Family physicians clinical aptitude for the nutritional management of type 2 diabetes mellitus in Guadalajara, Mexico.

There are 180,000 new Diabetes Mellitus cases in Mexico each year (1). This chronic, complex and multifactor disease requires an adequate nutritional management plan to be prescribed by family physicians. They should be trained to identify the potential difficulties in the patient's dietary schedule and orientate their management from an integrative point of view. The purpose of this study was to detect and measure family physician's clinical aptitudes for the nutritional management of Type 2 diabetes, in a representative family physician's sample from five Family Medicine Units of the Mexican Institute of Social Security in Guadalajara, Jalisco, Mexico. A structured and validated instrument was applied to 117 physicians from a total of 450 in Guadalajara, Jalisco. The main study variable was clinical aptitude for nutritional management of Type 2 diabetes. Aptitude levels were defined by an ordinal scale and related to the other variables using the median, Mann-Whitney's U test and Kruskal Wallis (KW) test. Global results showed a median of 30 points that relates to a low and a very low aptitude level for the 72% of physicians without statistical significance (KW: p>0.05) with the rest of variables. These results reflect family physician's difficulties to orientate the nutritional management of Type 2 diabetes, as well as the lack of work environments that facilitate case reflection and formative educational strategies.

[Effects of an educational intervention on plasma levels of LDL cholesterol in type 2 diabetics]. / Efectos de una intervención educativa sobre los niveles plasmáticos de LDL-colesterol en diabéticos tipo 2.

OBJECTIVE: To prove the benefit of an educational intervention for controlling LDL cholesterol levels in LDL cholesterol. MATERIAL AND METHODS: A quasi-experimental study was conducted; diabetic patients were randomly allocated to an experimental and a control group. The experimental group consisted of 25 patients and the control group of 24 patients. The educational intervention was organized through a reflection-action process. LDL cholesterol levels were measured at baseline and monthly during the nine months of the study. The groups were controlled for age and sex. Statistical analysis included Wilcoxon's test for ordinal variables. RESULTS: The intervention group had a mean value of LDL cholesterol of 148.4 +/- 21.3, compared to 185 +/- 24.1 in the control group (p < or = 0.05). CONCLUSIONS: The participative educational intervention contributed to improving the levels of LDL cholesterol, by promoting a lifestyle change in type-2 diabetic patients.

[Effect of oral administration of ascorbic acid on insulin sensitivity and lipid profile in obese individuals]. / Efecto de la administración oral de ácido ascórbico sobre la sensibilidad a la insulina y el perfil de lípidos en individuos con obesidad.

BACKGROUND: The aim of this study was to identify the effect of an oral ascorbic acid (AA) supplement on lipid profile and insulin sensitivity in obese people. RESEARCH DESIGN AND METHODS: A randomized double-blind clinical trial placebo controlled was performed in 16 obese male volunteers [body mass index (BMI) 30-40 kg/m2]. Eight received orally 1 g of AA daily for four weeks and the other eight volunteers received placebo by the same scheme and period of time. Before and after the pharmacological intervention were measured total cholesterol, high-density-lipoprotein (HDL) cholesterol, triglycerides, glucose, creatinine and uric acid. Low-density-lipoprotein (LDL) cholesterol and very-low-density-lipoprotein (VLDL) triglycerides were calculated using formulas. In order to assess insulin sensitivity before and after the intervention, the steady-state glucose (SSG) was calculated from the insulin suppression test modified with octreotide. RESULTS: There were not significant differences in clinical characteristics between both groups. Basal metabolic profile and SSG were similar between both groups. There were not significant differences in both groups between before and after the intervention in metabolic profile and insulin sensitivity. CONCLUSION: AA did not modify the lipid profile nor insulin sensitivity in the group of obese people studied.

Effects of behavior-modifying education in the metabolic profile of the type 2 diabetes mellitus patient.

