Effect of oral supplementation with whey protein on muscle mass in adults with type 2 diabetes mellitus: a systematic review of randomized controlled trials.

OBJECTIVE: To investigate the overall effect of whey protein supplementation on skeletal muscle mass in adults with type 2 diabetes mellitus (T2DM). METHODS: Systematic review of reports on corporal muscle mass from clinical trials that assessed the use of whey protein supplementation by means of validated techniques in patients with T2DM. PubMed, SCOPUS, Web of Science, LILACS, and SciELO databases were searched up to April 2022. Risk of bias was assessed by the Cochrane Collaboration Risk of Bias tool. We conducted a qualitative synthesis of information. RESULTS: Four studies (424 participants) that met the selection criteria were identified out of 1,787 records. Of these, 3 studies assessed the total muscle mass using dual-energy X-ray absorptiometry (DXA), and 1 reported changes to the transverse diameter of the vastus lateralis muscle with ultrasound imaging. In the intervention groups, DXA assessments demonstrated an increase in total muscle mass in 3 studies and in the appendicular muscle mass in 2. Changes to the proportion of muscle mass were not seen in the DXA studies and only a discrete difference was seen in the comparative groups studied by ultrasound imaging. CONCLUSION: Following the administration of whey protein supplementation in patients with T2DM, a partially positive effect was seen in skeletal muscle mass gain with a moderate certainty of evidence.

Family out-of-pocket expenditure for type 2 diabetes mellitus care and percentage of family income.

BACKGROUND: Type 2 diabetes has economic implications involving family income and out-of-pocket spending. OBJECTIVE: Determine family out-of-pocket expenditure for type 2 diabetes mellitus care and percentage of family income. MATERIAL AND METHODS: Study of family out-of-pocket spending in families with patients with type 2 diabetes treated at primary care level. Out-of-pocket expenses included expenses for transportation, food-drinks, and external medications. Family income corresponded to the total economic income contributed by family members. The percentage of out-of-pocket spending in relation to family income was identified with the relationship between these two variables. Statistical analysis included averages and percentages. RESULTS: The annual family out-of-pocket expenditure on transportation was $2,621.24, the family out-of-pocket expenditure on food and beverages was $1,075.67, and the family out-of-pocket expenditure on external medications was $722.08. The total annual family out-of-pocket expense was $4,418.89 and corresponds to 4.73% of family income. CONCLUSION: The family out-of-pocket expense in the family with a patient with diabetes mellitus 2 was $4,418.89 and represents 4.73% of the family income.

ANTECEDENTES: La diabetes tipo 2 tiene implicaciones económicas en el ingreso familiar y el gasto de bolsillo. OBJETIVO: Determinar el gasto de bolsillo familiar en la atención de la diabetes mellitus tipo 2 y el porcentaje que representa en el ingreso familiar. MATERIAL Y MÉTODOS: Estudio de gasto de bolsillo de las familias con pacientes con diabetes tipo 2 atendidos en el primer nivel de atención. El gasto de bolsillo familiar incluyó gasto en traslado, alimentos-bebidas y medicamentos externos. El ingreso familiar correspondió al total de ingresos económicos aportados por los miembros de la familia. El porcentaje del gasto de bolsillo con relación al ingreso familiar se identificó con la relación entre estas dos variables. El análisis estadístico incluyó promedios y porcentajes. RESULTADOS: El gasto de bolsillo familiar anual en transporte fue de $2621.24, en alimentos y bebidas fue de $1075.67 y en medicamentos externos fue de $722.08. El gasto familiar de bolsillo total anual fue de $4418.89 y correspondió a 4.73 % del ingreso familiar. CONCLUSIÓN: El gasto de bolsillo en las familias con un paciente con diabetes mellitus tipo 2 fue de $4418.89 y representó 4.73 % del ingreso familiar.

Hepatic Insulin Resistance: A liver-specific type 2 diabetes / Resistência insulínica hepática: Um diabetes tipo 2 hepático

Introduction: The liver plays a critical role in glucose and lipid homeostasis. Insulin resistance (IR) has been increasingly recognized as a primary etiological factor in metabolic disorders. Hepatic insulin resistance (HIR) is a specific manifestation of IR characterized by the liver's reduced responsiveness to insulin despite elevated circulating insulin levels. Objective: This review aims to elucidate the role of HIR in the pathogenesis of metabolic disorders, focusing on its relationship with metabolic dysfunction-associated fatty liver disease (MAFLD) and type 2 diabetes mellitus (T2DM). Methods: A comprehensive literature search was conducted to explore the underlying mechanisms of HIR, its clinical implications, and its association with MAFLD and T2DM. Results: HIR is characterized by impaired insulin-mediated glucose uptake and increased hepatic glucose output. This metabolic dysfunction contributes to the development of hepatic steatosis, dyslipidemia, and insulin resistance in peripheral tissues. The interplay between HIR and lipogenesis is important in the progression of MAFLD and its association with T2DM, and could be described as a hepatic equivalent of T2DM. Conclusion: The understanding of a T2DM-like condition in the liver is decisive for developing more targeted and effective treatments.

Introdução: O fígado desempenha um papel crítico na homeostase da glicose e lipídios. A resistência à insulina (RI) tem sido cada vez mais reconhecida como um fator etiológico primário em distúrbios metabólicos. A resistência à insulina hepática (RIH) é uma manifestação específica da RI caracterizada pela redução da resposta hepática à insulina, apesar dos níveis elevados de insulina circulante. Objetivo: Este manuscrito visa avaliar o papel da RIH na patogênese dos distúrbios metabólicos, com foco em sua relação com a doença hepática gordurosa associada à disfunção metabólica (DHGDM) e o diabetes mellitus tipo 2 (DMT2). Métodos: Foi realizada uma busca abrangente na literatura para explorar os mecanismos subjacentes da RIH, suas implicações clínicas e sua associação com a DHGDM e o DMT2. Resultados: A RIH é caracterizada pela redução da captação de glicose mediada pela insulina e pelo aumento da produção hepática de glicose. Essa disfunção metabólica contribui para o desenvolvimento de esteatose hepática, dislipidemia e RI em tecidos periféricos. A interação entre RIH e lipogênese é importante na progressão da DHGDM e sua associação com o DMT2, podendo ser descrita como um equivalente hepático do DMT2. Conclusão: A compreensão de uma condição semelhante ao DMT2 no fígado é decisiva para o desenvolvimento de tratamentos mais direcionados e eficazes.

