[Prevalence of obesity and diabetes in Spain. Evolution in the last 10 years]. / Prevalencia de obesidad y diabetes en España. Evolución en los últimos 10 años.

The prevalence of overweight and obesity has been increasing in recent decades, worldwide and in all age groups, including children and adolescents. In Spain, the prevalence of overweight and obesity is high and is expected to increase in the coming years. The World Atlas of Obesity suggests that in 2035 the prevalence of obesity in Spain will be high or very high, both in adults and children, following the worldwide trend. The prevalence of diabetes and obesity in Spain is higher in older people, especially those aged 65 and over. In the case of Spanish children and adolescents, there seems to be a stabilization in the rates of overweight and obesity, with the exception of the group of girls aged 10-15 years, where a gradual increase has been observed in the last 10 years.

Results of the implementation of the DP-TRANSFERS project in Catalonia: a translational method to improve diabetes screening and prevention in primary care.

INTRODUCTION: DP-TRANSFERS is a translational lifestyle intervention project, which follows a previous protocol described in the DE-PLAN-CAT study. OBJECTIVE: Analyze the feasibility of reproducing the intensive intervention and estimating the effect of translation in real conditions of clinical practice in primary care. METHODOLOGY: Implementation of the face-to-face group intervention adjusted to 2 years. After screening, the intervention consisted of a basic module and a continuity module. Stratifying by clusters (health centers), a representative sample (centers, professionals and participants) was evaluated (FINDRISC > 11 and/or prediabetes) from 2016 to 2020. The effect of the intervention on the incidence of diabetes was analyzed. RESULTS: The intervention, feasible in 95 of 123 centers, involved 343 of 647 professionals. Of 2381 subjects screened, 1713 participated in the basic module, with 1186 participants completing the first year and 776 completing the second. 121 participants (7.06%) were diagnosed with diabetes: 77 (4.49%) during the first year; 44 (2.57%) during the second. The bivariate analysis showed that those subjects in whom diabetes affected differed in: previous glycemic status, A1c, HDL-cholesterol, FINDRISC score and adherence to the Mediterranean diet, and in the differences between the beginning and end of the study of: body weight, BMI and abdominal circumference. CONCLUSIONS: The intensive intervention substantially reduced (23.6%) the incidence of diabetes compared to that previously estimated in standardized intervention. The following acted as protective factors: a better glycemic status, lower baseline risk, elevated HDL-cholesterol, or achieving a reduction in weight or abdominal circumference during the study.

Impact of the presence and type of cardiovascular disease on the risk of mortality in type 2 diabetic patients: The DIABET-IC trial.

INTRODUCTION: All-cause mortality and cardiovascular mortality (CVM) risk can be very high in adults with type 2 diabetes mellitus (DM2) with previous cardiovascular disease (CVD). Our objective was to determine this risk among the different clinical spectrum of CVD. MATERIAL AND METHODS: The DIABET-IC trial is a multicenter, prospective, observational, and analytical study. Consecutive subjects with DM2 attending our outpatients' clinics were recruited. Data on clinical features, lab test results, and echocardiographic measures were collected. Patients were categorized depending on the presence and type of CVD: heart failure (HF), coronary artery disease (CAD), cerebrovascular disease (CVD) and peripheral artery disease (PAD). All-cause mortality and CVM were the dependent variables analyzed. Mortality rate was expressed as deaths per 1000 patients-year. Cox proportional hazards regressions models were used to establish the mortality risk associated with every type of CVD. RESULTS: We studied a total of 1246 patients (mean age, 6.3 (SD, 9.9) years; 31.6%, female) with an initial prevalence of CVD of 59.3%. A total of 122 deaths (46 due to CVD) occurred at the 2.6-year follow-up. All-cause and MCV rates associated with the presence of PAD (85.6/1000 and 33.6/1000, respectively) and HF (72.9/1000 and 28.7/1000 respectively) were the most elevated of all. In multivariate analysis, HF increased all-cause mortality risk (HR, 1.63; CI 95% 1.03-2.58; P=.037) and the risk of CVM (HR, 3.41; 95% CI, 1.68-6.93; P=.001). CONCLUSIONS: Mortality among DM2 patients is highly increased in the presence of HF and PAD. This justifies the screening of these conditions to intensify therapeutic strategies.

[Antihypertensive prescription in type 2 diabetes patients in Andalusia and SEH-LELHA 2022 guidelines: An economic cost evaluation]. / Prescripción de antihipertensivos en personas con diabetes tipo 2 en Andalucía y recomendaciones SEH-LELHA 2022: evaluación del coste y uso.

