Cost-effectiveness of a self-management and comprehensive training intervention in patients with type 2 diabetes up to 5 years of diagnosis in a specialized hospital in Mexico City.

INTRODUCTION: To assess the cost-effectiveness of a multidisciplinary and comprehensive innovative diabetes care program (CAIPaDi) versus usual treatment in public health institutions. RESEARCH DESIGN AND METHODS: Using a cost-effectiveness analysis, we compared the CAIPaDi program versus usual treatment given in Mexican public health institutions. The analysis was based on the IQVIA Core Diabetes Model, a validated simulation model used to estimate long-term clinical outcomes. Data were prospectively obtained from the CAIPaDi program and from public databases and published papers. Health outcomes were expressed in terms of life-years gained and quality-adjusted life years (QALYs). Health and economic outcomes were estimated from a public perspective and discounted at 5% per year over a 20-year horizon. Costs are reported in US dollars (US$) of 2019. A probabilistic sensitivity analysis was performed using life-years gained and QALYs. RESULTS: The CAIPaDi costs on average US$559 (95% CI: -$879 to -$239) less than the usual treatment (95% CI: -$879 to -$239) and produced a difference in mean life-years gained (0.48, 95% CI: 0.45 to 0.52) and mean QALYs (1.43, 95% CI: 1.40 to 1.46). The cost-effectiveness ratio resulted in a saving per life-year gained of -US$1155 (95% CI: -$1962 to -$460). Mean differences in QALYs resulted in a saving per QALY of -US$735 (95% CI: -$1193 to -$305). Probabilistic sensitivity analysis proved the results are robust on both life-years gained and QALYs. CONCLUSIONS: CAIPaDi has a better cost-effectiveness ratio than the usual therapy in Mexican public health institutions.

[Impact of different front-of-pack nutrition labels on foods according to their nutritional quality: a comparative study in Mexico]. / Impacto de diferentes etiquetados frontales de alimentos según su calidad nutricional: estudio comparativo en México.

OBJECTIVE: This study aimed to compare consumers' objec- tive understanding of five FoPLs [Health Star Rating system (HSR), Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), Warning Symbol] in Mexico. MATERIALS AND METHODS: 1 001 Mexican consumers were recruited and asked to rank three sets of label-free products according to their nutritional quality, via a survey. Upon completion of this task, participants were randomized to one of five FoPL condi- tions and were again asked to rank the same sets of products, this time with a FoPL displayed on pack. Change in ability to correctly rank products across the two tasks was assessed by FoPL using ordinal logistic regression. RESULTS: Nutri-Score and MTL performed best, followed Warning Symbol, HSR and RIs. CONCLUSIONS: Nutri-Score and MTL appear as efficient schemes to inform consumers on the nutritional quality of foods, in particular in Mexico, where it would be a helpful tool for consumers in purchasing situations.

OBJETIVO: Evaluar la comprensión objetiva de cinco tipos de etiquetados frontales de paquetes (EFP) (Sistema de Clasifi- cación de Estrellas de Salud, Semáforo Múltiple, Nutri-Score, Ingestas de Referencia y Símbolo de Advertencia) en México. MATERIAL Y MÉTODOS: Se reclutaron 1 001 consumidores mexicanos para clasificar tres productos de tres categorías de alimentos sin EFP, según su calidad nutricional. Se les asignó al azar uno de los cinco EFP para clasificar los mismos productos, esta vez con un EFP en el empaque. El cambio en la capacidad para clasificar correctamente los productos en las dos tareas fue evaluado por EFP, utilizando un modelo de regresión logística ordinal. RESULTADOS: Nutri-Score y Semáforo Múltiple obtuvieron un mejor desempeño, seguidos del Símbolo de Advertencia, Sistema de Clasificación de Estrellas de Salud e Ingestas de Referencia. CONCLUSIONES: Nutri-Score y el Semáforo Múltiple surgen como esquemas eficientes para informar a los consumidores sobre la calidad nutricional de los alimentos en México, donde podrían ser una herramienta útil para los consumidores en situación de compra.

