The Effects of an Educational Intervention About Front-of-Package Labeling on Food and Beverage Selection Among Children and Their Caregivers: Protocol for a Randomized Controlled Trial.

BACKGROUND: Overweight and obesity pose a global public health challenge and have a multifactorial origin. One of these factors includes obesogenic environments, which promote ultraprocessed foods characterized by being high in calories, saturated fats, added sugars, and sodium. In Mexico, it has been estimated that 30% of the total energy consumed comes from processed foods. The Modification to the Official Mexican Standards introduces nutritional information through black octagonal seals that alert consumers about products with excessive amounts of some components for a better food selection in the population. However, the effects of warning labels on processed food selection and purchases among children remain unknown. OBJECTIVE: We aimed to evaluate the impact of a digital educational intervention focusing on front-of-package warning labels on the food selection and purchasing behavior of elementary schoolchildren and their caregivers. METHODS: Children from 4 elementary schools in Mexico City, 2 public and 2 private schools, will participate in a randomized controlled trial. The schools will be chosen by simple random sampling. Schools will be randomized into 2 groups: intervention and control. In the control group, the dyads (caregiver-schoolchildren) will receive general nutritional education, and in the intervention group, they will receive guidance on reading labels and raising awareness about the impact of consuming ultraprocessed products on health. The educational intervention will be conducted via a website. Baseline measurements will be taken for both groups at 3 and 6 months. All participants will have access to an online store through the website, allowing them to engage in exercises for selecting and purchasing food and beverages. In addition, other measures will include a brief 5-question exam to evaluate theoretical understanding, a 24-hour reminder, a survey on food habits and consumption, application of a food preference scale, anthropometric measurements, and recording of school lunch choices. RESULTS: Registration and funding were authorized in 2022, and we will begin data collection in September 2024. Recruitment has not yet taken place, but the status of data analysis and expected results will be published in April 2025. CONCLUSIONS: The study is expected to contribute to evaluating whether reinforcing front-of-package warning labels with education enhances its effects and makes them more sustainable. Conducting this study will allow us to propose whether or not it is necessary to develop new intervention strategies related to front-of-package labeling for a better understanding of the population, improved food choices, and better health outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT06102473; https://clinicaltrials.gov/study/NCT06102473. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54783.

Inadequate diabetes knowledge is associated with poor glycemia control in patients with type 2 diabetes / El conocimiento inadecuado de la diabetes se asocia con un control glucémico deficiente en pacientes con diabetes de tipo 2

Objective: To identify the association between glycemia control with level of diabetes knowledge, diabetes education, and lifestyle variables in patients with type 2 diabetes. Design: Cross-sectional analytical study. Site: Clinics of the Mexican Institute of Social Security (IMSS), Mexico. Participants: Patients with type 2 diabetes. Main measurements: Glycated hemoglobin (HbA1c), glucose, and lipid profile levels were measured from fasting venous blood samples. Assessment of disease knowledge was performed using the Diabetes Knowledge Questionnaire (DKQ-24). Systolic and diastolic blood pressure was measured. Weight and abdominal circumference were measured, as well as body composition using bioimpedance. Sociodemographic, clinical, and lifestyle variables were obtained. Results: A total of 297 patients were included, sixty-seven percent (67%) were women with a median of six years since the diagnosis of diabetes. Only 7% of patients had adequate diabetes knowledge, and 56% had regular knowledge. Patients with adequate diabetes knowledge had a lower body mass index (p=0.016), lower percentage of fat (p=0.008), and lower fat mass (p=0.018); followed a diet (p=0.004) and had received diabetes education (p=0.002), and to obtain information about their illness (p=0.001). Patients with low levels of diabetes knowledge had a higher risk of HbA1c≥7% (OR: 4.68; 95% CI: 1.48,14.86; p=0.009), as well as those who did not receive diabetes education (OR: 2.17; 95% CI: 1.21–3.90; p=0.009) and those who did not follow a diet (OR: 2.37; 95% CI: 1.01,5.55; p=0.046). Conclusion: Inadequate knowledge of diabetes, lack of diabetes education, and dietary adherence are associated with poor glycemia control in patients with diabetes.(AU)

Objetivo: Identificar la asociación entre el control de la glicemia con el nivel de conocimiento, la educación y las variables de estilo de vida en pacientes con diabetes tipo 2. Diseño: Estudio transversal analítico. Sitio: Clínicas del Instituto Mexicano del Seguro Social, México. Participantes: Pacientes con diabetes tipo 2. Medidas principales: Se midió el nivel de hemoglobina glicosilada (HbA1c), glucosa y perfil de lípidos en ayuno. La evaluación del conocimiento de la enfermedad se realizó con el Cuestionario de Conocimiento de la Diabetes (DKQ-24). Se midió presión arterial, peso y circunferencia abdominal, así como la composición corporal con bioimpedancia. Las variables clínicas y de estilo de vida fueron registradas. Resultados: Se incluyó a 297 participantes y 67% fueron mujeres, con una mediana de diagnóstico de diabetes de seis años. Solo 7% tuvo un conocimiento adecuado de la diabetes y 56% un conocimiento regular. Los pacientes con conocimiento adecuado de la diabetes tuvieron un índice de masa corporal más bajo (p = 0,016), seguían una dieta (p = 0,004), recibieron educación en diabetes (p = 0,002), y obtuvieron información de su enfermedad (p = 0,001). Los pacientes con bajo nivel de conocimiento tuvieron mayor riesgo de HbA1c ≥ 7% (OR: 4,68; IC 95%: 1,48-14,86; p = 0,009), así como aquellos sin educación en diabetes (OR: 2,17; IC 95%: 1,21-3,90; p = 0,009) y quienes no seguían una dieta (OR: 2,37; IC 95%: 1,01-5,55; p = 0,046). Conclusión. El conocimiento inadecuado de diabetes, la falta de educación en diabetes y adherencia a la dieta se asocian a un control glucémico deficiente en pacientes con diabetes.(AU)

Inadequate diabetes knowledge is associated with poor glycemia control in patients with type 2 diabetes.