OBJECTIVE: This study aims to analyze the prescription of antihypertensive drugs in patients with type 2 diabetes (T2D) in Andalusia, comparing it with the SEH-LELHA 2022 guidelines, and to assess the direct cost of these treatments. MATERIALS AND METHODS: A multicentric, cross-sectional, and descriptive study was conducted with 385 T2D patients. Participants were randomly selected from the patient lists of 120 primary care physicians from Andalusia. Inclusion criteria included a diagnosis of T2D and complete clinical records for the year 2022. Demographic data and drug prescription information were collected, with the average cost per patient being calculated. RESULTS: The mean age of the subjects was 70.72 years, with 53.51% being male. A total of 70.9% of the patients were taking antihypertensive drugs, the most common being ACE inhibitors/ARBs (70.9%), diuretics (70.1%), beta-blockers (40.0%), and calcium channel blockers (20.0%). Each patient took an average of 2.46±1.06 antihypertendsive, and fixed association of 2 or more antihypertensive drugs were used by 40.9% of the studied patients. The annual cost per patient was 141.45€/year. CONCLUSIONS: The study reveals strong adherence to the SEH-LELHA 2022 guidelines among physicians in Andalusia regarding the of antihypertensives for T2D patients, with a significant preference for Renin-Angiotensin System blockers, diuretics, and beta-blockers. However, a notable deviation in prescription practices was observed with the frequent choice of doxazosin over spironolactone, despite the latter being the recommended option for resistant hypertension. Although the overall expenditure on antihypertensives is moderate, their cost-effectiveness is enhanced by the efficacy of these treatments in preventing cardiovascular complications.

Comparison of baseline clinical characteristics among people with type 2 diabetes on second-line therapy previously added with dapagliflozin or another oral glucose-lowering drug: AGORA study.

INTRODUCTION: Type 2 diabetes mellitus (T2D) has acquired epidemic proportions worldwide. In recent years, new oral glucose-lowering drugs (OGLD) have emerged that improve the cardiovascular-kidney-metabolic control in T2D people. OBJECTIVES: To compare the baseline clinical-biological characteristics among T2D people to whom had added-on dapagliflozin (DAPA group) or another OGLD (SOC group) second-line hypoglycaemic therapies among the AGORA study population. METHODS: This is a multicentre cross-sectional observational study of the baseline characteristics of T2D people recruited through competitive sampling among 46 primary care health centres in Spain for the AGORA study. The inclusion and exclusion criteria of participants, and justification of the sample size are reported. After verifying the data necessary to be evaluated and informed consent, 317 subjects were included to the DAPA group and 288 to the SOC group. Both categorical and continuous variables were analysed and compared with the usual statistics. Cohen's d was used to assess the standardised difference in means. RESULTS: Six hundred and five patients with T2D were assessed (mean age 63.5 [SD±8.1] years, 61.8% men), whom 17.4% were smokers, 47.6% had obesity, 74.8% hypertension, 87.3% dyslipidaemia, and 41.7% reported physical inactivity, with no significant differences between both comparison groups. The mean (SD) evolution time of T2D was 10.1 (5.6) years. Most baseline clinical-biological characteristics at recruitment were similar in both groups. However, DAPA group was younger (2.9 years), and had lower systolic blood pressure (SBP) (2.8mmHg), higher body weight (BW) (3.7kg), and higher glycated haemoglobin A1c (HbA1c) (0.3%) than SOC group. Only 11.5% of participants had poor glycaemic control (HbA1c>8%) at recruitment, 54.9% had good glycaemic control (HbA1c<7%), being significantly lower in the DAPA group (47.3%) than in the SOC group (63.4%). The percentage of T2D patients with high vascular risk (VR) was 46.3%, and 53.7% with very high VR, being significantly higher in the DAPA group (57.4%) than in the SOC group (49.6%). CONCLUSIONS: Most baseline cardiovascular-kidney-metabolic characteristics were similar in T2D patients whom had added dapagliflozin on second-line hypoglycaemic therapy as those whom had added-on another OGLD. However, patients whom had added-on dapagliflozin had higher VR, lower SBP, higher BW, and slightly worse HbA1c control. Future research is necessary to explain the causes of these differences in cardiometabolic control.

Características clínicas de pacientes con enfermedad del pie relacionado a la diabetes mellitus que acudieron al Hospital Nacional 2022-2023

Introducción: las enfermedades del pie relacionadas a la diabetes mellitus representan una de las causas de mayor morbilidad e incapacidad en las personas con diabetes mellitus tipo 2, siendo la causa más frecuente de ingreso hospitalario en dicho grupo. Objetivo: describir las características clínicas de los pacientes con enfermedad del pie relacionadas a la diabetes mellitus del Hospital Nacional 2022-2023. Metodología: se seleccionaron 113 pacientes portadores de diabetes mellitus tipo 2 con pie diabético mayores de 18 años. Se evaluaron las variables demográficas, medidas antropométricas, características de la enfermedad, comorbilidades y características clínicas del pie. Resultados: de los 113 estudiados 42 pacientes (37 %) correspondieron al sexo femenino y 71 (63 %) al sexo masculino, promedio de edad fue de 65 años DE 12,191. 75 pacientes (66 %) presentaron pie diabético, con lesión Wagner grado 4. El 81 % (92) tenía hipertensión arterial, sedentarismo 65 % (84), en menor frecuencia pacientes con sobrepeso 38 % (43), obesidad 25 % (38), tabaquismo 23 % (26) y dislipidemia 18 % (20). Conclusión: las características clínicas de los pacientes con diabetes tipo 2 con lesión en el pie coinciden con otros trabajos obtenidos a nivel mundial. Es muy importante prestar atención a este grupo de riesgo, mediante medidas preventivas y realizar el tratamiento precoz para disminuir las complicaciones.