Representaciones sociales sobre diabetes tipo 2 en pacientes del área Metropolitana de Buenos Aires, Argentina

Introducción: Las características y complejidad de la diabetes mellitus tipo 2 motivan la necesidad de un abordaje multi e interdisciplinario. El estudio persigue caracterizar las representaciones sociales de la diabetes mellitus tipo 2 que posee un grupo de pacientes adultos, residentes en Área Metropolitana de Buenos Aires, Argentina Método: Estudio cuantitativo, descriptivo, corte transversal. Se aplicó cuestionario sociodemográfico elaborado ad hoc y técnica de palabras asociadas. Participaron 90 pacientes adultos, reclutados principalmente del servicio de diabetológica del Hospital de Clínicas "José de San Martin" dependiente de la Universidad de Buenos Aires. Resultados: El núcleo de la representación social estuvo integrado por palabras referidas al impacto y malestar emocional que causa esta patología; la identidad de la enfermedad y la necesidad de cuidado de la salud. La periferia contuvo los siguientes temas, de mayor a menor importancia: obesidad, complicaciones de la diabetes, plan alimentario, tratamiento médico y medicación. En menor medida, se mencionaron elementos como actividad física y sedentarismo. De manera tangencial, surgieron los elementos de desinformación y sexualidad. Discusión: La representación social de la diabetes mellitus tipo 2 en pacientes se caracteriza por reflejar, en su núcleo, el temor, impacto y malestar que causa esta enfermedad. La reproducción del discurso médico mediante los temas referidos a factores de riesgo, complicaciones y tratamiento, conforman el sistema periférico de la representación. Elementos importantes tales como actividad física, sedentarismo, desinformación y sexualidad, son poco mencionados. Se destaca la importancia de la salud mental, como una problemática central a abordar en este tipo de patologías. También se sugiere implementación de educación terapéutica.

Introduction: Characteristics and complexity of type 2 diabetes generates the need for a multi and interdisciplinary approach. The aim of the study is to characterize social representations of type 2 diabetes in a group of adult patients, living in the Metropolitan Area of Buenos Aires, Argentina. Method: Descriptive and cross-sectional design. An ad-hoc sociodemographic questionnaire and the associated words technique were applied. 90 adult patients participated, recruited mainly from a diabetes service of a public hospital. Results: The core of the social representation was made up of words referring to the impact and emotional discomfort caused by this pathology, the identity of the disease and the need for health care. The periphery contained the following topics, from most to least important: obesity, diabetes complications, eating plan, medical treatment, and medication. Elements such as physical activity and sedentary lifestyle were mentioned to a lesser extent. Also, misinformation and sexuality were mentioned tangentially. Discussion: Social representation of type 2 diabetes in patients is characterized by reflecting at its core, the fear, impact and discomfort that this disease causes. The reproduction of medical discourse, through topics related to risk factors, complications and treatment, make up the peripheral system of representation. Important elements such as physical activity, sedentary lifestyle, misinformation and sexuality are rarely mentioned. The importance of mental health is highlighted as a central problem to be addressed in this type of pathology. Also, it's suggested the implementation of therapeutic education.

Relationship between adherence to oral antidiabetic drugs and control of type 2 diabetes mellitus.

INTRODUCTION AND OBJECTIVES: Poor adherence to oral antidiabetic drugs (Adh-OAD) is a risk factor for poor control of type 2 diabetes mellitus (T2DM). Therefore, it is necessary to quantify the Adh-OAD. This quantification is possible through electronic dispensing records from the community pharmacy. The objective was to evaluate the influence of the Adh-OAD on the control of T2DM and the percentage of glycosylated hemoglobin (%HbA1c) in the patient. MATERIALS AND METHODS: A cross-sectional descriptive observational study was conducted in 8 community pharmacies in Granada (Spain). Patients older than 18 years with T2DM and on oral antidiabetic drugs (OADs) for at least 6 months were included. The main study variables were the control of T2DM, %HbA1c, and the Adh-OAD considering three cut-off points (≥80%, ≥70%, ≥60%). This relationship was studied using multivariate binary logistic regression and multivariate linear regression, respectively. RESULTS: A total of 107 patients were included. The mean age was 70.5 years (SD: 9.7), and 54.2% were men. Eighty-five patients (79.4%) had well-controlled T2DM (mean %HbA1c: 6.5%; SD=0.6). Considering Adh-OAD≥80%, 13.1% (n=14) had a poor adherence and was related to the %HbA1c (ß=0.742; p=0.007) and the control of T2DM (OR: 7.327; 95% CI: 1.302-41.241). Poor adherence was found in 9.3% (n=10) considering Adh-OAD≥70% and in 3.7% (n=4) considering Adh-OAD≥60%. In both cases, a statistically significant relationship was found between Adh-OAD and the %HbA1c and between Adh-OAD and the control of T2DM. CONCLUSIONS: Adh-OAD influenced the %HbA1c in patients with T2DM and the control of their disease.

Real-world evaluation of vascular complications and comorbidities in Portuguese patients with type 2 diabetes: Results from the cMORE study.