OBJECTIVE: To identify the association between glycemia control with level of diabetes knowledge, diabetes education, and lifestyle variables in patients with type 2 diabetes. DESIGN: Cross-sectional analytical study. SITE: Clinics of the Mexican Institute of Social Security (IMSS), Mexico. PARTICIPANTS: Patients with type 2 diabetes. MAIN MEASUREMENTS: Glycated hemoglobin (HbA1c), glucose, and lipid profile levels were measured from fasting venous blood samples. Assessment of disease knowledge was performed using the Diabetes Knowledge Questionnaire (DKQ-24). Systolic and diastolic blood pressure was measured. Weight and abdominal circumference were measured, as well as body composition using bioimpedance. Sociodemographic, clinical, and lifestyle variables were obtained. RESULTS: A total of 297 patients were included, sixty-seven percent (67%) were women with a median of six years since the diagnosis of diabetes. Only 7% of patients had adequate diabetes knowledge, and 56% had regular knowledge. Patients with adequate diabetes knowledge had a lower body mass index (p=0.016), lower percentage of fat (p=0.008), and lower fat mass (p=0.018); followed a diet (p=0.004) and had received diabetes education (p=0.002), and to obtain information about their illness (p=0.001). Patients with low levels of diabetes knowledge had a higher risk of HbA1c≥7% (OR: 4.68; 95% CI: 1.48,14.86; p=0.009), as well as those who did not receive diabetes education (OR: 2.17; 95% CI: 1.21-3.90; p=0.009) and those who did not follow a diet (OR: 2.37; 95% CI: 1.01,5.55; p=0.046). CONCLUSION: Inadequate knowledge of diabetes, lack of diabetes education, and dietary adherence are associated with poor glycemia control in patients with diabetes.

Increased body fat, physical inactivity, and hypertension are associated with poor quality of life in patients with type 2 diabetes.

BACKGROUND: Diabetes is a significant health problem that affects quality of life in the medium and long term. OBJECTIVE: To identify the association between quality of life with comorbidity, metabolic control, and lifestyle in patients with type 2 diabetes. METHOD: A cross-sectional study was performed in 392 patients. Glycosylated hemoglobin, fasting glucose, lipid profile, blood pressure, weight, waist circumference and body composition were measured. Diabetic neuropathy, renal disease, visual health, diet and physical exercise were measured. Health-related quality of life (HRQoL) was measured with the 36-item Short Form survey (SF-36). RESULTS: The mean age was 54.6 years, 68 % were women, median years of diabetes diagnosis was 7 years. Eighty percent had a good HRQoL (SF-36 ≥ 50). The dimension with the highest score was physical function (81.0), and vitality the lowest (46.5). Body fat was associated with more impairments in the SF-36 dimensions (p < 0.05). Factors associated with worse HRQOL are physical inactivity (odds ratio [OR]: 2.7; 95% confidence interval [95%CI]: 1.10-6.62; p = 0.009), arterial hypertension (OR: 1.78; 95% CI: 1.05-3.02; p = 0.032) and being female (OR: 2.7; 95% CI: 1.45-5.27; p = 0.002). CONCLUSIONS: Poor quality of life is associated with higher fat percentage, physical inactivity and hypertension in patients with type 2 diabetes.

ANTECEDENTES: La diabetes es un importante problema de salud que afecta la calidad de vida a mediano y largo plazo. OBJETIVO: Identificar la asociación entre la calidad de vida y la comorbilidad, el control metabólico y el estilo de vida de pacientes con diabetes tipo 2. MÉTODO: Se realizó un estudio transversal en 392 pacientes. Se midieron la hemoglobina glucosilada, la glucosa de ayuno, el perfil de lípidos, la presión arterial, el peso, la circunferencia de la cintura y la composición corporal. Se evaluaron la neuropatía diabética, la enfermedad renal, la salud visual, la dieta y el ejercicio físico. La calidad de vida relacionada con la salud (CVRS) se midió con la encuesta en su versión corta de 36 ítems (SF-36). RESULTADOS: La edad promedio fue de 54.6 años, el 68% fueron mujeres y la mediana de años de diagnóstico de diabetes fue de 7 años. Un 80% tienen una buena CVRS (SF-36 ≥ 50). La dimensión con mayor puntaje fue función física (81.0), y la más baja fue vitalidad (46.5). La grasa corporal se asoció a más afectaciones en las dimensiones del SF-36 (p < 0.05). Los factores asociados a una peor CVRS son la inactividad física (odds ratio [OR]: 2.7; intervalo de confianza del 95% [IC95%]: 1.10-6.62; p = 0.009), la hipertensión arterial (OR: 1.78; IC95%: 1.05-3.02; p = 0.032) y ser mujer (OR: 2.7; IC95%: 1.45-5.27; p = 0.002). CONCLUSIONES: Una pobre calidad de vida se asocia con mayor porcentaje de grasa, inactividad física e hipertensión en pacientes con diabetes tipo 2.