Introduction: foot diseases related to diabetes mellitus represent one of the causes of greatest morbidity and disability in people with type 2 diabetes mellitus, being the most frequent cause of hospital admission in said group. Objective: to describe the clinical characteristics of patients with foot disease related to diabetes mellitus at Hospital Nacional 2022-2023. Methodology: 113 patients with type 2 diabetes mellitus with diabetic foot over 18 years of age were selected. Demographic variables, anthropometric measurements, disease characteristics, comorbidities, and clinical characteristics of the foot were evaluated. Results: of the 113 studied, 42 patients (37 %) were female and 71 (63 %) were male, average age was 65 years SD 12,191. 75 patients (66 %) presented diabetic foot, with Wagner grade 4 lesion. 81 % (92) had high blood pressure, sedentary lifestyle 65 % (84), less frequently overweight patients 38 % (43), obesity 25% (38) ), smoking 23 % (26) and dyslipidemia 18 % (20). Conclusion: the clinical characteristics of patients with type 2 diabetes with foot injury coincide with other works obtained worldwide. It is very important to pay attention to this risk group, through preventive measures and carry out early treatment to reduce complications.

[Strategies for the prevention and non-pharmacological treatment of diabetes. Models of care]. / Estrategias para la prevención y tratamiento no farmacológico de la diabetes. Modelos de atención.

Diabetes is a highly prevalent, chronic disease that over time generates potentially serious complications. In the treatment of diabetes, the use of drugs that have shown significant benefits is important, but, in addition, the use of non-pharmacological interventions is essential, which constitute an efficient and effective way to reduce the appearance of diabetes itself and the complications of the disease. These interventions, which are described here, include health education, aimed at incorporating a healthier lifestyle, dietary modifications, increased physical activity or psychological support. Finally, the characteristics that a care system for people with diabetes must meet to achieve the established objectives are discussed.

[Factors associated with caregiver burden in primary caregivers of older adults with type2 diabetes]. / Factores asociados a la sobrecarga del cuidador en cuidadores primarios de personas adultas mayores con diabetes tipo2.

OBJECTIVE: To characterize the profile of the informal primary caregiver (IPC) of adult patients with type2 diabetes (T2D) and the possible factors associated with caregiver collapse (CC). DESIGN: Observational, descriptive, cross-sectional and analytical study. SITE: Ambulatory Care Medical Unit. PARTICIPANTS: Mexican CPIs of adult patients with T2D. MAIN MEASUREMENTS: Data were collected through a prolective design using the Zarit scale and a structured survey on sociodemographic factors. A descriptive statistical analysis and univariate and multivariate logistic regression models were performed. RESULTS: The CPI profile is assumed by: women, people aged 36-58, daughters, people with a secondary and high school educational level, married, Catholic, with income <8,900 Mexican pesos, own home, inhabited by a maximum of 5 inhabitants, with support networks, who have dedicated >5years to the care of their patient, without training and with chronic diseases. The risk factors that increase the risk of CC are: being a woman (OR=11.03; 95%CI: 1.49-81.95), having a history of more than 5years of having assumed the role of caregiver (OR=2, 65; 95%CI: 1.07-6.55), living in one's own house (OR=3.03; 95%CI: 1.04-8.82), with 6 or more inhabitants (OR=2.41; 95%CI: 1.08-5.38). The support of other family members and/or friends was associated as a protective factor (OR=0.15; 95%CI: 0.07-0.33). CONCLUSIONS: Prevention programs are required to avoid CC and complications, as well as interventions to improve the quality of life of the CPI and patients in care, incorporating strategies to generate and/or increase their family and social support networks.

Sleep and cardiometabolic risk. Narrative revision. / Sueño y riesgo cardiometabólico. Revisión narrativa.

OBJECTIVES: Sleep disturbances, including disrupted sleep and short sleep duration, are highly prevalent and are prospectively associated with an increased risk for various chronic diseases, including cardiometabolic, neurodegenerative, and autoimmune diseases. MATERIAL AND METHODS: This is a narrative review of the literature based on numerous articles published in peer-reviewed journals since the beginning of this century. RESULTS: The relationship between sleep disorders and metabolic dysregulation has been clearly established, mainly in the setting of modern epidemic of cardiometabolic disease, a cluster of conditions include obesity, insulin resistance, arterial hypertension, and dyslipidaemia, all of them considered as main risk factor for atherosclerotic cardiovascular disease (ACVD) and its clinical expression such as ischemic ictus, myocardial infarction and type 2 diabetes. Clinically viable tools to measure sleep duration and quality are needed for routine screening and intervention. CONCLUSIONS: In view of what has been exposed in this review, it is evident that the timing, amount, and quality of sleep are critical to reduce the burden of risk factors for several chronic disease, including ACVD and type 2 diabetes, and most relevant in young people. Future research studies should elucidate the effectiveness of multimodal interventions to counteract the risk of short sleep for optimal patient outcomes across the healthcare continuum, especially in young people.

Approach to patients with diabetes and obesity in primary care.