INTRODUCTION AND OBJECTIVES: Type 2 diabetes poses a significant health challenge in Portugal, increasing the susceptibility to complications/comorbidities such as hypertension, obesity, and cardiovascular (CV) disease. This study aimed to evaluate the prevalence of type 2 diabetes-related vascular complications/comorbidities and their pharmacological management in Portugal. METHODS: cMORE was a non-interventional, cross-sectional, multicenter study conducted in 32 Portuguese primary healthcare units between October 2020 and 2022. Secondary data, including sociodemographic, anthropometric, clinical information, cardiometabolic comorbidities, HbA1c levels, lipid parameters and medication, were collected from electronic medical records. RESULTS: Seven hundred and eighty adult patients with type 2 diabetes were included, predominantly male (55.5%), with an average age of 67.7 years and a mean disease duration of 10.5 years. Family history of type 2 diabetes (43.1%) and CV disease (32.1%) was prevalent. Mean HbA1c was 7.0%, progressively increasing with disease duration (p<0.001). Microvascular and macrovascular complications occurred in 38.1% and 19.6% of patients, respectively. The most prevalent comorbidities included overweight/obesity (85.5%), dyslipidemia (85.4%), and hypertension (82.6%). Multimorbidity burden was significant (99.3%) and positively correlated with older age, larger waist circumference, and overweight/obesity. Longer type 2 diabetes duration was associated with higher odds of diabetic retinopathy and CV disease/procedures, while dyslipidemia and hypertension were linked with older age, regardless of disease duration. Most patients received oral antidiabetic medications (94.6%), primarily biguanides (92.4%), followed by DPP-4 (39.1%) and SGLT2 inhibitors (34.2%). CONCLUSIONS: The cMORE study reveals a substantial burden of vascular complications/comorbidities among Portuguese patients with type 2 diabetes. Despite the high multimorbidity rates, effective type 2 diabetes management is observed, emphasizing the country's commitment to personalized care.

[Determinants of avoidable hospitalization for type2 diabetes. Narrative review]. / Factores determinantes de las hospitalizaciones evitables por diabetes tipo2. Revisión narrativa.

OBJECTIVE: To identify the structural and intermediate determinants associated with avoidable hospitalizations (AH) of patients with type2 diabetes mellitus (T2DM). DESIGN: Literature review based on narrative synthesis. DATA SOURCES: Databases: PubMed, Science Direct, and Latin American and Caribbean Literature in Health Sciences (LILACS). STUDY SELECTION: Documents were selected and analyzed under a critical literature review, considering inclusion and exclusion criteria. DATA EXTRACTION: Information extracted from each selected article was synthesized based on the countries' income levels and the social determinants of health framework. RESULTS: A total of 4,166 articles were relevant, 36 were selected for review. From this selection, 21 were publications conducted in high-income countries, 14 in upper-middle-income countries, and one in lower-middle-income countries. The review identified that the coverage of health services -mainly primary health care- and health insurance contribute to reducing the risk of AH for T2DM, while social inequalities tend to increase the risk. CONCLUSIONS: The AH due to T2DM are susceptible to reduction through policies that contribute to increasing effective access to health services (availability, insurance), since they express social inequality, occurring to a greater extent in socioeconomically vulnerable populations. This review also provides evidence of the need to expand research on this topic in middle and low-income countries.

Percepción y conocimiento de Diabetes tipo 2 y riesgo de diabesidad en adultos / Perception and knowledge of type 2 Diabetes and diabesity risk in adults / Percepção e conhecimento do risco de Diabetes tipo 2 e diabetes em adultos

Las enfermedades crónicas no transmisibles se han convertido en un problema mundial debido a los altos índices de morbilidad y mortalidad, derivadas de estilos de vida inadecuados que incluyen una falta de una percepción y bajo conocimiento de estos padecimientos. Objetivo: Establecerla relación entre la percepción y el conocimiento de Diabetes Tipo 2 y el Riesgo de Diabesidad en adultos de Puebla. Metodología: Cuantitativo con diseño descriptivo, correlacional y de alcance transversal, se incluyeron personas de 20 a 65 pertenecientes al Centro de Salud de Almecatla, Puebla. Se excluyeron a las personas que hablen lengua indígena y mujeres embarazadas. El cálculo de la muestra fue de 182 personas. Se utilizó el instrumento DKQ-24 y Percepción de Riesgo de Diabetes, una cédula de datos socio demográfica y consentimiento informado. Análisis y resultados: El 78% fueron mujeres, con promedio de edad de 58.8 años, glicemia capilar 163.8, hemoglobina glucosilada 8.6, 88.5% tienen conocimiento de DT2 adecuado y el 50.5% una percepción de riesgo de DT2 alto. Existe una relación positiva y significativa entre el conocimiento y la percepción de riesgo de DT2 (p<05).Conclusión: Existe una correlación positiva significativa entre el conocimiento de DT2 y la percepción de riesgo de DT2. Existen indicadores corporales y bioquímicos que sugieren el aumento del riesgo de Diabesidad, a pesar de la asistencia al centro de salud no se refleja el control de las patologías, por tal motivo persisten los niveles de morbi-mortalidad.

Introduction: Chronic non-communicable diseases have become a global problem due to high morbidity and mortality rates, derived from inadequate lifestyles that include a lack of perception and low knowledge of these conditions. Objective: To stablish the relation between perception and knowledge of Type 2 Diabetes and the Risk of Diabesity in adults from Puebla. Method: Quantitative with a descriptive, correlational and cross-sectional design, including people from 20 to 65 belonging to the Almecatla Health Center, Puebla. People who spoke an indigenous language and pregnant women were excluded. The calculation of the sample was 182 people. The DKQ-24 instrument and Diabetes Risk Perception, a socio-demographic data card and informed consent were acquired. Analysis and results: 78% were women, with an average age of 58.8 years, capillary glycemia 163.8, glycosylated hemoglobin 8.6, 88.5% have adequate knowledge of T2D and 50.5% a perception of high T2D risk. There is a positive and significant relationship between knowledge and perception of T2D risk (p<05).Conclusion: There is a significant positive correlation between the knowledge of T2D and the perception of T2D risk. There are bodily and biochemical indicators that suggest the increased risk of Diabesity, despite the attendance at the health center, the control of the pathologies is not reflected, for this reason the levels of morbidity and mortality persist.

