Association of vitamin D receptor gene polymorphisms with type 2 diabetes mellitus in Taif population: a case-control study / Associação de polimorfismos do gene do receptor de vitamina D com diabetes mellitus tipo 2 na população Taif: um estudo de caso-controle

Abstract Several reasons may underlie the dramatic increase in type2 diabetes mellitus. One of these reasons is the genetic basis and variations. Vitamin D receptor polymorphisms are associated with different diseases such as rheumatoid arthritis and diabetes. The aim of this study is to investigate the possible association of two identified mutations ApaI (rs7975232) and TaqI (rs731236). Eighty-nine healthy individuals and Fifty-six Type 2 Diabetic (T2D) patients were investigated using RFLP technique for genotyping and haplotyping as well. The distribution of Apal genotypes was not statistically significant among the control (P=0.65) as well as for diabetic patients (P=0.58). For Taql allele frequencies of T allele was 0.61 where of G allele was 0.39. The frequency distribution of Taql genotypes was not statistically significant among the control (P=0.26) as well as diabetic patients (P=0.17). Relative risk of the allele T of Apa1 gene is 1.28 and the odds ratio of the same allele is 1.53, while both estimates were < 1.0 of the allele G. Similarly, with the Taq1 gene the relative risk and the odds ratio values for the allele T are 1.09 and 1.27 respectively and both estimates of the allele C were 0.86 for the relative risk and 0.79 for the odds ratio. The pairwise linkage disequilibrium between the two SNPs Taq1/apa1 was statistically significant in control group (D = 0.218, D' = 0.925 and P value < 0.001) and similar data in diabetic groups (D = 0.2, D' = 0.875 and P value < 0.001). These data suggest that the T allele of both genes Apa1 and Taq1 is associated with the increased risk of type 2 diabetes. We think that we need a larger number of volunteers to reach a more accurate conclusion.

Resumo Várias razões podem estar subjacentes ao aumento dramático da diabetes mellitus tipo 2. Um desses motivos é a base genética e variações. Os polimorfismos do receptor da vitamina D estão associados a diferentes doenças, como artrite reumatoide e diabetes. O objetivo deste estudo é investigar a possível associação de duas mutações identificadas ApaI (rs7975232) e TaqI (rs731236). Oitenta e nove indivíduos saudáveis ​​e 56 pacientes com diabetes tipo 2 (T2D) foram investigados usando a técnica RFLP para genotipagem e haplotipagem também. A distribuição dos genótipos Apal não foi estatisticamente significativa entre o controle (P = 0,65), bem como para os pacientes diabéticos (P = 0,58). Para as frequências do alelo Taql, o alelo T foi de 0,61, onde o alelo G foi de 0,39. A distribuição de frequência dos genótipos Taql não foi estatisticamente significativa entre o controle (P = 0,26), bem como os pacientes diabéticos (P = 0,17). O risco relativo do alelo T do gene Apa1 é 1,28 e a razão de chances do mesmo alelo é 1,53, enquanto ambas as estimativas foram < 1,0 do alelo G. Da mesma forma, com o gene Taq1, os valores de risco relativo e razão de chances para o alelo T são 1,09 e 1,27, respectivamente, e ambas as estimativas do alelo C foram de 0,86 para o risco relativo e 0,79 para o odds ratio. O desequilíbrio de ligação par a par entre os dois SNPs Taq1 / apa1 foi estatisticamente significativo no grupo de controle (D = 0,218, D' = 0,925 e valor P < 0,001) e dados semelhantes em grupos diabéticos (D = 0,2, D' = 0,875 e valor P < 0,001). Esses dados sugerem que o alelo T de ambos os genes Apa1 e Taq1 está associado ao aumento do risco de diabetes tipo 2. Achamos que precisamos de um número maior de voluntários para chegar a uma conclusão mais precisa.

Relación entre la diabetes mellitus y el cáncer / Relationship between Diabetes Mellitus and Cancer

Introducción: La diabetes mellitus y el cáncer son dos problemas de salud que afectan a la población mundial. Considerar previamente el riesgo de desarrollo de cáncer en pacientes con diabetes mellitus puede contribuir de manera significativa a su prevención en este grupo de riesgo. Objetivo: Describir la relación existente entre la diabetes mellitus y el cáncer. Métodos: Se realizó una revisión bibliográfica, entre septiembre de 2019 y marzo de 2020. Se consultaron artículos científicos en Pubmed; la estrategia de búsqueda fue: diabetes mellitus [Mesh] OR diabetes mellitus[TIAB] OR diabetes mellitus, type 2[Mesh] OR type 2 diabetes mellitus[TIAB] OR obesity[Mesh] OR obesity[TIAB] OR hyperglycemia[Mesh] OR hyperglycemia[TIAB]) AND (cancer[Mesh] OR cancer[TIAB] OR neoplasia[Mesh] OR neoplasia[TIAB] OR neoplasias[Mesh] OR neoplasias[TIAB] OR neoplasm[Mesh] OR neoplasm[TIAB] OR tumors[Mesh] OR tumors[TIAB] OR tumor[Mesh] OR tumor[TIAB] OR cancers[Mesh] OR cancers[TIAB]). Se consultaron además artículos de SCOPUS, Scielo, LILACS, Biblioteca Virtual de Salud de Cuba y Google Scholar. Se seleccionaron artículos publicados a partir de 2005, con 63 por ciento de los últimos cinco años (2016‒2020). Se trabajó con 51 publicaciones. Conclusiones: Existe consenso sobre la relación entre la diabetes y el cáncer. La diabetes mellitus es un factor de riesgo para el desarrollo de cáncer, fundamentalmente en las localizaciones de páncreas, riñón, colon y recto y cuerpo uterino, ovarios y mama en la mujer; y factor protector para el cáncer de próstata en hombres. Ambas enfermedades comparten factores de riesgo no modificables (edad y sexo), modificables (dieta, actividad física, alcoholismo, entre otros) y condiciones biológicas (hiperglucemia e hiperinsulinemia)(AU)