[Diagnostic performance of the FINDRISC questionnaire to identify insulin resistance in adults]. / Certeza diagnóstica del instrumento FINDRISC para identificar resistencia a la insulina en adultos.

Background: Insulin resistance (IR) is a state prior to the development of type 2 diabetes (T2D) and it is reversible with lifestyle modification. However, it is underdiagnosed due to the difficulty in its measurement. Objective: To evaluate the diagnostic performance of the FINDRISC questionnaire to identify IR. Material and methods: An analytical cross-sectional study was performed in adults aged 20 to 60 years without previous diagnosis of T2D. Those using steroids and pregnant women were excluded. IR was diagnosed through the Triglycerides/glucose index. A ROC curve was used to establish the cut-off point for the diagnosis of IR. Sensitivity, specificity, predictive values and likelihood ratios were calculated. Risk measurement for IR was performed with the FINDRISC instrument. Results: A total of 253 participants were included, with a prevalence of IR of 60.8%. The area under the curve of the FINDRISC instrument was 0.813 (95% confidence interval [95% CI] 0.759-0.865), with a cut-off point of 8. Sensitivity was 94.8% and specificity was 48.5%, positive predictive value was 74% and negative 86%, with a positive likelihood ratio of 1.84 and a negative of 0.11. Conclusions: The FINDRISC instrument is a useful screening tool to identify subjects with IR at the first level of care. A score ≥ 8 identifies subjects with IR.

Introducción: la resistencia a la insulina (RI) es un estado previo al desarrollo de diabetes tipo 2 (DT2) y es reversible con modificación en el estilo de vida. Sin embargo, este estado se encuentra subdiagnosticado por la dificultad en su medición. Objetivo: evaluar el desempeño diagnóstico del cuestionario FINDRISC para identificar RI. Material y métodos: se realizó un estudio transversal analítico en adultos de 20 a 60 años sin diagnóstico previo de DT2. Fueron excluidos quienes utilizaran esteroides y mujeres embarazadas. La RI fue diagnosticada mediante el índice triglicéridos/glucosa. Una curva ROC fue utilizada para establecer el punto de corte para el diagnóstico de RI. Se calculó sensibilidad, especificidad, valores predictivos y razones de verosimilitud. La medición del riesgo para RI se realizó con el instrumento FINDRISC. Resultados: se incluyeron 253 participantes, con una prevalencia de RI de 60.8%. El área bajo la curva del instrumento FINDRISC fue de 0.813 (intervalo de confianza del 95% [IC 95%] 0.759-0.865), con un punto de corte de 8. La sensibilidad fue de 94.8%, con una especificidad de 48.5%, valor predictivo positivo de 74% y negativo de 86%, con una razón de verosimilitud positiva de 1.84 y una negativa de 0.11. Conclusiones: el instrumento FINDRISC puede ser una herramienta útil para identificar a sujetos con resistencia a la insulina en el primer nivel de atención. Un puntaje igual o mayor que 8 identifica a sujetos con RI.

La adherencia al tratamiento no farmacológico se asocia con metas de control cardiovascular y mejores hábitos dietéticos en pacientes mexicanos con diabetes mellitus tipo 2 / Adherence to non-pharmacological treatment is associated with the goals of cardiovascular control and better eating habits in Mexican patients with type 2 diabetes mellitus

OBJETIVO: Identificar la asociación de la educación en diabetes y terapia médica en nutrición con metas de control de indicadores de riesgo cardiovascular y hábitos dietéticos en pacientes con diabetes mellitus tipo 2. MATERIAL Y MÉTODOS: Estudio transversal analítico en 395 pacientes de atención primaria. Se realizaron mediciones de HbA1c, glucosa y perfil de lípidos en ayuno, presión arterial, peso, circunferencia de cintura y composición corporal. Los hábitos dietéticos se midieron a través del «Instrumento para medir el estilo de vida en los pacientes con diabetes mellitus tipo 2» (IMEVID), en la dimensión nutrición. La terapia médica nutricional (TMN) y la educación en diabetes (ED), se consideró como recibida por el paciente cuando esta fue otorgada en su clínica de atención. RESULTADOS:Se incluyeron 68% mujeres, con una mediana de seis años de diagnóstico de diabetes. Recibieron ED y TMN un 21%, solo ED o TMN 28% y 51% ninguna de ellas. La HbA1c fue menor en pacientes con ED y TMN (7,7 ± 1,9% vs. 8,7 ± 2,3%, 8,4 ± 2,2%; p = 0,003), respectivamente. En pacientes con ED y TMN hubo una mayor proporción que realizó ejercicio físico, menor consumo de tabaco, mejores hábitos dietéticos (p < 0,05). Los pacientes que recibieron ED y TMN alcanzaron metas de control de la HbA1c y HDL-c. Mostraron mayor riesgo de tener una HbA1c > 7% cuando solo recibieron ED o TMN o ninguna de ellas, mayor tiempo de diagnóstico de la enfermedad y seguir con menor frecuencia una dieta para el control de la enfermedad (p < 0,05). CONCLUSIÓN: La educación en diabetes y la terapia médica nutricional favorecen las metas de control de riesgo cardiovascular y mejores hábitos dietéticos del paciente con diabetes tipo 2.