Introdução: As doenças crônicas não transmissíveis tornaram-se um problema global devido às altas taxas de morbidade e mortalidade, decorrentes de estilos de vida inadequados que incluem a falta de percepção e baixo conhecimento dessas condições. Objetivo: Estabelecer a relação entre percepção e conhecimento sobre Diabetes Tipo 2 e Risco de Diabesidade em adultos de Puebla. Método: Quantitativa com desenho descritivo, correlacional e transversal, incluindo pessoas de 20 a 65 anos pertencentes ao Centro de Saúde Almecatla, Puebla. Foram excluídas pessoas que falam línguas indígenas e gestantes. O cálculo amostra foi de 182 pessoas. Foram utilizados o instrumento DKQ-24 e Percepção de Risco de Diabetes, ficha de dados sociodemográficos e consentimento informado. Análise e resultados: 78% eran mulheres, com idade média de 58,8 anos, glicemia capilar 163,8, hemoglobina glicosilada 8,6, 88,5% têm conhecimento adequado de DM2 e 50,5% percepção de alto risco de DM2. Existe uma relação positiva e significativa entre o conhecimento e a percepção do risco de DM2 (p<0,05). Conclusão: Existe uma correlação positiva significativa entre o conhecimento de DM2 e a percepção do risco de DM2. Existem indicadores corporais e bioquímicos que sugerem o aumento do risco de Diabesidade, apesar da ida ao centro de saúde não se reflectir no controlo das patologias, por isso persistem os níveis de morbilidade e mortalidade.

Detección y seguimiento de pacientes según resultados de la prueba de FINDRISK en Atención Primaria

Introducción: la diabetes mellitus es una patología prevalente y por ello la implementación de estrategias prácticas para su diagnóstico son importantes desde la Atención Primaria. Objetivo: determinar los parámetros laboratoriales de los pacientes de la Unidad de Salud Familiar del barrio Chaipe (Encarnación, Paraguay) con moderado a muy alto riesgo de diabetes mellitus tipo 2 según la prueba de FINDRISK. Metodología: estudio prospectivo, observacional, descriptivo, transversal. Se incluyeron pacientes mayores de 18 años que acudieron a consultar en la Unidad de Salud Familiar del barrio Chaipe desde setiembre del 2022 a febrero del 2023. Se aplicó la prueba de FINDRISK para seleccionar a aquellos con moderado a muy alto riesgo de diabetes mellitus tipo 2 para las determinaciones laboratoriales. Resultados: la muestra estuvo conformada por 142 pacientes, con rango de edad menor a 45 años y predominio del sexo femenino. El 42,96 % tenía índice de masa corporal aumentado y 62,68 % circunferencia abdominal de riesgo. El 52,11 % no realizaba actividad física y el 27,46 % no consumía frutas y verduras diariamente. El 25,35 % eran hipertensos, el 11,97 % presentó en alguna oportunidad glicemia elevada y el 56,34 % tenía familiares con diabetes mellitus. El 4,93 % presentó glicemia ≥ 126 mg/dl y el 10,56 % valores de hemoglobina glicosilada (HBA1C) ≥ 6,5 %. El 14,08 % presentó colesterol total ≥ 200 mg/dl y 19,72 % triglicéridos ≥ 150 mg/dl. El 26,65 % presentó 3 o más criterios para síndrome metabólico y se encontró una relación significativa con el riesgo de diabetes mellitus. Conclusiones: se encontró una proporción significativa de pacientes con parámetros laboratoriales de glicemia, HBA1C, colesterol y triglicéridos aumentados.

Introduction: diabetes mellitus is a prevalent pathology and therefore the implementation of practical strategies for its diagnosis are important from Primary Care. Objective: to determine the laboratory parameters of patients from the United Family Healthcare of the Chaipe neighborhood (Encarnación, Paraguay) with moderate to very high risk of diabetes mellitus type 2 according to the FINDRISK test. Methodology: prospective, observational, descriptive, cross-sectional study. Patients over 18 years of age who came to consult at the United Family Healthcare in the Chaipe neighborhood from September 2022 to February 2023 were included. The FINDRISK test was applied to select those with moderate to very high risk of diabetes mellitus type 2 for the laboratory's determinations. Results: the sample was made up of 142 patients, with an age range of less than 45 years and a predominance of the female sex. 42.96 % had an increased body mass index and 62.68 % had an abdominal circumference at risk. 52.11 % did not do physical activity and 27.46 % did not consume fruits and vegetables daily. 25.35 % were hypertensive, 11.97 % had high blood glucose at some point and 56.34 % had family members with diabetes mellitus. 4.93 % had blood glucose ≥ 126 mg/dl and 10.56 % had glycosylated hemoglobin (HBA1C) values ​​≥ 6.5 %. 14.08 % had total cholesterol ≥ 200 mg/dl and 19.72 % had triglycerides ≥ 150 mg/dl. 26.65 % presented 3 or more criteria for metabolic syndrome and a significant relationship was found with the risk of diabetes mellitus. Conclusions: a significant proportion of patients with increased laboratory parameters of glycemia, HBA1C, cholesterol and triglycerides were found.

