Diabetes self-care activities and perception and glycemic control in adult Puerto Rican residents with Type 2 Diabetes: The LLIPDS Study.

Background: Individuals with diabetes frequently have comorbid health conditions and suffer longer term complications. The control of blood glucose relies on diabetes management/self-care behaviors. Poor glycemic control, commonly encountered in underserved populations with type 2 diabetes (T2D) often results from inadequate diabetes self-care activities and/or perception. We aimed to assess the association between diabetes self-care activities/perception and glycemic control in adult Puerto Rican residents with T2D. Design and methods: We used a cross-sectional study design; our sample population was 260 individuals aged 40-65 years with T2D. We asked participants about their diabetes self-care over 8 weeks. High fasting blood glucose (≥130 mg/dL) and glycated hemoglobin (HbA1c; ≥7%) measures were defined. We estimated the strength of the following associations using logistic regression: each of three self-care activities and fasting glucose or HbA1c, adjusting for confounders. Results: Nearly 27% of the participants reported not checking their glucose levels, 7% did not take their medications as prescribed and 31% perceived their diabetes self-care as poor. Participants with less education perceived their diabetes self-care as poor more often than their counterparts (44% vs 25%; p = 0.003). Most participants had high glycemic levels (60%) or hbA1c levels (65%). Participants who perceived their diabetes self-care as poor had higher HbA1c levels than their counterparts (adj. odds ratio: 2.14, 95% CI (1.13, 4.08)). Conclusion: Poor diabetes self-care perception, possibly related to less education, likely explains poor glycemic control among adult Puerto Rican residents with T2D.

Longitudinal association between periodontitis and development of diabetes.

BACKGROUND: Clinical trials have shown very modest short-term improvements in glycemic control among participants with diabetes after periodontitis treatment. Few longitudinal studies suggest that periodontitis may be related to prediabetes/diabetes risk. METHODS: We evaluated 1206 diabetes free participants in the San Juan Overweight Adults Longitudinal Study (SOALS) and 941 with complete 3-year follow-up data were included. The National Health and Nutrition Examination Survey (NHANES) methods were used to assess periodontitis. Diabetes and prediabetes were classified using American Diabetes Association cutoffs for fasting and 2-hour post-load glucose and HbA1c. We used Poisson regression adjusting for baseline age, gender, smoking, education, family history of diabetes, physical activity, waist circumference, and alcohol intake. RESULTS: Over the 3-year follow-up, 69 (7.3%) of the 941 individuals developed type 2 diabetes, and 142 (34.9%) of the 407 with normal glycemia at baseline developed prediabetes. In multivariable models, greater mean pocket depth and mean attachment loss at baseline were associated with lower risk of developing prediabetes/diabetes over the follow-up (IRR = 0.81; 95% CI: 0.67-0.99, and IRR = 0.86; 95% CI: 0.74-0.99, respectively). Increase in periodontal attachment loss from baseline to follow-up was associated with higher prediabetes/diabetes risk (multivariate IRR = 1.25; 95% CI: 1.09-1.42), and increase in pocket depth was associated with >20% fasting glucose increase (multivariate IRR = 1.43; 95% CI: 1.14-1.79). The inverse associations persisted after additionally adjusting for baseline income, sugar-sweetened beverages, number of teeth, oral hygiene, glycemia, or previous periodontal therapy. CONCLUSIONS: There is no association between periodontitis and risk of prediabetes/diabetes in this longitudinal study.

Comparing glucose and hemoglobin A1c diagnostic tests among a high metabolic risk Hispanic population.

BACKGROUND: Compare glycated hemoglobin (HbA1c ) diagnostic tests for prediabetes and diabetes with plasma glucose criteria and compare the metabolic profiles of people classified by HbA1c versus by glucose levels. METHODS: Participants were recruited for the San Juan Overweight Adults Longitudinal Study. The participants were primarily Hispanic (98%), without previously diagnosed diabetes, and aged 40 to 65 years. Participants classified as normal glycemic, prediabetes, or diabetes on the basis of baseline HbA1c and plasma glucose criteria were compared with respect to baseline cardiometabolic factors. RESULTS: The 1342 participants had a mean age of 50.5 ± 6.8 years and 28% were men. Thirty-one percent were diagnosed with prediabetes by plasma glucose criteria and 53.4% by HbA1c , and 8.1% were diagnosed with diabetes by plasma glucose criteria and 6.3% by HbA1c ; overall concordance rate was 55.1%. The area under the receiver operating characteristic curve of HbA1c compared to plasma glucose criteria was 0.62 for impaired glucose and 0.76 for diabetes. A worse cardiometabolic profile was seen within subgroups that met HbA1c and plasma glucose criteria for diabetes or prediabetes. Those diagnosed with prediabetes by plasma glucose criteria had significantly higher systolic blood pressure and higher homeostatic model assessment than those diagnosed using HbA1c . Participants diagnosed with diabetes by plasma glucose criteria had lower body mass index, smaller waist circumference, and lower insulinogenic and disposition indices, but higher homeostatic model assessment of insulin resistance, than those diagnosed by HbA1c . CONCLUSIONS: Low concordance was seen between HbA1c and glucose measurements. The HbA1c is not a good test for prediabetes but shows reasonable validity for diabetes in this high-risk predominantly female Hispanic population. People classified by HbA1c , plasma glucose criteria, or both show different metabolic profiles; a combined test may be ideal.

Pheochromocytoma in pregnancy: A case Report.

