Papel objetivo de las bebidas azucaradas embotelladas en la etiofisiopatología y la epidemiología de la obesidad y la diabetes mellitus tipo 2 en México / Objective role of bottled sugar-sweetened beverages in the pathophysiology and epidemiology of obesity and type 2 diabetes mellitus in Mexico

En México son altas las prevalencias de obesidad y de diabetes mellitus tipo 2 (DM2), y es alto también el consumo de bebidas azucaradas embotelladas (BAE) y también de bebidas azucaradas de venta libre en las calles. Partiendo de la premisa en la que el consumo regular de BAE podría contribuir con la prevalencia de obesidad y de DM2, a partir de 2014 se instituyó en México el Impuesto Especial sobre Productos y Servicios (IEPS) a alimentos y bebidas de densidad energética alta, incluidas las BAE. Sin embargo, la aplicación del IEPS no ha disminuido ni el consumo de BAE ni las prevalencias de obesidad y DM2, puesto que —además del consumo de BAE— participan en la etiofisiopatología de la obesidad y la DM2 en México factores genéticos idiosincráticos y un patrón de inestabilidad alimentaria asociado con alto consumo de alimentos de gran densidad energética, sumado a índices particularmente elevados de sedentarismo. Para frenar la obesidad y laDM2, hacen falta estrategias basadas en la educación eficaz de la población y en el abatimiento social y económico de lapobre calidad alimentaria hasta ahora prevalente. (AU)

In Mexico, the prevalence of obesity and type 2 diabetes mellitus (DM2) is high, and the consumption of bottled sugar-sweetened beverages (BSSB), as well as sugar sweetened beverages sold over the counter on the streets, is also high. Based on the premise that regular consumption of BSSB could contribute to the prevalence of obesity and DM2, as of 2014, the Special Tax on Products and Services (IEPS) was instituted in Mexico on foods and beverages with high energy density, including BSSB. However, the application of the IEPS has not reduced either the consumption of BSSB or the prevalence of obesity and DM2, since —in addition to the consumption of BSSB— idiosyncratic genetic factors and a pattern of food instability associated with high consumption of energy dense foods, coupled with particularly high rates of sedentary lifestyle. To curb obesity and DM2, strategies based on the effective education of the population and the social and economic abatement of the poor food quality that has prevailed up to now are needed. (AU)

[The incretin effect and type 2 diabetes]. / El efecto incretina y su participación en la diabetes mellitus tipo 2.

In the gastrointestinal tract we produce hormones, called incretins, in response to food ingestion with a direct effect on pancreatic ß and α cell improving the insulin and glucagon response to glucose. The effect consisting in a greater secretion of insulin with a glucose stimulus from the gut or IV injection is called "the incretin effect." The main incretins are: glucagon like peptide-1 (GLP1) and glucose-dependent insulinotropic peptide (GIP). The action of both incretins is very short due to a rapid inhibition in the circulation by an enzyme dipeptylpeptidase IV (DPP4). In type 2 diabetics, the incretin effect is altered and can be improved by elaboration of a GLP1 resistant to the action of DPP4 (GLP1 analogs) or by direct inhibition of DPP4 producing better effect of native GLP1 and GIP. We have exenatide a derivative from exendin 4, and liraglutide very similar to the native human GLP1. Three inhibitors of DPP4: sitagliptin, and vildagliptin and saxagliptin produce a prolonged inhibition of DPP4 and as a consequence increased effect of native incretins with better control of fasting and postprandial glucose and improve on A1c with a very few hypoglycemic events.

Effects of pioglitazone and glimepiride on glycemic control and insulin sensitivity in Mexican patients with type 2 diabetes mellitus: A multicenter, randomized, double-blind, parallel-group trial.

