[Poor metabolic control in primary care]. / Causas de descontrol metabólico en atención primaria.

INTRODUCTION: Poor metabolic control is a constant in patients with diabetes worldwide, despite resources demonstrated to achieve therapeutic targets. The object of this study was to identify causes of poor metabolic control in patients with diabetes treated in Family Medicine Clinics in metropolitan Mexico City at the Instituto Mexicano del Seguro Social. MATERIAL AND METHODS: We analyzed 638 of 1,170 patients studied between 2000 and 2006. Anthropometric variables, occurrence of infections, treatment adherence, medical prescriptions, diet, exercise, and laboratory results were recorded. RESULTS: The proportion of patients with HbA1c < 7% worsened over time: from 38.9% at baseline it decreased to 21.4% (p < 0.001); LDL cholesterol decreased from 51.9 to 12.2% (p < 0.001), and controlled blood pressure from 35.6 to 23.3% (p < 0.001). A diet high in calories was associated with poor metabolic control (OR: 2.36; 95% CI: 1.34-4.13) and treatment intensification with elevated HbA1c (OR: 2.1; 95% CI: 1.14-4.14). Treatment was not intensified in 90% of patients outside targets. Infections, non-adherence, and drugs that interfere with oral hypoglycemic agents were not associated with higher HbA1c. CONCLUSIONS: The main factors associated with higher HbA1c were: disease progression, an inadequate diet, and lack of treatment intensification. Any program designed to improve the conditions of these patients must consider these factors.

No association between lymphoma and hepatitis C virus.

Several epidemiological studies have associated the presence of hepatitis C virus (HCV) with the development of B-cell malignant lymphoma. However, in areas where the prevalence of HCV is low, this association has not been demonstrated. The aim of this study was to established the prevalence of HCV in patients with B-cell malignant lymphoma. The study was performed in 416 patients with new, previously untreated B-cell malignant lymphoma (236 diffuse large cell [DLC], 97 follicular lymphoma, and 83 marginal B-cell zone malignant lymphoma) and 1902 cases (682 first-degree relatives, 832 healthy blood donors, and 408 patients with solid tumors); furthermore, 353 patients with chronic liver disease associated to HCV were the control groups. We found a prevalence of 0.48 positive HCV among malignant lymphoma, 0.12 for healthy blood donors, 0 in first-degree relatives, and 0.56 in patients with solid tumors, that were statistically significant. The odds ratio was 1.86 and its confidence interval included the equality. None of the patients with chronic liver disease and HCV developed malignant lymphoma in a median follow-up of 7.9 yr. We felt that the presence of HCV is not significant in the development of malignant lymphoma, and that reports of high prevalence were associated also to a high prevalence of HCV in the general population and this association will be considered hazardous.