AIMS: The aim of this study is to analyse the effect of pharmacological and non-pharmacological treatment on weight control in patients with diabetes and obesity. DESIGN: Epidemiological, descriptive, cross-sectional study. SITE: Primary care. In 11 health centres in Málaga and Cádiz during April and October 2022. PARTICIPANTS: 281 patients over 18 years old with type 2 diabetes and obesity are included. MAIN MEASUREMENTS: Socio-demographics, clinical, treatment and lifestyle habits variables were obtained from medical records and personal interview. Descriptive statistics were obtained for continuous variables. Statistical tests were performed based on the nature of the variables. RESULTS: Variables like marital status, level of education and occupation, and smoking habit, shows differences regarding the sex (p<0.05). 82.3% of those who received education lost weight, compared to 67.5% of lost weight who received no health education (p=0.004). GLP1 and SGLT2 were more commonly prescribed for women (p=0.048), and SGLT2 more commonly prescribed for men (p=0.047). Patients taking GLP1, SGLT2 or both, regardless of sex, weight loss during the study period was -3.1kg (SE: 0.60), while the loss of those who took other medications was -1.33kg (SE: 0.62). The mean difference was 1.75kg (p=0.046). CONCLUSIONS: In terms of weight loss, obese diabetics who took GLP1, SGLT2 or both were 2.5 times more likely to lose weight than those who did not. Healthy lifestyle choices are key to weight loss in obese diabetic patients.

[Diabetes control and visits to the family doctor during the COVID-19 pandemic: a multicenter study in primary care]. / Control de diabetes y consultas al médico de familia durante la pandemia de COVID-19: estudio multicéntrico en atención primaria.

OBJECTIVES: To determine whether in patients with type 2 diabetes (DM2) the changes in their relationship with family doctors during the COVID-19 pandemic, in-person (iPC) and telematic (TC) consultations, were associated with control of their disease. DESIGN: Multicentric study of retrospective follow-up. SETTING: Seven health centers in Tenerife, Spain. PARTICIPANTS: 3543 patients with DM2. MAIN MEASUREMENTS: Sex, age, iPC, TC and DM2 control using glycosylated hemoglobin (A1c) during the period 2019-2021. Logistic regression models were fitted with DM2 control as an effect, and with the other measurements as independent variables. RESULTS: 50% were women. 38% were less than 65 years old. A1c was measured in 84% of patients in 2019, 68% in 2020, and 77% in 2021. 58.4% had good control in 2019, 46.1% in 2020, and 50.3% in 2021. Median iPC were 7 in 2019, 4 in 2020 and 5 in 2021 (p<0.001). The OR(95%CI) of good control in 2019 were 1.04(1.04-1.05) per year of age and 1.03(1.01-1.04) for each iPC; In 2020 they were 1.04 (1.03-1.05) per year of age, 1.05 (1.04-1.07) for each iPC and 1.04 (1.02-1.07) for each TC; in 2021 they were 1.04 (1.04-1.05) per year of age, 1.05 (1.03-1.06) for each iPC and 1.02 (1.00-1.04) for each TC. CONCLUSIONS: The control of patients with DM2 during the period 2019-2021 had a direct relationship with the change in the frequency of consultations at the health center, with differences depending on the type of consultation and the age of the patient.

Clinical outcomes of percutaneous coronary intervention in chronic total occlusion in patients with type 2 diabetes mellitus.

INTRODUCTION AND OBJECTIVES: Coronary chronic total occlusions (CTOs) are relatively common findings in patients with type 2 diabetes mellitus (T2DM). However, the indication for percutaneous coronary intervention (PCI) and its clinical benefit in these patients remain controversial. METHODS: A single-center retrospective cohort study with prospectively collected outcomes was carried out with CTO patients undergoing PCI in 2019 and 2020. Patients were divided into two groups according to previous T2DM diagnosis (T2DM and non-T2DM). The primary outcome was recurrence of angina and/or heart failure symptoms and secondary outcomes were myocardial infarction and all-cause mortality. RESULTS: A total of 177 patients (82.5% male) were included in the analysis, with a mean age of 65±11 years. The primary outcome (total symptom recurrence) occurred in 16.6% of the sample, with no difference between groups (non-T2DM 13.6% vs. T2DM 21.2%, p=0.194) in a two-year follow-up. Angina recurrence was significantly more frequent in T2DM patients (15.2%, p=0.043). The presence of T2DM was not an independent predictor of symptom recurrence (p=0.429, HR 1.37, 95% CI 0.62-2.98). Myocardial infarction and all-cause mortality were also not different between groups (T2DM 1.5%, p=0.786 and 4.5%, p=0.352, respectively, on survival analysis). Independent predictors of all-cause mortality were left ventricular function and creatine clearance (p=0.039, HR 0.92, 95% CI 0.85-0.99 and p=0.013, HR 0.96, 95% CI 0.93-0.99, respectively). CONCLUSIONS: T2DM did not influence outcomes in CTO patients undergoing PCI, and its presence should not be a limiting factor in deciding on CTO revascularization.

