[Prevalencia de complicaciones de la diabetes y comorbilidades asociadas en medicina familiar del Instituto Mexicano del Seguro Social].

Introduction: The prevalence of chronic complications and comorbidities in patients with type 2 diabetes (T2D) has increased worldwide. Objective: To compare the prevalence of complications and chronic comorbidities in patients with T2D at 36 family medicine units of five chapters of the Mexican Institute of Social Security (IMSS). Method: Complications (hypoglycemia, diabetic foot, kidney disease, retinopathy, ischemic heart disease, cerebrovascular disease and heart failure) and comorbidities (liver disease, cancer and anemia) were identified according to codes of the International Classification of Diseases, 10th Revision. Comparisons were made by chapter, age, gender and evolution time. Results: Complications and comorbidities were more common in subjects aged ≥ 62 years. Out of 297 100 patients, 34.9 % had any complication; microvascular complications (32 %) prevailed in the industrial North, whereas macrovascular complications (12.3 %) did in the rural East, and comorbidities (5 %) in southern Mexico City. Complications predominated in men (any complication, 30.2 %). Heart failure and comorbidities were more common in women (5.6 % and 4.9 %, respectively). Conclusions: T2D complications and comorbidities showed geographic and gender differences, and were greater with older age and longer evolution time. It is urgent for strategies for the prevention of complications and comorbidities to be reinforced in patients with T2D.

Introducción: La prevalencia de complicaciones crónicas y comorbilidades en pacientes con diabetes tipo 2 (DT2) se han incrementado en el mundo. Objetivo: Comparar la prevalencia de complicaciones y comorbilidades crónicas en pacientes con DT2 en 36 unidades de medicina familiar de cinco delegaciones del Instituto Mexicano del Seguro Social (IMSS). Métodos: Conforme los códigos de la Décima Revisión de la Clasificación Internacional de Enfermedades se identificaron las complicaciones (hipoglucemia, pie diabético, enfermedad renal, retinopatía, enfermedad cardiaca isquémica, enfermedad cerebrovascular y falla cardiaca) y comorbilidades (enfermedad hepática, cáncer, anemia) de DT2. Se compararon por delegación, edad, sexo y tiempo de evolución. Resultados: Las complicaciones y comorbilidades fueron más comunes en personas ≥ 62 años. De 297 100 pacientes, 34.9 % presentó cualquier complicación; microvasculares en el norte industrial (32 %), macrovasculares en el este rural (12.3 %) y comorbilidades (5 %) en el sur de la Ciudad de México; estas complicaciones predominaron en los hombres (cualquier complicación 30.2 %). La falla cardiaca y las comorbilidades fueron más comunes en mujeres (5.6 y 4.9 %). Conclusiones: Las complicaciones y comorbilidades de DT2 mostraron diferencias geográficas y de sexo y fueron mayores con la edad y el tiempo de evolución. Urge reforzar estrategias para la prevención de las complicaciones y comorbilidades en los pacientes con DT2.

Prevalencia de complicaciones de la diabetes y comorbilidades asociadas en medicina familiar del Instituto Mexicano del Seguro Social / Prevalence of complications of diabetes and associated comorbidities in family medicine of the Mexican Institute

Resumen Introducción: La prevalencia de complicaciones crónicas y comorbilidades en pacientes con diabetes tipo 2 (DT2) se han incrementado en el mundo. Objetivo: Comparar la prevalencia de complicaciones y comorbilidades crónicas en pacientes con DT2 en 36 unidades de medicina familiar de cinco delegaciones del Instituto Mexicano del Seguro Social (IMSS). Métodos: Conforme los códigos de la Décima Revisión de la Clasificación Internacional de Enfermedades se identificaron las complicaciones (hipoglucemia, pie diabético, enfermedad renal, retinopatía, enfermedad cardiaca isquémica, enfermedad cerebrovascular y falla cardiaca) y comorbilidades (enfermedad hepática, cáncer, anemia) de DT2. Se compararon por delegación, edad, sexo y tiempo de evolución. Resultados: Las complicaciones y comorbilidades fueron más comunes en personas ≥ 62 años. De 297 100 pacientes, 34.9 % presentó cualquier complicación; microvasculares en el norte industrial (32 %), macrovasculares en el este rural (12.3 %) y comorbilidades (5 %) en el sur de la Ciudad de México; estas complicaciones predominaron en los hombres (cualquier complicación 30.2 %). La falla cardiaca y las comorbilidades fueron más comunes en mujeres (5.6 y 4.9 %). Conclusiones: Las complicaciones y comorbilidades de DT2 mostraron diferencias geográficas y de sexo y fueron mayores con la edad y el tiempo de evolución. Urge reforzar estrategias para la prevención de las complicaciones y comorbilidades en los pacientes con DT2.