Esteatosis hepática metabólica y nefropatía diabética: una llamada a la acción / Targeting metabolic-associated fatty liver disease in diabetic kidney disease: A call to action

La incidencia y la prevalencia de hígado graso no alcohólico o enfermedad hepática metabólica (EHmet) está en aumento y es mayor en pacientes con diabetes mellitus tipo 2 (DM2). El riesgo cardiovascular y renal está claramente incrementado en estos pacientes, especialmente cuando se desarrolla nefropatía diabética. El eje cardio-reno-hepato-metabólico, conformado por la enfermedad cardiovascular (ECV), la enfermedad renal crónica (ERC), la EHmet y la DM2, tiene una base fisiopatogénica común. La relación clínica entre todos los componentes es inevitable y multidireccional, pudiendo la EHmet preceder al desarrollo de complicaciones cardiovasculares y renales, y también empeorar el pronóstico de las mismas una vez desarrolladas. En esta revisión enfatizamos la importancia de buscar y tratar la EHmet en pacientes con ERC y DM2 con el objetivo de identificar pacientes de mayor riesgo y de mejorar su pronóstico.(AU)

Non-alcoholic fatty liver disease or metabolic-associated fatty liver disease (MAFLD) is a common condition with increasing prevalence and incidence, specially in patients with type 2 diabetes mellitus (DM2). Both cardiovascular and renal disease are clearly increased in these patients, particularly in those with diabetic nephropathy. In the liver–heart–kidney–metabolic axis, the common pathophysiological basis of MAFLD, cardiovascular disease (CVD), chronic kidney disease (CKD), and DM2 is the same. The clinical relationship between all of them is clear and is multidirectional: MAFLD may precede the development of cardiovascular and renal disease, and may also worsen the prognosis of these complications once developed. In this review we emphasize the importance of targeting MAFLD in diabetic kidney disease, with the goal of detecting high-risk patients in order to improve their prognosis.(AU)

Probable interacción farmacológica entre sulfonilurea y betabloqueante en paciente con DM-II. Un reporte de caso / Probable pharmacological interaction between sulfonylurea and beta blocker in patients with DM-II. A case report

El estudio presenta el caso de una mujer de 47 años con diabetes tipo 2 (DM-II), hipertensión y anemia, tratada con metformina, glibenclamida, metoprolol y hierro/ácido fólico. Se identificó una interacción farmacológica entre glibenclamida y metoprolol, causando síntomas de hipoglucemia por la tarde. La evaluación mediante la Escala de Probabilidad de Interacciones Farmacológicas (EPIF) de Horn sugirió una interacción probable. El análisis farmacocinético reveló que el tiempo en el cual se alcanzan las concentraciones máximas de ambos fármacos coincidía con el inicio de los síntomas. Se implementó un nuevo horario de medicación que resolvió los síntomas. La interacción farmacológica se atribuyó al bloqueo de los efectos adrenérgicos por el metoprolol, comprometiendo la capacidad de contrarrestar la acción de la insulina liberada por la glibenclamida. Se resalta la importancia de la vigilancia, la toma de decisiones informadas y la implementación de estrategias preventivas para garantizar la seguridad y eficacia del tratamiento farmacológico en pacientes con condiciones clínicas específicas, como la DM-II y enfermedades cardiovasculares concomitantes.(AU)

Targeting metabolic-associated fatty liver disease in diabetic kidney disease: A call to action.

Nonalcoholic fatty liver disease or metabolic-associated fatty liver disease (MAFLD) is a common condicion with increasing prevalence and incidence, specially in patients with type 2 diabetes mellitus (T2DM). Both cardiovascular and renal disease are clearly increased in these patients, particularly in those with diabetic nephropathy. In the liver-heart-kidney-metabolic axis, the common pathophysiological basis of MAFLD, cardiovascular disease (CVD), chronic kidney disease (CKD), and T2DM is the same. The clinical relationship between all of them is clear and is multidirectional: MAFLD may precede the development of cardiovascular and renal disease, and may also worsen the prognosis of these complications once developed. In this review we emphasize the importance of targeting MAFLD in Diabetic kidney disease, with the goal of detecting high-risk patients in order to improve their prognosis.

Educational intervention on perceived stress among adults with type 2 diabetes and metabolic syndrome: a non-randomized clinical trial / Intervención educativa sobre el estrés percibido en adultos con diabetes tipo 2 y síndrome metabólico: ensayo clínico no aleatorizado / Intervenção educativa sobre o estresse percebido de adultos com diabetes tipo 2 e síndrome metabólica: ensaio clínico não-randomizado

Objective.To assess the effectiveness of an educational intervention on perceived stress and metabolic syndrome parameters among adults with type 2 diabetes mellitus. Method. Fifty-one adults (aged 48.73±7.84; 86.3% of women) were included in a non-randomized clinical trial performed in a healthcare unit for six months (Brazilian Clinical Trial Registry: RBR-43K52N). All participants were diagnosed with type 2 diabetes mellitus and metabolic syndrome (intervention group, n=26; control group, n=25). The intervention consisted of a nurse-led educational health-promoting program with a multidisciplinary approach organized in seven workshops. The primary outcome was decreased perceived stress, and the secondary outcome was improvement in metabolic syndrome parameters according to perceived stress levels. These outcomes were assessed at two points in time, at the baseline and follow-up. Results. Participation in the intervention program resulted in a significant decrease in perceived stress (p=0.028). The stressed participants in the intervention group experienced a significant decrease in blood glucose levels (p=0.001) and a significant increase in high-density lipoprotein-cholesterol (p=0.003) concentrations after the six-month intervention. Conclusion.The nurse-led educational health-promoting program decreased perceived stress among adults with type 2 diabetes mellitus and metabolic syndrome, improving fasting blood glucose and high-density lipoprotein cholesterol among the stressed participants in the intervention group.