Association of vitamin D receptor gene polymorphisms with type 2 diabetes mellitus in Taif population: a case-control study

Abstract Several reasons may underlie the dramatic increase in type2 diabetes mellitus. One of these reasons is the genetic basis and variations. Vitamin D receptor polymorphisms are associated with different diseases such as rheumatoid arthritis and diabetes. The aim of this study is to investigate the possible association of two identified mutations ApaI (rs7975232) and TaqI (rs731236). Eighty-nine healthy individuals and Fifty-six Type 2 Diabetic (T2D) patients were investigated using RFLP technique for genotyping and haplotyping as well. The distribution of Apal genotypes was not statistically significant among the control (P=0.65) as well as for diabetic patients (P=0.58). For Taql allele frequencies of T allele was 0.61 where of G allele was 0.39. The frequency distribution of Taql genotypes was not statistically significant among the control (P=0.26) as well as diabetic patients (P=0.17). Relative risk of the allele T of Apa1 gene is 1.28 and the odds ratio of the same allele is 1.53, while both estimates were 1.0 of the allele G. Similarly, with the Taq1 gene the relative risk and the odds ratio values for the allele T are 1.09 and 1.27 respectively and both estimates of the allele C were 0.86 for the relative risk and 0.79 for the odds ratio. The pairwise linkage disequilibrium between the two SNPs Taq1/apa1 was statistically significant in control group (D = 0.218, D' = 0.925 and P value 0.001) and similar data in diabetic groups (D = 0.2, D' = 0.875 and P value 0.001). These data suggest that the T allele of both genes Apa1 and Taq1 is associated with the increased risk of type 2 diabetes. We think that we need a larger number of volunteers to reach a more accurate conclusion.

Resumo Várias razões podem estar subjacentes ao aumento dramático da diabetes mellitus tipo 2. Um desses motivos é a base genética e variações. Os polimorfismos do receptor da vitamina D estão associados a diferentes doenças, como artrite reumatoide e diabetes. O objetivo deste estudo é investigar a possível associação de duas mutações identificadas ApaI (rs7975232) e TaqI (rs731236). Oitenta e nove indivíduos saudáveis e 56 pacientes com diabetes tipo 2 (T2D) foram investigados usando a técnica RFLP para genotipagem e haplotipagem também. A distribuição dos genótipos Apal não foi estatisticamente significativa entre o controle (P = 0,65), bem como para os pacientes diabéticos (P = 0,58). Para as frequências do alelo Taql, o alelo T foi de 0,61, onde o alelo G foi de 0,39. A distribuição de frequência dos genótipos Taql não foi estatisticamente significativa entre o controle (P = 0,26), bem como os pacientes diabéticos (P = 0,17). O risco relativo do alelo T do gene Apa1 é 1,28 e a razão de chances do mesmo alelo é 1,53, enquanto ambas as estimativas foram 1,0 do alelo G. Da mesma forma, com o gene Taq1, os valores de risco relativo e razão de chances para o alelo T são 1,09 e 1,27, respectivamente, e ambas as estimativas do alelo C foram de 0,86 para o risco relativo e 0,79 para o odds ratio. O desequilíbrio de ligação par a par entre os dois SNPs Taq1 / apa1 foi estatisticamente significativo no grupo de controle (D = 0,218, D' = 0,925 e valor P 0,001) e dados semelhantes em grupos diabéticos (D = 0,2, D' = 0,875 e valor P 0,001). Esses dados sugerem que o alelo T de ambos os genes Apa1 e Taq1 está associado ao aumento do risco de diabetes tipo 2. Achamos que precisamos de um número maior de voluntários para chegar a uma conclusão mais precisa.

Evaluación del puntaje FINDRISC para detección de prediabetes y diabetes tipo 2 sin diagnóstico / FINDRISC as screening for detection of prediabetes and unknown type 2 diabetes

Resumen Introducción : Es fundamental poner en práctica ac ciones preventivas y de diagnóstico poblacional precoz para detectar a las personas en riesgo de desarrollar Diabetes tipo 2 (DT2). El objetivo del trabajo fue evaluar el desempeño del score FINDRISC como método de cri bado para detectar prediabetes y DT2 sin diagnostico en trabajadores municipales. Métodos : Estudio epidemiológico, descriptivo de corte transversal desde 10/21 al 3/22. Ingresaron voluntarios mayores a 18 años sin diagnóstico previo de DT2, se excluyó quienes padecían una enfermedad aguda, emba razadas o que realizaban tratamiento con medicamentos que modifiquen la glucemia. Los participantes comple taron el FINDRISC y realizaron una Prueba Oral de Tole rancia a la Glucosa (POTG). El desempeño se determinó mediante el cálculo de la sensibilidad (S), especificidad (E), y el área bajo la curva (AUC-ROC). Se utilizó un índice de Youden para definir el punto de corte óptimo. Resultados : Ingresaron 148 personas, entre 18-67 años, con media de edad 42.9 ± 11.8 años, el 68.9% de sexo masculino. La frecuencia de DT2 sin diagnóstico fue del 3.3% (n = 5) y de prediabetes del 12.2% (n = 18). El promedio de puntos de FINDRISC fue de 10.0 ± 4.8. El punto de corte optimo fue ≥ 13 (S = 65.2% y E = 74.4%) y el AUC-ROC 0.76 (IC95%: 0.66-0.86). Conclusión : El FINDRISC demostró ser un método eficaz para identificar personas con DT2 y prediabetes con punto de corte 13 en la población, lugar y periodo de estudio.

