The diabetes education material on diabetes for website: Results of a validation process.

OBJECTIVE: To validate an educational material on diabetes through an expert consensus for its implementation into a web site. MATERIAL AND METHODS: An observational study was carried out in a group of health professionals, for which an educational material was developed for patients with diabetes. Topics included nutrition, physical exercise, control indicators, complications, pharmacological treatment, among others. The language, text and figures were focused on easy comprehension, additionally, a section of didactic activities to be answered by the patient with diabetes at the end of each module was included. To evaluate the educational material by health professionals, an instrument was designed and validated. Once all the educational material was available, each of the modules was sent by e-mail to at least three clinical experts in the assigned topic, as well as the instrument for the evaluation of the module. RESULTS: Thirty-seven experts were included in the study, 76% rated the educational modules evaluated as highly adequate, while only 24% rated them as adequate. The instrument used obtained a good level of internal consistency, with a Cronbach's alpha coefficient of 0.92. In the dimensions of the instrument, the lowest Cronbach's alpha score was that of "call-to-action", with a value of 0.71. CONCLUSION: The diabetes educational material was rated as highly appropriate by the clinical experts. The developed instrument has an adequate content validity, as well as a good level of internal consistency.

A dietary pattern high in full-fat dairy and sweetened beverages is associated with glycated hemoglobin and weight in Mexican patients with type-2 diabetes / Un patrón dietético con alto contenido de lácteos enteros y bebidas azucaradas se asocia con la hemoglobina glicosilada y el peso en pacientes mexicanos con diabetes de tipo 2

Objective the aim of this study was to identify dietary patterns in a sample of patients with type-2 diabetes, and to evaluate their association with markers of metabolic control. Methods: a cross-sectional study in 395 patients with type-2 diabetes in primary care was conducted. Fasting blood levels of glycated hemoglobin (A1c), glucose, total cholesterol, low- (LDL-c) and high-density lipoprotein cholesterol (HDL-c), and triglycerides were measured. Waist circumference, body mass index (BMI), and blood pressure were evaluated. Dietary intake was assessed by a food frequency questionnaire, and dietary patterns were derived by cluster analysis. Three dietary patterns were identified: ‘fruits and vegetables', ‘dairy and sweetened beverages', and ‘diverse with alcohol'. Results: an association between the ‘dairy and sweetened beverages' dietary pattern and A1c levels was identified (ß = 0.61; 95 % CI; 0.09, 1.12, p = 0.021), considering the ‘fruits and vegetables' dietary pattern as the reference group. We also observed a trend towards an adjusted increased risk of A1c ≥ 7 % (odds ratio [OR]: 1.56; 95 % CI: 0.92, 2.64; p = 0.099) and an increased risk of BMI ≥ 25 kg/m2 (OR: 2.62, 95 % CI: 1.20, 5.71, p = 0.015) among patients in the ‘dairy and sweetened beverages' dietary pattern as compared to the reference group. Conclusions a dietary pattern characterized by a high intake of full-fat dairy and sweetened beverages was associated with higher A1c levels and increased risk of high glucose and BMI when compared to a dietary pattern with a higher consumption of fruits and vegetables (AU)

Objetivo:el objetivo de este estudio fue identificar los patrones dietéticos de una muestra de pacientes con diabetes de tipo 2 y evaluar su asociación con los marcadores de control metabólico. étodos: se realizó un estudio transversal de 395 pacientes con diabetes de tipo 2 en atención primaria. Se estimaron los niveles de hemoglobina glicosilada (A1c), glucosa, colesterol total, colesterol de lipoproteínas de baja (LDL-c) y alta densidad (HDL-c), y triglicéridos en ayunas. Se evaluaron el perímetro de la cintura, el índice de masa corporal (IMC) y la presión arterial. La ingesta dietética se evaluó mediante un cuestionario de frecuencia de alimentos y los patrones dietéticos se obtuvieron mediante un análisis de conglomerados. Se identificaron tres patrones dietéticos: “frutas y verduras”, “lácteos y bebidas azucaradas” y “diversos con alcohol”. Resultados: se identificó una asociación entre el patrón dietético de “productos lácteos y bebidas azucaradas” y los niveles de A1c (ß = 0,61; IC del 95 %: 0,09, 1,12, p = 0,021), considerando el patrón dietético de “frutas y verduras” como grupo de referencia. También se observó una tendencia a un mayor riesgo ajustado de A1c ≥ 7 % (odds ratio [OR]: 1,56; IC del 95 %: 0,92, 2,64; p = 0,099) y un mayor riesgo de IMC ≥ 25 kg/m2 (OR: 2,62; IC del 95 %: 1,20, 5,71, p = 0,015) entre los pacientes del patrón “lácteos y bebidas azucaradas” en comparación con el grupo de referencia. Conclusiones: el patrón dietético caracterizado por un alto consumo de lácteos y bebidas azucaradas se asoció con niveles más altos de A1c y un mayor riesgo de elevación de la glucosa y el IMC, en comparación con un patrón dietético con mayor consumo de frutas y verduras (AU)