Introduction: Diabetes mellitus and cancer are two health problems affecting the world population. Prior consideration of the risk for cancer development in patients with diabetes mellitus can contribute significantly to its prevention in this risk group. Objective: To describe the relationship between diabetes mellitus and cancer. Methods: A literature review was carried out between September 2019 and March 2020. Scientific articles were consulted in Pubmed; the search strategy was defined as it follows: diabetes mellitus[Mesh] OR diabetes mellitus[TIAB] OR diabetes mellitus, type 2[Mesh] OR type 2 diabetes mellitus[TIAB] OR obesity[Mesh] OR obesity[TIAB] OR hyperglycemia[Mesh] OR hyperglycemia[TIAB]) AND (cancer[Mesh] OR cancer[TIAB] OR neoplasia[Mesh] OR neoplasia[TIAB] OR neoplasias[Mesh] OR neoplasias[TIAB] OR neoplasm[Mesh] OR neoplasm[TIAB] OR tumors[Mesh] OR tumors[TIAB] OR tumor[Mesh] OR tumor[TIAB] OR cancers[Mesh] OR cancers[TIAB]). Articles from SCOPUS, Scielo, LILACS, the Virtual Health Library of Cuba, and Google Scholar were also reviewed. Articles published from 2005 onwards were selected, with 63 percent from the last five years (2016-2020). Fifty-one publications were analyzed. Conclusions: There is consensus regarding the relationship between diabetes and cancer. Diabetes mellitus is a risk factor for the development of cancer, fundamentally in the locations of pancreas, kidney, colon and rectum, as well as the uterine body, ovaries and breast in women; while being a protective factor for prostate cancer in men. Both diseases share nonmodifiable risk factors (age and sex), modifiable risk factors (diet, physical activity, alcoholism, among others) and biological conditions (hyperglycemia and hyperinsulinemia)(AU)

Hábito Alimentar de Idosos Diabéticos e não Diabéticos: Vigitel, Brasil, 2016 / Eating Behavior of Older Adults with and Without Diabetes: The Vigitel Survey, Brazil, 2016

Resumo Fundamentos A alimentação saudável é um fator de proteção contra o diabetes tipo 2 e desempenha importante papel no tratamento do diabetes e das comorbidades associadas. Objetivo Caracterizar o hábito alimentar de idosos diabéticos e não diabéticos com 65 anos ou mais, residentes nas capitais brasileiras e no Distrito Federal. Métodos Estudo transversal com dados da pesquisa Vigilância de Fatores de Risco e Proteção para as Doenças Crônicas por Inquérito Telefônico (Vigitel, 2016). Foram estimadas as prevalências de diabetes melito segundo variáveis sociodemográficas, inatividade física, autoavaliação da saúde e índice de massa corporal (IMC). O hábito alimentar foi avaliado pela frequência (semanal e diária) de consumo de alimentos saudáveis e não saudáveis, e pela substituição da comida por lanches. As diferenças foram verificadas por meio do teste Qui-quadrado de Pearson (Rao-Scott) com nível de significância de 5%. Resultados Foram entrevistados 13.649 idosos, e a prevalência de diabetes autorreferido foi de 27,2% (IC95%:25,5; 29,0). Nos pacientes diabéticos, observou-se maior consumo de hortaliças cruas (32,1% vs. 26,5%/3-4 dias/semana) e menor de frango (3,8% vs. 6,4%/quase nunca/nunca), suco (24,0% vs. 29,6%) e doces (6,8% vs. 16,2%) ≥5 dias/semana. Os percentuais de idosos com consumo de leite desnatado (51,5% vs. 44,6%) e refrigerante dietético (60,0% vs. 17,3%) ≥5 dias/semana, hortaliças cruas (9,1% vs. 2,5%/no jantar) e doces (37,7% vs. 20,5%/2 vezes/dia) 3-4 dias/semana foram maiores nos diabéticos, comparados aos não diabéticos. Conclusão As diferenças observadas sinalizam a necessidade de promover intervenções para alimentação saudável entre todos os idosos, bem como orientações específicas para os diabéticos.

Abstract Background A healthy diet is a protection factor against type 2 diabetes and plays an important role in the treatment of the disease, as well as associated comorbidities. Objective Characterize the eating habits of older adults (≥ 65 years) with and without diabetes residing in capital cities and the Federal District of Brazil. Methods A cross-sectional study was conducted using data from the Surveillance of Risk and Protection Factors for Chronic Diseases Through a Telephone Survey (Vigitel, 2016). The prevalence of diabetes mellitus was estimated according to sociodemographic variables, physical inactivity level, self-rated health status and body mass index. Dietary habits were assessed based on the frequency (weekly and daily) of consumption of healthy and unhealthy foods and the replacement of food by snacks. Differences were determined using Pearson's chi-square test (Rao-Scott), with the significance level set at 5%. Results A total of 13,649 older adults were interviewed. The prevalence of self-reported diabetes was 27.2% (95% CI: 25.5; 29.0). Compared to non-diabetics, diabetic individuals had a higher consumption of raw vegetables (32.1% vs. 26.5%/3-4 days/week) and lower consumption of chicken (3.8% vs. 6.4%/hardly ever/never), fruit juice (24.0% vs. 29.6%) and sweets (6.8% vs. 16.2%) ≥ 5 days/week. Compared to non-diabetics, diabetic individuals consumed more skim milk (51.5% vs. 44.6%) and diet soda (60.0% vs. 17.3%) ≥ 5 days/week, raw vegetables (9.1% vs. 2.5%/at dinner) and sweets (37.7% vs. 20.5%/twice/day) 3-4 days/week. Conclusion The observed differences emphasize the need for healthy eating interventions for all older adults, as well as specific counseling for those with diabetes.

