Perfil de uso de los servicios del módulo DiabetIMSS por pacientes con diabetes mellitus 2 / Service use profile of DiabetIMSS module by patients with type 2 diabetes

Resumen:

Introducción: el programa DiabetIMSS tiene por objetivo el manejo y control de pacientes diagnosticados con diabetes mellitus 2 a través de intervenciones multidisciplinarias.

Objetivo: identificar el perfil de uso de los servicios del módulo DiabetIMSS por pacientes con diabetes mellitus 2.

Metodología: estudio transversal descriptivo en pacientes inscritos al módulo DiabetIMSS. Para el tamaño de la muestra se utilizó la fórmula de porcentajes para población finita (n=125), las unidades muestrales se eligieron al azar. Se analizaron variables sociodemográficas, de salud y enfermedades asociadas. El perfil de uso del paciente en el módulo DiabetIMSS se implementó mediante la utilización anual de los servicios de salud. El plan de análisis incluyó promedios, porcentaje e intervalos de confianza.

Resultados: el promedio anual más alto de uso de los servicios del módulo DiabetIMSS se tuvo en la atención de enfermería otorgando 10.26 consultas y 10.24 del médico familiar. En la consulta que brinda el médico familiar, laboratorio y enfermería, el porcentaje anual de uso del módulo es del 100% de los pacientes inscritos. Para una población de 100 pacientes atendidos en el programa de DiabetIMSS se requieren al año 1 026 atenciones de enfermería.

Conclusión: la falta de equipo multidisciplinario propio para el módulo dificulta las acciones de cada uno de los servicios involucrados, por lo que el perfil de uso de la población incorporada a DiabetIMSS se sigue quedando mayoritariamente con el médico familiar y enfermería, quedando en segundo plano la atención multidisciplinaria.

Abstract:

Introduction: the DiabetlMSS program is aimed to control and manage patients diagnosed with type 2 diabetes through multidisciplinary interventions.

Objective: to identify the use profile of DiabetlMSS module services by type 2 diabetes patients.

Methodology: cross-sectional, descriptive study in patients enrolled in DiabetlMSS module. For the sample size, the formula for finite population percentages was used (n = 125), the sampling units were randomly selected. Sociodemographic, health and associated-diseases variables were analyzed. The usage profile of DiabetlMSS module patients was operationalized through annual health services use. The analysis plan included averages, percentages and confidence intervals.

Results: the highest annual average use of DiabetlMSS module services was nursing care 10.26 consultations and 10.24 medical consultations. The annual percentage use of family physician consultation, laboratory and nursing services is 100% of the enrolled patients. For a population of 100 patients treated in the DiabetlMSS program 1026 nursing consultations are required annually.

Conclusions: the lack of multidisciplinary team for the module itself hinders the actions of each of the services involved, so that the profile use of the DiabetlMSS enrolled patients still remains mostly with the family physician and nursing staff leaving in the background the multidisciplinary attention.

The effect of a desogestrel-containing oral contraceptive on glucose tolerance and leptin concentrations in hyperandrogenic women.

Ovarian hyperandrogenism can be associated with insulin resistance, hyperinsulinemia, glucose intolerance, and obesity. High levels of the lipostatic hormone, leptin, have also been reported in this condition. The purpose of the present study was to examine the effect of an oral contraceptive (OC) of low androgenicity containing desogestrel on glucose tolerance in hyperandrogenic women and the impact of changes in androgenic/estrogenic status on leptin concentrations. Sixteen nondiabetic hyperandrogenic women, aged 29 +/- 1 yr with a body mass index (BMI) of 36.8 +/- 1.8 kg/m2, underwent an oral glucose tolerance test before and after 6 months of therapy with the OC. Free testosterone decreased and sex hormone-binding globulin increased after therapy (P < 0.001). Glucose tolerance deteriorated significantly, and two women developed diabetes. Body weight, BMI, and leptin did not change significantly. Leptin correlated with BMI before (r = 0.56; P = 0.02) and after (r = 0.51; P = 0.04) treatment, but not with glucose, insulin, total and free testosterone, or sex hormone-binding globulin before or after treatment. In conclusion, 1) glucose tolerance should be monitored in hyperandrogenic women using OC, even those of low androgenicity; and 2) changes in androgenic/estrogenic status had no effect on the leptin concentration, suggesting that its sexual dimorphism is not related to sex steroids.

