[Practice guideline. Diagnosis and treatment of type 2 diabetes mellitus]. / Guía de práctica clínica. Diagnóstico y tratamiento de la diabetes mellitus tipo 2.

Our objective was to develop a guide based on the best available evidence that allow family physicians to establish criteria for screening, diagnosis, prevention, treatment of disease, early detection and management of complications; to standardize the organizing processes of the diabetic patient's care in the primary care level; and to achieve lifestyle modification for patients and promote self-care. Clinical questions were stated according to the diagram and structured patient-intervention-comparison-outcome. We used a mixed methodology-adoption adjustment, and include 32 guides. For recommendations not included in these, the search process was conducted in PubMed and Cochrane Library Plus with these terms: diabetes mellitus type 2, epidemiology, detection and diagnosis, classification, drug therapy, effects, prevention, control and complication. The clinical practice guideline emphasizes the fundamental change in lifestyle (diet and exercise), self-care and proactive participation of the patient, in addition to the dynamic prescription of medications that would achieve metabolic control in order to reduce late complications.

[Integrated Care Protocol: Prevention, diagnosis and treatment of diabetes mellitus 2]. / Protocolo de Atención Integral: prevención, diagnóstico y tratamiento de diabetes mellitus 2.

Background: Type 2 diabetes mellitus (DM2) represents one of the ten non- transmissible chronic diseases that constitute the main causes of death and disability in Mexico. It is the leading cause of disability and the second cause of death. The IMSS serves 4.2 million people living with this disease. Objective: Establish lines of action that allow standardizing the substantive activities to be carried out by the multidisciplinary health team, promoting healthy lifestyles, establishing timely diagnoses, providing adequate and intensified care and treatments, preventing complications, and providing comprehensive care and of quality for the benefit of the beneficiaries. Material and methods: The process of development of the Integrated Care Protocols consisted of: 1) Prioritization of the health problem, 2) Conformation of an interdisciplinary work group, 3) Development of content and systematic search for information 4) Analysis, review and discussion of interventions, 5) Review and validation by regulatory areas, 6) Dissemination and implementation. Conclusions: Promotion and prevention actions must be carried out at all levels and by all health personnel, likewise, the incorporation of new treatments for DM2 in the IMSS, requires the homologation of the criteria in risk stratification, diagnosis, profile risk of hypoglycemia and adverse effects to limit the complications of the disease and reduce the burden of disease (disability and premature death).

Introducción: la diabetes mellitus tipo 2 (DM2) es una de las diez enfermedades crónicas no transmisibles que constituyen las principales causas de muerte y discapacidad en México, es la principal causa de invalidez y la segunda de muerte. El Instituto Mexicano del Seguro Social (IMSS) atiende a 4.2 millones personas que viven con esta enfermedad. Objetivo: establecer líneas de acción que permitan homologar las actividades sustantivas que debe llevar a cabo el equipo multidisciplinario de salud, promoviendo estilos de vida saludables, estableciendo diagnósticos oportunos, otorgando atención y tratamientos adecuados e intensificados, previniendo complicaciones y brindando atención integral y de calidad para el beneficio de los derechohabientes. Material y métodos: el proceso de desarrollo de los Protocolos de Atención Integral consistió en: 1) Priorización del problema de salud; 2) Conformación de grupo de trabajo interdisciplinario; 3) Desarrollo del contenido y búsqueda sistemática de información; 4) Análisis, revisión y discusión de las intervenciones; 5) Revisión y validación por las áreas normativas, y 6) Difusión e implementación. Conclusiones: las acciones de promoción y prevención deben realizarse en todos los niveles y por parte de todo el personal de salud; asimismo, la incorporación de nuevos tratamientos para DM2 en el IMSS requiere de la homologación de los criterios en estratificación de riesgo, diagnóstico, perfil riesgo de hipoglucemia y efectos adversos, con el objetivo de limitar las complicaciones de la enfermedad y disminuir la carga de enfermedad (discapacidad y muerte prematura).