Alfabetización en e-Salud en pacientes con diabetes mellitus tipo 2 al sur del Perú / E-Health Literacy In Patients with Diabetes Mellitus Type 2 in Southern Peru

La diabetes mellitus tipo 2 es un problema de salud pública a nivel mundial debido a la alta morbimortalidad asociada a sus complicaciones cardiovasculares, renales y neurológicas. Los estudios muestran que la prevalencia de diabetes en el Perú ha aumentado y se registra una incidencia de dos casos por cada cien personas al año. (1) El uso de tecnologías de información y comunicación (TIC) como aplicaciones móviles, web, redes sociales, y contenidos multimedia para el manejo de la diabetes es cada vez más frecuente aunque la efectividad de estas es aún controversial. (2) En Perú, se encontró un uso poco frecuente (menos del 20 por ciento) de las TIC en pacientes diabéticos. (3, 4) Este uso poco frecuente probablemente se deba a al limitado acceso a estas tecnologías por los costos que implica aunque cada vez los precios son más bajos, otra posible explicación es la insuficiente o nula alfabetización digital. Ningún estudio ha evaluado el nivel de alfabetización en e-Salud o alfabetización digital en salud de pacientes dentro del contexto peruano. El objetivo fue evaluar de forma exploratoria la alfabetización en e-Salud en un grupo de pacientes diabéticos(AU)

Type 2 diabetes mellitus is a public health problem worldwide due to the high morbidity and mortality associated with its cardiovascular, renal and neurological complications. Studies show that the prevalence of diabetes in Peru has increased and there is an incidence of two cases per hundred people per year. The use of information and communication technologies (ICT) such as mobile applications, web, social networks, and multimedia content for diabetes management is increasingly frequent, although their effectiveness is still controversial. In Peru, infrequent use (less than 20 percent) of ICT was found in diabetic patients. This infrequent use is probably due to the limited access to these technologies due to the costs involved, although prices are increasingly lower, another possible explanation is insufficient or no digital literacy. No study has evaluated the level of e-Health literacy or digital health literacy of patients within the Peruvian context. The objective was to evaluate in exploratory way e-Health literacy in a group of diabetic patients(AU)

Incidence and risk factors of ischemic stroke in patients with type 2 diabetes among urban workers in Beijing, China / 北京大学学报(医学版)

OBJECTIVE@#To explore the incidence of ischemic stroke after the onset of type 2 diabetes, and further analyze the risk factors, so as to provide a basis for further research.@*METHODS@#The data were obtained from the database of the Beijing Urban Employee Basic Medical Insurance Database. The study used a prospective design to describe the incidence of ischemic stroke in patients with type 2 diabetes. In our study, these patients were followed up for seven years. Multivariate Logistic regression models were used to analyze the risk factors of ischemic stroke in patients with type 2 diabetes.@*RESULTS@#A total of 185 813 newly diagnosed type 2 diabetes patients were enrolled, with an average age of (58.5±13.2) years, and 49.0% of them were males. A total of 10 393 patients with newly diagnosed ischemic stroke occurred in 7 years, with a cumulative incidence of 5.6% and an incidence density of 8.1/1 000 person-years. Ischemic stroke occurred in all age groups in patients with type 2 diabetes. The cumulative incidence was 1.5% (95%CI: 1.3%-1.6%) in group ≤44 years old, 3.6% (95%CI: 3.4%-3.7%) in group 45-54 years old, 5.4% (95%CI: 5.2%-5.5%) in group 55-64 years old, and 9.2% (95%CI: 9.0%-9.4%) in group ≥65 years old, and the cumulative incidence increased with age (P < 0.05). Cumulative incidence rate of the males (6.8%, 95%CI: 6.7%-7.0%) was higher than the females (4.4%, 95%CI: 4.3%-4.6%). Among the patients < 80 years old, the cumulative incidence rate of the males was higher than that of the females in all the age groups. In the patients ≥80 years of age, the cumulative incidence was higher in the females (9.2%) than in the males (7.9%). Further analysis revealed that complications, such as coronary heart disease (OR=3.18, 95%CI: 2.72-3.72), heart failure (OR=1.53, 95%CI: 1.32-1.79) and kidney failure (OR=1.45, 95%CI: 1.20-1.75) were associated with ischemic stroke in the patients with type 2 diabetes.@*CONCLUSION@#The incidence level of ischemic stroke in patients with type 2 diabetes is high. It is necessary to strengthen the management of risk factors in elderly patients, screen the complications of type 2 diabetes as early as possible, and take active preventive and control measures.

Risk of gestational diabetes recurrence and the development of type 2 diabetes among women with a history of gestational diabetes and risk factors: a study among 18 clinical centers in China / 中华医学杂志(英文版)

