Identificación de prediabetes en grupos de riesgo: una oportunidad para prevenir la enfermedad / Identification of pre-diabetes in risk groups: an opportunity to prevent the disease

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Percepción de la insulinoterapia en pacientes con diabetes mellitus tipo 2 descontrolada / Perception of insulin therapy in uncontrolled patients with type 2 diabetes mellitus

OBJETIVO: Conocer la percepción de la insulinoterapia en los pacientes con diabetes mellitus tipo 2 descontrolada tratados con hipoglucemiantes orales o con insulina. DISEÑO: Transversal comparativo prospectivo. Emplazamiento: Unidad de Medicina Familiar número 53 de la Delegación Guanajuato del Instituto Mexicano del Seguro Social. PARTICIPANTES: Pacientes de 40 a 80 años afectos de diabetes tipo 2, descontrolados, en tratamiento con insulina o hipoglucemiantes orales. MEDICIONES PRINCIPALES: La percepción se evaluó con la escala de percepción del tratamiento de insulina (Insulin Treatment Appraisal Scale [ITAS]). La calificación de la encuesta es de 20 a 100 puntos, de tal manera que cuanto mayor es la puntuación, mayor es la opinión negativa. RESULTADOS: Se encuestaron 459 pacientes, 261 (56,9%) tratados con hipoglucemiantes orales (HO) y 198 (43,1%) con insulina sola o combinada con hipoglucemiantes orales (IN). La calificación global de la percepción del tratamiento con insulina fue de 56,95 ± 7,78 en el grupo HO y de 49,55 ± 8,89 en el grupo IN (p < 0,001). CONCLUSIONES: La percepción de la insulinoterapia es más negativa en los sujetos que usan hipoglucemiantes orales que en los que usan insulina

OBJECTIVE: To determine the perception of insulin therapy by patients with uncontrolled type 2 diabetes mellitus, who have been treated with oral hypoglycaemic agents or insulin. DESIGN: Prospective comparative cross-sectional study. SETTING: Family Medicine Unit No.53 León, Guanajuato of Mexican Institute of Social Security. PARTICIPANTS: Patients between 40 and 80 years old with uncontrolled type 2 mellitus diabetes, treated with insulin or oral hypoglycaemic agents. MAIN MEASUREMENTS: Perception was assessed using the insulin treatment appraisal scale (ITAS). The rating of the survey is from 20 to 100 points, as such that when score increases the greater is the negative opinion. RESULTS: A sample of 459 diabetes patients were interviewed and split into 2 groups of patients according to their treatment. The OH group were patients treated with oral hypoglycaemic drugs only (56.9%), and the IN group were patients treated with insulin alone or combined with an oral hypoglycaemic (43.1%). Perception score was significantly higher in OH group (56.95 ± 7.78 versus 49.55 ± 8.89 points) than in the IN group (P <.001). CONCLUSIONS: The perception of insulin therapy was worse in patients treated with only oral hypoglycaemic agents than in patients using insulin

[Perception of insulin therapy in uncontrolled patients with type 2 diabetes mellitus]. / Percepción de la insulinoterapia en pacientes con diabetes mellitus tipo 2 descontrolada.

OBJECTIVE: To determine the perception of insulin therapy by patients with uncontrolled type2 diabetes mellitus, who have been treated with oral hypoglycaemic agents or insulin. DESIGN: Prospective comparative cross-sectional study. SETTING: Family Medicine Unit No. 53 León, Guanajuato of Mexican Institute of Social Security. PARTICIPANTS: Patients between 40 and 80years old with uncontrolled type2 mellitus diabetes, treated with insulin or oral hypoglycaemic agents. MAIN MEASUREMENTS: Perception was assessed using the insulin treatment appraisal scale (ITAS). The rating of the survey is from 20 to 100 points, as such that when score increases the greater is the negative opinion. RESULTS: A sample of 459 diabetes patients were interviewed and split into 2 groups of patients according to their treatment. The OH group were patients treated with oral hypoglycaemic drugs only (56.9%), and the IN group were patients treated with insulin alone or combined with an oral hypoglycaemic (43.1%). Perception score was significantly higher in OH group (56.95±7.78 versus 49.55±8.89 points) than in the IN group (P<.001). CONCLUSIONS: The perception of insulin therapy was worse in patients treated with only oral hypoglycaemic agents than in patients using insulin.

