RESUMO
PURPOSE OF REVIEW: Type 2 diabetes mellitus (T2DM) is one of the leading causes of death and disability in the world. The majority of diabetes deaths (> 80%) occur in low- and middle-income countries, which are predominant in Latin America. Therefore, the purpose of this article is to compare the clinical practice guideline (CPG) for the pharmacological management of T2DM in Latin America (LA) with international reference guidelines. RECENT FINDINGS: Several LA countries have recently developed CPGs. However, the quality of these guidelines is unknown according to the AGREE II tool and taking as reference three CPGs of international impact: American Diabetes Association (ADA), European Diabetes Association (EASD), and Latin American Diabetes Association (ALAD). Ten CPGs were selected for analysis. The ADA scored > 80% on the AGREE II domains and was selected as the main comparator. Eighty percent of LA CPGs were developed before 2018. Only one was not recommended (all domains < 60%). The CPGs in LA have good quality but are outdated. They have significant gaps compared to the reference. There is a need for improvement, as proposing updates every three years to maintain the best available clinical evidence in all guidelines.
Assuntos
Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , América Latina/epidemiologia , Fosfatos de DinucleosídeosRESUMO
Introducción: dentro de la familia se conjugan una serie de acontecimientos que permiten el desarrollo de sus integrantes. Es de suponer que si los niños crecen en un entorno favorable socioeconómico y afectivo, podrían llegar a tener un buen estado nutricional. Si se relacionan la seguridad alimentaria y la funcionalidad familiar con el estado nutricional, ello da cuenta de factores alternativos que pueden intervenirse para prevenir la desnutrición en los niños. Métodos: fueron seleccionados probabilísticamente en 63 municipios los usuarios de complementaciónalimentaria del Plan de Mejoramiento Alimentario y Nutricional (MANA). La muestra fue de 11 436 niños, y el muestreo utilizado fue aleatorio simple.A cada usuario se le realizó evaluación antropométrica, teniendoen cuenta las tablas de referencia de la OMS 2006 y la Resolución 2121 de Ministerio de la Protección Social.Se les aplicó a sus familias la escala de seguridad alimentaria en el hogar y se evaluó la funcionalidad familiar con el instrumento de Apgar familiar. Se utilizó estadística no paramétrica, regresión logística y análisis de correspondenciasmúltiples para analizar la información.Resultados: el retraso en la estatura se encontró en 14,9 % de los menores, 3,3 % presentó muy bajo pesopara la edad, 1,2 % muy bajo peso para la estatura y delgadez en 2 %. Se evidenció, por el contrario, elevadafrecuencia de sobrepeso y obesidad (superior al 30 %). En más del 70 % de los hogares se percibió inseguridadalimentaria y disfuncionalidad familiar en el 49 %. Se asociaron positivamente con la desnutrición crónica, elnúmero de integrantes del hogar, la inseguridad alimentaria,la disfunción familiar y la desnutrición aguda. Conclusión: se encontró asociación entre la seguridadalimentaria, la funcionalidad familiar y la desnutrición crónica, por lo cual estos, al igual que otros, se conviertenen factores de riesgo y hacen parte de indicadores indirectos susceptibles de intervención.
Introduction: Family is the unit in which theinternal and external subjects are combinedallowing development of childs aptitude. Thisitem is relevant if nutritional topics, their connectionswith food security and family functionare taken into account. Thus, the possible associationbetween these indirect factors and theproper nutritional state of a child give tools for a future intervention against other factors toovercome the malnutrition in the department of Antioquia.Methods: The aim of this transversal descriptive study was to investigate family function andfood security at the childrens homes of the program MANA (Nutritional and feeding improvementprogram of Antioquia). The childrens homes were selected from a representative sampleof 63 towns (municipalities) of the Department of Antioquia. The sample was comprised of 11 436 children and their families. An anthropometricevaluation was made to every child,taking into account the WHO 2006 reference tables and the Resolution 2121 of the ProtectionMinistry of Colombia. Sampling method was simple randomized. We used nonparametric statistics,logistic regression and correspondenceanalysis to analyze the data.Results: The delay in height was found in 14.9%, 3.3% with very low weight for age, and 1.2% withvery low weight for height and thin 2%. In contrast was a high prevalence of overweight and obesity(over 30%). In total, over 70% of households perceived food insecure and 49% dysfunctionalfamily. In the linear regression model were positively associated with chronic malnutrition, number of household members, food insecurity,family dysfunction, and severe malnutrition. Variables such as household income and age wasnegatively associated.Conclusion: There is association between food security, family functioning and chronic malnutrition.So these, as well as other factors, become risk factors and are part of indirect intervention policies.