BACKGROUND@#Gestational diabetes mellitus (GDM) brings health issues for both mothers and offspring, and GDM prevention is as important as GDM management. It was shown that a history of GDM was significantly associated with a higher maternal risk for GDM recurrence. The incidence of GDM recurrence was unclear because of the incidence of second-child was low before 2016 in China. We aim to investigate the prevalence of GDM recurrence and its associated high-risk factors which may be useful for the prediction of GDM recurrence in China.@*METHODS@#A retrospective study was conducted which enrolled participants who underwent regular prenatal examination and delivered twice in the same hospital of 18 research centers. All participants were enrolled from January 2018 to October 2018, where they delivered the second baby during this period. A total of 6204 women were enrolled in this study, and 1002 women with a history of GDM were analyzed further. All participants enrolled in the study had an oral glucose tolerance test (OGTT) result at 24 to 28 weeks and were diagnosed as GDM in the first pregnancy according to the OGTT value (when any one of the following values is met or exceeded to the 75-g OGTT: 0 h [fasting], ≥5.10 mmol/L; 1 h, ≥10.00 mmol/L; and 2 h, ≥8.50 mmol/L). The prevalence of GDM recurrence and development of type 2 diabetes mellitus were calculated, and its related risk factors were analyzed.@*RESULTS@#In 6204 participants, there are 1002 women (1002/6204,16.15%) with a history of GDM and 5202 women (5202/6204, 83.85%) without a history of GDM. There are significant differences in age (32.43 ± 4.03 years vs. 33.00 ± 3.34 years vs. 32.19 ± 3.37 years, P  < 0.001), pregnancy interval (4.06 ± 1.44 years vs. 3.52 ± 1.43 years vs. 3.38 ± 1.35 years, P  = 0.004), prepregnancy body mass index (BMI) (27.40 ± 4.62 kg/m2vs. 23.50 ± 3.52 kg/m2vs. 22.55 ± 3.47 kg/m2, P < 0.001), history of delivered macrosomia (22.7% vs. 11.0% vs. 6.2%, P < 0.001) among the development of diabetes mellitus (DM), recurrence of GDM, and normal women. Moreover, it seems so important in the degree of abnormal glucose metabolism in the first pregnancy to the recurrence of GDM and the development of DM. There are significant differences in OGTT levels of the first pregnancy such as area under the curve of OGTT value (18.31 ± 1.90 mmol/L vs. 16.27 ± 1.93 mmol/L vs. 15.55 ± 1.92 mmol/L, P < 0.001), OGTT fasting value (5.43 ± 0.48 mmol/L vs. 5.16 ± 0.49 mmol/L vs. 5.02 ± 0.47 mmol/L, P < 0.001), OGTT 1-hour value (10.93 ± 1.34 mmol/L vs. 9.69 ± 1.53 mmol/L vs. 9.15 ± 1.58 mmol/L, P < 0.001), OGTT 2-hour value (9.30 ± 1.66 mmol/L vs. 8.01 ± 1.32 mmol/L vs. 7.79 ± 1.38 mmol/L, P < 0.001), incidence of impaired fasting glucose (IFG) (fasting plasma glucose ≥5.6 mmol/L) (31.3% vs. 14.6% vs. 8.8%, P < 0.001), and incidence of two or more abnormal OGTT values (68.8% vs. 39.7% vs. 23.9%, P < 0.001) among the three groups. Using multivariate analysis, the factors, such as age (1.07 [1.02-1.12], P = 0.006), prepregnancy BMI (1.07 [1.02, 1.12], P  = 0.003), and area under the curve of OGTT in the first pregnancy (1.14 [1.02, 1.26], P  = 0.02), have an effect on maternal GDM recurrence; the factors, such as age (1.28 [1.01-1.61], P  = 0.04), pre-pregnancy BMI (1.26 [1.04, 1.53], P = 0.02), and area under the curve of OGTT in the first pregnancy (1.65 [1.04, 2.62], P = 0.03), have an effect on maternal DM developed further.@*CONCLUSIONS@#The history of GDM was significantly associated with a higher maternal risk for GDM recurrence during follow-up after the first pregnancy. The associated risk factors for GDM recurrence or development of DM include age, high pre-pregnancy BMI, history of delivered macrosomia, the OGTT level in the first pregnancy, such as the high area under the curve of OGTT, IFG, and two or more abnormal OGTT values. To prevent GDM recurrence, women with a history of GDM should do the preconception counseling before preparing next pregnancy.

Osteosarcopenia and trabecular bone score in patients with type 2 diabetes mellitus

ABSTRACT Objective: To evaluate the prevalence of osteosarcopenia and the association of osteosarcopenia with trabecular bone score (TBS) in a group of patients with type 2 diabetes mellitus(T2DMG) compared with a paired control group (CG). Materials and methods: Cross-sectional study with men and women ≥ 50 years recruited by convenience. Patients in both groups answered questionnaires and underwent evaluation of bone mineral density (BMD), handgrip strength (HGS), and TBS. The T2DMG also underwent a gait speed (GS) test. Sarcopenia was defined as low lean mass plus low HGS or GS according to the Foundation for the National Institute of Health Sarcopenia Project, and osteosarcopenia was deemed present when sarcopenia was associated with osteopenia, osteoporosis, or low-energy trauma fractures. Results: The T2DMG (n = 177) and CG (n = 146) had, respectively, mean ages of 65.1 ± 8.2 years and 68.8 ± 11.0 years and 114 (64.4%) and 80 (54.7%) women. T2DMG versus the CG had higher rates of osteosarcopenia (11.9% versus 2.14%, respectively, p = 0.010), sarcopenia (12.9% versus 5.4%, respectively, p < 0.030), and fractures (29.9% versus 18.5%, respectively, p = 0.019), and lower HGS values (24.4 ± 10.3 kg versus 30.9 ± 9.15 kg, respectively, p < 0.001), but comparable BMD values. Mean TBS values were 1.272 ± 0.11 and 1.320 ± 0.12, respectively (p = 0.001). On multivariate analysis, age, greater waist circumference, fractures, and osteoporosis increased the risk of degraded TBS. Osteosarcopenia was associated with diabetes complications (p = 0.03), calcium and vitamin D supplementation (p = 0.01), and all components of osteosarcopenia diagnosis (p < 0.05). Conclusion: Compared with the CG, the T2DMG had a higher prevalence of osteosarcopenia, sarcopenia, and fractures and lower bone quality assessed by TBS.

Riesgo de padecer diabetes mellitus tipo 2 en una población adulta del Caribe colombiano / Risk of Suffering from Type 2 Diabetes Mellitus in an Adult Population of the Colombian Caribbean

Introducción: La diabetes mellitus es una enfermedad crónica con alta prevalencia, que afecta la calidad de vida de la población que la padece, por cuanto identificar el riesgo de desarrollarla permite implementar estrategias para retrasar su aparición y prevenir complicaciones. Objetivo: Identificar el nivel de riesgo de desarrollar diabetes mellitus tipo 2 en una población del Caribe colombiano. Métodos: Estudio cuantitativo, de corte transversal. Participaron 248 individuos del área urbana de un corregimiento de Santa Marta, Colombia, en el primer semestre de 2018, mediante un muestreo estratificado por sectores. Se utilizó el test Finnish Diabetes Risk Score para la recolección de información, así como la medición del perímetro abdominal, el peso, la talla y la tensión arterial. Para el análisis de las variables numéricas se aplicó T de Student para variables independientes y para las variables categóricas se aplicó chi cuadrado. Resultados: Del total de participantes, 36,29 por ciento presentó un riesgo ligeramente elevado y 8,87 por ciento riesgo moderado alto. El grupo poblacional con mayor riesgo fue el de 58 a 65 años (34,78 por ciento). Se encontró significancia estadística entre el riesgo de presentar diabetes en los próximos 10 años y las variables sobrepeso y obesidad, circunferencia abdominal aumentada, antecedentes personales de hiperglucemia, consumo de medicamentos antihipertensivos y antecedentes personales de diabetes mellitus tipo 2 en padres, hermanos e hijos. Conclusiones: El riesgo de desarrollar diabetes mellitus tipo 2 en la población estudiada fue ligeramente elevado en un alto porcentaje de la población(AU)