Educación diabetológica en la atención primaria / Diabetes education in primary care

Recientemente, en el Instituto Mexicano del Seguro Social se implementó el programa educativo DiabetIMSS, alcanzándose una mejora en los parámetros clínicos y bioquímicos; sin embargo, los resultados no han sido contrastados con los de la estrategia educativa habitual. Objetivos: Comparar la efectividad de DiabetIMSS y de la educación grupal tradicional sobre el conocimiento y la capacidad de autocuidado. Material y métodos: Estudio cuasi experimental que se realizó en dos unidades de medicina familiar con pacientes con diabetes tipo 2, mayores de 19 años de edad, que supieran leer y escribir. El muestreo fue por casos consecutivos y la asignación a los grupos fue no aleatorizada. El conocimiento se midió con el Cuestionario de Conocimientos en Diabetes-24 y la capacidad de autocuidado con el Cuestionario Resumido sobre Actividades de Autocuidado en Diabetes. Resultados: El grupo DiabetIMSS estuvo conformado por 53 sujetos, y el de educación tradicional, por 63. En el grupo DiabetIMSS el nivel de conocimiento inicial fue suficiente en el 17% (n = 9) y en el 60.4% (n = 32) al final del estudio(p < 0.05). En los pacientes asignados a educación grupal tradicional el nivel de conocimiento inicial fue suficiente en el 9.5% (n = 6) y en el 34.9% (n = 22) al término de la intervención (p < 0.05). En cuanto a las capacidades de autocuidado, sólo se observaron cambios significativos en la actividad física y en la revisión de los pies, en ambos grupos. Conclusiones: El programa DiabetIMSS es más efectivo para la adquisición de conocimiento, no así para mejorar la capacidad de autocuidado...

Insuficiencia renal oculta en diabéticos tipo 2 de una unidad médica de atención primaria / Occult renal disease in type 2 diabetes mellitus in a primary care medical unit

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[Self-care ability in the hypertensive patient control]. / La capacidad de autocuidado en el control del paciente hipertenso.

MATERIAL AND METHODS: Trough an analytical cross-sectional study the association of self-care ability and the blood pressure control was evaluated. We studied controlled and uncontrolled hypertensive patients, both groups with 79 subjects. Self-care basic conditioning factors and capacities scale in patients with hypertension was used. RESULTS: Self-care ability was good in 73.4% of controlled and in 3.8% of the uncontrolled patients (p < 0.05). The 91.2% of controlled and 67.9% of uncontrolled presented a positive family system (p < 0.05). Socio-cultural factors were good in 64.6% of controlled against 16.7% of the uncontrolled (p < 0.05). Environmental factors were good in 50.6% of controlled and 2.6% of the uncontrolled (p < 0.05). CONCLUSION: According to these results we conclude that there is association between self-care ability and control of hypertension.

[Effect of pentoxifylline on the evolution of diabetic nephropathy]. / Efecto de la pentoxifilina sobre la evolución de la nefropatía diabética.

BACKGROUND AND OBJECTIVE: Diabetic nephropathy (DN) is the principal cause of end-chronic kidney disease. Metabolic and hemodynamic components are directly involved. However, convincing data have shown that inflammation participates in the diabetic complications. The aim of this study was to investigate whether the inhibition of the inflammation and pro-inflammatory cytokines with pentoxifylline (PXF) attenuate the progression of the DN. SUBJECTS AND METHOD: In a prospective, randomized, double-blind, placebo- controlled study, we evaluated the effect of PXF (1200 mg daily) during 12 months, in 34 patients with incipient or established DN. Evaluated parameters were inflammation, pro-inflammatory cytokines and urinary albumin excretion (UAE). RESULTS: PXF treatment had a reno-protective effect determined by a significant reduction in the UAE in both incipient and established (p<0,01) DN patient. This effect was attributed to a reduction in the C-reactive protein, interleukin-6, tumor necrosis factor-alpha and leptin serum levels (p<0,01). CONCLUSIONS: PXF treatment caused regression and prevented the progression of renal damage. Thus, PXF should be used in the preventive treatment of DN. These results showed that inflammation and pro-inflammatory cytokines are related to the progression of diabetic nephropathy.

