Food addiction behavior in patients with newly-diagnosed type 2 diabetes.

BACKGROUND: The concept of food addiction describes the difficulties of some individuals with regard to food consumption. OBJECTIVE: To determine the frequency of food addiction and its association with body mass index (BMI), calorie consumption and therapeutic control in patients with newly-diagnosed type 2 diabetes mellitus (T2DM). MATERIAL AND METHODS: A total of 1,080 patients with T2DM were included. The degree of metabolic control was determined with the levels of glycated hemoglobin, low-density lipoprotein cholesterol and blood pressure. Daily caloric consumption was estimated with a semi-quantitative questionnaire of food consumption frequency. RESULTS: Nearly all patients showed overweight (40.5 %) and obesity (49.1 %). The frequency of food addiction was 54.2 % (56.9 % in women and 48.9 % in men). Food addiction was associated with BMI (OR = 1.89, p ≤ 0.05), high caloric intake (OR = 1.14, p ≤ 0.05) and glycated hemoglobin > 7 % (OR = 1.43, p ≤ 0.05). CONCLUSIONS: Food addiction is common in patients with overweight/obesity and newly-diagnosed T2DM, and is associated with higher-than-recommended caloric consumption, obesity degree and poor metabolic control.

ANTECEDENTES: El concepto de adicción a la comida describe las dificultades de algunos individuos respecto al consumo de comida. OBJETIVO: Determinar la frecuencia de la adicción a la comida y su asociación con el índice de masa corporal (IMC), consumo de calorías y control terapéutico en pacientes con diabetes mellitus tipo 2 (DMT2) de diagnóstico reciente. MATERIAL Y MÉTODOS: Se incluyeron 1080 pacientes con DMT2. Se determinó el grado de control terapéutico con niveles de hemoglobina glicada, colesterol de baja densidad y presión arterial. El consumo diario de calorías fue estimado con un cuestionario semicuantitativo de frecuencia de consumo de alimentos. RESULTADOS: Casi todos los pacientes mostraron sobrepeso (40.5 %) y obesidad (49.1 %). La frecuencia de adicción a la comida fue de 54.2 % (56.9 % en mujeres y 48.9 % en hombres). La adicción a la comida se asoció a IMC (RM = 1.89, p ≤ 0.05), alto consumo calórico (RM = 1.14, p ≤ 0.05) y hemoglobina glicada > 7 % (RM = 1.43, p ≤ 0.05). CONCLUSIONES: La adicción a la comida es frecuente en pacientes con sobrepeso/obesidad y DMT2 recientemente diagnosticada y se asocia al consumo calórico superior a lo recomendado, grado de obesidad y pobre control terapéutico.

Comportamiento de adicción a la comida en pacientes recientemente diagnosticados con diabetes tipo 2 / Food addiction behavior in patients with newly-diagnosed type 2 diabetes

Resumen Antecedentes: El concepto de adicción a la comida describe las dificultades de algunos individuos respecto al consumo de comida. Objetivo: Determinar la frecuencia de la adicción a la comida y su asociación con el índice de masa corporal (IMC), consumo de calorías y control terapéutico en pacientes con diabetes mellitus tipo 2 (DMT2) de diagnóstico reciente. Material y: métodos: Se incluyeron 1080 pacientes con DMT2. Se determinó el grado de control terapéutico con niveles de hemoglobina glicada, colesterol de baja densidad y presión arterial. El consumo diario de calorías fue estimado con un cuestionario semicuantitativo de frecuencia de consumo de alimentos. Resultados: Casi todos los pacientes mostraron sobrepeso (40.5 %) y obesidad (49.1 %). La frecuencia de adicción a la comida fue de 54.2 % (56.9 % en mujeres y 48.9 % en hombres). La adicción a la comida se asoció a IMC (RM = 1.89, p ≤ 0.05), alto consumo calórico (RM = 1.14, p ≤ 0.05) y hemoglobina glicada > 7 % (RM = 1.43, p ≤ 0.05). Conclusiones: La adicción a la comida es frecuente en pacientes con sobrepeso/obesidad y DMT2 recientemente diagnosticada y se asocia al consumo calórico superior a lo recomendado, grado de obesidad y pobre control terapéutico.