Introduction: Diabetes mellitus is a chronic disease with high prevalence, which affects the quality of life of the population that suffers from it, since identifying the risk of developing it allows the implementation of strategies to delay its onset and prevent complications. Objective: To identify the level of risk of developing type 2 diabetes mellitus in a Colombian Caribbean population. Methods: This is a quantitative, cross-sectional study. two hundred forty eight individuals from the urban area of a village in Santa Marta, Colombia, participated in the first semester of 2018, through a sampling stratified by sectors. The Finnish Diabetes Risk Score test was used to collect information, as well as to measure abdominal circumference, weight, height, and blood pressure. For the analysis of the numerical variables, Student's t-test was applied for independent variables and chi-square was applied for the categorical variables. Results: Of the total of participants, 36.29 percent had slightly high risk and 8.87 percent moderate high risk. The population group with the highest risk was 58 to 65 years (34.78 percent). Statistical significance was found between the risk of developing diabetes in the subsequent 10 years and the variables overweight and obesity, increased abdominal circumference, personal history of hyperglycemia, consumption of antihypertensive drugs, and personal history of type 2 diabetes mellitus in parents, siblings, and children. Conclusions: The risk of developing type 2 diabetes mellitus in the studied population was slightly elevated in a high percentage of the population(AU)

Validación de instrumentos para diabetes mellitus tipo 2 en adultos mayores / Instrument validation for older adults with type 2 diabetes mellitus

Una de las principales dificultades en la atención al adulto mayor diabético continúa siendo la falta de educación hacia un estilo de vida y una actitud favorable hacia la enfermedad, lo cual solo puede lograrse mediante estrategias educativas. Objetivo: Validar los instrumentos AM1 ­ MO de la investigación factores modificables y su influencia en la presencia de complicaciones en adultos mayores con Diabetes Mellitus tipo 2 en el club de adultos mayores Lupita Nolivos en la Carrera de Enfermería de la Universidad de Guayaquil, en los periodos de septiembre a diciembre 2019. Materiales y Métodos: El Instrumento AM1 ­MO se realizó un estudio descriptivo, exploratorio y transversal, este instrumento cuantitativo se aplicó al universo de 50 adultos mayores entre 55 y 65 años y más, utilizando el SOFTWARE IBM SPSS Statistics Base 22.0. Resultados: Del total de pacientes con DMT2, el sexo femenino estuvo representado con 60,0 % y el masculino aportó 40,0 %. El grupo de edad de 70-79 fue el de mayor predominio de dicha afección con 62,0 %, de ellos 18 eran mujeres y 13 hombres. En cuanto a los hábitos alimentarios resulto se obtuvo los siguientes resultados que hay un alto consumo de gaseosas y dulces 24%. Conclusiones: En este trabajo se identificó que las personas que tienen mayor riesgo de desarrollar DMT2 son aquellas que tienen una edad superior a 55 años, presentan antecedentes familiares para esta enfermedad, son del sexo femenino, presentan exceso de peso, son físicamente inactivas y padecen HTA. En conclusión, el instrumento construido constituye una aproximación para determinar los factores modificables y su influencia en la presencia de complicaciones en adultos mayores con diabetes mellitus tipo 2. Los resultados obtenidos por las diferentes vías para evaluar los instrumentos utilizados fueron adecuados. Está disponible un instrumento válido y confiable que justifica su uso y aplicación en el ámbito investigativo(AU)

One of the main difficulties in caring for the elderly with diabetes continues to be the lack of education towards a lifestyle and a favorable attitude towards the disease, which can only be achieved through educational strategies. Objective: to validate the AM1 ­ MO instrument of the research, modifiable factors and their influence on the presence of complications in older adults with Type 2 Diabetes Mellitus in the Lupita Nolivos club for older adults in the Nursing Career of the University of Guayaquil, in the periods from September to December 2019. Materials and Methods: The AM1-MO Instrument was carried out a descriptive, exploratory and cross-sectional study, this quantitative instrument was applied to the universe of 50 older adults between 55 and 65 years old and over, using the IBM SPSS SOFTWARE Statistics Base 22.0. Results: Of the total number of patients with T2DM, the female sex was represented with 60.0% and the male contributed 40.0%. The age group 70-79 was the one with the highest prevalence of this condition with 62.0%, of which 18 were women and 13 were men. Regarding eating habits, the following results were obtained that there is a high consumption of soda and sweets 24%. Conclusions: In this work it was identified that the people who have a higher risk of developing T2DM are those who are older than 55 years, have a family history for this disease, are female, are overweight, are physically inactive and suffer from HTA. In conclusion, the instrument constructed constitutes an approximation to determine the modifiable factors and their influence on the presence of complications in older adults with type 2 diabetes mellitus. The results obtained by the different ways to evaluate the instruments used were adequate. A valid and reliable instrument is available that justifies its use and application in the research field(AU)

Riesgo cardiovascular en la mujer diabética / Cardiovascular risk in the diabetic woman

Resumen Introducción: La enfermedad cardiovascular en mujeres ha sido un apartado con diversas investigaciones que han intentado llegar a los factores de riesgo más determinantes o las vías moleculares más específicas para explicar el riesgo aumentado que poseen las mujeres respecto a los hombres. Objetivo: Dar una visión global de esta situación al lector, involucrando especialmente aquella población de mujeres que padece diabetes mellitus tipo 2, cuya condición es un factor de riesgo independiente para el desarrollo de enfermedad cardiovascular, de gran costo y morbimortalidad mundiales. Métodos: Se realizó una búsqueda en PubMed y Google Scholar con términos MeSH y términos comunes y se obtuvieron algunas referencias cruzadas a criterio de los autores. Conclusiones: Es necesario implementar en la práctica médica diaria un contexto específico de prevención de riesgo cardiovascular mediante programas de educación continuada o por medio de las entidades prestadoras de servicios de salud para evitar la progresión de enfermedad cardiovascular en las mujeres diabéticas antes de llegar a desenlaces mayores y potencialmente fatales.