Efecto de la pentoxifilina sobre la evolución de la nefropatía diabética / Effect of pentoxifylline on the evolution of diabetic nephropathy

Fundamento y objetivo: La nefropatía diabética (ND) es la principal causa de enfermedad renal crónica terminal. Hay componentes metabólicos y hemodinámicos que se encuentran directamente involucrados. Sin embargo, hay datos convincentes de que la inflamación participa en las complicaciones de la diabetes. El objetivo de este estudio fue investigar si la inhibición de la inflamación y de las citocinas proinflamatorias con pentoxifilina (PXF) atenúa la progresión de la ND. Sujetos y método: En un estudio prospectivo, aleatorizado, doble ciego y controlado con placebo se evaluó el efecto nefroprotector de la PXF (1.200mg diarios) usada durante 12 meses en 34 pacientes con ND incipiente o ND establecida. Los parámetros analizados fueron la inflamación, las citocinas proinflamatorias y la excreción de albúmina en orina (EAO). Resultados: El tratamiento con PXF tuvo un efecto nefroprotector determinado por una reducción significativa en la EAO en los pacientes con ND incipiente y ND establecida (p<0,01). Este efecto se atribuyó a una disminución en los valores séricos de la proteína C reactiva, de la interleucina-6, del factor de necrosis tumoral-α y de la leptina (p<0,01). Conclusiones: El tratamiento con PXF produjo una regresión y previno la progresión de la lesión renal en el paciente diabético. Por su efecto nefroprotector, la PXF debería emplearse en el tratamiento preventivo de la ND. Los resultados indican que la inflamación y que las citocinas proinflamatorias participan en la progresión de la ND (AU)

Background and objective: Diabetic nephropathy (DN) is the principal cause of end-chronic kidney disease. Metabolic and hemodynamic components are directly involved. However, convincing data have shown that inflammation participates in the diabetic complications. The aim of this study was to investigate whether the inhibition of the inflammation and pro-inflammatory cytokines with pentoxifylline (PXF) attenuate the progression of the DN. Subjects and method: In a prospective, randomized, double-blind, placebo- controlled study, we evaluated the effect of PXF (1200mg daily) during 12 months, in 34 patients with incipient or established DN. Evaluated parameters were inflammation, pro-inflammatory cytokines and urinary albumin excretion (UAE). Results: PXF treatment had a reno-protective effect determined by a significant reduction in the UAE in both incipient and established (p<0,01) DN patient. This effect was attributed to a reduction in the C-reactive protein, interleukin-6, tumor necrosis factor-¦Á and leptin serum levels (p<0,01). Conclusions: PXF treatment caused regression and prevented the progression of renal damage. Thus, PXF should be used in the preventive treatment of DN. These results showed that inflammation and pro-inflammatory cytokines are related to the progression of diabetic nephropathy (AU)

[Depression in adolescents and family functioning]. / Depresión en adolescentes y funcionamiento familiar.

OBJECTIVE: to determine the frequency of depression and family function in adolescents. METHODOLOGY: 252 students participated in the study, 134 males and 118 females; the average age was 16 years. The Birleson depression self-rating scale and the Family Adaptability and Cohesion Scale III (FACES III) served to assess depression and family functionality. RESULTS: the overall depression was 29.8%, although in young males was 18.7% and in young females was 42.4% (p < 0.05, OR = 3.2). The rigidly dispersed family was more frequently found in the group of adolescents with depression (p < 0.05, OR = 6.3). While in the group of adolescents without depression the most frequent were, the flexible agglutinated (p < 0.05; OR = 0.215), structurally agglutinated (p < 0.05, OR = 0.215) and rigidly agglutinated families (p < 0.05, OR = 0.106). CONCLUSIONS: this study showed that a significant percentage of adolescents suffer depression. This finding should prompt to further actions to detect adolescents' depression in primary care settings to provide timely care and to avert its severe consequences such as suicide, drug and alcohol use.

[Irritable bowel syndrome in adults attending to medical offices at UMF]. / Síndrome de intestino irritable en el adulto que acude a una unidad de medicina familiar.

OBJECTIVE: To determine the prevalence of irritable bowel syndrome (IBS) in adults between 20-49 years of age that are attended at a medical offices at UMF 53 of the IMSS, León, Guanajuato. MATERIAL AND METHODS: All adult patients between 20-49 years old that attended medical offices at UMF 53 were carried out a survey to diagnose SII according to the approaches of Rome II. RESULTS: 246 patients were studied, 85 patients (35%) had a diagnosis of IBS. Of those 85 patients, 8 patients (9%) had IBS with prevalence of diarrhea, 41 patients (48%) to the subgroup of IBS had prevalence of constipation and 32 patients (42%) with IBS had alternating symptoms; 18 patients (21%) they were men and 67 patients (79%) were women. CONCLUSIONS: Prevalence of IBS in adults between 20-49 year-old attending to medical offices at UMF 53 of the IMSS, León, Guanajuato, is of 35%, being more frequent the IBS with constipation.