Objetivo. Evaluar la efectividad de una intervención educativa sobre el estrés percibido y los componentes del síndrome metabólico en adultos con diabetes mellitus tipo 2. Métodos. Se incluyeron 51 adultos (48.73±7.84 años; 86.3% mujeres) de un estudio no-ensayo aleatorizado realizado en una unidad de salud durante seis meses, con Registro Brasileño de Ensayos Clínicos: RBR-43K52N, todos los participantes fueron diagnosticados con diabetes mellitus tipo 2 y síndrome metabólico (grupo intervención, n=26; grupo control, n=25). La intervención consistió en un programa educativo de promoción de la salud con enfoque multidisciplinario, liderado por una enfermera, estructurado en siete talleres grupales. El resultado primario fue la reducción del estrés percibido y el secundario, la mejora de los componentes del síndrome metabólico influenciados por el nivel de estrés percibido, evaluado en dos momentos, al inicio y después del seguimiento. Resultados. La participación en el programa de intervención resultó en una reducción significativa del estrés percibido en comparación con el grupo control (p=0.028). Los participantes estresados en el grupo de intervención tuvieron, respectivamente, una disminución y un aumento significativos en las concentraciones séricas de glucosa (p=0.001) y lipoproteínas de alta densidad-colesterol (p=0.003) después de seis meses de intervención. Conclusión. Un programa educativo de promoción de la salud liderado por enfermeras fue eficiente para reducir el estrés percibido entre adultos con diabetes mellitus tipo 2 y síndrome metabólico, además de mejorar la glucemia en ayunas y el colesterol unido a lipoproteínas de alta densidad en los participantes del grupo estresado de intervención.

Objetivo. Avaliar a efetividade de uma intervenção educativa sobre o estresse percebido e os componentes da síndrome metabólica em adultos com diabetes mellitus tipo 2. Métodos. Foram incluídos 51 adultos (48.73±7.84 anos de idade; 86.3% mulheres) em um ensaio clínico não-randomizado realizado em uma unidade de saúde durante seis meses, com Registro de Ensaio Clínico Brasileiro: RBR-43K52N.Todos os participantes apresentavam diagnóstico de diabetes mellitus tipo 2 e síndrome metabólica (grupo intervenção, n=26; grupo controle, n=25). A intervenção consistiu em um programa educativo de promoção da saúde com abordagem multidisciplinar, liderado por enfermeiro, estruturado em sete oficinas em grupo. O desfecho primário foi a redução do estresse percebido, e o secundário, a melhora dos componentes da síndrome metabólica conforme influência do nível de estresse percebido, avaliados em dois momentos, na condição basal e após o acompanhamento. Resultados. A participação no programa de intervenção resultou na redução significativa do estresse percebido em comparação com o grupo controle (p=0.028). Os participantes estressados do grupo intervenção tiveram, respectivamente, diminuição e aumento significativos das concentrações séricas de glicose (p=0.001) e da lipoproteína-colesterol de alta densidade (p=0.003) após seis meses de intervenção. Conclusão. Um programa educativo de promoção da saúde liderado por enfermeiros foi eficiente para reduzir estresse percebido entre adultos com diabetes mellitus tipo 2 e síndrome metabólica, além de causar melhora da glicemia de jejum e e da lipoproteína-colesterol de alta densidade dos participantes estressados do grupo intervenção.

Relación entre índice cintura cadera, índice cintura talla y la Escala FINDRISC en adultos de Guatemala / Relationship between waist-hip index, waist-height index and the FINDRISC Scale in adults from Guatemala

La diabetes mellitus tipo 2 (DM2) es una amenaza para la salud por las complicaciones derivadas de un diagnóstico tardío, donde la identificación oportuna es primordial. Con el objetivo de establecer la relación entre índice cintura talla (ICT), índice cintura cadera (ICC) y puntaje de la escala FINDRISC (Finnish Diabetes Risk Score) como determinantes del riesgo de padecer DM2 a largo plazo, se realizó este estudio predictivo transversal con adultos de 18 y 60 años atendidos en el Centro de Salud Primero de Julio del municipio de Mixco, Guatemala. Participaron 80 adultos, seleccionados por un muestreo aleatorio simple. El instrumento de recolección de datos estuvo conformado por tres secciones: información general de la persona, parámetros antropométricos y la encuesta de FINDRISC. Se generaron modelos lineales generalizados para identificar relaciones entre índice cintura talla (ICT), índice cintura cadera (ICC) y puntaje de la escala FINDRISC (Finnish Diabetes Risk Score). El 36.2% presentó riesgo de desarrollar DM2 a largo plazo; encontrándose un 21.2% en el nivel de riesgo alto y muy alto. Se comprobó que únicamente existe relación significativa entre el ICT y el puntaje de la escala de FINDRISC como determinante del riesgo de padecer DM2 a largo plazo. Se concluye que la implementación de la medición del ICT constituye una herramienta útil para identificar personas con riesgo de desarrollar DM2, siendo su aplicación sencilla, no invasiva, económica y de fácil acceso en los servicios de salud.

Type 2 diabetes mellitus (T2DM) is a health threat due to the complications derived from a late diagnosis, where timely identification is essential. This study aimed to establish the relationship between waist-height index (WHR), waist-hip index (WHR) and the FINDRISC (Finnish Diabetes Risk Score)scale as determinants of the risk of suffering from T2DM in the long term. A cross-sectional predictive study was carried out with a simple random sample of 80 adults between 18 and 60 years old treated at the Primero de Julio Health Center in Mixco, Guatemala. The data collection instrument was structured into three sections: general information, anthropometric parameters and the FINDRISC survey. Generalized linear models were generated to identify relationships between waist-height ratio (WHR), waist-hip ratio (WHR) and the FINDRISC scale score (Finish Diabetes Risk Score). The results shows that 36.2% of the participants were at risk of developing T2DM in the long term; 21.2% being at the high and very high risk level. It was found that there is only a significant relationship between the WHR and the FINDRISC scale score as a determinant of the risk of suffering from T2DM in the long term. The implementation of the waist height index measurement constitutes a useful tool to identify people at risk of developing T2DM, its application being simple, non-invasive, economical and easily accessible in health services.

[Evaluation of healthcare for patients with diabetes in primary care: A systematic review]. / Evaluación de la asistencia sanitaria del paciente con diabetes en atención primaria: una revisión sistemática.