[Integrated Care Protocol: Chronic complications of diabetes mellitus 2]. / Protocolo de Atención Integral: complicaciones crónicas de diabetes mellitus 2.

BACKGROUND: According to the International Diabetes Federation, 18% of Mexican adults live with diabetes and it is expected that by 2030 it will occupy the seventh place in the world in number of cases. In the population covered by the Mexican Institute of Social Security, diabetes is the second cause of mortality, years lost due to premature death, years lived with disability and years of healthy life lost, placing it as one of the costliest diseases. OBJECTIVE: Address in a timely and integrated manner chronic complications of type 2 diabetes mellitus, by implementing coordinated actions by multidisciplinary health team in the 3 levels of care. MATERIAL AND METHODS: The process of developing the Integrated Care Protocols consisted of: 1) Prioritization of the health problem, 2) Formation of an interdisciplinary working group, 3) Development of content and systematic search for information 4) Analysis, review and discussion of interventions, 5) Review and validation by regulatory areas, 6) Dissemination and implementation. CONCLUSIONS: Adequate glycemic control, blood pressure, lipids and a healthy lifestyle are the key to delaying the presence of micro and macrovascular complications of DM2. However, the progression of the disease will eventually be inevitable, it will confront the health personnel and the patient with some of the complications. In this sense, timely detection and treatment to delay them becomes the main function of the health worker.

INTRODUCCIÓN: de acuerdo con la Federación Internacional de Diabetes, en México el 18% de los adultos viven con diabetes, y se espera que para el 2030 ocupe el séptimo lugar mundial en número de casos. En la población cubierta por el Instituto Mexicano del Seguro Social, la diabetes es la segunda causa de mortalidad, así como de años perdidos por muerte prematura, de años vividos con discapacidad y de años de vida saludable perdidos, colocándola como una de las enfermedades más costosas. OBJETIVO: atender de manera oportuna e integral las complicaciones crónicas de la diabetes mellitus tipo 2 (DM2), mediante la implementación articulada de las acciones a cargo de equipo multidisciplinario de salud en los tres niveles de atención. MATERIAL Y MÉTODOS: el proceso de desarrollo de los Protocolos de Atención Integral consistió en: 1) Priorización del problema de salud, 2) Conformación de grupo de trabajo interdisciplinario, 3) Desarrollo del contenido y búsqueda sistemática de información 4) Análisis, revisión y discusión de las intervenciones, 5) Revisión y validación por las áreas normativas y 6) Difusión e implementación. CONCLUSIONES: el adecuado control glucémico, del presión arterial y lípidos, así como un estilo de vida saludable son la clave para retrasar la presencia de complicaciones micro y macrovasculares de la DM2. Sin embargo, la progresión de la enfermedad eventualmente será inevitable, enfrentará al personal de salud y al paciente a alguna de las complicaciones. En este sentido, la detección oportuna y el tratamiento para retrasarlas se convierte en la principal función del trabajador de la salud.

[Clinical practice guideline: a complete geriatric evaluation]. / Guía de práctica clínica. Valoración geriátrica integral.

The care of elderly patients requires an evaluation that deserves a host of special considerations, such as biological aspects of aging, those related to activities of daily living and functionality, neuro-psychological conceptions, family dynamics and economic conditions. The growth of the aging population in our country is accompanied by an increase in chronic diseases and more individuals have greater vulnerability, requiring a more consumption of resources because of the high demand for services. This requires the incorporation of specialized care in the institutional system, which has caused serious consequences in the current health system, benefiting specialization and technology, but with a loss of an integrated and horizontal view of the patient. Therefore it is necessary to develop a practical tool that allows the family physician to identify and differentiate the geriatric population that requires specialized care from who does not, identifying problems that may improve and allow the design of strategies to improve health status and maintain functional autonomy of the elderly. Comprehensive Geriatric Assessment (CGA) is a fundamental tool for clinical practice of any medical care to the elderly.

