Direct and indirect costs associated to type 2 diabetes and its complications measured in a social security institution of Argentina.

OBJECTIVES: To estimate direct and indirect costs of care of type 2 diabetes (T2DM) and its complications in Argentina, and compare them with those recorded in people without diabetes (ND). METHODS: Observational retrospective case-control study performed in one institution of the Social Security System of Argentina. Participants were identified and randomly selected from the Institution's electronic medical records. We recruited persons with T2DM with (387) or without (387) chronic complications and 774 ND, matched by age and gender. Data were obtained by telephone interviews and supplemented with data from the Institution's records. Parametric and non-parametric tests were used for group comparisons. RESULTS: Direct costs were higher in people with T2DM than in ND: twice as high in people with T2DM without complications and 3.6 times in those with complications. Absenteeism was only higher in T2DM with complications, but there were no differences among groups either in the duration or in the cost of such absenteeism. CONCLUSIONS: T2DM and the development of its complications are positively associated with higher direct costs in Argentina.

Association between socioeconomic status, type 2 diabetes and its chronic complications in Argentina.

AIM: To compare the socioeconomic status (SES) of people with type 2 diabetes (T2DM) in Argentina (Córdoba) with and without major chronic complications of diabetes, with that recorded in persons without diabetes matched by age and gender. METHODS: For this descriptive and analytic case-control study, potential candidates were identified from the electronic records of one institution of the Social Security System of the city of Córdoba. We identified and recruited 387 persons each with T2DM with or without chronic complications and 774 gender- and age-matched persons without T2DM (recruitment rate, 83%). Data were obtained by telephone interviews and supplemented with data from the institution's records. Group comparisons were performed with parametric or non-parametric tests as appropriate. We used ordinary least squares to regress household income and the difference between income and household expenses on diabetes status, age, sex, education and body mass index. RESULTS: Persons with T2DM, particularly those with complications, reported fewer years of general education (13.6±4.2 years vs. 12.2±4.4 years), a lower percentage of full time jobs (43.0% vs. 26.9%), lower salaries and monthly household income among those with full-time jobs (> 5000 ARG$: 52.6% vs. 24.5%), and a higher propensity to spend more money than they earned (expenditure/income ratio≥1: 10.2% vs. 16.0%). The percentage of unmarried people was also higher among people with type 2 diabetes (7.0% vs. 10.9%). CONCLUSION: T2DM and the development of its complications are each positively associated with lower SES and greater economic distress in Argentina.

High prevalence of secondary hyperparathyroidism in chronic kidney disease patients on dialysis in Argentina.

BACKGROUND: There are few data in Argentina on the prevalence and management of bone and mineral metabolism (BMM) in patients with chronic kidney disease (CKD). OBJECTIVES AND METHODS: A survey was carried out in dialysis units in 2010 to measure the prevalence of and types of treatments for BMM disorders in Argentina. The data obtained was then compared to the published results from other large population studies. We recorded characteristics of dialysis centres and participating patients, the frequency of measurements and individual results for BMM biochemical markers, as well as the type of management used to control hyperphosphataemia and secondary hyperparathyroidism. RESULTS: 1210 patients from 25 dialysis centres in Argentina participated in the study (representing 4.7% of the country's prevalent dialysis population in 2010). The mean patient age was 55.3±17.6 years, 60.8% were male, 3.3% were on peritoneal dialysis and 29.1% suffered diabetes. In all centres, phosphataemia and calcaemia were measured on a monthly basis, 60% of centres measured intact parathyroid hormone (iPTH) every 6 months, 36% every 3 to 4 months, and 4% annually. As recommended by K/DOQI, 51.6% of patients had adequate levels of calcium (8.4-9.5 mg/dl), 51.6% had adequate phosphorus (3.5-5.5 mg/dl) and 21.1% displayed acceptable iPTH levels (150-300 pg/ml). 24% had iPTH <150 pg/ml and 54.5% >300 pg/ml. iPTH ≥600 pg/ml was present in 28.3%, and 13.3% had values ≥1000 pg/ml. These figures differed from those published by the DOPPS II study, in which 51.1% of patients had iPTH <150 pg/ml, and only 26.7% had iPTH ≥300 pg/ml. Calcium-based phosphate binders were used in 83.6% of the patients, 5.6% used sevelamer and 4.0% used aluminium-containing compounds. To achieve control of hyperparathyroidism, oral or intravenous calcitriol was predominantly used (50.5%) with a small percentage of patients receiving paricalcitol or doxercalciferol. CONCLUSIONS: The present study shows a high prevalence of secondary hyperparathyroidism, which differs from that published by other large population studies. There was a high proportion of patients with BMM markers outside the ranges suggested by K/DOQI. Mainly phosphate binders based on calcium and calcitriol continue to be used for the management of hyperphosphatemia and hyperparathyroidism respectively.

Medicina e historia: a propósito del caso de un hombre con un tumor en la frente / Medicine and history: concerning a man with a tumor on his forehead

This case report is about the sickness of a 59 year old priest, politician and war veteran who died in 1844. The case history is based on the detailed report of his doctor, gathered in a diary and later published. The collected clinical data relied exclusively on touch and observation. The patient's illness started with a painful lump on his forehead that was in part excised. Surgical exploration revealed a soft tissue mass that bled easily and involved the frontal bone. In the following months, the lesion, which had been treated with complex topical medications, became ulcerated and extended to the orbit and the chin. The patient died postrated and in severe undernutrition one year after the onset of the symptoms. The case discussion, presented in the format of a clinicopathological conference, concluded that a metastasis of a renal cell carcinoma or an osseous lymphoma were the more likely diagnoses.

Medicina e historia: a propósito del caso de un hombre con un tumor en la frente / Medicine and history: concerning a man with a tumor on his forehead

This case report is about the sickness of a 59 year old priest, politician and war veteran who died in 1844. The case history is based on the detailed report of his doctor, gathered in a diary and later published. The collected clinical data relied exclusively on touch and observation. The patients illness started with a painful lump on his forehead that was in part excised. Surgical exploration revealed a soft tissue mass that bled easily and involved the frontal bone. In the following months, the lesion, which had been treated with complex topical medications, became ulcerated and extended to the orbit and the chin. The patient died postrated and in severe undernutrition one year after the onset of the symptoms. The case discussion, presented in the format of a clinicopathological conference, concluded that a metastasis of a renal cell carcinoma or an osseous lymphoma were the more likely diagnoses. (Au)