Abstract Introduction : It is fundamental to put into practice preventive and early population diagnosis actions to detect people at risk for developing Type 2 diabetes (T2D). The aim of this study was to evaluate the FINDRISC score performance as screening method to detect prediabetes and unknown T2D in municipal workers. Methods : descriptive epidemiological and cross-sectional study from 10/21 to 03/22. People suffering from a severe illness, pregnant or were already receiv ing drugs that modify blood glucose, were excluded. Participants completed the FINDRISC and performed an oral glucose tolerance test (OGTT). The performance of the FINDRISC was determined by calculating sensitiv ity, specificity, and area under the curve (AUC-ROC). The Youden's J statistic index was used to define the optimal cutoff point. Results : 148 subjects between the ages of 18-65 were admitted, with a mean age of 42,9 ± 11,8, the 69% being males. The frequency of unknown T2D was of 3.3% (n = 5) and frequency of prediabetes was of 12.2% (n = 18). The mean of FINDRISC score was of 10.0 ± 4.8. The optimal cutoff point was ≥ 13 (sensitiv ity = 65.2%, Specificity = 74.4%) and the AUC-ROC 0.76 (IC95%: 0.66-0.86). Conclusion : The FINDRISC proved to be an effective method for identifying people with undiagnosed T2D and prediabetes with a cut-off point of 13 in the popula tion, place, and study period.

Actividades enzimáticas séricas de la ceruplasmina y la mieloperoxidasa en diabéticos tipo 2

Introducción: La diabetes mellitus tipo 2 se caracteriza por la hiperglucemia debido a la insuficiente producción de insulina de las células β. La mieloperoxidasa promueve el estrés oxidativo durante la inflamación y la ceruloplasmina se considera su inhibidor endógeno. Objetivo: Evaluar la relación entre la ceruloplasmina y la mieloperoxidasa, determinadas simultáneamente en el suero de pacientes diabéticos tipo 2. Métodos: Se estudiaron 362 pacientes diabéticos tipo 2 y 110 sujetos sanos. La actividad sérica de la ceruloplasmina se determinó por el método de Siotto; y el de la mieloperoxidasa, por el de Kraeisz. Resultados: El 72 % de los pacientes diabéticos tenían hiperglucemia y el 77 % presentaba obesidad abdominal. Las actividades de ambas enzimas se incrementaron significativamente en relación con el grupo control. El coeficiente de correlación de la actividad enzimática resultó bajo. El cociente RMPO/CP de los pacientes diabéticos superó el de los controles. La ceruloplasmina no inhibió la mieloperoxidasa. Conclusiones: Predominó la mieloperoxidasa, por tanto, no se manifestó el efecto inhibitorio de la ceruloplasmina. La elevada actividad de la mieloperoxidasa se asocia con un agravamiento del cuadro clínico del paciente diabético.

Introduction: Type 2 diabetes mellitus is characterized by hyperglycemia due to insufficient insulin production by β cells. Myeloperoxidase promotes oxidative stress during inflammation and ceruloplasmin is considered its endogenous inhibitor. Objective: To evaluate the relationship between ceruloplasmin and myeloperoxidase, determined simultaneously in the serum of type 2 diabetic patients. Methods: A total of 362 type 2 diabetic patients and 110 healthy subjects were studied. Serum ceruloplasmin activity was determined by the Siotto KM method and myeloperoxidase by the Kraeisz JE method. Results: 72% of diabetic patients had hyperglycemia and 77% had abdominal obesity. The activities of both enzymes were significantly increased relative to the control group. The correlation coefficient of enzyme activity was low. The ORMO/CP ratio of diabetic patients exceeded that of controls. Ceruloplasmin did not inhibit myeloperoxidase. Conclusions: Myeloperoxidase predominated, therefore, the inhibitory effect of ceruloplasmin was not manifested. The high activity of myeloperoxidase was associated with a worsening of the clinical picture of the diabetic patient.

Association of vitamin D receptor gene polymorphisms with type 2 diabetes mellitus in Taif population: a case-control study / Associação de polimorfismos do gene do receptor de vitamina D com diabetes mellitus tipo 2 na população Taif: um estudo de caso-controle

Abstract Several reasons may underlie the dramatic increase in type2 diabetes mellitus. One of these reasons is the genetic basis and variations. Vitamin D receptor polymorphisms are associated with different diseases such as rheumatoid arthritis and diabetes. The aim of this study is to investigate the possible association of two identified mutations ApaI (rs7975232) and TaqI (rs731236). Eighty-nine healthy individuals and Fifty-six Type 2 Diabetic (T2D) patients were investigated using RFLP technique for genotyping and haplotyping as well. The distribution of Apal genotypes was not statistically significant among the control (P=0.65) as well as for diabetic patients (P=0.58). For Taql allele frequencies of T allele was 0.61 where of G allele was 0.39. The frequency distribution of Taql genotypes was not statistically significant among the control (P=0.26) as well as diabetic patients (P=0.17). Relative risk of the allele T of Apa1 gene is 1.28 and the odds ratio of the same allele is 1.53, while both estimates were < 1.0 of the allele G. Similarly, with the Taq1 gene the relative risk and the odds ratio values for the allele T are 1.09 and 1.27 respectively and both estimates of the allele C were 0.86 for the relative risk and 0.79 for the odds ratio. The pairwise linkage disequilibrium between the two SNPs Taq1/apa1 was statistically significant in control group (D = 0.218, D' = 0.925 and P value < 0.001) and similar data in diabetic groups (D = 0.2, D' = 0.875 and P value < 0.001). These data suggest that the T allele of both genes Apa1 and Taq1 is associated with the increased risk of type 2 diabetes. We think that we need a larger number of volunteers to reach a more accurate conclusion.

