Perspectives on emerging technologies, personalised medicine, and clinical research for cancer control in Latin America and the Caribbean.

Challenges of health systems in Latin America and the Caribbean include accessibility, inequity, segmentation, and poverty. These challenges are similar in different countries of the region and transcend national borders. The increasing digital transformation of health care holds promise of more precise interventions, improved health outcomes, increased efficiency, and ultimately reduced health-care costs. In Latin America and the Caribbean, the adoption of digital health tools is in early stages and the quality of cancer registries, electronic health records, and structured databases are problematic. Cancer research and innovation in the region are limited due to inadequate academic resources and translational research is almost fully dependent on public funding. Regulatory complexity and extended timelines jeopardise the potential improvement in participation in international studies. Emerging technologies, artificial intelligence, big data, and cancer research represent an opportunity to address the health-care challenges in Latin America and the Caribbean collectively, by optimising national capacities, sharing and comparing best practices, and transferring scientific and technical capabilities.

Prevalence of type 2 diabetes in Argentina 1979-2012.

The objective of this review was to revise the existing information regarding type 2 diabetes (T2D) prevalence in the Argentine population during the past 30 years and to see whether the available data and methodology of the studies conducted allow analysis of time trends. The PubMED and LILACS databases were searched using the search terms "diabetes prevalence" and "Argentina". A total of 301 studies were identified and 19 of them remained in the review after applying the inclusion and exclusion criteria. The studies reviewed covered a time period of 30 years (1979-2012). The studies conducted in Argentina during the last 30 years assessing the prevalence of T2D are very heterogeneous. The majority of the studies were conducted in the province of Buenos Aires. As the assessment of T2D varied between the studies in respect of diagnostic criteria and diagnostic tests for T2D, meaningful comparisons are difficult to make, not to mention an analysis of time trends. All in all, the T2D prevalence seems to be at least 10% in the Argentina population. However, the latest large population surveys conducted in Argentina is promising and may offer the most reliable estimates of the T2D prevalence even though the diagnosis of T2D was based on participant self-report. This article is protected by copyright. All rights reserved.

Insulin lispro low mixture twice daily vs basal insulin glargine once daily and prandial insulin lispro once daily as insulin intensification strategies in patients with type 2 diabetes: Latin American subpopulation analysis of a randomized trial.

BACKGROUND: This post hoc analysis examined the efficacy and safety of twice-daily insulin lispro low mixture (LM25) and once-daily basal insulin glargine plus once-daily prandial insulin lispro (IGL) in a Latin American subpopulation with type 2 diabetes mellitus (T2DM). METHODS: A phase 4, randomized, open-label, parallel-arm trial included participants aged 18-75 years with T2DM taking once-daily insulin glargine and stable doses of metformin and/or pioglitazone with glycated hemoglobin (HbA1c) 7.5-10.5 % and fasting plasma glucose ≤121 mg/dL. Participants were randomized 1:1 to receive their stable dose of metformin and/or pioglitazone plus twice-daily LM25 or IGL for 24 weeks. The primary efficacy outcome was change in HbA1c after 24 weeks of treatment. Results from participants in Argentina, Brazil, and Mexico are presented here. RESULTS: 162 participants (80 LM25; 82 IGL) with mean ± standard deviation (SD) age = 57.3 ± 9.0 years and body mass index = 31.3 ± 5.2 kg/m(2) were included. Mean ± SD change in HbA1c from baseline to week 24 was -1.5 ± 1.0 % (LM25) and -1.1 ± 1.2 % (IGL). At week 24, 35.1 % (LM25) and 31.6 % (IGL) of participants achieved HbA1c <7.0 %. Mean ± SD weight gain from baseline to week 24 was 2.4 ± 2.9 kg in the LM25 group and 1.0 ± 3.1 kg in the IGL group. The mean ± SD rates of total hypoglycemia per year were 18.9 ± 27.3 (LM25) and 21.6 ± 31.1 (IGL). Rates of treatment-emergent adverse events were 46 % (LM25) and 39 % (IGL). CONCLUSIONS: Our results suggest that both LM25 and IGL are viable treatment options for insulin intensification in Latin American patients with T2DM with suboptimal glycemic control on basal insulin glargine. The safety and tolerability profiles of LM25 and IGL are consistent between this Latin American population and the global trial-level population. Trial registration NCT01175824.

Dapagliflozin: drug profile and its role in individualized treatment.

Dapagliflozin is the first sodium-glucose co-transporter inhibitor developed. An extensive program covering all phases of clinical research showed us the efficacy and safety profile of the drug. Dapagliflozin and the other SGLT2 inhibitors are a new treatment alternative in patients with Type 2 diabetes either as monotherapy or combined with the hypoglycemic agents currently available and is approved in approximately 38 countries worldwide. This drug profile provides the necessary tools to assess the risks and benefits of this new molecule.

