Racial health disparities: a population-based analysis of physical activity and diabetes-related complications in Brazil.

OBJECTIVES: Racial disparity in physical activity in people with diabetes in Brazil remains scarcely investigated. We examined the association between physical activity and diabetes-related complications according to race in the Brazilian population. STUDY DESIGN: Cross-sectional. METHODS: We analyzed data from the 2019 National Health Survey, a population-based survey of Brazilian adults. We used a self-reported questionnaire to assess physical activity during commuting, leisure-time, domestic, and occupational activities. Diabetes-related complications included vision, kidney, and circulatory impairment, foot ulcers, diabetic coma, and all-cause complications. We used robust Poisson regression models with restricted cubic splines to examine the association between physical activity and diabetes-related complications. RESULTS: We included 2529 adults with diabetes (48.9% women; mean age: 53.5 ± 11.9 years). One-third experienced diabetes-related complications. Black adults performed less leisure-time and more occupational and commuting physical activity than White participants. Black participants showed a higher probability of all-cause (1.61; 95%CI: 1.29, 2.02) and vision complications (1.58; 95%CI: 1.23, 2.04) compared to White participants independent of physical activity status. Only leisure-time physical activity was associated with a reduced probability of all-cause complications (PR: 0.78; 0.71, 0.86) whereas commuting and occupational physical activity were not associated with any diabetes-related complications. Physically inactive, Brown adults showed a higher probability of kidney, circulatory, vision, and all-cause complications than active, White adults. However, physical activity attenuated the probability of these complications in Brown participants. CONCLUSION: The association between physical activity and diabetes-related complications is domain-specific. We revealed a racial disparity in physical activity in people with diabetes in Brazil.

Living well with diabetes in Alaska.

Many people with diabetes mellitus experience minimal or no complications. Our objective was to determine the proportion of Alaska Native people who experienced four major complications or mortality and to identify factors that may be associated with these outcomes. We used records in a diabetes registry and clinical and demographic variables in our analyses. We used logistic regression and Cox Proportional Hazards models to evaluate associations of these parameters with death and complications that occurred prior to 2013. The study included 591 Alaska Native people with non-type 1 diabetes mellitus, diagnosed between 1986 and 1992. Over 60% of people in this study remained free of four major diabetes-related complications for the remainder of life or throughout the approximately 20-year study period. Lower BMI, higher age at diagnosis of diabetes, and use of at least one diabetes medication were associated with death and a composite of four complications. A majority of Alaska Native people with DM had none of four major complications over a 20-year period. Lower BMI and use of diabetes medications were associated with higher hazard for some deleterious outcomes. This suggests that goals in care of elders should be carefully individualised. In addition, we discuss several programme factors that we believe contributed to favourable outcomes.

The epidemiology of end stage renal disease at a centre in Trinidad / Epidemiología de la fase terminal de la enfermedad renal en un centro de Trinidad

OBJECTIVE: The aim of this study is to estimate the trends in prevalence of end stage renal disease (ESRD) during the period 1999-2007 at one site in Trinidad, the Eric Williams Medical Sciences Complex (EWMSC), and to describe the epidemiological features, age, gender, ethnicity and co-morbidities associated with ESRD. DESIGN AND METHODS: A retrospective cohort study design was used. There was a count of patients on haemodialysis at the EWMSC centre from 1999 - 2007 in order to demonstrate trends in prevalence but more detailed data were collected and analysed for patients with ESRD attending the nephrology clinic between January 2002 and December 2007. The data that were collected from the patients' records included: demographic data (age, gender and ethnicity), medical history (diabetes mellitus, hypertension, end stage renal disease and autoimmune disorders), history of dialysis (type of vascular access, frequency of dialysis), mortality and its cause. RESULTS: Records of 81 patients were retrieved. Their age range was 10-79 years. The survey showed that patients most affected in the study population were: males, aged 50-59 years, who were hypertensive and/or diabetic and of African descent. CONCLUSIONS: In conclusion, we provide epidemiological evidence of ESRD and the associated contributing factors at one hospital in Trinidad.