Abstract Background: The concept of food addiction describes the difficulties of some individuals with regard to food consumption. Objective: To determine the frequency of food addiction and its association with body mass index (BMI), calorie consumption and therapeutic control in patients with newly-diagnosed type 2 diabetes mellitus (T2DM). Material and methods: A total of 1,080 patients with T2DM were included. The degree of metabolic control was determined with the levels of glycated hemoglobin, low-density lipoprotein cholesterol and blood pressure. Daily caloric consumption was estimated with a semi-quantitative questionnaire of food consumption frequency. Results: Nearly all patients showed overweight (40.5 %) and obesity (49.1 %). The frequency of food addiction was 54.2 % (56.9 % in women and 48.9 % in men). Food addiction was associated with BMI (OR = 1.89, p ≤ 0.05), high caloric intake (OR = 1.14, p ≤ 0.05) and glycated hemoglobin > 7 % (OR = 1.43, p ≤ 0.05) Conclusions: Food addiction is common in patients with overweight/obesity and newly-diagnosed T2DM, and is associated with higher-than-recommended caloric consumption, obesity degree and poor metabolic control.

Downregulation of SLC16A11 is Present in Offspring of Mothers with Gestational Diabetes.

BACKGROUND: Studies have identified that diseases in pregnancy affect fetal growth and development of the newborn. In Mexican population, the gene SLC16A11 has been identified as a factor that increases the risk of developing type 2 diabetes mellitus. To date, information is scarce about its expression in gestational diabetes mellitus (GDM); epigenetic modifications due to maternal hyperglycemic state could be identified early in fetal development. PURPOSE: This study aimed to determine the SLC16A11 expression and methylation status in umbilical cord blood of newborns offspring of mothers with or without GDM. METHODS: Cross-sectional, analytic study. Pregnant patients undergoing caesarean delivery with and without GDM in the Unidad Medica de Alta Especialidad Hospital de Gineco-obstetricia #4 Luis Castelazo Ayala, Instituto Mexicano del Seguro Social, were invited to participate. DNA was extracted from the mothers' blood cells, or umbilical cord blood cells of their newborns, and subjected to methylation status. Total RNA was used to evaluate the SLC16A11 expression by endpoint RT-PCR. Variables were analyzed with Student t. Values of p <0.05 were considered statistically significant. RESULTS: A SLC16A11 downregulation was observed for newborns, while methylation status was found in only 1 of 68 mother-child pairs. Somatometry of newborns showed no differences between groups. Differences were found in total cholesterol, triglycerides, ALT, glucose, and HbA1c. CONCLUSIONS: For the first time, a differential expression for SLC16A11 was observed in offspring. Downregulation in this gene expression could characterize the offspring from GDM. No difference was found in somatometry of newborns of mothers with and without GDM.

Micronutrients of the one-carbon metabolism cycle are altered in mothers and neonates by gestational diabetes and are associated with weight, height and head circumference at birth.

While several studies have previously described the levels of one-carbon metabolism-related micronutrients in women with gestational diabetes mellitus (GDM) and their neonates, the results in these literature reports have been contradictory. We hypothesized that the concentrations of micronutrients involved in the one-carbon cycle are altered in pregnant women and their neonates by GDM, and that these changes could further modify the neonatal anthropometry. Micronutrient levels were measured in 123 pregnant women with normal glucose levels (M-ND) and their neonates (N-ND), as well as in 54 pregnant women with gestational diabetes (M-GDM) and their neonates (M-GDM). Folate and vitamin B12 levels were measured via competitive ELISA, and betaine, choline, and glycine levels were measured via ultra-high performance liquid chromatography-mass spectrometry (UHPLC-MS/MS). Vitamin B12 and Glycine were found to be higher in M-GDM compared to M-ND. N-GDM had higher levels of folic acid and vitamin B12 and lower levels of betaine and choline compared to N-ND. In general, neonates presented with high concentrations of micronutrients compared to their mothers, and the fetus/maternal ratio of micronutrients was higher among the N-ND as compared to the N-GDM. Micronutrients were also variably associated with anthropometric measurements. The association of betaine with neonatal anthropometry in N-GDM is highlighted. In summary, our results implicate a potential role of GDM in altering the levels of one-carbon metabolism-related micronutrients among pregnant women and their neonates. Likewise, our results also elucidate a potential association between the concentrations of micronutrients and the weight, height, and head circumference of neonates.