[Spatio-temporal trend in detections of diabetes mellitus and systematic arterial hypertension in IMSS users, 2004-2019]. / Tendencia espacio-temporal de detecciones de diabetes mellitus e hipertensión arterial sistémica en usuarios del IMSS, 2004-2019.

Background: Diabetes Mellitus (DM) and heart diseases, which include Systemic Arterial Hypertension (SAH), have been positioned as the two main causes of mortality in Mexico, which represents important challenges for the different health institutions. Objective: To analyze the spatio-temporal trend of DM and SAH based on the detections made in first and and second level units of the Instituto Mexicano del Seguro Social, during the period 2004-2019. Material and methods: Ecological study in which detection rates of both diseases were calculated per 1,000 persons according to year, triennium and representation. The spatiotemporal trend was analyzed by spatial statistics using Geographic Information Systems. Results: During 2004-2019 therere were 9 399 889 and 11 862 069 detections on average of DM and SAH, respectively. Regarding DM, the detection rate ranged from 203.4 (2004) to 384.4 (2019) per 1000 persons, this trend increased in Tamaulipas. While SAH decreased from 1140.2 (2004) to 352 (2019) per 1000 persons in Veracruz Sur and Tamaulipas, respectively. Conclusions: The observed spatio-temporal trend can contribute to organizing and guiding, according to representation and level of care, institutional programs, integrated care protocols, clinical practice guidelines and other public policy instruments available at the Instituto Mexicano del Seguro Social to improve early detection, care, control and access to medications for DM and SAH.

Introducción: la diabetes mellitus (DM) y las enfermedades del corazón, entre las que se incluye la hipertensión arterial sistémica (HTA), se han posicionado entre las primeras causas de mortalidad en México, lo que plantea retos importantes para las diferentes instituciones de salud. Objetivo: analizar la tendencia espacio-temporal de DM e HTA con base en las detecciones realizadas en unidades de primero y segundo nivel del Instituto Mexicano del Seguro Social (IMSS), durante el periodo 2004-2019. Materiales y métodos: estudio ecológico en el que se calcularon las tasas de detección de ambos padecimientos por mil derechohabientes según año, trienio y representación. La tendencia espacio-temporal se analizó mediante estadística espacial utilizando Sistemas de Información Geográfica. Resultados: de 2004 a 2019 hubo 9 399 889 y 11 862 069 detecciones en promedio de DM e HTA, respectivamente. Referente al primer padecimiento, la tasa de deteccion osciló de 203.4 (2004) a 384.4 (2019) por mil derechohabientes, cuya tendencia aumentó en Tamaulipas. Mientras que la HTA disminuyó de 1140.2 (2004) a 352 (2019) detecciones por mil derechohabientes en Veracruz Sur y Tamaulipas, respectivamente. Conclusiones: la tendencia espacio-temporal observada puede contribuir a organizar y orientar, según su representación y nivel de atención, los programas institucionales, protocolos de atención, guías de práctica clínica y demás instrumentos de políticia pública disponibles en el IMSS para mejorar la detección oportuna, atención, control y acceso a medicamentos para DM e HTA.

Hand grip strength and early mortality after hip fracture.

This research describes the risk of death in elderly after hip fracture according to their strength, measured by hand grip. The result is that the weaker the patient, the greater the risk of death after hip fracture, highlighting the need to assess the force in those patients. For the coming years, most of hip fractures will occur in developing countries. It has been described that low muscular strength, measured by grip strength, increases the risk of mortality in those with hip fracture, in both high-and low- income countries. The objective of this study was to determine the mortality among patients with hip fracture and lower hand grip strength (HGS). MATERIAL AND METHODS: We conducted a cohort and longitudinal study at Hip and Pelvic Surgery Department of a tertiary hospital, in Monterrey, Mexico. The study included patients aged over of 69, admitted for hip fracture surgery from February 1st 2013 to July 31st 2014. HGS measurement was performed by a trained physician at arrival to emergency department prior to surgery; clinimetric variables were asked, and a complete medical history was included. RESULTS: A total of 670 patients were included in the study and grouped in different tertiles according to hand grip strength. During follow-up, there were 112 deaths (17.4%), 61 (27.5%) in tertile 1, 37 (17.1%) in tertile 2, and 14 (6.8%) in tertile 3, p < 0.001. The association remained significant after adjusting for confounding variables. Less than 5% of patients discharged from hospital were identified with osteoporosis. CONCLUSION: Lower hand grip strength in patients with a hip fracture is associated with high mortality after hip fracture.