Abstract Introduction: The prevalence of chronic complications and comorbidities in patients with type 2 diabetes (T2D) has increased worldwide. Objective: To compare the prevalence of complications and chronic comorbidities in patients with T2D at 36 family medicine units of five chapters of the Mexican Institute of Social Security (IMSS). Method: Complications (hypoglycemia, diabetic foot, kidney disease, retinopathy, ischemic heart disease, cerebrovascular disease and heart failure) and comorbidities (liver disease, cancer and anemia) were identified according to codes of the International Classification of Diseases, 10th Revision. Comparisons were made by chapter, age, gender and evolution time. Results: Complications and comorbidities were more common in subjects aged ≥ 62 years. Out of 297 100 patients, 34.9 % had any complication; microvascular complications (32 %) prevailed in the industrial North, whereas macrovascular complications (12.3 %) did in the rural East, and comorbidities (5 %) in southern Mexico City. Complications predominated in men (any complication, 30.2 %). Heart failure and comorbidities were more common in women (5.6 % and 4.9 %, respectively). Conclusions: T2D complications and comorbidities showed geographic and gender differences, and were greater with older age and longer evolution time. It is urgent for strategies for the prevention of complications and comorbidities to be reinforced in patients with T2D.

[Myocardial infarction in young mexicans associated to metabolic syndrome]. / Infarto agudo al miocardio en jóvenes mexicanos asociado a síndrome metabólico.

BACKGROUND: Acute coronary diseases are catastrophic, especially in young patients. OBJECTIVE: To determine the risk of metabolic syndrome (MS) for premature acute myocardial infarction (AMI), combined with familial, behavioral, and nutritional factors in the northeast of Mexico. MATERIAL AND METHODS: This is a case control study of patients less than 47 years of age with no personal history of angina, AMI, or cerebrovascular disease. Cases corresponded to patients with AMI (incident and primary cases; n = 55) and controls were blood donors located at the same hospital (n = 55). Behavioral, nutritional, and cardiometabolic risk factors were measured. Multivariate logistic regression was used for estimating odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: MS increased the risk for premature AMI (95% CI: 1.73-39.5) eightfold, followed by smoking (OR: 7.76; 95% CI: 1.27-47.3), family history of AMI or sudden death (OR: 11.0; 95% CI: 2.03-60.4), and sedentary lifestyle (OR: 2.26; 95% CI: 2.52-9.80), independent of potential confounders. CONCLUSIONS: The study highlights the magnitude of the risk of MS for AMI in Mexican young adults. The phenomenon of coronary diseases among young adults needs essential attention from the health sector.

Stepwise strategies to successfully recruit diabetes patients in a large research study in Mexican population.

AIMS: Describe stepwise strategies (electronic chart review, patient preselection, call-center, personnel dedicated to recruitment) for the successful recruitment of >5000 type 2 diabetes patients in four months. METHODS: Twenty-five family medicine clinics from Mexico City and the State of Mexico participated: 13 usual care, 6 specialized diabetes care and 6 chronic disease care. Appointments were scheduled from 11/3/2015 to 3/31/2016. Phone calls were generated automatically from an electronic database. A telephone questionnaire verified inclusion criteria, and scheduled an appointment, with a daily report of appointments, patient attendance, acceptance rate, and questionnaire completeness. Another recruitment log reviewed samples collected. Absolute number (percentage) of patients are reported. Means and standard deviations were estimated for continuous variables, χ2 test and independent "t" tests were used. OR and 95% CI were estimated. RESULTS: 14,358 appointments were scheduled, 9146 (63.7%) attended their appointment: 5710 (62.4%) fulfilled inclusion criteria and 5244 agreed to participate (91.8% acceptance). Those accepting participation were more likely women, younger and with longer disease duration (p<0.05). The cost of the call-center service was $3,010,000.00 Mexican pesos (∼$31.70 USD per recruited patient). CONCLUSIONS: Stepwise strategies recruit a high number of patients in a short time. Call centers offer a low cost per patient.

[Estimation of overweight and obesity in preschoolers according to national and international normativity]. / Estimación de sobrepeso y obesidad en preescolares. Normatividad nacional e internacional.

BACKGROUND: Prevalence of overweight and obesity in children under 5 years can be affected by type of anthropometric indicator and selected threshold values. We assessed variation on estimates according to national and international regulations (NOM-031-SSA2-1999, NOM-008-SSA3-2010, GPC-SSA-025-08 and GPC-IMSS-029-08; WHO-2006, CDC-2000 and IOTF, respectively). METHODS: Cross-sectional study in all the daycare centers (100 %) affiliated to Instituto Mexicano del Seguro Social-Nuevo León during June-December, 2010 (n = 11 141 children). Overweight and obesity were defined on the basis of each regulation, and total and stratified prevalences by age and sex were estimated. RESULTS: According to national regulation, overweight/obesity estimates varied from 12 to 22 %, and to international normativity, from 3 to 14 %. The highest prevalence was given by NOM-008-SSA3-2010 and GPC-SSA-025-08; and the lowest by WHO-2006. There were no differences by sex, but they existed by age; the highest discrepancy occurred in the 3.0-3.9 age group with 28 %. CONCLUSION: Health personnel and health policy makers should be aware of variation on estimates according to the definition employed. We recommend to standardize national regulation for pointing out overweight/obesity in preschoolers.

