[Comprehensive care in type 2 diabetes: from DiabeIMSS to CADIMSS]. / Atención integral en diabetes tipo 2: transición del modelo DiabetIMSS a CADIMSS.

In diabetes, obtaining optimal control is key to reducing chronic complications. Unfortunately, not all patients achieve the recommended goals. Therefore, the challenges to develop and evaluate comprehensive care models are enormous. In October 2008, the Diabetic Patient Care Program (DiabetIMSS) was designed and implemented in family medicine. Its principal component is the multidisciplinary team (doctor, nurse, psychologist, dietitian, dentist, and social worker) that offers coordinated health care; monthly medical consultation and individual, family and group education on self-care and prevention of complications for 12 months. Due to the COVID-19 pandemic, the percentage of attendance at the DiabetIMSS modules decreased significantly. This is how the Medical Director considered it necessary to strengthen them, and the Diabetes Care Centers (CADIMSS) arose. In addition to providing medical care with a comprehensive and multidisciplinary approach, the CADIMSS encourages the co-responsibility of the patient and his family. It consists of monthly medical consultation and nursing staff provides monthly educational sessions for 6 months. Pending tasks remain and there are still areas of opportunity to modernize and reorganize services that contribute to improving the health of the population with diabetes.

En un paciente con diabetes, la obtención de un control óptimo es clave para reducir las complicaciones crónicas. Desafortunadamente, no todos los pacientes logran las metas recomendadas. Por ello, son substanciales los desafíos para desarrollar y evaluar modelos de atención integral. En octubre del 2008, se diseñó e implementó el Programa de Atención al Paciente Diabético (DiabetIMSS) en medicina familiar. Su componente básico es el equipo multidisciplinario (médico, enfermera, psicólogo, dietista, dentista y trabajador social) que ofrece asistencia sanitaria coordinada, consulta médica mensual y educación individual, familiar y grupal sobre autocuidado y prevención de complicaciones durante 12 meses. Debido a la pandemia de COVID-19, el porcentaje de asistencia a los módulos DiabetIMSS disminuyó importantemente. Es así como la Dirección de Prestaciones Médicas consideró necesario su fortalecimiento, por lo que surgen los Centros de Atención a la Diabetes (CADIMSS). Además de proporcionar atención médico-asistencial con enfoque integral y multidisciplinario, en los CADIMSS se fomenta la corresponsabilidad del paciente y su familia, y se otorga consulta médica mensual y sesiones educativas a cargo de personal de enfermería durante 6 meses. Sin embargo, siguen tareas pendientes, y aún hay áreas de oportunidad para modernizar y reorganizar los servicios que contribuyan a mejorar la salud de la población con diabetes.

Altered Glycemic Control Associated With Polymorphisms in the SLC22A1 (OCT1) Gene in a Mexican Population With Type 2 Diabetes Mellitus Treated With Metformin: A Cohort Study.

The organic cation transporters OCT1 and OCT2 and the multidrug and toxin extrusion transporter MATE1, encoded by the SLC22A1, SLC22A2, and SLC47A1 genes, respectively, are responsible for the absorption of metformin in enterocytes, hepatocytes, and kidney cells. The aim of this study was to evaluate whether genetic variations in the SLC22A1, SLC22A2, and SLC47A1 genes could be associated with an altered response to metformin in patients with type 2 diabetes mellitus. A cohort study was conducted in 308 individuals with a diagnosis of type 2 diabetes mellitus of less than 3 years and who had metformin monotherapy. Three measurements of blood glycated hemoglobin (HbA1c ) were obtained at the beginning of the study and after 6 and 12 months. Five polymorphisms were analyzed in the SLC22A1 (rs622342, rs628031, rs594709), SLC22A2 (rs316019), and SLC47A1 (rs2289669) genes by real-time polymerase chain reaction. The results showed a significant association among genotypes CC-rs622342 (ß = 1.36; P < .001), AA-rs628031 (ß = 0.98; P = .032), and GG-rs594709 (ß = 1.21; P = .016) in the SLC22A1 gene with an increase in HbA1c levels during the follow-up period. Additionally, a significant association was found in the CGA and CAG haplotypes with an increase in HbA1c levels compared to the highest-frequency haplotype (AGA). In conclusion, the genetic variation in the SLC22A1 gene was significantly related to the variation of the HbA1c levels, an important indicator of glycemic control in diabetic patients. This information may contribute to identifying patients with an altered response to metformin before starting their therapy.