PIP: Ovarian hyperandrogenism can be associated with insulin resistance, hyperinsulinemia, and glucose intolerance--all of which, in turn, have been linked to high levels of the lipostatic hormone, leptin. This study investigated the effect of an oral contraceptive (OC) containing a progestin of low androgenicity on glucose tolerance and insulinemia in hyperandrogenic women and the impact of changes in androgenic/estrogenic status on plasma leptin levels. 16 nondiabetic hyperandrogenic US women (mean age, 29 years) with a mean body mass index of 36.8 kg/sq. m underwent oral glucose tolerance testing before and after 6 months of treatment with an OC containing 30 mcg of ethinyl estradiol and 150 mcg of desogestrel. Treatment was associated with significant decreases in free testosterone and increased sex hormone-binding globulin (p 0.001). Glucose tolerance deteriorated moderately but significantly. After 6 months of treatment, 5 women had normal glucose tolerance, 9 had impaired glucose tolerance, and 2 developed non-insulin-dependent diabetes mellitus. There were no significant changes in serum insulin concentrations, body weight, body mass index, or leptin, but leptin levels were highly correlated with body mass index both before and after treatment. The data suggest that the sexual dimorphism of leptin is not caused by differences in sex hormones. Even when OCs containing low androgenic progestins are prescribed, women at high risk for diabetes should receive regular glucose tolerance tests.

Diabetes-A Risk Factor for Periodontitis in Adults?

With the increasing number of diabetics in an aging population and controversial research reports on the relationship of diabetes to periodontitis, clarification of diabetes as a risk factor for periodontitis would be helpful. This review notes variations in type, metabolic control, and duration of diabetes and highlights the results of studies that have considered these variations. Diabetics who maintained reasonably good metabolic control had not lost more teeth or experienced more periodontal attachment loss than non-diabetics, although they had more periodontal pockets. Poorly-controlled diabetics with extensive calculus on their teeth had more periodontitis and tooth loss than well-controlled diabetics or non-diabetics. Long-duration diabetics were also at greater risk for periodontitis. Mechanisms by which diabetes may contribute to periodontitis include vascular changes, neutrophil dysfunction, altered collagen synthesis, and genetic predisposition. Minimizing plaque and calculus in the oral cavity through careful self-care and regular professional care is important to reduce the risk of periodontitis in diabetics. J Periodontol 1994; 65:530-538.

Diabetes mellitus in Bahrain: an overview.

Bahrain has faced a rapid transition in its socio-economic status, which resulted in great changes both in life-style and in patterns of health and disease. There has been a marked decline in infectious diseases and an increase in chronic diseases. Diabetes mellitus has become one of the most common public health problems in the country. In 1988 it was estimated that 3.4% of total deaths in Bahrain were due to diabetes. A community-based study among mothers aged 18 to 48 years showed that 8.5% of them had diabetes. The percentage was found to be higher among elderly Bahrainis (12.9%). Obesity, lack of physical activity, alteration in food habits, and change in social conditions have all played a vital role in the changing prevalence of diabetes in this country. The current programmes to manage and control diabetes are limited and ineffective. Thus measures to treat diabetes should be given a high priority in the national health policy. Training of physicians in the management of diabetes, public education, epidemiological surveys, and nutritional evaluation of local foods are among the most important measures needed to control diabetes in Bahrain.

PIP: Rapid socioeconomic development has led to great changes in health and disease patterns in Bahrain. Specifically, chronic diseases are replacing infectious diseases as the leading causes of morbidity and mortality. Diabetes mellitus is 1 chronic disease which causes considerable problems in Bahrain. It has a higher death rate than that of hypertension, but a lower death rate than that of cardiovascular diseases. Type 2 (noninsulin-dependent) diabetes is the most prevalent form of diabetes in Bahrain. Changes in dietary habits and lifestyle occur with rapid development in Bahrain, often resulting in obesity and decreased physical activity, particularly in women. Obesity and lack of physical exercise are risk factors of Type 2 diabetes. A community- based nutrition survey among 18-to-48 year-old mothers in Bahrain reports that 8.5% suffer from diabetes. The prevalence of diabetes among elderly Bahrainis is 13.4% (15% in females and 10.2% in males). Physicians in Bahrain tend not to list diabetes mellitus as the main cause of death; thus there is underreporting of diabetes-related mortality. Nevertheless, diabetes is responsible for 3.4% of all deaths in Bahrain. Yet, Bahrain does not have programs to detect or control diabetes. Health workers in health centers can and do provide advice on health care and dietary management, but they are not properly trained. Physicians manage diabetes through dietary restrictions, tablets, or insulin injections. Mass media promote prevention of diabetes. Their effectiveness is low, however, because educational programs are poorly designed and unattractive. The government should accord diabetes prevention and control high priority. It should support and implement training of physicians in diabetes management, public education, epidemiological surveys, and nutritional assessment of local foods.