OBJETIVE: To identify the association of diabetes education or medical nutrition therapy with the goals of control of cardiovascular risk indicators and dietary habits in patients with type 2 diabetes mellitus. METHODS: Analytical cross-sectional study in 395 primary care patients. HbA1c, fasting glucose and lipid profile, blood pressure, weight, waist circumference, and body composition were measured. Dietary habits were measured using the «Instrument for measuring lifestyle in patients with type 2 diabetes mellitus» (IMEVID), in the nutrition dimension. Medical nutrition therapy (MNT) and diabetes education (DE) were considered as received by the patient when provided in their healthcare clinic. RESULTS: Women comprised 68% of the patients, with a median of 6 years from diabetes diagnosis. Of the patients, 21% received DE and MNT, 28% DE or MNT, and 51% received neither. The HbA1c was lower in the patients with DE and MNT (7.7% ± 1.9% vs. 8.7% ± 2.3%, 8.4% ± 2.2%; p = .003) respectively. In the patients with DE and MNT, a higher proportion took physical exercise, consumed less tobacco, and had better dietary habits (p < .05). Patients who received DE and MNT achieved HbA1c and HDL-c control levels. A greater risk of HbA1c > 7% was identified when they only received DE or MNT or neither, a longer time since diagnosis of the disease and less frequent adherence to a diet to control the disease (p < .05). CONCLUSIONS: Diabetes education and medical nutritional therapy favour the goal of cardiovascular risk control and better dietary habits in the patient with type 2 diabetes.

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.

INTRODUCTION: 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.

INTRODUCCIÓN: 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. Métodos: 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.

Adherence to non-pharmacological treatment is associated with the goals of cardiovascular control and better eating habits in Mexican patients with type 2 diabetes mellitus. / La adherencia al tratamiento no farmacológico se asocia con metas de control cardiovascular y mejores hábitos dietéticos en pacientes mexicanos con diabetes mellitus tipo 2.

OBJECTIVE: To identify the association of diabetes education or medical nutrition therapy with the goals of control of cardiovascular risk indicators and dietary habits in patients with type 2 diabetes mellitus. METHODS: Analytical cross-sectional study in 395 primary care patients. HbA1c, fasting glucose and lipid profile, blood pressure, weight, waist circumference, and body composition were measured. Dietary habits were measured using the «Instrument for measuring lifestyle in patients with type 2 diabetes mellitus¼ (IMEVID), in the nutrition dimension. Medical nutrition therapy (MNT) and diabetes education (DE) were considered as received by the patient when provided in their healthcare clinic. RESULTS: Women comprised 68% of the patients, with a median of 6 years from diabetes diagnosis. Of the patients, 21% received DE and MNT, 28% DE or MNT, and 51% received neither. The HbA1c was lower in the patients with DE and MNT (7.7% ± 1.9% vs. 8.7% ± 2.3%, 8.4% ± 2.2%; p = .003) respectively. In the patients with DE and MNT, a higher proportion took physical exercise, consumed less tobacco, and had better dietary habits (p < .05). Patients who received DE and MNT achieved HbA1c and HDL-c control levels. A greater risk of HbA1c > 7% was identified when they only received DE or MNT or neither, a longer time since diagnosis of the disease and less frequent adherence to a diet to control the disease (p < .05). CONCLUSION: Diabetes education and medical nutritional therapy favour the goal of cardiovascular risk control and better dietary habits in the patient with type 2 diabetes.

Indicadores antropométricos y descontrol glucémico en diabetes tipo 2 con enfermedad renal / Anthropometric indicators and poor glycemic control in type 2 diabetes with kidney disease

Introducción: la relación de los indicadores antropométricos y de composición corporal, con la evolución de la enfermedad renal en pacientes con diabetes tipo 2 sigue siendo controversial. Objetivo: identificar la asociación de los indicadores de la enfermedad renal con indicadores de control metabólico y antropométricos en pacientes con diabetes tipo 2. Material y métodos: se realizó un estudio transversal analítico en 395 pacientes del primer nivel de atención. La glucosa, hemoglobina glucosilada (HbA1c), perfil de lípidos y creatina se midió en ayuno. La enfermedad renal crónica (ERC) se consideró cuando la excreción de albumina urina- ria (EAU) > 30 mg/g y con la reducción del nivel de la tasa de filtrado glomerular < 60 mL/min/1.73 m2, utilizando la ecuación CKD-EPI. Se midió el peso y circunferencia de cintura, así como la composición corporal a través de bioimpedancia. Resultados: un 17% de la población presentó ERC con alteración de la EAU y 6.6% con una TFG reducida. Un mayor tiempo de diagnóstico de la enfermedad, mayor nivel de HbA1c y menor nivel grasa corporal se asoció a una EAU > 30 mg/g, (p < 0.05). La disminución de la TFG (< 60 mL/ min/1.73 m2) se asoció con mayor edad, ser mujer, tener mayor circunferencia de cintura y menor porcentaje de grasa corporal (p < 0.05). Conclusiones: un mayor nivel de circunferencia de cintura y menor porcentaje de grasa corporal se asocian a mayor evolución de la ERC en pacientes con diabetes tipo 2. El descontrol glucémico se identificó en pacientes con mayor excreción de albumina urinaria.