Validation of the COVID-19 Fear Scale modified for application during the perinatal period.

PURPOSE: The COVID-19 Fear Scale (FCV-19S) allows screening in general population; however, there is no specific instrument in our population for screening in the perinatal period that considers fear related with COVID-19 and offspring well-being. We aimed to validate the FCV-19S modified for application during the perinatal period. MATERIALS AND METHODS: Analytical, cross-sectional design. After signing consent, women 18-45 years were included. Internal consistency was calculated with Cronbach's alpha, external validity using the Hospital Anxiety and Depression Scale (HADS), factorial analysis and intraclass correlation coefficient for re-test. RESULTS: The sample included 178 women, mean age 31.04 ± 5.9. We obtained internal consistency with Cronbach's alpha = 0.873 (95%CI, 0.842-0.899). Spearman's Rho coefficient was 0.207 (p= .013). All the elements were statistically significant for the polychoric correlation (p<.001). Reliability test-retest with intraclass correlation was 0.873. CONCLUSIONS: The version of FCV-19S modified with eight items is a valid measurement instrument for application during the perinatal period, showing adequate internal consistency and external validity with HADS as measure of concurrence to identify anxiety related with COVID-19 during the perinatal period.

The Triglycerides and Glucose Index is Negatively Associated with Insulin Secretion in Young Adults with Normal Weight.

Several studies have supported the usefulness of the triglycerides and glucose (TyG) index as a surrogate measure of insulin resistance; however, it has not been evaluated in insulin secretion. The aim of this study was to assess the association between the TyG index and insulin secretion in young adults with normal weight. Apparently healthy non-pregnant women and men, aged 18 to 23 years, were enrolled in a cross-sectional study. Overweight, obesity, pregnancy, smoking, alcohol consumption, diabetes, liver disease, renal disease, cardiovascular disease, and neoplasia were the exclusion criteria. Normal weight was defined by a body mass index (BMI)≥18.5<25.0 kg/m2 and the TyG index was calculated as the Ln [fasting triglycerides (mg/dl) x fasting glucose (mg/dl)]/2. A total of 1676 young adults with normal-weight, 1141 (68%) women, and 535 (32%) men were enrolled. Of them, 269 (16%) individuals exhibited insulin resistance; 213 (12.7%) women and 56 (3.3%) men. The linear regression analysis adjusted by gender, BMI, and waist circumference showed a significant association between the TyG index and HOMA-B (B=-35.90; 95% CI:-68.25 to-3.54, p=0.03) in the overall population. An additional analysis adjusted by BMI and waist circumference revealed that the TyG index is significantly associated with HOMA-B in subjects with and without insulin resistance (B=-104.73; 95% CI:-204.28 to-5.18, p=0.03 and B=-74.72; 95% CI:-108.04 to-41.40, p<0.001). The results of this study showed that the TyG index is negatively associated with insulin secretion in young adults with normal weight.

Disfunción endotelial en niños con enfermedad renal crónica / Endothelial dysfunction in children with chronic kidney disease