Association between abdominal fat distribution, adipocytokines and metabolic alterations in obese low-birth-weight children.

BACKGROUND: In addition to obesity, low birth weight (LBW) has been proposed as another independent risk factor associated with cardiovascular disease and type 2 diabetes mellitus. OBJECTIVE: This study aimed to evaluate the influence of birth weight on abdominal fat distribution, adipocytokine levels and associated metabolic alterations in obese children. METHODS: A cross-sectional study was conducted in 92 children. Children were divided into three groups according to their body mass index and birth weight. Glucose and insulin (0 and 120 min), lipid profile and adipocytokines were measured. Abdominal fat distribution was assessed by magnetic resonance imaging. RESULTS: Obese LBW children had higher fasting glucose (P = 0.054) and insulin (P < 0.001), and 120 min glucose (P < 0.001) and insulin levels (P < 0.001), such as increased HOMA-IR (homeostasis model assessment of insulin resistance index) (P < 0.001). Obesity and LBW were associated with lower concentrations of high molecular weight (HMW) adiponectin (-2.38 [IC 95% -4.27; -0.42, P = 0.018]) and higher subcutaneous adipose tissue (SAT) (28.05 [IC 95% 0.40; 55.7, P = 0.047]) compared with NBW obese children, independent of age or sex. CONCLUSIONS: LBW in obese children is associated with lower HMW adiponectin, increased insulin resistance and greater SAT.

Effect of protein restriction diet on renal function and metabolic control in patients with type 2 diabetes: a randomized clinical trial.

OBJECTIVE: To assess the effect of a low protein diet (LPD) on renal function and metabolic control in three sub-groups of patients with type 2 diabetes those with or without nephropathy. RESEARCH DESIGN AND METHODS: A randomized clinical trial was conducted on 60 patients with type 2 diabetes in primary care -19 with normoalbuminuria, 22 with microalbuminuria, and 19 with macroalbuminuria-. All patients experienced a screening phase during the 3 months, and were designated according to percentages of daily caloric intake (e.g., carbohydrates 50%, fat 30%, and 20% of protein). After this period, they were randomly assigned to receive either LPD (0.6-0.8 g/kg per day) or normal protein diet (NPD) (1.0-1.2 g/kg per day) for a period of 4 months. Twenty nine patients received LPD and 31 received NPD. Primary endpoints included measures of renal function (UAER, serum creatinine and GFR) and glycemic control (fasting glucose and glycosylated hemoglobin A1c). RESULTS: Renal function improved among patients with macroalbuminuria who received LPD: UAER decreased (1,280.7 +/- 1,139.7 to 444.4 +/- 329.8 mg/24 h; p < 0.05) and GFR increased (56.3 +/- 29.0-74.2 +/- 40.4 ml/min; p < 0.05). In normoalbuminuric and microalbuminuric patients, there were no significant changes in UAER or GFR after either diet. HbA1c decreased significantly among microalbuminuric patients on both diets (LPD, 8.2 +/- 1.6-7.2 +/- 1.8%; p < 0.05; NPD, 8.8 +/- 1.9-7.1 +/- 0.8%; p < 0.05) and among macroalbuminuric patients who received NPD (8.1 +/- 1.8-6.9 +/- 1.6%; p < 0.05). CONCLUSIONS: A moderated protein restriction diet improved the renal function in patients with type diabetes 2 and macroalbuminuria.