Resumo Várias razões podem estar subjacentes ao aumento dramático da diabetes mellitus tipo 2. Um desses motivos é a base genética e variações. Os polimorfismos do receptor da vitamina D estão associados a diferentes doenças, como artrite reumatoide e diabetes. O objetivo deste estudo é investigar a possível associação de duas mutações identificadas ApaI (rs7975232) e TaqI (rs731236). Oitenta e nove indivíduos saudáveis ​​e 56 pacientes com diabetes tipo 2 (T2D) foram investigados usando a técnica RFLP para genotipagem e haplotipagem também. A distribuição dos genótipos Apal não foi estatisticamente significativa entre o controle (P = 0,65), bem como para os pacientes diabéticos (P = 0,58). Para as frequências do alelo Taql, o alelo T foi de 0,61, onde o alelo G foi de 0,39. A distribuição de frequência dos genótipos Taql não foi estatisticamente significativa entre o controle (P = 0,26), bem como os pacientes diabéticos (P = 0,17). O risco relativo do alelo T do gene Apa1 é 1,28 e a razão de chances do mesmo alelo é 1,53, enquanto ambas as estimativas foram < 1,0 do alelo G. Da mesma forma, com o gene Taq1, os valores de risco relativo e razão de chances para o alelo T são 1,09 e 1,27, respectivamente, e ambas as estimativas do alelo C foram de 0,86 para o risco relativo e 0,79 para o odds ratio. O desequilíbrio de ligação par a par entre os dois SNPs Taq1 / apa1 foi estatisticamente significativo no grupo de controle (D = 0,218, D' = 0,925 e valor P < 0,001) e dados semelhantes em grupos diabéticos (D = 0,2, D' = 0,875 e valor P < 0,001). Esses dados sugerem que o alelo T de ambos os genes Apa1 e Taq1 está associado ao aumento do risco de diabetes tipo 2. Achamos que precisamos de um número maior de voluntários para chegar a uma conclusão mais precisa.

Epidemia de diabetes tipo 2 en México. Análisis de la carga de la enfermedad 1990-2021 e implicaciones en la política pública / Type 2 diabetes epidemic in Mexico. Burden of disease 1990-2021 analysis and implications for public policies

Resumen Antecedentes: México enfrenta un desafío por la carga que representa la diabetes tipo 2 (DT2). Objetivo: Analizar la epidemiología y la carga de DT2 en México de 1990 a 2021 en los ámbitos nacional y estatal. Material y métodos: Se empleó el Global Burden of Disease 2021 para evaluar prevalencia, incidencia, mortalidad, carga letal y no letal. Se consideraron factores metabólicos, ambientales y de comportamiento. Se realizó análisis comparativo por sexo, edad y entidad federativa. Resultados: Se incrementó la prevalencia de DT2 en 25 % y la incidencia en menores de 45 años; la mortalidad en mujeres disminuyó. La tasa de años de vida saludable (AVISA) perdidos se incrementó en todos los estados, entre 45.2 % en Nuevo León y 237.6 % en Tabasco. En 2021, la DT2 ocasionó 3.1 millones de AVISA perdidos, que representaron 6.6 % de la carga total en México, de la cual 64 % se atribuyó a muertes prematuras. La neuropatía diabética afectó a 47 % y las afecciones visuales a 270 000 personas; 66.3 % de la carga se atribuyó a obesidad. Conclusiones: Urgen políticas integrales para reducir la carga de DT2 en México, mediante pautas estandarizadas, estrategias basadas en evidencia y recursos tecnológicos que mejoren la accesibilidad y eficiencia de la atención médica.

Abstract Background: Mexico faces a challenge due to the burden imposed by type 2 diabetes (T2D). Objective: To analyze T2D epidemiology and burden in Mexico from 1990 to 2021, at the national and state levels. Material and methods: Estimates from the Global Burden of Disease 2021 study were used to evaluate the prevalence, incidence, mortality, fatal and non-fatal burden. Metabolic, environmental and behavioral factors were considered. Comparative analyses were carried out by gender, age and state of the country. Results: The prevalence of T2D increased by 25%. The incidence increased in those younger than 45 years, with a mortality decrease being found among women. The rate of disability-adjusted life years (DALY) showed an increase in all states, from 45.2% in Nuevo León to 237.6% in Tabasco. In 2021, T2D caused the loss of 3.1 million DALYs, which accounted for 6.6% of total burden in Mexico, out of which 64% was due to premature deaths. Diabetic neuropathy affected 47%, and there were 270,000 cases of visual impairment; 66.3% of the burden was attributed to obesity. Conclusions: Comprehensive policies are urgently needed in order to reduce the burden of T2D in Mexico, through standardized guidelines, evidence-based strategies and technological resources that improve medical care accessibility and efficiency.