Antecedentes y objetivo: La enfermedad cardiovascular es la principal causa de muerte en niños con enfermedad renal crónica. La inflamación y la disfunción endotelial se presenta en la mayoría de estos pacientes y son factores asociados a enfermedad cardiovascular. La dilatación mediada por flujo (DMF)<7% es un marcador subrogado validado en la evaluación de la disfunción endotelial. Nuestro objetivo fue identificar los factores de riesgo asociados a disfunción endotelial en niños con enfermedad renal crónica. Materiales y métodos: Se estudió a niños de 2-16 años de edad. Se recopiló su información clínica y variables bioquímicas, incluidos hormona paratiroidea intacta (iPTH), interleucinas 6 y 1β, proteína C reactiva de alta sensibilidad (hsCRP), glutatión reducido, óxido nítrico, malondialdehído y homocisteína. Se consideró DMF alterada<7%. Resultados: Se incluyó a 129 pacientes con edad de 13,1±2,6 años. Tuvieron DMF<7% 69 (52,7%). Los pacientes con DMF<7% tuvieron niveles más altos de triglicéridos y de hsCRP que aquellos con DMF≥7% (145,5 vs. 120,0mg/dl, p=0,042, y 1,24 vs. 0,55U/l, p=0,007, respectivamente), así como una mayor frecuencia de iPTH baja (19,1 vs. 4,9%, p=0,036). Los niveles de hsCRP se correlacionaron significativamente con la DMF (Rho=−0,28, p=0,003). Los pacientes con iPTH baja (OR 4,41, IC 95% 1,13-17,27, p=0,033) y con hsCRP incrementada (OR 2,89, IC 95% 1,16-7,17, p=0,022) tuvieron un riesgo ajustado mayor de DMF<7%. Conclusiones: La hipertrigliceridemia, la inflamación y una iPTH baja se asociaron significativamente a una DMF alterada. Son factores de riesgo de enfermedad cardiovascular frecuentes y tratables. (AU)

Background and objective: Cardiovascular disease is the main cause of death in children with chronic kidney disease. Inflammation and endothelial dysfunction are found in the majority of these patients and are factors associated to cardiovascular disease. Flow mediated dilatation (FMD) is a surrogate marker validated for evaluating endothelial dysfunction. Our objective was to identify risk factors associated to endothelial dysfunction in children with chronic kidney disease. Materials and methods: Children 2-16 years of age were studied. Clinical information and biochemical variables were gathered, including intact parathyroid hormone (iPTH), interleukins 6 and 1β, high sensitivity C reactive protein (hsCRP), reduced glutathione, nitric oxide, malondialdehyde and homocysteine. FMD was measured, and considered altered if<7%. Results: Included were 129 patients aged 13.1±2.6 years. FMD<7% was found in 69 (52.7%). Patients with altered FMD had higher levels of triglycerides and hsCRP than those with normal FMD (145.5 vs. 120.0mg/dL, P=.042, and 1.24 vs. 0.55U/L, P=.007, respectively), as well as higher frequency of low iPTH (19.1 vs. 4.9%, P=.036). Levels of hsCRP correlated significantly with FMD (Rho=−0.28, P=.003). Patients with low iPTH (OR 4.41, 95% CI 1.13-17.27, P=.033) and increased hsCRP (OR 2.89, 95% CI 1.16-7.17, P=.022) had higher adjusted risk of having FMD<7%. Conclusions: Hypertriglyceridemia, inflammation and low iPTH associated significantly with altered FMD. They are frequent, treatable risk factors for cardiovascular disease. (AU)

Fear of COVID-19 scale: validation in Spanish in the Mexican general population.

INTRODUCTION: The fear of COVID-19 scale (FCV-19S) is used to screen for symptoms of anxiety and depression related to COVID-19 in the general population; it consists of seven questions with Likert-type answers (1-5). Our objective was to validate FCV-19S Spanish version in the Mexican general population. MATERIAL AND METHODS: Analytical, cross-sectional design. Three-hundred and six subjects from the general population were included during 2020 after having signed informed consent. Barlett and Kaiser-Meyer-Olkin (KMO) sphericity tests were applied. Reliability was calculated with Cronbach's alpha, and external validity, using the Hospital Anxiety and Depression Scale and Pearson's correlation coefficient for retest. RESULTS: The general population sample included 306 participants; 64.4 % were women (n = 197), mean age was 32 years (18-68). We obtained a KMO = 0.848, internal consistency with Cronbach's alpha = 0.870 (95% CI: 0.848-0.891), a rho coefficient of 0.508 (p < 0.001) and external validity of 0.151 (p = 0.008). Confirmatory analysis showed: χ2 = 22.802 (df = 13) with CMIN-DF = 1.900 (p ≤ 0.001), GFI = 0.972, CFI = 0.901, RMSEA = 0.062 (90% CI: 0.019-0.100) and TLI = 0.827. CONCLUSIONS: According to our findings, the scale shows adequate psychometric properties: reliability, internal consistency, correlation with subsequent measurements and convergence validity, for initial screening of the Mexican general population.