Background: The relationship of anthropometric and body composition indicators with the evolution of kidney disease in patients with type 2 diabetes, is still inconsistent. Objective: To identify the association of indicators of kid- ney disease with indicators of metabolic and anthropometric control in patients with type 2 diabetes. Material and methods: An analytical cross-sectional study was carried out in 395 patients of the first level of care. The glucose, glycosylated hemoglobin (HbA1c), creatinine and lipid profile were measured. The kidney disease (CKD) was made when urinary albumin excretion (UAE) > 30 mg/g and with a reduction in the level of glomerular filtration rate < 60 mL/min/1.73 m2, using the CKD-formula. Weight and waist circumference were measured, as well as the body composition through bioimpedance. Results: Seventeen percent of the population has a diagnosed with CKD with alteration of the UAE and 6.6% had a reduced GFR. A longer time of diagnosis of the diabetes, hig- her HbA1c level and body fat were associated with an UAE > 30 mg/g, (p < 0.05). The decline in GFR (< 60 mL/min/ 1.73 m2) was associated with older age, being a woman, greater waist circumference, and a higher percentage of body fat (p < 0.05). Conclusions: A higher level of waist circumference and a lower percentage of body fat are associated with a greater evolution of chronic kidney disease in patients with type 2 diabetes. Glycemic uncontrol is identified in patients with high urinary albumin excretion.

[Anthropometric indicators and poor glycemic control in type 2 diabetes with kidney disease]. / Indicadores antropométricos y descontrol glucémico en diabetes tipo 2 con enfermedad renal.

Background: The relationship of anthropometric and body composition indicators with the evolution of kidney disease in patients with type 2 diabetes, is still inconsistent. Objective: To identify the association of indicators of kidney disease with indicators of metabolic and anthropometric control in patients with type 2 diabetes. Material and methods: An analytical cross-sectional study was carried out in 395 patients of the first level of care. The glucose, glycosylated hemoglobin (HbA1c), creatinine and lipid profile were measured. The kidney disease (CKD) was made when urinary albumin excretion (UAE) > 30 mg/g and with a reduction in the level of glomerular filtration rate < 60 mL/min/1.73 m2, using the CKD-formula. Weight and waist circumference were measured, as well as the body composition through bioimpedance. Results: Seventeen percent of the population has a diagnosed with CKD with alteration of the UAE and 6.6% had a reduced GFR. A longer time of diagnosis of the diabetes, higher HbA1c level and body fat were associated with an UAE > 30 mg/g, (p < 0.05). The decline in GFR (< 60 mL/min/1.73 m2) was associated with older age, being a woman, greater waist circumference, and a higher percentage of body fat (p < 0.05). Conclusions: A higher level of waist circumference and a lower percentage of body fat are associated with a greater evolution of chronic kidney disease in patients with type 2 diabetes. Glycemic uncontrol is identified in patients with high urinary albumin excretion.

Introducción: la relación de los indicadores antropométricos y de composición corporal, con la evolución de la enfermedad renal en pacientes con diabetes tipo 2 sigue siendo controversial. Objetivo: identificar la asociación de los indicadores de la enfermedad renal con indicadores de control metabólico y antropométricos en pacientes con diabetes tipo 2. Material y métodos: se realizó un estudio transversal analítico en 395 pacientes del primer nivel de atención. La glucosa, hemoglobina glucosilada (HbA1c), perfil de lípidos y creatina se midió en ayuno. La enfermedad renal crónica (ERC) se consideró cuando la excreción de albumina urinaria (EAU) > 30 mg/g y con la reducción del nivel de la tasa de filtrado glomerular < 60 mL/min/1.73 m2, utilizando la ecuación CKD-EPI. Se midió el peso y circunferencia de cintura, así como la composición corporal a través de bioimpedancia. Resultados: un 17% de la población presentó ERC con alteración de la EAU y 6.6% con una TFG reducida. Un mayor tiempo de diagnóstico de la enfermedad, mayor nivel de HbA1c y menor nivel grasa corporal se asoció a una EAU > 30 mg/g, (p < 0.05). La disminución de la TFG (< 60 mL/min/1.73 m2) se asoció con mayor edad, ser mujer, tener mayor circunferencia de cintura y menor porcentaje de grasa corporal (p < 0.05). Conclusiones: un mayor nivel de circunferencia de cintura y menor porcentaje de grasa corporal se asocian a mayor evolución de la ERC en pacientes con diabetes tipo 2. El descontrol glucémico se identificó en pacientes con mayor excreción de albumina urinaria.