OBJECTIVE: Have the most current evidence in relation to the evaluation of medical healthcare for patients with diabetes in primary care. METHOD: During the review process, we followed the recommendations to improve the publication of systematic reviews and meta-analyses and the preferred reporting points for PRISMA systematic reviews. The bibliographic search was carried out in Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, Scielo, MedLine/ PubMed, Cochrane databases and in the Google Scholar search engine, with free and controlled language, using the MeSh search terms: «Physicians, Primary Care¼, «Diabetes Mellitus, Type2¼. Eight selected articles were analyzed. The articles were selected based on their relevance, published in peer-reviewed academic journals and published between 2019 and 2023. RESULTS: The main study tool represents interventions in knowledge and practice about the care of patients with diabetes among primary care physicians. The most important discussion topics extracted in the analyzed articles refer to knowledge, clinical inertia, patients' housing challenges, adherence intervention programs, and a self-care application for patients with diabetes. CONCLUSIONS: The findings of this study indicate the need to improve medical health care through knowledge, attitudes and practices in primary care regarding patients with diabetes. In this way, it could be considered a useful tool to promote medical healthcare in primary care.

Risk factors associated with glomerular filtration rate in Mexican adults with type 2 diabetes mellitus.

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is related to glomerular filtration rate (GFR) impairment, which is one of the main causes of chronic kidney disease. The objective of this study was to identify the risk factors related to GFR in Mexican adults with T2DM, using a validated multiple linear regression model (MLRM), with emphasis in body adiposity, glycemic control, duration of the diabetes and other relevant risk factors. MATERIALS AND METHODS: A cross-sectional, analytical, and observational study was carried out in 252 adults with a previous diagnosis of T2DM. Body mass index (BMI) and waist circumference (WC) were determined and a fasting blood sample was collected for glucose, creatinine and HbA1c determinations. GFR was calculated with the Cockcroft-Gault equation adjusted for body surface area. Four MLRM were performed to determine the factors related to the GFR; it was evaluated whether these models complied with the statistical assumptions of the linear regression model. RESULTS: The average age of the participants was 60 ±â€¯12 years, 62.3% of them were women. GFR correlated with BMI and WC; age and duration of the diabetes were associated inversely. Model 4 of the MLRM reported a coefficient of determination of 53.5% where the variables BMI (ß = 1.31), male sex (ß = -6.01), duration of T2DM (ß = -0.57), arterial hypertension (ß = -6.53) and age (ß = -1.45) were simultaneously and significantly related to the GFR. CONCLUSIONS: Older age, male sex, longer duration of T2DM and the presence of arterial hypertension were associated with a decrease in the GFR; BMI and WC were directly associated. No effect of glucose and HbA1c on GFR was observed.

Validez y fiabilidad del cuestionario ARMS-e en pacientes con Diabetes mellitus tipo 2 / Validity and reliability of the ARMS-e questionnaire in patients with type 2 Diabetes mellitus

Introducción: El cuestionario “Adherence to Refills and Medications Scale” (ARMS) se diseñó para medir adherencia al tratamiento. Fue traducido y adaptado al español, pero no se han evaluado sus propiedades psicométricas. El objetivo fue evaluar dichas propiedades en una población con diabetes mellitus tipo 2. Método: El estudio se llevó a cabo en farmacias comunitarias de Granada (España) mediante entrevista. Se realizó un análisis factorial de componentes principales (AFCP) con rotación Varimax (validez de constructo), un análisis de concordancia (validez de criterio concurrente y fiabilidad por estabilidad temporal) y alfa de Cronbach y correlación ítem-total (fiabilidad por homogeneidad). Resultados: 107 pacientes entraron en el estudio. El 54,2 % (58) fueron hombres y la edad media fue 70,5 años (D.E.: 9,7). El AFCP extrajo 4 factores que explicaron el 57,49 % de la varianza total. El alfa de Cronbach= 0,428 y el test-retest κ= 0,627 (p > 0,001). Conclusiones: El ARMS-e no puede ser considerado una herramienta útil para medir la adherencia al tratamiento antidiabético oral en esta muestra. (AU)

Introduction: The Adherence to Refills and Medications Scale questionnaire (ARMS) was designed to measure ad-herence to treatment. It was translated and adapted into Spanish, but its psychometric properties have not been evaluated. The aim was to evaluate these properties in a population with type 2 diabetes mellitus. Method: The study was carried out in community pharmacies in Granada (Spain) by interview. A principal compo-nent factor analysis (PCA) with Varimax rotation (construct validity), a concordance analysis (concurrent criterion validity and reliability by temporal stability) and Cronbach’s alpha and item-total correlation (reliability by homo-geneity) were performed. Results: 107 patients entered the study. 54.2 % (58) were male and the mean age was 70.5 (SD: 9.7). The PCA extract-ed 4 factors that explained 57.49 % of the total variance. Cronbach’s alpha= 0.428, and in the test-retest κ= 0.627 (p > 0.001). Conclusions: The ARMS-e cannot be considered a useful tool to measure adherence to oral antidiabetic treatment in this sample. (AU)

[Association between therapeutic adherence and phases of grief in patients with type 2 diabetes mellitus]. / Asociación entre la adherencia terapéutica y las fases de duelo en pacientes con diabetes mellitus tipo 2.