Tendencia espacio-temporal de detecciones de diabetes mellitus e hipertensión arterial sistémica en usuarios del IMSS, 2004-2019 / Spatio-temporal trend in detections of diabetes mellitus and systematic arterial hypertension in IMSS users, 2004-2019

Introducción: la diabetes mellitus (DM) y las enfermedades del corazón, entre las que se incluye la hipertensión arterial sistémica (HTA), se han posicionado entre las primeras causas de mortalidad en México, lo que plantea retos importantes para las diferentes instituciones de salud. Objetivo: analizar la tendencia espacio-temporal de DM e HTA con base en las detecciones realizadas en unidades de primero y segundo nivel del Instituto Mexicano del Seguro Social (IMSS), durante el periodo 2004-2019. Material y métodos: estudio ecológico en el que se calcularon las tasas de detección de ambos padecimientos por mil derechohabientes según año, trienio y representación. La tendencia espacio-temporal se analizó mediante estadística espacial utilizando Sistemas de Información Geográfica. Resultados: de 2004 a 2019 hubo 9 399 889 y 11 862 069 detecciones en promedio de DM e HTA, respectivamente. Referente al primer padecimiento, la tasa de deteccion osciló de 203.4 (2004) a 384.4 (2019) por mil derechohabientes, cuya tendencia aumentó en Tamaulipas. Mientras que la HTA disminuyó de 1140.2 (2004) a 352 (2019) detecciones por mil derechohabientes en Veracruz Sur y Tamaulipas, respectivamente. Conclusiones: la tendencia espacio-temporal observada puede contribuir a organizar y orientar, según su representación y nivel de atención, los programas institucionales, protocolos de atención, guías de práctica clínica y demás instrumentos de políticia pública disponibles en el IMSS para mejorar la detección oportuna, atención, control y acceso a medicamentos para DM e HTA.

Background: Diabetes Mellitus (DM) and heart diseases, which include Systemic Arterial Hypertension (SAH), have been positioned as the two main causes of mortality in Mexico, which represents important challenges for the different health institutions. Objective: To analyze the spatio-temporal trend of DM and SAH based on the detections made in first and and second level units of the Instituto Mexicano del Seguro Social, during the period 2004-2019. Material and methods: Ecological study in which detection rates of both diseases were calculated per 1,000 persons according to year, triennium and representation. The spatio-temporal trend was analyzed by spatial statistics using Geographic Information Systems. Results: During 2004-2019 therere were 9 399 889 and 11 862 069 detections on average of DM and SAH, respectively. Regarding DM, the detection rate ranged from 203.4 (2004) to 384.4 (2019) per 1000 persons, this trend increased in Tamaulipas. While SAH decreased from 1140.2 (2004) to 352 (2019) per 1000 persons in Veracruz Sur and Tamaulipas, respectively. Conclusions: The observed spatio-temporal trend can contribute to organizing and guiding, according to representation and level of care, institutional programs, integrated care protocols, clinical practice guidelines and other public policy instruments available at the Instituto Mexicano del Seguro Social to improve early detection, care, control and access to medications for DM and SAH.

C allele of the rs2209972 single nucleotide polymorphism of the insulin degrading enzyme gene and Alzheimer's disease in type 2 diabetes, a case control study.