This is the case of a 38 year-old female patient with an intrauterine pregnancy, in which a previous incidentally identified adrenal mass proved to be a pheochromocytoma during the antenatal period. The patient was started on α-and ß-adrenergic blockade to maintain hemodynamic stability, and surgical removal of the lesion was performed during the second trimester without major complications. In view of the rarity of this disorder in pregnancy, it is imperative to have a high index of suspicion for a prompt and dedicated management, since this tumor, if unrecognized, is associated with high fetal and maternal mortality.

Prevalence of Vitamin D Insufficiency and Deficiency among Young Physicians at University District Hospital in San Juan, Puerto Rico.

Vitamin D has been attracting increased attention because of higher prevalences of vitamin D insufficiency and deficiency than expected in areas with sufficient sun exposure. Even though sunlight exposure and diet are the main determinants of vitamin D status, other factors, such as age, race, the use (or not) of sunscreen, medications, and malabsorptive conditions, also affect vitamin D levels. Recent studies have found high prevalences of vitamin D deficiency and insufficiency in different populations. However, there are limited data regarding the prevalence of vitamin D deficiency and insufficiency in Puerto Rico. To shed more light on the subject, we evaluated a sample of 51 internal medicine residents and research fellows, aged from 25 to 39 years at the University District Hospital in San Juan, Puerto Rico, doing so by means of a questionnaire that explored basic socio demographic and lifestyle characteristics and collected anthropometric data; in addition, we obtained blood samples in order to determine 25-hydroxyvitamin D levels. The median 25-hydroxyvitamin D level was 21 ng/mL (range, 7-38 ng/mL). Forty-five participants (88.2%) had 25-hydroxyvitamin D concentrations of lower than 30 ng/mL. We found vitamin D deficiencies in 43.1% of the population and insufficiencies in 45.1%. Contributory factors to our findings include limited exposure to sunlight during periods of high sun intensity, increased body mass index, and a limited area of the body being exposed to sunlight. A relationship between reduced physical activity levels and hypovitaminosis D was also found. Both calcium intake and vitamin D intake, which were markedly below recommended daily allowances, were positively correlated with 25-hydroxy vitamin D levels, but with a weak association.

Quality of life-in patients with differentiated thyroid cancer at the general endocrinology clinics of the University Hospital of Puerto Rico.

UNLABELLED: Differentiated thyroid cancer (DTC) can compromise the quality of life of patients. Our purpose is to investigate if the quality of life, in a cohort of patients in Puerto Rico, is affected by the diagnosis and/or treatment modalities received for DTC. METHODS: This is a cross-sectional study of 75 subjects with DTC. A Spanish version of the University of Washington Quality of Life Questionnaire was used, including multiple aspects of physical and social functioning. Descriptive and bivariate analysis between domain scores and variables of interest were performed. RESULTS: 82.7% of the patients reported that their health was the same or better than it was before treatment. The mean composite score obtained was 82.3, reflecting an overall little effect on quality of life. Patients diagnosed with DTC at an age of > or =45 years reported a significantly better score on the pain domain when compared with those diagnosed earlier (p < 0.05). Patient who received >150 mCi of radioiodine had a tendency towards a worse score on the same domain (p = 0.05). CONCLUSIONS: Our cohort reported an overall minimal effect on the quality of life of patients with DTC. Future treatment strategies should include periodic quality of life evaluations, in order to tailor therapy in this growing population.

An uncommon presentation of follicular thyroid carcinoma: when chronic back pain should raise a flag.

Follicular thyroid carcinoma is the second most common type of thyroid cancer, and its incidence has increased dramatically in recent years. Although it typically presents as a thyroid nodule, it can spread to distant sites via hematogenous dissemination. Bone metastasis is diagnosed clinically in 2%-13% of patients with differentiated thyroid cancer; nevertheless spinal cord compression complicating thyroid carcinoma is rare and only few cases has been reported in the literature. This case illustrates a strange case of a minimally invasive follicular carcinoma that showed an aggressive behavior, and thus the importance of considering metastatic thyroid carcinoma in the differential diagnosis of chronic back pain progressing to spinal cord compression carrying a severe morbidity.

Increasing incidence of thyroid cancer in Puerto Rico, 1985-2004.

OBJECTIVE: Thyroid cancer has become one of the fastest growing malignancies in several countries worldwide. Few studies have examined thyroid cancer trends in Puerto Rico, and those studies have been conducted over relatively short time frames. This study aimed to describe both overall thyroid cancer incidence trends by age, sex, and histology, and the mortality rate by age and sex in Puerto Rico for the period of 1985 to 2004. METHODS: Using the Central Cancer Registry of Puerto Rico database, we conducted a retrospective study of patients with thyroid cancer diagnosed from January 1, 1985, to December 31, 2004. RESULTS: The overall incidence rate of thyroid cancer increased from 3.0 to 7.0 per 100,000 population (a 2.3-fold increase), with an annual percent change (APC) of 5.3% (p < 0.05) during the period of 1985 to 2004. Incidence rates were higher for females (rising from 4.7 in 1985 to 10.5 per 100,000 women in 2004) compared to those for males (rising from 1.1 in 1985 to 3.0 per 100,000 men in 2004). The rising trend was mostly due to an increase in the incidence of papillary thyroid cancer, which rose from 2.4 to 6.0 per 100,000 population (a 2.5-fold increase), with an APC of 5.7% (p < 0.05). The overall mortality rate of thyroid cancer was very low (0.4 in 1985 and 0.3 per 100,000 population in 2004), with a non-significant APC of -1.1% (p > 0.05). CONCLUSION: The incidence of thyroid cancer in Puerto Rico increased significantly from 1985 to 2004, mostly due to an increase of papillary cancer. However, the mortality remained low.