMI was 29.2 +/- 5.7 kg/m(2); three-quarters of the cases had BMI >25 kg/m(2). The average waist circumference was 102 +/- 13.4 cm, and increased waist circumference was more common among women. Arterial hypertension was found in half of the cases and, of those on treatment, only one-third had a blood pressure <140/90 mmHg. Smoking was reported in 34% of the diabetic group, a higher rate than in the nondiabetic subjects. There was at least one modifiable coronary risk factor in 67.6% of the cases. Very few followed an exercise or dietary regimen and a small percentage used insulin. CONCLUSIONS: Diabetes affects a large proportion of Mexican adults (8.18%). This figure may be underestimated. The majority of the subjects had modifiable risk factors for the chronic complications of diabetes. Only a few achieved adequate blood pressure control and other treatment goals.

Correlations between surrogate measures of insulin resistance and cardiovascular risk factors in obese and overweight patients.

There are different equations to estimate insulin sensitivity by using OGTT with a reasonable approximation to whole body sensitivity obtained with the glucose clamp. Further work is needed to address their role in clinical practice as markers of the metabolic syndrome and predictors for cardiovascular disease. In the present study, we determined plasma glucose and insulin values during an OGTT test in 144 overweight and obese individuals. We assessed insulin resistance by the use of different equations and established their relationship with cardiovascular risk factors associated to the insulin resistance syndrome. Distributed the patients by quintiles of body mass index (BMI), the different surrogate measures clearly demonstrated that the more obese individuals were the most insulin resistant, a similar but not significant trend was observed related to the other cardiovascular risk factors. Efforts to use both fasting and post-load glucose and insulin concentrations to create indexes for routine use in clinical practice do not seem to be particularly useful in overweight or obese patients, as most of these patients will be insulin-resistant and insulin resistance is closely linked but not equal to the metabolic syndrome.

Familial hypercholesterolemia due to ligand-defective apolipoprotein B100: first case report in a Mexican family.

BACKGROUND: Familial defective apolipoprotein B100 (FDB) is one of the known causes of familial hypercholesterolemia (FH). Its frequency among subjects with FH varies among ethnic groups; information on FH is insufficient for populations from Latin America. We proposed to describe prevalence of FDB in a cohort of Mexican FH probands (n = 30). METHODS: We searched for the known FDB mutations using polymerase chain reaction assays. In this set of patients, mean lipid values were representative of FH (cholesterol 351 mg/dL, LDL cholesterol 274 mg/dL, HDL cholesterol 51 mg/dL, and triglycerides 132 mg/dL). RESULTS: One subject with Arg3500Gln mutation was found: a 44-year-old male with a history of coronary heart disease (CHD) among paternal relatives. His lipid profile was cholesterol 370 mg/dL, LDL-cholesterol 300 mg/dL, HDL-cholesterol 32 mg/dL, and triglycerides 189 mg/dL. Tendinous xanthomata were detected. Three of four siblings, one of three sons, and one of nine nieces and nephews carried the mutation. The mutation was confirmed by automated sequencing. Tendinous xanthomata were absent in affected subjects younger than age 20 years; additionally, the subjects had borderline cholesterol levels. CONCLUSIONS: Our data suggest that FDB explains the small number of FH cases in Mexico. Inclusion of molecular biology assays to the clinical laboratory makes it possible to diagnose affected individuals with borderline cholesterol levels or without tendinous xanthomata.

Early-onset type 2 diabetes in Mexico.

This review summarizes the clinical, metabolic and genetic characteristics of early-onset type 2 diabetes in Mexico. Early-onset type 2 diabetes is both a clinical challenge and a public health problem. It is calculated that almost 300,000 Mexican diabetics are diagnosed between the ages of 20 and 40. The large Mexican family structure and the high prevalence of the disease provide a unique opportunity to identify the genes and the metabolic abnormalities involved in this form of the disease. In a hospital-based population, our group found that insulin deficiency was the main defect in this form of diabetes. Mutations in the NHF-1 alpha or HNF-4 alpha genes or autoimmunity to the beta cell were found in a small proportion of cases, leaving unexplained the majority of cases. Also discussed are the epidemiologic and therapeutic implications of early-onset type 2 diabetes, and the possible role of genetic testing for prevention.

Comparing easy and accessible parameters of glycemic control in type 2 diabetes

La determinación de hemoglobina glucosilada es estándar de oro para evaluar el control metabólico a largo plazo y se recomienda como estudio de rutina para paciente con diabetes. Su empleo en la práctica clínica tiene problemas derivados de la falta de estandarización entre los diferentes laboratorios y su costo. Estudios recientes han mostrado que la determinación de la glucemia postprandial puede resultar un mejor marcador del control glucémico que la glucemia de ayunas. El objetivo del presente estudio fue el de evaluar el valor relativo de la determinación de glucosa plasmática a diferentes horas del día y un programa sencillo y accesible a nuestra población de monitoreo en casa de glucemias capilares y glucosuria, comparado con la hemoglobina glucosilada en la evaluación del control metabólico de pacientes con diabetes tipo 2. Métodos. Sesenta pacientes con diabetes tipo 2 fueron instruidos para realizar durante un par de meses un monitoreo ambulatorio con glucemias capilares y glucosurias, al final se obtuvieron determinaciones de glucemia en varios momentos del día antes y después de los alimentos. Resultados. El promedio de las determinaciones de glucemia capilar mostró la mejor correlación con la HbA1c(r=0.84, p<0.001), seguida por el promedio de lecturas exclusivamente antes del desayuno o antes de la cena (r=0.82, p<0.001), y del valor de glucemia plasmática 2 horas posteriores al desayuno (r=0.79 p<0.001). La determinación de glucemia plasmática de ayuno mostró una correlación baja (r=0.65, p<0.001), pero una sensibilidad adecuada para predecir un control metabólico regular o malo. La duración de la diabetes y el tipo de tratamiento explicaron la varianza en los niveles de la HbA1c. Conclusiones. Los valores de glucemia de ayuno cada 2 meses, correlacionaron bien con la hemoglobina glucosilada y son el método más sencillo para evaluar el control metabólico en pacientes con diabetes tipo 2 que tienen aún preservada parte de su función pancreática endógena (diabetes por menos de 10 años y que utilizan un solo agente hipoglucemiante). Una determinación a la semana de glucemias capilares en ayuno tiene mejor correlación con la hemoglobina glucosilada que una glucemia plasmática de ayuno cada 2-3 meses. Determinaciones de glucemia plasmática postprandiales a las 2 y 5 horas tienen una buena correlación con la HbAic, pero no deben de sustituir el monitoreo en casa