OBJECTIVE: To evaluate the association between therapeutic adherence and the phases of grief in patients with type 2 diabetes mellitus. DESIGN: Cross-sectional observational study. SITE: Family Medicine Unit No. 53 of the Mexican Institute of Social Security in the State of Guanajuato. PARTICIPANTS: A total of 354 patients with type 2 diabetes mellitus were recruited, of whom 236 corresponded to the group without therapeutic adherence and 118 to the group with therapeutic adherence. INTERVENTIONS: Two structured surveys were administered to both groups. MAIN MEASUREMENTS: The Morisky 8 scale was used to measure therapeutic adherence and the phases of grief scale (EFD-66) to measure grief due to loss of health. RESULTS: The median denial phase and depression phase scores were higher in the nonadherence group than in the adherence group (p=.000). The median negotiation phase and acceptance phase score was higher in the adherence group than in the nonadherence group (p=.000). Multivariate analysis identifies that denial is the main factor associated with non-adherence (OR=1.25; 95% CI: 1.14-1.37); while negotiation (OR=0.88; 95% CI: 0.82-0.94) and acceptance are associated with adherence (OR=0.79; 95% CI: 0.75-0.83). CONCLUSIONS: There is an association between therapeutic adherence and phases of grief.

Dairy product consumption and type 2 diabetes in an Argentinian population:is there an association? / Consumo de productos lácteos y diabetes tipo 2 en una población argentina: ¿existe asociación?

Introduction: dairy products have long been recommended as part of a healthy eating plan, but there is a controversial opinion about whetheror not they should be included in the diet of people with type 2 diabetes (T2D).Objective: the aim of this study was to know if there is an association between the intake of total dairy and dairy subgroups and the chance ofhaving T2D, and the status of markers of glucose metabolism.Methods: three hundred and forty-two adult subjects participated in the study. A validated food-frequency questionnaire was applied to establishthe dairy intake. Clinical-pathological and anthropometric variables (height, weight, waist circumference and serum concentrations of blood glucose,glycated hemoglobin [HbA1c], high sensitive C-reactive protein [hs-CRP], tumor necrosis factor alpha [TNFα], interleukin [IL] 6 and IL-10) weremeasured. Consumption tertiles were calculated for each dairy subgroup. Correlation coefficients, multiple linear regression models and logisticregression models were used to assess the relation between dairy product consumption and markers of glucose metabolism.Results: a negative correlation was observed between the consumption of fermented dairy products and IL-10 (r = -0.27, p = 0.0206). Fermenteddairy products were inversely associated with blood glucose, and HbA1c. Total dairy intake was positively associated with a lower chance ofhaving diabetes in tertiles 2 and 3 of consumption, in relation to the reference tertile, adjusted for age, smoking habit, and alcohol intake, bodymass index (BMI) and dietary variables.Conclusions: with this study, we broaden our understanding of the role of dairy intake in diabetes risk. However, more long-term studies areneeded to confirm the associations and explore different confounding factors.(AU)

Introducción: los lácteos se han recomendado durante mucho tiempo como parte de un plan de alimentación saludable, pero existen opinionescontrovertidas sobre si deben incluirse en la dieta de las personas con diabetes tipo 2 (DT2).Objetivo: el objetivo fue conocer si existe asociación entre la ingesta de lácteos totales y subgrupos lácteos y la posibilidad de tener DT2, y elestado de los marcadores del metabolismo de la glucosa.Métodos: participaron 342 sujetos adultos. Se aplicó un cuestionario de frecuencia de consumo para establecer el consumo de lácteos. Semidieron variables clínicas-patológicas y antropométricas (talla, peso, circunferencia de cintura y concentraciones séricas de glucosa en sangre,hemoglobina glicosilada [HbA1c], proteína C reactiva ultrasensible [PCR-us], factor de necrosis tumoral alfa [TNFα], interleuquina [IL] 6 e IL-10).Se calcularon terciles de consumo para cada subgrupo de lácteos. Se utilizaron coeficientes de correlación, modelos de regresión lineal múltipley regresión logística para evaluar la relación entre el consumo de lácteos y los marcadores del metabolismo de la glucosa.Resultados: los productos lácteos fermentados se asociaron inversamente con la glucosa en sangre y la HbA1c. La ingesta total de lácteos seasoció positivamente con una menor probabilidad de tener diabetes en los terciles 2 y 3 de consumo, en comparación con el tercil de referencia,ajustado por edad, tabaquismo, ingesta de alcohol, índice de masa corporal (IMC) y variables dietéticas.Conclusiones: con este estudio, ampliamos nuestra comprensión del papel de la ingesta de lácteos en el riesgo de diabetes. Sin embargo, senecesitan más estudios a largo plazo para confirmar las asociaciones y explorar diferentes factores de confusión.(AU)

Thrombotic risk assessed by PAI-1 in patients with COVID-19: The influence of hyperglycemia and diabetes mellitus.

OBJECTIVE: To assess thrombotic risk with PAI-1 levels in patients with COVID-19, to evaluate PAI-1 differences between hyperglycemic and/or Type 2 Diabetes Mellitus (T2DM) versus non-hyperglycemic patients, and to analyze the association of plasminogen activator inhibitor-1 (PAI-1) with hyperglycemia and T2DM. METHODS: A cross-sectional study carried out in 181 patients hospitalized for COVID-19. Two groups were formed: the patients with hyperglycemia at admission and/or previously diagnosed T2DM group and the non-hyperglycemic group. Fibrinolysis was assessed by measuring PAI-1 levels by ELISA. RESULTS: The mean age was 59.4±16.1 years; 55.8% were male 54.1% of patients presented obesity, 38.1% had pre-existing T2DM and 50.8% had admission hyperglycemia and/or pre-existing T2DM. The patients with admission hyperglycemia and/or preexisting T2DM had higher PAI-1 compared with non-hyperglycemic patients [197.5 (128.8-315.9) vs 158.1 (113.4-201.4) ng/mL; p=0.031]. The glucose levels showed a positive correlation with PAI-1 levels (r=0.284, p=0.041). A multivariate logistic regression analysis showed association of PAI-1 level and hyperglycemia and pre-existing T2DM with severity of COVID-19. CONCLUSION: Patients hospitalized for COVID-19 infection with preexisting T2DM or hyperglycemia detected during their hospitalization presented a greater increase in PAI-1 levels, which suggests that hyperglycemia contributes directly to the hypercoagulable state and probably a worse outcome from the patients.