La educación con una plataforma multimedia en web mejora los conocimientos y la HbA1c de pacientes mexicanos con diabetes tipo 2. Ensayo clínico abierto / Education with a multimedia web platform improves knowledge and HbA1c of Mexican patients with type 2 diabetes. Open clinical trial

INTRODUCCIÓN: El paciente con diabetes mellitus tipo 2 requiere recibir educación acerca de la enfermedad dirigida a mejorar los conocimientos y habilidades para su control. El objetivo de este estudio fue evaluar la eficacia de la terapia nutricia y de la educación a través de un sitio multimedia, sobre el nivel de conocimientos y control metabólico en pacientes con diabetes tipo 2. MATERIAL Y MÉTODOS: Ensayo clínico abierto de 12 meses de seguimiento en 161 pacientes con diabetes tipo 2. Se asignaron 101 pacientes al grupo de intervención con terapia nutricional (TN) + Nutriluv (sitio multimedia), 80 pacientes al grupo control con TN. Se midió al inicio y al final la hemoglobina glucosilada (HbA1c), glucosa, colesterol, triglicéridos, colesterol LDL y HDL. Se registró el peso, la circunferencia de cintura, el porcentaje de grasa, la presión arterial sistólica y la diastólica. El nivel de conocimientos se midió con el cuestionario de conocimientos en diabetes DKQ24 (por sus siglas en inglés). RESULTADOS: Los conocimientos en diabetes mejoraron en el grupo con TN+Nutriluv comparado con el grupo TN (p < 0,05). La HbA1c, HDL, presión arterial diastólica y circunferencia de cintura mejoraron en el grupo con TN+Nutriluv (p < 0,05). En el grupo con TN mejoró el colesterol HDL, la presión arterial diastólica, la circunferencia de cintura y se incrementó el porcentaje de grasa (p < 0,05). Presentaron mayor riesgo de una HbA1c > 7% quienes tuvieron más años de diagnóstico de la diabetes. CONCLUSIÓN: El uso de un sitio multimedia para proveer educación en diabetes mejora los conocimientos, el HbA1c y otros indicadores de riesgo cardiovascular en pacientes con diabetes tipo 2

INTRODUCTION: The patient with diabetes mellitus type requires to receive education about the disease aimed at improving knowledge and skills for their control. The objective of this study is to evaluate the efficacy of nutritional therapy and education through a multimedia site on the level of knowledge and metabolic control in patients with type 2 diabetes. PATIENTS AND METHODS: Open-label clinical trial of 12 months of follow-up in 161 patients with type 2 diabetes. A total of 101 patients were assigned to the intervention group with nutrition therapy (TN) + Nutriluv (multimedia site in diabetes), 80 patients to the TN control group. The glycosylated hemoglobin (HbA1c), glucose, cholesterol, triglycerides, LDL and HDL cholesterol were measured at the beginning and end. Weight, waist circumference, percentage of fat, systolic blood pressure and diastolic blood pressure were recorded. The level of knowledge was measured with the Diabetes Knowledge Questionnaire (DKQ24). RESULTS: The knowledge in diabetes improved in the group with TN+Nutriluv compared with the TN group (P<0.05). HbA1c, HDL, diastolic blood pressure and waist circumference, improved in the group with TN+Nutriluv (P<0.05). In the group with TN, cholesterol HDL, diastolic blood pressure, waist circumference and the fat percentage was increased (P<0.05). They had a higher risk of having an HbA1c>7% who had more years of diagnosis of diabetes. CONCLUSIONS: The use of a multimedia site with education in diabetes, improves knowledge, HbA1c, and other indicators of cardiovascular risk in diabetes type 2 patients

Positive health beliefs are associated with improvement of glycated hemoglobin and lipid profiles in Mexican patients with type 2 diabetes mellitus: a cross-sectional study.

BACKGROUND: Health beliefs are relevant to consider in patients with type 2 diabetes since disease control depends mainly on the patient's behaviour. The aim of this study was to assess the association between health beliefs and glycated hemoglobin levels in Mexican patients with type 2 diabetes. METHODS: An analytical cross-sectional study was conducted, and 336 patients were included. Fasting blood levels of glycated hemoglobin, glucose, cholesterol; triglycerides, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) were measured. Body fat percentage, weight, height; waist circumference, and systolic and diastolic blood pressures were also obtained. A previously validated self-administered questionnaire was used to assess the health beliefs with regards to non-pharmacological treatment. Health beliefs were classified as positive, neutral, and negative. RESULTS: The average age of patients was 54.7 ± 8.5 years, with a higher proportion of females (69%). The questionnaire had a good internal consistency with a Cronbach's alpha score of 0.83. More than 90% of patients attributed a health benefit to diet and exercise, 30 to 40% experienced barriers, and more than 80% had a perception of complications associated to uncontrolled diabetes. Patients with positive health beliefs had lower HbA1c levels (8.2 ± 1.7%) compared to those with neutral (9.0 ± 2.3%), or negative (8.8 ± 1.8%; p = 0.042). The LDL-c levels were lower (p = 0.03), and HDL-c levels were higher (0.002) in patients with positive heath beliefs. CONCLUSIONS: Positive health beliefs are associated with better metabolic control indicators in patients with type 2 diabetes.

Education with a multimedia web platform improves knowledge and HbA1c of Mexican patients with type 2 diabetes. Open clinical trial. / La educación con una plataforma multimedia en web mejora los conocimientos y la HbA1c de pacientes mexicanos con diabetes tipo 2. Ensayo clínico abierto.