Impacto de diferentes etiquetados frontales de alimentos según su calidad nutricional: estudio comparativo en México / Impact of different front-of-pack nutrition labels on foods according to their nutritional quality: a comparative study in Mexico

Resumen: Objetivo: Evaluar la comprensión objetiva de cinco tipos de etiquetados frontales de paquetes (EFP) (Sistema de Clasificación de Estrellas de Salud, Semáforo Múltiple, Nutri-Score, Ingestas de Referencia y Símbolo de Advertencia) en México. Material y métodos: Se reclutaron 1 001 consumidores mexicanos para clasificar tres productos de tres categorías de alimentos sin EFP, según su calidad nutricional. Se les asignó al azar uno de los cinco EFP para clasificar los mismos productos, esta vez con un EFP en el empaque. El cambio en la capacidad para clasificar correctamente los productos en las dos tareas fue evaluado por EFP, utilizando un modelo de regresión logística ordinal. Resultados: Nutri-Score y Semáforo Múltiple obtuvieron un mejor desempeño, seguidos del Símbolo de Advertencia, Sistema de Clasificación de Estrellas de Salud e Ingestas de Referencia. Conclusión: Nutri-Score y el Semáforo Múltiple surgen como esquemas eficientes para informar a los consumidores sobre la calidad nutricional de los alimentos en México, donde podrían ser una herramienta útil para los consumidores en situación de compra.

Abstract: Objective: This study aimed to compare consumers' objective understanding of five FoPLs [Health Star Rating system (HSR), Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), Warning Symbol] in Mexico. Materials and methods: 1 001 Mexican consumers were recruited and asked to rank three sets of label-free products according to their nutritional quality, via a survey. Upon completion of this task, participants were randomized to one of five FoPL conditions and were again asked to rank the same sets of products, this time with a FoPL displayed on pack. Change in ability to correctly rank products across the two tasks was assessed by FoPL using ordinal logistic regression. Results: Nutri-Score and MTL performed best, followed Warning Symbol, HSR and RIs. Conclusion: Nutri-Score and MTL appear as efficient schemes to inform consumers on the nutritional quality of foods, in particular in Mexico, where it would be a helpful tool for consumers in purchasing situations.

A panel of 32 AIMs suitable for population stratification correction and global ancestry estimation in Mexican mestizos.

BACKGROUND: Association studies are useful to unravel the genetic basis of common human diseases. However, the presence of undetected population structure can lead to both false positive results and failures to detect genuine associations. Even when most of the approaches to deal with population stratification require genome-wide data, the use of a well-selected panel of ancestry informative markers (AIMs) may appropriately correct for population stratification. Few panels of AIMs have been developed for Latino populations and most contain a high number of markers (> 100 AIMs). For some association studies such as candidate gene approaches, it may be unfeasible to genotype a numerous set of markers to avoid false positive results. In such cases, methods that use fewer AIMs may be appropriate. RESULTS: We validated an accurate and cost-effective panel of AIMs, for use in population stratification correction of association studies and global ancestry estimation in Mexicans, as well as in populations having large proportions of both European and Native American ancestries. Based on genome-wide data from 1953 Mexican individuals, we performed a PCA and SNP weights were calculated to select subsets of unlinked AIMs within percentiles 0.10 and 0.90, ensuring that all chromosomes were represented. Correlations between PC1 calculated using genome-wide data versus each subset of AIMs (16, 32, 48 and 64) were r2 = 0.923, 0.959, 0.972 and 0.978, respectively. When evaluating PCs performance as population stratification adjustment covariates, no correlation was found between P values obtained from uncorrected and genome-wide corrected association analyses (r2 = 0.141), highlighting that population stratification correction is compulsory for association analyses in admixed populations. In contrast, high correlations were found when adjusting for both PC1 and PC2 for either subset of AIMs (r2 > 0.900). After multiple validations, including an independent sample, we selected a minimal panel of 32 AIMs, which are highly informative of the major ancestral components of Mexican mestizos, namely European and Native American ancestries. Finally, the correlation between the global ancestry proportions calculated using genome-wide data and our panel of 32 AIMs was r2 = 0.972. CONCLUSIONS: Our panel of 32 AIMs accurately estimated global ancestry and corrected for population stratification in association studies in Mexican individuals.