INTRODUCCIÓN: La Escala de temor a la COVID-19 (FCV-19S) se usa en el tamizaje de síntomas de ansiedad y depresión relacionados con la COVID-19 en población general; consta de siete preguntas con respuestas tipo Likert (1-5). Nuestro objetivo fue validar la versión del FCV-19S en la población general mexicana. MATERIAL Y MÉTODOS: Diseño transversal analítico. Se incluyeron 306 sujetos de la población general durante 2020 con firma previa de consentimiento informado. Se aplicaron pruebas de esfericidad de Barlett y Kaiser-Meyer-Olkin (KMO). Se calculó la confiabilidad con el alfa de Cronbach, la validez externa utilizando la Escala hospitalaria de ansiedad y depresión y el coeficiente de correlación de Pearson para retest. RESULTADOS: La muestra de la población general incluyó a 306 participantes, el 64.4% mujeres (n = 197), edad media 32 años (18-68). Obtuvimos un KMO = 0.848, consistencia interna con alfa de Cronbach = 0.870 (IC 95%: 0.848-0.891), coeficiente rho de 0.508 (p < 0.001) y validez externa de 0.151 (p = 0.008). El análisis confirmatorio mostró: χ2 = 22.802 (df = 13) con CMIN-DF= 1.900, p ≤ 0.001, GFI = 0.972, CFI = 0.901, RMSEA = 0.062 (IC 90%: 0.019-0.100) y TLI = 0.827. CONCLUSIONES: La FCV-19S demuestra propiedades psicométricas adecuadas (confiabilidad, consistencia interna, correlación con mediciones subsecuentes y validez de convergencia) para su aplicación en la población general mexicana.

Endothelial dysfunction in children with chronic kidney disease.

BACKGROUND AND OBJECTIVE: Cardiovascular disease (CVD) is the main cause of death in children with chronic kidney disease (CKD). Inflammation and endothelial dysfunction (ED) are found in the majority of these patients and are factors associated to CVD. Flow mediated dilatation (FMD) is a surrogate marker validated for evaluating ED. Our objective was to identify risk factors associated to ED in children with CKD. MATERIALS AND METHODS: Children 2-16 years of age were studied. Clinical information and biochemical variables were gathered, including intact parathyroid hormone (iPTH), interleukins 6 and 1b, high sensitivity C reactive protein (hsCRP), reduced glutathione, nitric oxide, malondialdehyde and homocysteine. FMD was measured, and considered altered if <7%. RESULTS: Included were 129 patients aged 13.1 ±â€¯2.6 years. FMD < 7% was found in 69 (52.7%). Patients with altered FMD had higher levels of triglycerides and hsCRP than those with normal FMD (145.5 mg/dl vs. 120.0 mg/dl, P = .042, y 1.24 U/L vs. 0.55 U/L, P = .007, respectively), as well as higher frequency of low iPTH (19.1% vs. 4.9%, P = .036). Levels of hsCRP correlated significantly with FMD (Rho = -0.28, P = .003). Patients with low iPTH (OR = 4.41, 95%CI 1.13-17.27, P = .033) and increased hsCRP (OR = 2.89, 95%CI 1.16-7.17, P = .022) had higher adjusted risk of having FMD < 7%. CONCLUSIONS: Hypertriglyceridemia, inflammation and low iPTH associated significantly with altered FMD. They are frequent, treatable risk factors for CVD.

Type 1 diabetes incidence in children and adolescents in Mexico: Data from a nation-wide institutional register during 2000-2018.