INTRODUCTION: The patient with diabetes mellitus type requires to receive education about the disease aimed at improving knowledge and skills for their control. The objective of this study is to evaluate the efficacy of nutritional therapy and education through a multimedia site on the level of knowledge and metabolic control in patients with type 2 diabetes. PATIENTS AND METHODS: Open-label clinical trial of 12 months of follow-up in 161 patients with type 2 diabetes. A total of 101 patients were assigned to the intervention group with nutrition therapy (TN) + Nutriluv (multimedia site in diabetes), 80 patients to the TN control group. The glycosylated hemoglobin (HbA1c), glucose, cholesterol, triglycerides, LDL and HDL cholesterol were measured at the beginning and end. Weight, waist circumference, percentage of fat, systolic blood pressure and diastolic blood pressure were recorded. The level of knowledge was measured with the Diabetes Knowledge Questionnaire (DKQ24). RESULTS: The knowledge in diabetes improved in the group with TN+Nutriluv compared with the TN group (P<0.05). HbA1c, HDL, diastolic blood pressure and waist circumference, improved in the group with TN+Nutriluv (P<0.05). In the group with TN, cholesterol HDL, diastolic blood pressure, waist circumference and the fat percentage was increased (P<0.05). They had a higher risk of having an HbA1c>7% who had more years of diagnosis of diabetes. CONCLUSIONS: The use of a multimedia site with education in diabetes, improves knowledge, HbA1c, and other indicators of cardiovascular risk in diabetes type 2 patients.

[La educación multimedia como apoyo en el manejo de pacientes con diabetes tipo 2. Estudio cuasi experimental]. / Multimedia education to support management of type 2 diabetes patients. A quasi-experimental study.

OBJETIVO: Evaluar la eficacia de la educación a través de un sistema de información multimedia en el control del paciente con diabetes tipo 2. MÉTODO: Ensayo clínico abierto aleatorizado. El grupo de intervención fue instruido para consultar una herramienta educativa multimedia en la sala de espera de los consultorios, misma que fue diseñada de acuerdo a las caracteristicas de la población y centrada en automonitoreo de indicadores, información sobre diabetes tipo 2 y nutrición. Se midieron en sangre venosa las concentraciones de glucosa, hemoglobina glucosilada (HbA1c), triglicéridos, colesterol total, colesterol ligado a lipoproteínas de alta densidad (HDL-c) y colesterol ligado a lipoproteínas de baja densidad. Con la t de Student pareada se evaluó el efecto de la intervención. RESULTADOS: Se incluyeron 2334 pacientes, 958 en el grupo de intervención y 1376 en el grupo control. Se observó en el grupo de intervención un incremento del HDL-c (de 40.45 a 47.40 mg/dl; p = 0.001) y una disminución de los triglicéridos (de 227.78 a 210.38 mg/dl; p = 0.001). En el grupo control disminuyeron los triglicéridos (de 232.64 a 210.84 mg/dl; p = 0.016). En ambos grupos se incrementó de forma significativa el colesterol total. No se observaron cambios en los valores de glucosa y HbA1c posterior a la intervención. CONCLUSIÓN: La implementación de un sistema de información multimedia mejora el HDL-c y los triglicéridos del paciente con diabetes. Se requiere un reforzamiento continuo de la intervención educativa por parte del profesional de la salud para incidir en el control glucémico y otros indicadores del control metabólico. OBJECTIVE: To evaluate the efficacy of education through a multimedia information system, in controlling patients with type 2 diabetes. METHODS: Randomized open clinical trial. The intervention group was trained to consult an educative multimedia tool in the waiting room, which was developed according to the population characteristics and centered on monitoring indicators, information on type 2 diabetes and nutrition. Venous blood concentrations of glucose, glycated hemoglobin (HbA1c), triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were measured. Paired t Student was used to assess the effect of the intervention. RESULTS: 2,334 patients were included, 958 in the intervention group and 1,376 in the control group. In the intervention group, an increase in HDL-c values was observed (from 40.45 to 47.40 mg/dL; p=0.001) as well as a descent on triglycerides values (from 227.78 to 210.38 mg/dL; p=0.001). There was a reduction on triglycerides levels in the control group (from 232.64 to 210.84 mg/dL; p=0.016). There was a significative increase in total cholesterol values in both groups. There were no changes in the mean values of glucose and HbA1c after the intervention. CONCLUSION: Implementation of a multimedia information system improves HDL-c and triglycerides in patients with diabetes. There is a need for a continuous reinforcement of the educative intervention by health professionals to improve glycemic and other indicators in metabolic control.

Cardiometabolic Risk Indicators for Kidney Disease in Mexican Patients with Type 2 Diabetes.

INTRODUCTION: Kidney disease is one of the main complications in the diabetic patient. Risk factors such as obesity, dyslipidemia, and hyperglycemia have been associated with increased urinary albumin excretion (UAE) and decreased glomerular filtration rates (GFR). However, the data are inconsistent. The objective of this study was to identify the primary risk factors associated with kidney disease in Mexican patients with type 2 diabetes. METHODS: A cross-sectional study was done in 395 patients with type 2 diabetes from four primary-care clinics. From fasting venous blood samples, the serum creatinine, glucose, glycated hemoglobin (HbA1c), and lipid profiles were measured. The diagnosis of diabetic kidney disease (DKD) was made by measuring GFR with the CKD-EPI equation, and the UAE from the first morning urination, according to the KDIGO 2012 Guidelines. Weight and waist circumference (WC), as well as body composition through the method of bioimpedance, were measured. RESULTS: Fourteen percent of the study population was diagnosed with DKD. Higher age and higher triglyceride levels were associated with a greater risk of DKD (p <0.05). In a multivariate analysis, higher age (OR = 1.06, 95% CI 1.02-1.11), triglyceride level (OR = 2.4, 95% CI 1.18-4.92), WC (OR = 1.09, 95% CI 1.03-1.15), and smoking (OR 2.6, 95% CI 1.07-6.49) were associated to DKD. CONCLUSION: Higher triglyceride levels, greater WC, and smoking are risk factors associated to DKD. An early diagnosis and opportune treatment for several cardiometabolic risk factors associated to DKD and cardiovascular disease should be identified and treated.