INTRODUCCIÓN: la prevalencia de sobrepeso/obesidad en menores de 5 años se puede ver afectada por tipo de indicador antropométrico y punto de corte aplicado. Se evaluó la variación en las estimaciones según la normatividad nacional (NOM-031-SSA2-1999, NOM-008-SSA3-2010, GPC-SSA-025-08 y GPC-IMSS-029-08) y la internacional (OMS-2006, CDC-2000 e IOTF). MÉTODOS: estudio transversal en 100 % de guarderías afiliadas al Instituto Mexicano del Seguro Social-Nuevo León durante junio-diciembre de 2010 (n = 11 141 infantes). Se definió sobrepeso y obesidad con base en cada normatividad y se estimaron las prevalencias totales y estratificadas por edad y sexo. RESULTADOS: de acuerdo con la normatividad nacional, el sobrepeso/obesidad varió entre 12 y 22 %; y con la normatividad internacional, entre 3 y 14 %. La mayor prevalencia fue con la NOM-008-SSA3-2010 y GPC-SSA-025-08; y la menor, con OMS-2006. No hubo diferencias por sexo, pero sÍ por edad; la mayor discrepancia ocurrió en niños entre 3.0 y 3.9 años, con 28 puntos porcentuales. CONCLUSIÓN: el personal y las personas relacionadas con la generación de políticas de salud tienen que estar conscientes de la variación de las estimaciones según la definición utilizada. Se recomienda estandarizar la normatividad nacional para señalar sobrepeso/obesidad en preescolares.

[Effects of incorporating group visits on the metabolic control of type 2 diabetic patients]. / Diabetes y consulta médica grupal en atención primaria. ¿Vale la pena el cambio?

BACKGROUND: A better metabolic control is an important objective of health care in diabetes mellitus. This objective has been achieved elsewhere, incorporating group visits to the usual care of diabetic patients. AIM: To evaluate the effects of a primary care group visit model after 9 and 15 months of implementation, on the metabolic control of diabetic patients. MATERIAL AND METHODS: Two cohorts of type 2 diabetic patients, matched by sex, age and fasting plasma glucose (FPG) were studied. Group visits (monthly medical consultation and one hour sessions with group interaction on the same day) were implemented in 600 patients and routine visits (monthly one-to-one medical consultation) were implemented in 601 patients. The evolution on FPG, cholesterol, systolic (SBP) and diastolic blood pressure (DBF) and body mass index (BMI) were compared. RESULTS: At 15 months of follow up, mean FPG was lower in patients with group visits compared to those in usual individual care (155.3 +/- 59.5 and 175.7 +/- 67.7 mg/dL respectively, p <0.01). SBP and DBF were also lower in patients on group visits (123.6 +/- 13.4 and 127.5 +/-12.8 mmHg, respectively for systolic pressure, p <0.01 and 73.5 +/-8.5 and 79.4 +/-6.3 mmHg, respectively for diastolic pressure, p <0.01). No differences between groups were observed for blood cholesterol or BMI. CONCLUSIONS: Incorporation of group visits in type 2 diabetic patients improved metabolic control and blood pressure, compared to the usual individual care model.

Diabetes y consulta médica grupal en atención primaria: ¿Vale la pena el cambio? / Effects of incorporating group visits on the metabolic control of type 2 diabetic patients

Background: A better metabolic control is an important objective of health care in diabetes mellitus. This objective has been achieved elsewhere, incorporating group visits to the usual care of diabetic patients. Aim: To evaluate the effects of a primary care group visit model after 9 and 15 months of implementation, on the metabolic control of diabetic patients. Material and methods: Two cohorts of type 2 diabetic patients, matched by sex, age and fasting plasma glucose (FPG) were studied. Group visits (monthly medical consultation and one hour sessions with group interaction on the same day) were implemented in 600 patients and routine visits (monthly one-to-one medical consultation) were implemented in 601 patients. The evolution on FPG, cholesterol, systolic (SBP) and diastolic blood pressure (DBF) and body mass index (BMI) were compared. Results: At 15 months of follow up, mean FPG was lower in patients with group visits compared to those in usual individual care (155.3 ± 59.5 and 175.7 ± 67.7 mg/dL respectively, p <0.01). SBP and DBF were also lower in patients on group visits (123.6 ± 13.4 and 127.5 ±12.8 mmHg, respectively for systolic pressure, p <0.01 and 73.5 ±8.5 and 79.4 ±6.3 mmHg, respectively for diastolic pressure, p <0.01). No differences between groups were observed for blood cholesterol or BMI. Conclusions: Incorporation of group visits in type 2 diabetic patients improved metabolic control and blood pressure, compared to the usual individual care model.