Prevalencia de diabetes mellitus y factores de riesgo cardiovascular en adultos de Mar del Plata-Batan, 2015-2016 / Prevalence of diabetes mellitus and cardiovascular risk factors in adults from Mar del Plata-Batán, 2015-2016

INTRODUCCIÓN: Las enfermedades no transmisibles (ENT), que incluyen entre otras la diabetes mellitus (DM), afectan en mayor proporción a los países de ingresos bajos y medios, donde causan más de 31 millones de muertes por año. El objetivo fue describir aspectos metodológicos y resultados del estudio de prevalencia de DM, alteraciones del metabolismo de la glucosa y factores de riesgo cardiovascular en Mar del Plata-Batán (MdP-B) en 2015-2016. MÉTODOS: Se utilizó un diseño transversal en población de 35 años y más. La muestra fue polietápica, estratificada según nivel de instrucción del jefe de hogar y probabilística en la primera etapa. El estudio constó de dos fases: encuestas por autorreporte en domicilio; examen físico, medidas antropométricas, cuestionario FINDRISC y determinaciones analíticas sanguíneas en los institutos de investigación. RESULTADOS: Se encuestó a 1034 participantes; el 37,1% realizó determinaciones de laboratorio. El 54,7% eran mujeres. La mediana de edad fue 54±12,9 años. Las prevalencias halladas fueron DM: cruda 22,1%, ajustada 21,1%; hipertensión arterial: cruda 41,2%, ajustada 38,9%; colesterol elevado: cruda 37,3%, ajustada 35,7%. Se observó mayor prevalencia de DM en varones. DISCUSIÓN: MdP-B mostró una prevalencia de DM ajustada por edad significativamente mayor que la de Argentina, y los varones exhibieron peor situación cardio-metabólica, aspectos que merecen consideración en la elaboración de políticas de prevención de ENT

Prevalencia de diabetes mellitus y factores de riesgo cardiovascular en adultos de Mar del Plata-Batán, 2015-2016 / Prevalence of diabetes mellitus and cardiovascular risk factors in adults from Mar del Plata-Batán, 2015-2016

RESUMEN INTRODUCCIÓN Las enfermedades no transmisibles (ENT), que incluyen entre otras la diabetes mellitus (DM), afectan en mayor proporción a los países de ingresos bajos y medios, donde causan más de 31 millones de muertes por año. El objetivo fue describir aspectos metodológicos y resultados del estudio de prevalencia de DM, alteraciones del metabolismo de la glucosa y factores de riesgo cardiovascular en Mar del Plata-Batán (MdP-B) en 2015-2016. MÉTODOS Se utilizó un diseño transversal en población de 35 años y más. La muestra fue polietápica, estratificada según nivel de instrucción del jefe de hogar y probabilística en la primera etapa. El estudio constó de dos fases: encuestas por autorreporte en domicilio; examen físico, medidas antropométricas, cuestionario FINDRISC y determinaciones analíticas sanguíneas en los institutos de investigación. RESULTADOS Se encuestó a 1034 participantes; el 37,1% realizó determinaciones de laboratorio. El 54,7% eran mujeres. La mediana de edad fue 54±12,9 años. Las prevalencias halladas fueron DM: cruda 22,1%, ajustada 21,1%; hipertensión arterial: cruda 41,2%, ajustada 38,9%; colesterol elevado: cruda 37,3%, ajustada 35,7%. Se observó mayor prevalencia de DM en varones. DISCUSIÓN MdP-B mostró una prevalencia de DM ajustada por edad significativamente mayor que la de Argentina, y los varones exhibieron peor situación cardio-metabólica, aspectos que merecen consideración en la elaboración de políticas de prevención de ENT.

ABSTRACT INTRODUCTION Noncommunicable diseases (NCDs), which include among others diabetes mellitus (DM), disproportionately affect low- and middle-income countries, where they cause over 31 million deaths each year. The aim was to describe the methodological aspects and results of the study of the prevalence of DM, glucose metabolism disorders and cardiovascular risk factors in Mar del Plata-Batán (MdP-B), Argentina, in 2015-2016. METHODS A cross-sectional design was used in a population aged 35 years and over. The sample was multi-stage, stratified by education level of the head of household and probabilistic in the first stage. The study consisted of two phases: selfreport surveys at home; physical examination, anthropometric measurements, FINDRISC questionnaire and blood analytical determinations in research institutes. RESULTS A total of 1034 participants were surveyed, 37.1% underwent laboratory determinations, 54.7% were women, and the median age was 54±12.9 years. Prevalences found were DM: crude 22.1%, adjusted 21.1%; arterial hypertension: crude 41.2%, adjusted 38.9%; high cholesterol: crude 37.3%, adjusted 35.7%. There was a higher prevalence of DM in males. DISCUSSION MdP-B showed an age-adjusted prevalence of DM significantly higher than that of Argentina and men had a worse cardio-metabolic situation, aspects that should be taken into account in NCD prevention policies.