AIMS: To describe the annual incidence of type 1 diabetes in children and adolescents insured by the Mexican Institute of Social Security, the main health provider in Mexico, during 2000-2018. METHODS: We conducted a secondary data analyses using the incidence registers from the Epidemiological Surveillance Coordination of the Mexican Institute of Social Security collected during 2000-2018. Incident type 1 diabetes cases (age 19 years old and below) were identified using ICD-10-CM E10 diagnostic codes. Age, sex, and geographical region and seasonal-specific incidence were calculated with their corresponding annual percentage change (APC) as well. RESULTS: In the period 2000-2018, the number of incident cases with type 1 diabetes decreased from 3.4 to 2.8 per 100,000 in insured for subjects below 20 years old. We observed an increase in the 2000-2006, followed by a decrease for the 2006-2018 period (APC +16.1 and -8.7 respectively). Females and children <5 years old had a significant decrease in the incidence rate, while inhabitants in Central Mexico showed a significant increase. No difference was found in incidence between seasons. CONCLUSIONS: Our study describes significant fluctuations of the incidence of type 1 diabetes during the period 2000-2018, which appeared to correspond to influenza outbreaks, among Mexican children and adolescents.

Adipocytokines and High Blood Pressure in Mexican Children.

Given that adipocytokines may play an important role in the pathophysiology of high blood pressure (HBP) and because related reports in children are scarce and controversial, we evaluated the relationship of leptin, resistin, tumor necrosis factor-α, interleukin-6, adiponectin, and interferon-γ with HBP. Materials and Methods. A total of 129 (53.8%) girls and 111 (46.2%) boys, with average ages of 10.8 ± 0.9 and 10.6 ± 1.0 years, respectively, were enrolled in a cross-sectional study. HBP was defined by systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) between the 90th and 95th percentiles. A multivariate logistic regression backwards-stepwise analysis adjusted for body mass index, waist circumference, and triglyceride levels was performed to compute the association between adipocytokines and HBP. Results. Seventy-two (30.0%) participants showed HBP: 44 (61.1%) girls and 28 (38.9%) boys. Multivariate analysis showed that, irrespective of obesity, serum levels of adiponectin, but not those of other adipocytokines, are inversely associated with HBP (odds ratio 0.93; 95% CI 0.77 to 0.98, p = .04). Conclusions. Our results show that low serum adiponectin levels, but not those of other adipocytokines, are inversely associated with HBP; this association is independent of obesity.

[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.

Agreement between the 'point of care' tests for microalbuminuria and HbA1c performed in mexican family medicine units and the results of standard laboratory tests.

The albumin-creatinine ratio is considered an indicator of microalbuminuria, precursor to chronic kidney disease, while HbA1c is used to measure glycemic control. Given the prevalence of diabetes-related nephropathy, spot testing of albumin has long been recommended as a preventative measure, for the timely detection of microalbuminuria. However, many countries do not have this testing available in primary care, and sometimes not even in second- and third-level care. The objective of this study was to compare agreement of the microalbuminuria and HbA1c results obtained in the laboratory with 'gold standard' techniques, with those obtained on site with a 'Point of Care' DCA Vantage™ device by Siemens. Results for the albumin-creatinine ratio and HbA1c from the Siemens DCA Vantage™ point of care device were compared with those from standard laboratory tests in 25 family medicine units in Mexico City and Toluca, State of Mexico, in patients diagnosed with type-2 diabetes. Agreement between the albumin values of the 2 tests was 0.745 (CI 95% 0.655-0.812). Agreement between the two measurement techniques for HbA1c was 0.970 (CI 95% 0.966-0.973). The results obtained were sufficiently comparative (Ri= 0.74 for albumin-creatinine ratio and Ri = 0.97 for HbA1c) to justify the use of the point of care device. Given the high agreement between the point of care device and laboratory tests, this device could be used to identify chronic kidney disease and glycemic control for more adequate treatment in patients with diabetes, especially in remote areas.

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.

Association of V249I and T280M variants of fractalkine receptor CX3CR1 with carotid intima-media thickness in a mexican population with type 2 diabetes.