Abstract Introduction: Cardiovascular disease in woman has been an issue with plenty of investigations towards the finding of the most determinant risk factors o the specific molecular paths to explain the increased risk in women compared to men. Objective: To give to the reader a global vision of this situation, involving specially the type 2 diabetes mellitus woman population, whose condition is an independent risk factor to the development of the cardiovascular disease with great cost and morbidity and mortality worldwide. Methods: A PUBMED and Google Scholar search was performed with MeSH and common terms and were obtained some cross-references at the discretion of the authors. Conclusions: It is necessary to implement a specific context of cardiovascular risk prevention in daily medical practice through continuing education programs or through health service providers to prevent the progression of cardiovascular disease in diabetic women before reaching major outcomes and potentially fatal.

Uso e acesso aos medicamentos para o diabetes mellitus tipo 2 em idosos: um estudo de base populacional / Use and access to medications for type 2 diabetes mellitus in elderly: a population-based household survey

Resumo O objetivo deste estudo foi analisar o uso e o acesso aos medicamentos para o diabetes mellitus tipo 2 em idosos atendidos na Estratégia Saúde da Família de Ribeirão Preto, São Paulo. Trata-se de um inquérito domiciliar de base populacional realizado com 338 idosos, em amostragem por conglomerados. Investigou-se a farmacoterapia do diabetes e o acesso por meio de um questionário estruturado em entrevistas face a face. O número de medicamentos usados no tratamento do diabetes variou de um a quatro. Observou-se o predomínio de antidiabéticos orais, sendo o uso de apenas metformina autorreferido por 37,9% dos idosos, e 9,8% usavam sulfonilureia isoladamente. No grupo de idosos com idade igual ou superior a 80 anos, percebeu-se maior frequência (38,9%) no uso de insulina do que nos outros grupos etários. O acesso total foi estimado em 96,4%, a forma de financiamento gratuita correspondeu a 78,1% e as farmácias do Sistema Único de Saúde foram os principais locais de provisão dos medicamentos (74,8%). A metformina foi o antidiabético oral mais usado pelos idosos, em conformidade com as atuais recomendações para o tratamento da doença. Contudo, verificou-se usos inapropriados, especificamente na utilização isolada de sulfonilureia. Além disso, evidenciou-se a importância do sistema público de saúde para o fornecimento dos medicamentos.

Abstract The objective of this study was to analyze the use and access to medications for type 2 diabetes among older people registered in the family health strategy in Ribeirão Preto, São Paulo. A population-based household survey was undertaken with 338 older adults selected using two-stage cluster sampling. Pharmacotherapy of diabetes and access to medications was investigated using a structured questionnaire administered by means of face-to-face interviews. The number of medicines used to treat diabetes ranged between 1 and 4. Respondents predominantly used only oral antidiabetic agents. The use of metformin and sulfonylureas on their own was reported by 37.9% and 9.8% of respondents, respectively. Frequency of insulin use was greatest in the 80 years and overage group (38.9%). The large majority of respondents (96.4%) had full access to medicines. Means of payment was "free of charge" in 78.1% of the respondents and public pharmacies were the main source of medication (74.8%). The most commonly used oral antidiabetic was metformin, which is consistent with current treatment guidelines. However, the findings show inappropriate medication use among older people, more specifically the use of sulfonylureas on their own. The findings of this study highlight the important role played by the public health service in providing medications for type 2 diabetes.

Análisis de factores de riesgo cardiometabólicos y nutricionales en pacientes diabéticos tipo 2 e hipertensos esenciales usuarios de atención privada y pública / Analysis of cardiometabolic and nutritional risk factors in patients with diabetes type 2 and essential hypertension users of private and public care

La enfermedad cardiovascular es una de las principales causas de morbimortalidad en Chile, según resultados entregados por la Encuesta Nacional de Salud 2017 un 3,3% de la población ha presentado un infarto agudo al miocardio, un 2,6% reporta haber sufrido un ataque cerebrovascular, el 74% de los chilenos presenta obesidad y un 87% sedentarismo, siendo la diabetes mellitus tipo 2 (DM2) con un 12% y la hipertensión arterial con un 28% resultados que preocupan por su importante incremento. La investigación tuvo un diseño observacional de corte transversal. Se realizó en 69 pacientes con DM2 e hipertensos esenciales, entre 40 y 80 años de edad, pertenecientes al Sistema salud municipal (SMS) y privado (SPS) en la ciudad de Iquique. Se realizó encuesta alimentaria, medición antropométrica y exámenes bioquímicos y presión arterial. Al analizar ambos grupos se destaca los siguientes resultados: actividad física 17,24% SPS y 42,5% en SSM, presión arterial controlada 55,2% SPS y 87,5% en SSM, control de hemoglobina glicosilada 26,9% SPS y 52,5% en SSM, colesterol total alterado 17,9% SPS y 45% en SSM, síntomas depresivos 96,5% SPS y 26,3% en SSM. Se evidenció una prevalencia de mal nutrición por exceso de un 89,7% SPS y 95% SSM, riesgo cardiovascular (RCV) según circunferencia de cintura (CC) 96,5% SPS y 92,3% SSM. En relación a la encuesta alimentaria se observó que un 44,8% en usuarios SPS y 52,5% de SSM presentaron consumo alimentario hipercalórico. Los usuarios de atención privada y pública presentaron factores de riesgo cardiovascular, donde destacan la obesidad, sedentarismo y RCV según CC. Al comparar ambos grupos los usuarios SPS presentan menor control metabólico de su enfermedad y factores de riesgo cardiovascular aumentados en relación a los usuarios SSM.