"Tus pies te llaman": Impacto de una intervención para mejorar autocuidado de pies en diabetes / "Your feet call you": Impact of an intervention to improve self-care of feet in diabetes

Resumen Objetivo: Evaluar el impacto de una intervención educativa individualizada en los conocimientos, autocuidado de los pies, control glucémico, riesgo de ulceración e incidencia de úlceras en pacientes con diabetes tipo 2. Material y Métodos: Estudio de intervención realizado en 65 pacientes ambulatorios, mayores de 35 años, con diabetes tipo 2, distribuidos aleatoriamente en dos grupos: grupo control (35) quien recibió un manual de cuidado de los pies, y grupo intervención (30) quien recibió la intervención, un kit de cuidado de los pies y un manual. El seguimiento se realizó a los tres y seis meses después de la intervención. El análisis estadístico incluyó la prueba de Chi-cuadrado, prueba de Wilcoxon y prueba ANOVA de mediciones repetidas. Resultados: La intervención mejoró los conocimientos y el autocuidado de pies en el grupo de intervención, con diferencias significativas entre grupos (p=.001), pero no mejoró el control glucémico ni el riesgo de ulceración. Conclusiones: El programa "tus pies te llaman" fue efectivo parcialmente, este estudio puede ser replicado en instituciones de primer nivel de forma ordinaria para mejorar el autocuidado y prevenir la ulceración del pie a mediano plazo.

Abstract Objective: To evaluate the impact of an individualized educational intervention on knowledge, self-care of the feet, glycemic control, risk of ulceration and incidence of ulcers in patients with type 2 diabetes. Material and Methods: The intervention study, was carried out on 65 outpatients, over 35 years of age, with type 2 diabetes, patients were randomly distributed into two groups: the control group (35), who received a manual on foot care, and the intervention group (30), who received the intervention, a foot care kit, and manual. Follow-up was done at three and six months after the intervention. Statistical analysis included the Chi-square test, Wilcoxon test and the ANOVA test of repeated measures. Results: The intervention improved knowledge and foot self-care in the intervention group with significant differences between groups (p=.001), but not the glycemic control or the ulceration risk. Conclusions: The program "Your Feet Call You" was partially effective, and this study can be ordinarily replicated in first-level institutions to improve self-care and prevent foot ulceration in the medium term.

Consensus document of the management of type 2 diabetes and heart failure: Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) and Inter-American Society of Cardiology (IASC).

Heart failure (HF) syndrome is a global public health issue. On the other hand, type 2 diabetes is a risk factor associated with overweight/obesity and a sedentary lifestyle. This consensus aims to compile information available on the relationship between HF and type 2 diabetes and present, in a summarized and practical way, the management recommendations based on scientific evidence. The document includes the description of the epidemiology of HF and type 2 diabetes; pathophysiology of HF and type 2 diabetes; cardiovascular complications of type 2 diabetes; stages of HF; management of type 2 diabetes in patients with HF; and management of HF in patients with type 2 diabetes. Lastly, in the conclusions section, the growing trend of both events and the need to start preventive activities is presented, as well as the favorable role of antidiabetic drugs in the treatment of patients with HF.

El síndrome de insuficiencia cardíaca (IC) es un problema de salud pública global. Por su parte, la diabetes tipo 2 es un factor de riesgo asociado a sobrepeso/obesidad y sedentarismo. El presente consenso busca recopilar la información disponible sobre la relación entre la IC y la diabetes tipo 2, y presentar, de manera práctica y resumida, las recomendaciones de manejo basadas en la evidencia científica. El documento se estructura en la descripción de la epidemiología de la IC y la diabetes tipo 2; la fisiopatología de la IC y la diabetes tipo 2; las complicaciones cardiovasculares de la diabetes tipo 2; los estadios de la IC; el manejo de la diabetes tipo 2 en pacientes con IC; y el manejo de la IC en pacientes con diabetes tipo 2. Por último, en el apartado de conclusiones se presenta una clara tendencia creciente de ambos eventos y se señala la necesidad del inicio de actividades preventivas, así como también el papel favorable de los fármacos antidiabéticos en el tratamiento de los pacientes con IC.

Impact of diabetes, malnutrition and sarcopenia on the prognosis of patients admitted to internal medicine.

OBJECTIVE: To describe patients hospitalized in internal medicine in terms of malnutrition and sarcopenia, depending on the presence or absence of type 2 diabetes mellitus (DM2), as well as to evaluate short- and long-term mortality related to both. METHODS: Cross-sectional, single-center study, which included consecutive patients admitted to internal medicine in May and October 2021. Malnutrition was determined using the Mini Nutritional Assessment-Short Form (MNA-SF) and sarcopenia using SARC-F and handgrip strength. Patients hospitalized for more than 48 h are excluded. RESULTS: 511 patients were analyzed, 49.1% male, mean age 75.2 +/- 15 years, 210 (41.1%) DM2. 6 groups (2 × 3 design) are generated based on the presence of DM2 and the nutritional status according to the result of the MNA-SF: 12-14 points, without risk; MNA-SF 8-12 points, high risk; MNA-SF 0-7 points, malnourished. Malnourished patients with DM2 had significantly higher sarcopenia, comorbidity, inflammation, and pressure ulcers. The main determinants of in-hospital mortality were sarcopenia (OR 1.27, 95%CI 1.06-1.54, p = 0.01), comorbidity (OR 1.27, 95%CI 1,08-1,49, p = 0.003) and inflammation (OR 1.01, 95%CI 1.00-1.02, p = 0.02). The 120-day prognosis was worse among malnourished patients (p = 0.042). CONCLUSION: Patients admitted with DM2 have a similar degree of malnutrition than the rest, but with greater sarcopenia. This sarcopenia, together with inflammation and comorbidity determine a worse prognosis. The active and early identification of malnutrition and sarcopenia and their subsequent approach could improve the prognosis of patients.