[The Acapulco Declaration: a proposal to reduce incidence of diabetes in México]. / Declaración de Acapulco: propuesta para la reducción de la incidencia de la diabetes en México.

Type 2 diabetes is the main health problem in Mexico. The growing number of cases, the high percentage of individuals with chronic complications and the treatment's cost are among the explanations for the inability in the control of this disease. Diabetes prevention is most likely to reduce the rate of growth of this diabetes burden on our health system. At- risk individuals can be identified and several interventions have proved to be effective in decreasing diabetes incidence. Diabetes prevention related interventions can become a reality with the active participation of the government and society. Thus, a joint collaboration between the medical community, the government and society is needed to phase out the diabetes epidemic. Published diabetes prevention programs were reviewed and interventions feasible for Mexico were summarized in a document called "Declaración de Acapulco". This paper was reviewed and approved by the Sociedad Mexicana de Nutrición y Endocrinología; additional endorsement was obtained from several Mexican and international societies and institutions. The manuscript describes several initiatives, which can be applied in schools, work places, primary health services and by the government. Some of these are focused on the general population; others are applicable to at-risk individuals. The "Declaración de Acapulco" is a-call-for-action position directed towards the whole society and designed to achieve effective diabetes prevention.

Declaración de Acapulco: propuesta para la reducción de la incidencia de la diabetes en México / The "Declaración de Acapulco": a proposal to reduce incidence of diabetes in Mexico

Type 2 diabetes is the main health problem in Mexico. The growing number of cases, the high percentage of individuals with chronic complications and the treatment's cost are among the explanations for the inability in the control of this disease. Diabetes prevention is most likely to reduce the rate of growth of this diabetes burden on our health system. At- risk individuals can be identified and several interventions have proved to be effective in decreasing diabetes incidence. Diabetes prevention related interventions can become a reality with the active participation of the government and society. Thus, a joint collaboration between the medical community, the government and society is needed to phase out the diabetes epidemic. Published diabetes prevention programs were reviewed and interventions feasible for Mexico were summarized in a document called "Declaración de Acapulco". This paper was reviewed and approved by the Sociedad Mexicana de Nutrición y Endocrinología; additional endorsement was obtained from several Mexican and international societies and institutions. The manuscript describes several initiatives, which can be applied in schools, work places, primary health services and by the government. Some of these are focused on the general population; others are applicable to at-risk individuals. The "Declaración de Acapulco" is a-call-for-action position directed towards the whole society and designed to achieve effective diabetes prevention.

La diabetes es el principal problema de salud en México. El número creciente de casos, el elevado porcentaje que desarrollan complicaciones tardías y el costo del tratamiento hacen insuficientes los esfuerzos para confrontarla. La prevención de la diabetes es la forma más plausible para modificar el crecimiento de la epidemia. Los sujetos que desarrollarán la enfermedad pueden ser detectados y existen intervenciones que disminuyen la incidencia de la enfermedad. Las estrategias para la prevención de la diabetes sólo pueden ser llevadas a la práctica con la intervención de entidades gubernamentales y con el consenso de la sociedad. Por ello, se requiere un esfuerzo conjunto de la comunidad médica, del gobierno y de la sociedad para confrontar la epidemia de diabetes. Se revisaron los programas de prevención reportados en la literatura y se generó un documento, llamado "Declaración de Acapulco" que resume las maniobras que se consideraron factibles en nuestro país. El documento fue avalado por la Sociedad Mexicana de Nutrición y Endocrinología; también, recibió el aval de diversas sociedades e instituciones de México y otros países. El manuscrito describe iniciativas a realizar en escuelas, sitios de trabajo, servicios de salud y en el gobierno. Algunas acciones están dirigidas para la población general; otras son aplicables para sujetos en riesgo. La "Declaración de Acapulco" es un exhorto a la sociedad a tomar una actitud proactiva en la prevención de la diabetes.