Multimedia education program and nutrition therapy improves HbA1c, weight, and lipid profile of patients with type 2 diabetes: a randomized clinical trial.

PURPOSE: To evaluate the effect of a multimedia education program and nutrition therapy on metabolic control in patients with type 2 diabetes. RESEARCH QUESTION: What is the effect of a multimedia education program and nutritional therapy on metabolic control in type 2 diabetes? PATIENTS AND METHODS: A randomized clinical trial was conducted in 351 patients randomly assigned to either an experimental group receiving a multimedia diabetes education program (MDE) and nutrition therapy (NT) (NT + MDE: n = 173), or to a control group who received nutrition therapy only (NT: n = 178). At baseline, 7, 14, and 21 months, the glycated hemoglobin (HbA1c), glucose, cholesterol, triglycerides, LDL-cholesterol, and HDL-cholesterol were measured. Weight, body mass index (BMI), waist circumference (WC), fat percentage, fat and lean mass, systolic blood pressure (SBP), and diastolic (DBP) were also recorded. RESULTS: Glycated hemoglobin decreased in both groups, although the group with NT + MDE had a greater reduction, with a difference of -0.76% (95%CI -1.33 to -0.19) at 7 months and -0.73% (95%CI -1.37 to -0.09) at 21 months. Only in the NT + MDE did the glucose decrease at 7 (-41.2 mg/dL; 95%CI -52.0 to -30.5), 14 (-27.8 mg/dL; 95%CI -32.6 to -23.1), and 21 months (-36.6 mg/dL; 95%CI -46.6 to -26.6). Triglycerides and the atherogenic index decreased in both groups at 7 and 14 months; while only in the NT + MDE group did it decrease at 21 months. (p < 0.05). Weight decreased at 21 months in the NT + MDE group (-1.23, -2.29 at -0.16; p < 0.05). CONCLUSION: Nutrition therapy and a multimedia diabetes education program have a favorable impact on achieving metabolic control goals in type 2 diabetes.

Fiber in Diet Is Associated with Improvement of Glycated Hemoglobin and Lipid Profile in Mexican Patients with Type 2 Diabetes.

Objective. To assess the association of dietary fiber on current everyday diet and other dietary components with glycated hemoglobin levels (HbA1c), glucose, lipids profile, and body weight body weight, in patients with type 2 diabetes. Methods. A cross-sectional survey of 395 patients with type 2 diabetes was performed. HbA1c, fasting glucose, triglycerides, and lipids profile were measured. Weight, waist circumference, blood pressure, and body composition were measured. Everyday diet with a semiquantitative food frequency questionnaire was evaluated. ANOVA, Kruskal-Wallis, chi-square tests and multivariate logistic regression were used in statistical analysis. Results. Higher fiber intake was associated with a low HbA1c, high HDL-c levels, low weight, and waist circumference. The highest tertile of calories consumption was associated with a higher fasting glucose level and weight. The highest tertile of carbohydrate consumption was associated with a lower weight. The lowest tertile of total fat and saturated fat was associated with the highest tertile of HDL-c levels, and lower saturated fat intake was associated with lower weight (p < 0.05). Conclusions. A higher content of fiber in the diet reduces HbA1c and triglycerides, while improving HDL-c levels. Increasing fiber consumption while lowering calorie consumption seems to be an appropriate strategy to reduce body weight and promote blood glucose control.

Mediterranean-style diet reduces metabolic syndrome components in obese children and adolescents with obesity.

BACKGROUND: The beneficial effects of the Mediterranean diet have been amply proven in adults with cardiovascular risk factors. The effects of this diet have not been extensively assessed in pediatric populations with obesity, insulin resistance (IR) and metabolic syndrome (MetS). The aim of this study was to assess the efficacy of the Mediterranean style diet (MSD) to decrease cardiovascular risk factors in children and adolescents with obesity. METHODS: Participants were randomly assigned to a MSD rich in polyunsaturated fatty acids, fiber, flavonoids and antioxidants (60% of energy from carbohydrate, 25% from fat, and 15% from protein, (n = 24); or a standard diet (55% of carbohydrate, 30% from fat and 15% from protein, (n = 25), the caloric ingest was individualized. At baseline and 16-week of intervention, the glucose, triglycerides (TG), total cholesterol (TC), HDL-C, LDL-C were measured as well as the body composition and anthropometric data. The diet compliance was determined by the 24-hour recalls.Paired Student's t and Macnemar's test were used to compare effects in biochemical, body composition, anthropometric, and dietary variables. RESULTS: The MSD group had a significantly decrease in BMI, lean mass, fat mass, glucose, TC, TG, HDL-C and LDL-C. (p < 0.05); the diet compliance increased consumption of omega 9 fatty acids, zinc, vitamin E, selenium, and decreased consumption of saturated fatty acids (p < 0.05). The standard diet group decrease in glucose levels and frequency of glucose >100 mg/dL (p < 0.05). CONCLUSION: The MSD improves the BMI, glucose and lipid profile in children and adolescents with obesity and any MetS component.