Cardiovascular disease is one of the main causes of morbidity and mortality in Chile, according to the results provided by the 2017 National Health Survey, 3.3% of the population has presented acute myocardial infarction, 2.6% reported have suffered a cerebrovascular accident, 74% of Chileans are obese and 87% have sedentary behavior, belonging to type 2 diabetes mellitus (DM2) into 12% and arterial hypertension into 28%, alarming results due to their significant increase. The research had a cross-sectional observational study design. 69 patients with DM2 and essential hypertensive patients, between 40 and 80 years of age were studied, belonging to the municipal (SSM) and private (SPS) health systems in the city of Iquique. A food intake survey, anthropometric measurements, and biochemical and blood pressure tests were taken. When analyzing both groups, the following results stand out: physical activity 17.24% in SPS and 42.5% in SSM, controlled blood pressure 55.2% in SPS and 87.5% in SSM, controlled glycosylated hemoglobin 26.9% in SPS and 52.5% in SSM, altered values of total cholesterol 17.9% in SPS and 45% in SSM, depression symptoms 96.5% in SPS and 26.3% in SSM. Prevalence of malnutrition due to excess 89.7% in SPS and 95% in SSM, cardiovascular risk (RCV) according to waist circumference (CC) 96.5% in SPS and 92.3% in SSM were evidenced. In relation to the food intake survey, it was observed that 44.8% of SPS users and 52.5% of SSM users consume hypercaloric diet. The users of private and public care presented cardiovascular risk factors, where the obesity, sedentary lifestyle and RCV related to CC stand out. When comparing both groups, SPS users have less control of their disease in relation to SSM users.

Retinopatía Diabética en Chile: un reporte cuantitativo de la proporción de diabéticos con fondo de ojo anual / Coverage rates of eye fundus examinations among Chilean patients with diabetes mellitus

Background: Timely eye fundus examinations are essential to prevent the consequences of retinopathy among patients with type 2 diabetes mellitus. Aim: To assess the coverage rate (CR) of eye fundus examination in the Chilean diabetic population, between 2011 and 2019. Material and Methods: Analysis of monthly statistical summaries of the Cardiovascular Health Program published online by the Chilean Ministry of Health. The number of patients aged 15 years or more with a diagnosis of Type 2 diabetes mellitus and the number of those who had an eye fundus examination within the same year, were obtained. Data was analyzed at a national and regional level. Results: The national eye fundus examination CR was 19.1% in 2011. In 2016, the figures became significantly higher, reaching 32.5%. In 2019, the highest value of 36.5% was recoded although not significantly different from 2016. The highest average annual CR was observed in Ñuble Health Service (49.5%), and the lowest in Central Metropolitan Service (15%). The highest CR positive absolute and relative variation between 2011 and 2019 was observed in Viña del Mar Quillota Health Service (38.9 and 489% respectively), and the lowest negative variation was observed in Araucania Norte Health Service (-8.42 and -24.21% respectively). Conclusions: There is a low eye fundus examination CR in Chile, with important differences between regional health services.

Relationship between ethanol intake and insulin sensitivity metabolism in men with no comorbidities: a systematic review / Relación entre la ingesta de etanol y el metabolismo de la sensibilidad a la insulina en hombres sin comorbilidades: una revisión sistemática

SUMMARY: The association of alcohol consumption with type 2 diabetes has been explained by increased insulin sensitivity, anti-inflammatory effects, or effects of adiponectin. The aim was to launch a consistent relation between alcohol intake and insulin sensitivity. Several databases (MEDLINE, EMBASE, Scopus and Web of Science) were searched from 1990 to April 2020 for studies in English, using MeSH terms and text words involving to alcohol consumption and insulin sensitivity. Protocol registered on PROSPERO CRD42020205107. A total of seven original articles were analyzed, where four collected data through cross-sectional study, two papers with randomized crossover design, and one used a non-randomized study. The protective effect of moderate alcohol consumption on type 2 diabetes has been described, where an improvement on insulin levels has been shown in adults between 26.5-57 years old. Our research shows that alcohol effects on blood insulin levels could vary depending of the type of alcoholic drink ingested; and that alcohol intake increased leptin and adiponectin levels, suggesting that alcohol consumption may increase glucose catabolism promoting insulin sensitivity via leptin and adiponectin. However, original studies should consider time of exposure, age, dosage, ethnicity, and alcohol type in order to conclude right affirmations.

RESUMEN: La asociación del consumo de alcohol con la diabetes tipo 2 se ha explicado por una mayor sensibilidad a la insulina, efectos antiinflamatorios o efectos de la adiponectina. El objetivo fue establecer una relación coherente entre la ingesta de alcohol y la sensibilidad a la insulina. Se realizaron búsquedas en varias bases de datos (MEDLINE, EMBASE, Scopus y Web of Science) desde 1990 hasta abril de 2020 en busca de estudios en inglés, utilizando términos MeSH y palabras de textos relacionadas con el consumo de alcohol y la sensibilidad a la insulina. Protocolo registrado en PROSPERO CRD42020205107. Se analizaron un total de siete artículos originales, donde cuatro recopilaron datos a través de un estudio transversal, dos artículos con diseño cruzado aleatorizado y uno utilizó un estudio no aleatorizado. Se ha descrito el efecto protector del consumo moderado de alcohol sobre la diabetes tipo 2, donde se ha demostrado una mejora de los niveles de insulina en adultos entre 26,5 y 57 años. Nuestra investigación muestra que los efectos del alcohol sobre los niveles de insulina en sangre pueden variar según el tipo de bebida alcohólica ingerida; y que la ingesta de alcohol aumenta los niveles de leptina y adiponectina, lo que sugiere que el consumo de alcohol puede aumentar el catabolismo de la glucosa promoviendo la sensibilidad a la insulina a través de la leptina y la adiponectina. Sin embargo, los estudios originales deben considerar el tiempo de exposición, la edad, la dosis, el origen étnico y el tipo de alcohol para concluir afirmaciones correctas.