OBJETIVO: El objetivo de este estudio es estimar las tendencias de la prevalencia de la enfermedad renal en fase terminal (ERFT) durante el periodo 1999-2007 en el Complejo de Ciencias Médicas Eric Williams, en Trinidad, y describir los rasgos epidemiológicos - edad, género, etnicidad - y co-morbilidades asociadas con la ERFT. DISEÑO Y MÉTODOS: Se usó un diseño de estudio de cohorte retrospectivo. Se llevó a cabo un análisis de todos los pacientes que asistieron a las clínicas de nefrología de EWMSC, de enero de 2002 a diciembre de 2007. Los datos recogidos de las historias clínicas de los pacientes al final del período de estudio incluyeron: datos demográficos (edad, género y etnicidad), historia médica (diabetes mellitus, hipertensión, enfermedad renal en fase terminal, trastornos autoinmunes), historia de diálisis (tipo de acceso vascular, frecuencia de diálisis), mortalidad y causa. RESULTADOS: Se obtuvieron las historias clínicas de 81 pacientes, cuya edad fluctuaba de 10 a 79 años. La encuesta mostró que los pacientes más afectados en la población del estudio fueron varones, de 50-59 años de edad, que eran hipertensos y/o diabéticos, de ascendencia africana. CONCLUSIONES: En conclusión, se ofrece evidencia epidemiológica de la ERFT en un hospital en Trinidad y se señalan los factores asociados que contribuyen a la enfermedad.

The role of K121Q ENPP1 polymorphism in diabetes mellitus and its complications

The aim of the present study was to analyze the frequency of K121Q polymorphism in the ENPP1 gene of Brazilian subjects according to ethnic origin and to determine its possible association with diabetes mellitus (DM) and/or diabetic complications. A cross-sectional study was conducted on 1027 type 2 DM patients and 240 anonymous blood donors (BD). Ethnicity was classified based on self-report of European and African descent. The Q allele frequency was increased in African descendant type 2 DM patients (KK = 25.9 percent, KQ = 48.2 percent, and QQ = 25.9 percent) and BD (KK = 22.0 percent, KQ = 53.8 percent, and QQ = 24.2 percent) compared to European descendant type 2 DM patients (KK = 62.7 percent, KQ = 33.3 percent, and QQ = 4.1 percent) and BD (KK = 61.0 percent, KQ = 35.6 percent, and QQ = 3.4 percent). However, there was no difference in genotype distribution or Q allele frequency between diabetic and non-diabetic subjects (European descendants: DM = 0.21 vs BD = 0.21, P = 0.966, and African descendants: DM = 0.50 vs BD = 0.51, P = 0.899). In addition, there were no differences in clinical, laboratory or insulin resistance indices among the three genotypes. The prevalence of DM complications was also similar. In conclusion, K121Q polymorphism is more common among Afro-Brazilian descendants regardless of glycemic status or insulin sensitivity indices. Likewise, insulin sensitivity and DM chronic complications appear not to be related to the polymorphism in this sample.

Factores socioculturales y familiares que interfieren en el tratamiento dietético de la Diabetes / Cultural and family factors that interfere with the dietary management of diabetes

La diabetes es un grupo de trastornos metabólicos caracterizados por niveles elevados de glucosa en la sangre, su tratamiento implica un régimen dietético especial para poder mantener la glucosa en niveles normales.El objetivo de la investigación fue identificar los factores socioculturales y familiares que interfieren en el tratamiento dietético de pacientes atendidos en el hospital San Juan de Dios de Cliza – Cochabamba.El estudio se realizó desde el enfoque cuantitativo con una muestra de 50 pacientes entre las edades de 45 a 70 años. Para la recolección de datos se empleó el cuestionario.Los resultados muestran que un 60% recibió la información sobre el cuidado que debe tener con la dieta lo que indica que la mayoría conoce el tratamiento dietético. También se pudo observar que entre las costumbres y tradiciones de los familiares esta el consumo de los alimentos en base a la carne de cerdo (96%) el cual esta contraindicado; sin embargo, el diabético se siente forzado a consumirlo por las presiones familiares y socioculturales.La mayoría de los diabéticos refieren que reciben colaboración familiar con el cumplimiento dietético y un 48% que sus familiares no colaboran con el mismo, lo que implica un mayor compromiso socio familiar en el apoyo al diabético.