To demonstrate the advantages of behavior-modifying education in the metabolic profile of the type-2 diabetes mellitus patient. A quasi-experimental study was performed with a control group. The experimental group was made up of 25 type-2 diabetic patients and the control group consisted of 24. The type of education carried out was a behavior modification. Baseline measurements and subsequent monthly measurements of serum glucose, total cholesterol and triglycerides were carried out during 9 months after the intervention. The groups were controlled according to age and sex. The statistical analysis was performed using the Student's and Wilcoxon's test to determine the difference. The experimental group in comparison with the control group in the measurement after the intervention achieved a mean difference in serum glucose of 64.2 mg/dl (p=0.001), in the cholesterol of 31.6 (p=0.008), and in the triglycerides of 50.8 (p=0.006). The behavior-modifying education is a better option than traditional intervention for metabolic control in type-2 diabetes mellitus patients.

Educación para la salud en derechohabientes del primer nivel de atención médica / Health education for insured patients ar the first level of medical attention

Se efectuó un estudio en la población derechohabiente mayor de 15 años que demandaba los servicios médicos en una unidad de atención a la salud del primer nivel de atención del Instituto Mexicano del Seguro Social (IMSS) en la zona metropolitana de Guadalajara, Jalisco. El propósito fue identificar el nivel de educación para la salud de usuarios de los servicios y analizar el modelo de práctica educativa institutcional recibida por el derechohabiente. Mediante este proyecto de investigación se puede señalar que 27.1 por ciento de la población derechohabiente demandante tiene un adecuado nivel de educación para la salud, que la práctica educativa recibida se basa en la acumulación de información, y que ésta ha sido otorgada por un equipo disciplinario en salud, el cual refleja limitaciones en los métodos y técnicas de educación en salud.

Ambiente de trabajo en una Unidad de Medicina Familiar / Work milieu at a family medical unit

Se efectuó una investigación por encuesta de tipo prospectivo en trabajadores del Instituto Mexicano del Seguro Social en una Unidad de medicina Familiar del área metropolitana de Guadalajara Jalisco. El propósito, por medio de la Comisión Mixta de Mejoramiento del Ambiente Laboral, fue identificar las condiciones de trabajo a través de la valoración de la satisfacción de sus necesidades; se recolectaron los datos por medio de un instrumento estructurado y codificado que abarcó las variables de estudio mediante un censo que incluyó a la totalidad de los trabajadores. El número de encuestados fue de 167 y como promedio general de las variables se encontró que 66 por ciento aceptó haber cubierto sus necesidades, señalando que existen otras variables en donde la moda alcanza niveles más significativos, lo que permitió perfilar el nivel taxonómico de satisfacción de sus necesidades

[Knowledge, attitudes and dietary practices in patients with diabetes mellitus type II]. / Conocimientos, actitudes y prácticas dietéticas en pacientes con diabetes mellitus II.

The profile of type-II non-insulin dependent diabetic patients is characterized by overweight; exogenous obesity originates from inadequate nourishment habits and, among other things, educational, cultural, and psychological conditions. With regard to metabolic deficiency control, the explanation is centered fundamentally on the patient's not getting a complete diet. This could be due to a lack of information about their illness, thus becoming a determining factor in their treatment. The purpose of this study was to analyze the level of knowledge, attitudes, and dietary education practices by means of a survey using the likert scale. This was applied by means of a direct and codified interview directed to patients in a Primary Care Health Unit from the Mexican Social Security Institute (IMSS) in Guadalajara, Jalisco, Mexico. 201 Type II diabetic patients, selected from a systematic sample, were studied. The average age was 54 and predominantly female (a ratio of 1.7 to 1). The sample had an academic background not surpassing the elementary school level, and their occupation was that of housewife. Their central glycemia level was, on the average, 191 mg/dl with a standard deviation of 120. The average number of years of having suffered from the illness was 5.5 with a standard deviation of 5. Ninety per cent of the diabetic patients take oral hypoglucemiants. Although there does exist a high level of knowledge and attitudes about dietary education, there exists a low level of educational practices. We observed that only 10 per cent of the diabetic patients have both an acceptable metabolic control (CMA) and a high value in knowledge, attitudes, and practices (CAP).(ABSTRACT TRUNCATED AT 250 WORDS)