OBJECTIVE: To evaluate the association of the V249I and T280M variants of CX3CR1 fractalkine gene with carotid intima-media thickness in Mexican subjects with and without type 2 diabetes. METHODS: We analyzed the V249I and T280M variants of the CX3CR1 receptor by TaqMan assays in 111 subjects with type 2 diabetes and 109 healthy controls. Hemoglobin A1c, glucose, and lipid profile were determined. RESULTS: A significant increase in carotid intima-media thickness was observed in type 2 diabetes patients (0.979 ± 0.361 mm) compared to healthy controls (0.588 ± 0.175 mm). In subjects carrying the MM variant of the T280M polymorphism, hemoglobin A1c was higher (p = 0.008). Classic risk factors for atherosclerosis showed no differences between carriers of the T280M and V249I variants. Controls with the II249 genotype associated with carotid intima-media thickness (0.747 ± 0.192 mm; p = 0.041), and this difference remained significant even after adjusting factors such as age, gender, and body mass index (OR: 7.7; 95% CI: 1.269-47.31; p = 0.027). CONCLUSIONS: V249I genotype of the fractalkine receptor showed a protector role in patients with type 2 diabetes. The T280M genotype is associated with increased carotid intima-media thickness in Mexican individuals with or without type 2 diabetes.

Insulin resistance is associated with elevated transaminases and low aspartate aminotransferase/alanine aminotransferase ratio in young adults with normal weight.

OBJECTIVE: The aim of this study is to determine whether insulin resistance is associated with elevation of transaminases levels and aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio in normal-weight healthy young adults. PARTICIPANTS AND METHODS: Apparently healthy nonpregnant women and men, aged 18-23 years, were enrolled in a cross-sectional study. According to the homeostasis model assessment of insulin resistance, the participants were allocated into groups of patients with (>2.5) and without (≤2.5) insulin resistance. Normal weight was defined by BMI of at least 18.5 and less than 25.0 kg/m. A multiple logistic regression analysis was carried out to determine the association between insulin resistance and elevated transaminases and AST/ALT ratio of 1 or less. RESULTS: A total of 1732 young adults were enrolled and allocated into groups with (n=287) and without (n=1445) insulin resistance. The prevalence of insulin resistance was 16.6% in the overall population. The multivariate logistic regression analysis adjusted by age, sex, waist circumference, and BMI indicated that the odds ratio (OR) between insulin resistance and elevated ALT concentrations is 1.65 [95% confidence interval (CI): 1.04-2.62, P=0.03], for AST/ALT ratio lower than 1 OR is 1.69 (95% CI: 1.27-2.26, P<0.001), and for elevated AST levels OR is 1.31 (95% CI: 0.71-2.43, P=0.377). CONCLUSION: The results of the present study suggest that insulin resistance is significantly associated with elevated ALT levels and AST/ALT ratio of lower than 1, but not with elevated AST levels.

[Level of expression of gene CTSL and its correlation with natural killer T-Cells in mexican pediatric patients with recent-onset type 1 diabetes]. / Asociación de células NKT con la expresión del gen CTSL en población pediátrica mexicana con diabetes tipo 1 de reciente diagnóstico.

OBJECTIVE: To compare the level of expression of the gene CTSL and its correlation with NKT cells in patients with recent-onset type 1 diabetes (T1D), their siblings, and healthy controls. METHODS: Analytical cross-sectional design. Patients with T1D < 3 months evolution, their siblings, and healthy controls were included. Percentages and absolute numbers of NKT cells were measured with expression of the CTSL gene. RESULTS: 124 subjects: with T1D (n = 48), siblings (n = 44) and controls (n = 32) were included. HbA1c was greater and C-peptide lower in T1D than the other groups and sibling age was higher (p < 0.001). There were no differences in NKT cells between T1D (0.176 ± 0.202) and controls (0.118 ± 0.133), but the percentage was higher in siblings (0.246 ± 0.188; p = 0.002). Lower level of expression of the CTSL gene associated with both absolute number (r: 0.4607; 95% CI: -0.08425 to -0.7935; p = 0.043) and percentage of NKT cells (r: 0.4540; 95% CI: -0.0927 to -0.7903; p = 0.045) in the T1D group. CONCLUSIONS: Patients with T1D have lower percentage and absolute number of NKT cells compared to their siblings. NKT cells absolute numbers are correlated with the expression of CTSL in T1D patients.