BACKGROUND: Pioglitazone and glimepiride improve glycemic control in patients with type 2 diabetes mellitus by different mechanisms. Pioglitazone is a thiazolidinedione that reduces insulin resistance, and glimepiride is a sulfonylurea insulin secretagogue. OBJECTIVE: The goals of this study were to compare changes in measures of glycemic control and insulin sensitivity in Mexican patients with type 2 diabetes who received pioglitazone or glimepiride for 1 year. METHODS: This was a multicenter, 52-week, double-blind, parallel-group trial. Patients were randomized to receive monotherapy with either glimepiride (2 mg QD initially) or pioglitazone (15 mg QD initially). Doses were titrated (maximal doses: pioglitazone 45 mg, glimepiride 8 mg) to achieve glycemic targets (fasting blood glucose < or =7 mmol/L and 1-hour postprandial blood glucose < or =10 mmol/L). Insulin sensitivity (primary end point) was evaluated in terms of the Homeostasis Model Assessment for Insulin Sensitivity (HOMA-S), the Quantitative Insulin Sensitivity Check Index (QUICKI), and fasting serum insulin (FSI) concentrations. Glycemic control was evaluated in terms of glycosylated hemoglobin (HbA(1c)) values and fasting plasma glucose (FPG) concentrations. Patients were encouraged to maintain their individual diet and exercise regimens throughout the study. RESULTS: Two hundred forty-four patients (125 women, 119 men; all but 1 Hispanic) were randomized to receive pioglitazone (n = 121) or glimepiride (n = 123). In the intent-to-treat sample, pioglitazone and glimepirede produced comparable reductions in HbA(1c) from baseline to the end of the study (-0.78% and -0.68%, respectively). The pioglitazone group had significantly higher HbA(1c) values compared with the glimepiride group after 12 weeks of therapy (8.66% vs 7.80%; P = 0.007) but had significantly lower values after 52 weeks (7.46% vs 7.77%; P = 0.027). Pioglitazone significantly reduced FPG compared with glimepiride (-0.6 vs 0.6 mmol/L; P = 0.01). Pioglitazone therapy was associated with significant increases in insulin sensitivity (reduced insulin resistance), whereas glimepiride had no effect. HOMA-S values changed 18.0% for pioglitazone and -7.9% for glimepiride (P < 0.001), QUICKI values changed a respective 0.013 and -0.007 (P < 0.001), and FSI values were -21.1 and 15.1 pmol/L (P< 0.001). Both drugs were well tolerated, with pioglitazone associated with more peripheral edema (number of treatment-emergent cases: 35/121[28.9%] vs 17/123 [13.8%]; P = 0.005) and fewer hypoglycemic episodes (19 [15.7%] vs 38 [30.9%]; P = 0.024). The incidence of weight gain was not significantly different between treatment groups. CONCLUSIONS: These data suggest that long-term treatment with pioglitazone enhances insulin sensitivity relative to glimepiride in Mexican patients with type 2 diabetes and that pioglitazone may have a more sustained antihyperglycemic effect.

Efectos del acipimox sobre el metabolismo de la glucosa y de los lípidos, en pacientes con diabetes mellitus tipo II, obesos de difícil control con hiperlipoproteinemia tipo IIb y IV: resultados de un estudio multicéntrico / Acipimox affects in glucose metabolism in patients with diabetes mellitus type II and hyperlipidemia type IIb or IV

La interacción metabólica entre hidratos de carbono y lípidos, ha permitido considerar la hipótesis de que la corrección con hiperlipidemia en el diabético mal controlado, permite al paciente mejorar su control glucémico, posiblemente modificando la resistencia a la insulina. El objetivo de este trabajo multicéntrico fue evaluar la acción de un hipolipemiante, un análogo del ácido nicotínico acipimox en pacientes diabéticos no insulino dependientes con hiperlipoproteinemia tipo IIb y IV, que presentaban un descontrol metabólico aún recibiendo hipoglucemiantes orales a dosis máximas. La investigación incluyó 133 pacientes, de los que 67 tomaron acipimox por un periodo de tres meses (olbetam, *marca registrada) en dosis de 250 mg tres veces por vía oral; y 66 pacientes (grupo control) a quienes se les administró placebo. Se examinaron diversos parámetros bioquímicos antes de la administración del medicamento, a las cuatro, ocho y 12 semanas. En el grupo con acipimox se observó una disminución estadísticamente significativa de los niveles plasmáticos de triglicéridos, colesterol total, colesterol LDL, glucosa en ayuno y postprandial, hemoglobina glucosilada y un incremento de colesterol HDL. Estos resultados indican que el acipimox es un agente hipolipidemico con efecto sobre el control metabólico, tanto de los lípidos como de la glucosa, en pacientes diabéticos tipo II con hiperlipidemia tipo IIb o IV de difícil control