Effect of protein restriction diet on renal function and metabolic control in patients with type 2 diabetes: a randomized clinical trial / Efecto de la dieta con restricción proteica en la función renal y el control metabólico de pacientes con diabetes tipo 2: ensayo clínico de distribución aleatoria

Objective: To assess the effect of a low protein diet (LPD) on renal function and metabolic control in three sub-groups of patients with type 2 diabetes those with or without nephropathy. Research design and methods: A randomized clinical trial was conducted on 60 patients with type 2 diabetes in primary care -19 with normoalbuminuria, 22 with microalbuminuria, and 19 with macroalbuminuria-. All patients experienced a screening phase during the 3 months, and were designated according to percentages of daily caloric intake (e.g., carbohydrates 50%, fat 30%, and 20% of protein). After this period, they were randomly assigned to receive either LPD (0.6-0.8 g/kg per day) or normal protein diet (NPD) (1.0-1.2 g/kg per day) for a period of 4 months. Twenty nine patients received LPD and 31 received NPD. Primary endpoints included measures of renal function (UAER, serum creatinine and GFR) and glycemic control (fasting glucose and glycosylated hemoglobin A1c). Results: Renal function improved among patients with macroalbuminuria who received LPD: UAER decreased (1,280.7 ± 1,139.7 to 444.4 ± 329.8 mg/24 h; p < 0.05) and GFR increased (56.3 ± 29.0-74.2 ± 40.4 ml/min; p < 0.05). In normoalbuminuric and microalbuminuric patients, there were no significant changes in UAER or GFR after either diet. HbA1c decreased significantly among microalbuminuric patients on both diets (LPD, 8.2 ± 1.6-7.2 ± 1.8%; p < 0.05; NPD, 8.8 ± 1.9-7.1 ± 0.8%; p < 0.05) and among macroalbuminuric patients who received NPD (8.1 ± 1.8-6.9 ± 1.6%; p < 0.05). Conclusions: A moderated protein restriction diet improved the renal function in patients with type diabetes 2 and macroalbuminuria (AU)

Objetivo: Valorar el efecto de una dieta baja en proteínas (DBP) sobre la función renal y el control metabólico en tres subgrupos de pacientes con diabetes tipo 2 con y sin nefropatía. Diseño del estudio y métodos: Ensayo clínico de distribución aleatoria en 60 pacientes con diabetes tipo 2, en atención primaria- 19 con normoalbuminuria, 22 con microalbuminuria y 19 con macroalbuminuria. Todos los pacientes pasaron una fase de pre-intervención durante 3 meses y se anotó los porcentajes de ingesta calórica diaria (p.ej., carbohidratos 50%, grasas 30%, proteínas 20%). Después de este periodo de lavado, fueron distribuidos de forma aleatoria, para recibir o bien una DBP (0,6-0,8 g/kg, al día) o una dieta normoproteica (DNP) (1,0-1,2 g/kg al día), durante un periodo de 4 meses. Veintinueve pacientes recibieron DBP y 31 DNP. Las principales variables de desenlace fueron las medidas de función renal (EAU, creatinina sérica y TFG) y el control glucémico (glucemia en ayunas y hemoglobina A1 c glucosilada). Resultados: La función renal mejoró en los pacientes con macroalbuminuria que realizaron la DBP: la EAU disminuyó (de 1.280,7 ± 1.139,7 a 444,4 ± 329,8 mg/24 h; p < 0,05) la TFG aumentó ( 56,3 ± 29,0 - 74,2 ± 40,4 ml/min; p < 0,05). En los pacientes con normo y microalbuminuria, no hubo cambios significativos en la EAU o TFG tras cualquiera de las dietas. La HbA1c disminuyó significativamente en los pacientes con microalbuminuria, con ambas dietas (DBP, 8,2 ± 1,6-7,2 ± 1,8%; p < 0,05; DNP, 8,8 ± 1,9-7,1 ± 0,8%; p < 0,05) y en los pacientes con macroalbuminuria que siguieron la DNP (8,1 ±1,8-6,9 ±1,6%; p < 0,05). Conclusiones: Una dieta con restricción proteica moderada mejora la función renal en pacientes con diabetes tipo 2 y macroalbuminuria (AU)