Lower Plasma Ghrelin Levels are Found in Women with Diabetes-Complicated Pregnancies.

OBJECTIVE: To evaluate the associations of glycemic control and gestational age with ghrelin and proinsulin levels in cord blood and mothers' peripheral blood during pregnancy. METHODS: This is a cross-sectional comparative study of twenty-four pregnant women with gestational diabetes (GD), 18 with type 2 diabetes mellitus (T2DM), and 36 without diabetes, as well as their neonates. Levels of proinsulin, ghrelin, and glycated hemoglobin A1c (HbA1c) were measured from maternal blood during the last week before caesarian delivery and in neonatal umbilical cord blood samples. RESULTS: Mothers with GD and T2DM had significantly lower ghrelin levels compared to the healthy mothers (p<0.001). Maternal proinsulin was lower in women with GD than in women without diabetes (p<0.001). Proinsulin was significantly elevated in the neonates of women with GD and in women with HbA1c ≥6.5% (p<0.001). However, maternal ghrelin levels were higher (p=0.031) and neonate proinsulin levels lower in the pre-term offspring of mothers with GD (p=0.033). There was a negative correlation between HbA1c levels and birth weight (r=-0.407, p<0.001). CONCLUSION: Ghrelin levels were lower in pregnant women with diabetes, although pre-term birth appeared to reverse this trend in GD. Proinsulin levels were also low in pregnant women with diabetes and even lower in pre-term vs. at-term births. Both ghrelin and proinsulin levels were lower in pregnant women with diabetes and HbA1c of <6.5%. Thus, ghrelin participates in the adaptation to the caloric imbalance of diabetic pregnancy and may play a similar role in pregnancy-related complications, since high ghrelin concentrations may be necessary for normal fetal development.

HLA Risk Haplotype: Insulin Deficiency in Pediatric Type 1 Diabetes.

BACKGROUND: Certain HLA class II haplotypes have long been related with the risk of developing type 1 diabetes. The presence of the HLA haplotype DRB1*04/DQA1*03/DQB1*03:02, together with specific ß-cell autoantibodies, contributes to the development and/or severity of insulin deficiency in type 1 diabetes. OBJECTIVE: To evaluate the association of HLA risk haplotype HLA-DRB1/-DQA1/-DQB1 with ß-cell function and antibody markers in recent-onset type 1 diabetes patients, their siblings, and controls. METHODS: We studied recently diagnosed type 1 diabetes pediatric patients, their siblings, and healthy controls, analyzing autoantibodies (anti-glutamic acid decarboxylase, anti-IA-2, and anti-insulin), HLA risk and protector haplotypes, and ß-cell function (plasma proinsulin, insulin and C-peptide). X2, ANOVA or Kruskal-Wallis and multiple logistic regression were used to analyze data. RESULTS: We included 46 patients, 72 siblings, and 160 controls. Prevalence of anti-tyrosine phosphatase-related islet antigen 2 and anti-glutamic acid decarboxylase antibodies was higher in patients than siblings and controls. We found risk haplotype DRB1*04/DQA1*03/DQB1*03:02 in 95.7% of patients vs. 51.87% of controls; DRB1*03:01/DQA1*05/DQB1*02 in 47.8% of patients vs. 8.12% of controls; and DRB1*14/DQA1*05/DQB1*03:01 in 2.2% of patients vs. 20.0% of controls. With DRB1*04/DQA1*03/DQB1*03:02, the prevalence of antibodies was significantly higher in patients, although not within any single group. In regression model based on insulin secretion, only anti-tyrosine phosphatase-related islet antigen 2 antibodies and age were associated with the risk haplotype. CONCLUSIONS: The DRB1*04/DQA1*03/DQB1*03:02 haplotype increased the risk for lower insulin, proinsulin, and C-peptide concentrations, suggesting an association with the severity of insulin deficiency in type 1 diabetes patients. This haplotype, added to antibody positivity, is a predictor of deficient insulin secretion in a Mexican pediatric population.