BACKGROUND AND OBJECTIVE: In the last few decades we have witnessed an interesting transformation of the population pyramids throughout the world. As the population's life expectancy increases, there are more chronic diseases such as diabetes mellitus and dementias, and both of them have shown an association. GENERAL OBJETIVE: To determine the association between Alzheimer's disease in diabetic patients and the insulin degrading enzyme in outpatients of a second level Hospital in Monterrey, Mexico. MATERIALS AND METHODS: This was a case control study in which we included outpatients from the Geriatrics Clinic of a Hospital in Northeastern Mexico. Cases were patients with a Mini Mental Score Exam (MMSE) below 24 and DSM-IV criteria for Dementia. Controls were patients who had MMSE scores greater than 24. RESULTS: Data from 97 patients were analyzed. Regarding physical examination and the results of laboratory tests, there were no differences between the two groups (p>0.05). A 98% prevalence of the insulin degrading enzyme was documented in the sample studied. We found an association between a homozygous status for the CC genotype and Dementia with an estimated Odds Ratio (OR) of 2.5 (CI 95% 1.6-3.3) on the bivariate test, while, on the multivariate analysis, the OR was estimated 3.3 (CI 95% 1.3-8.2). CONCLUSIONS: Evidence shows that cognitive impairment is more frequent among those exposed to the C allele of the rs2209972 SNP of the insulin degrading enzyme gene.

[Clinical practice guideline. Diagnosis and treatment of insomnia in the elderly]. / Guía de práctica clínica. Diagnóstico y tratamiento del insomnio en el adulto mayor.

Insomnia is the difficulty to initiate or to maintain sleep. It also has to do with waking up too early at least for a month. A patient with insomnia has daytime consequences such as fatigue, sleepiness, changes in mood, lose of concentration, as well as changes in his social performance and his family relationships, among others. The relationship between this disorder and physical and mental health is important due to the impact that it has on the quality of life and life expectancy of those who suffer from it. Unfortunately, insomnia usually goes unnoticed or untreated, which contributes to the onset or worsening of psychiatric and medical conditions. This exacerbates the problem of insomnia in the elderly people. In relation to the treatment it is recommended: 1) the search and management of secondary causes of insomnia, 2) a non-drug therapy that includes sleep hygiene measures, 3) pharmacotherapy. It is not recommended to start a treatment with a hypnotic drug without rule out medications or diseases that cause or exacerbate insomnia. It is not recommended the use of narcoleptics, melatonin, antihistamines or long half-life benzodiazepines. The consequences include limitations on activities of daily living, loss of functionality, impaired quality of life, increased morbidity and mortality, as well as the worsening of preexisting chronic conditions.

El insomnio es la dificultad para conciliar o mantener el sueño; también consiste en despertar demasiado temprano al menos durante un mes. Un paciente con insomnio presenta consecuencias diurnas como fatiga, somnolencia, deterioro de la memoria, cambios en el estado de ánimo, en la concentración, así como en su desempeño social o familiar, entre otros. La asociación de este padecimiento con la salud física y mental es importante debido al impacto que tiene en la calidad y la esperanza de vida de los que lo padecen. Desafortunadamente, el insomnio suele pasar desapercibido o no tratarse, lo cual contribuye al empeoramiento de condiciones médicas y psiquiátricas. Esto se acentúa más en los adultos mayores, grupo por demás vulnerable. En relación con el tratamiento se recomienda aplicar la siguiente combinación: 1) la búsqueda y el manejo de causas secundarias de insomnio, 2) alguna terapia no farmacológica que incluya medidas de higiene del sueño, 3) tratamiento farmacológico. No es recomendable comenzar el tratamiento con un hipnótico sin haber descartado fármacos o enfermedades que provoquen o exacerben este padecimiento. Tampoco se recomienda el uso de neurolépticos, melatonina, antihistamínicos o benzodiacepinas de vida media larga. Las consecuencias incluyen limitación en las actividades de la vida diaria, pérdida de la funcionalidad, deterioro en la calidad de vida, incremento en la morbimortalidad, además del empeoramiento de las condiciones crónicas prexistentes.