Diagnóstico diferencial de adenoma folicular y carcinoma papilar de tiroides mediante variables cariométricas. Matanzas 2013-2016 / Differential diagnosis of thyroidal follicular adenoma and papillary carcinoma by means of karyometric variables. Matanzas 2013-2016

RESUMEN Introducción: los carcinomas diferenciados de tiroides se originan en el epitelio folicular. De ellos el carcinoma papilar muestra una mayor incidencia. Una variante del mismo es la folicular, que en ocasiones muestra un patrón arquitectural que imita a un adenoma folicular. Objetivo: contribuir al diagnóstico diferencial entre el carcinoma papilar variante folicular y el adenoma folicular de tiroides, utilizando variables cariométricas de las células foliculares. Materiales y métodos: se aplicaron técnicas morfométricas a muestras de biopsias de tiroides con carcinoma papilar variante folicular y adenoma folicular, así como a muestras sin patología, en el período comprendido de enero de 2013 a diciembre de 2016, obtenidas en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. Las técnicas aplicadas se basaron en las variables cuantitativas: área, perímetro y factor de forma nuclear de las células foliculares. Los resultados se expresaron en porcentajes; la media aritmética como medida de tendencia central; desviación típica, incluyéndose el cálculo de los valores máximo, mínimo y recorrido para cada variable comprendida en el estudio, reflejados en tablas y gráficos realizados a través del software Microsoft Office Excel. Resultados: se obtuvieron valores elevados de área y perímetro nuclear de las células foliculares del carcinoma papilar variante folicular con relación al adenoma folicular, mientras que el factor de forma no arrojó resultados significativos para la diferenciación de dichas enfermedades tiroideas. Conclusiones: la aplicación de técnicas morfométricas a variables cariométricas en el tiroides, para el diagnóstico diferencial entre el carcinoma papilar variante folicular y el adenoma folicular, ofrece resultados aplicables en estudios histopatológicos (AU).

ABSTRACT Introduction: differentiated thyroid carcinomas are originated in the follicular epithelium. Of them, the papillary carcinoma shows higher incidence. Follicular carcinoma, one of its variants, occasionally shows an architectural pattern imitating a follicular adenoma. Objective: to contribute to the differential diagnosis between the papillary carcinoma, follicular variant, and thyroid follicular adenoma, using karyometric variables of follicular cells. Materials and methods: morphometric techniques were applied to samples of biopsies of thyroids with papillary carcinoma, follicular variant, and follicular adenoma, and also to samples without any pathology, in the period from January 2013 to December 2016, gathered in the University Hospital Comandante Faustino Perez, of Matanzas. The applied techniques were based on quantitative variables: area, perimeter and nuclear form factor. Results were expressed in percentages; the arithmetic median as measure of central tendency; typical deviation, including the calculation of maximal, minimal values and the course for each variable included in the study, were drawn in tables and graphics using Microsoft Office Excel software. Results: highs values of area and nuclear perimeter of the follicular cells of the papillary carcinoma, follicular variant, were obtained, while the shape factor did not show significant results for those thyroidal diseases differentiation. Conclusions: the application of morphometric techniques to karyometric variables in the thyroids, for the differential diagnosis between the papillary carcinoma, follicular variant, in follicular carcinoma, offers results that can be applied in histopathological studies (AU).

Asociación entre adiposidad y diabetes mellitus tipo 2 según nivel educacional en población chilena: resultados de la Encuesta Nacional de Salud 2016-2017 / Association of adiposity and diabetes mellitus type 2 by education level in the Chilean population

Background: Adiposity and education are two independent risk factors for type 2 diabetes (T2D). However, there is limited evidence whether both education and adiposity are associated with T2D in an additive manner in the Chilean population. Aim: To investigate the joint association between adiposity and education with T2D in the Chilean adult population. Material and Methods: Analysis of data of the Chilean National Health Survey 2016-2017, which included 5,033 participants with a mean age of 43 years, (51% women). Poisson regression analyses with robust standard error were used to investigate the joint association of the education level and general and central adiposity with T2D. The results were reported as Prevalence Ratio and their 95% confidence intervals (PR, 95% CI). Results: Obesity was associated with a higher probability of having T2D in men than in women, however central adiposity was associated with a higher probability of having T2D in women than in men. Compared with men who had higher education (> 12 years) and had normal body weight, those with the same educational level and who were obese had 2.3-times higher probability of having T2D (PR: 2.35 [95% CI: 1.02; 5.39]). For women, having a low education and being obese was associated with 4.4-times higher probability of having T2D compared to those with higher education and normal body mass index (BMI) (PR: 4.47 [95% IC: 2.12; 9.24]). Similar results were observed when waist circumference was used as a marker of obesity rather than BMI. Conclusions: Women and men with higher BMI and low education had a higher risk of T2D. However, this risk was higher in women than in men.

Riesgo estimado de padecer diabetes mellitus tipo 2 en pacientes hipertensos con tratamiento farmacológico / Estimate Risk of Presenting Type 2 Diabetes Mellitus in Hypertensive Patients under Pharmacological Treatment

Introducción: La diabetes mellitus es un reto para los sistemas de salud pública de todas las naciones. Objetivo: Identificar el riesgo de padecer diabetes mellitus tipo 2 en pacientes que debutaron con hipertensión arterial que tienen tratamiento farmacológico. Métodos: Se realizó un estudio observacional, descriptivo de tipo serie de casos. El universo estuvo constituido por los 74 pacientes pertenecientes al área de salud del Policlínico Docente Universitario Alex Urquiola Marrero que debutaron con hipertensión arterial, en el año 2019; se estudió todo el universo. Las variables estudiadas fueron: edad, sexo, factores de riesgo asociados a la diabetes mellitus, antecedentes familiares de diabetes mellitus y riesgo de padecer diabetes mellitus. Luego de recolectar la información, esta fue digitalizada para su posterior procesamiento. La base de datos y su procesamiento se realizó utilizando el paquete de programas estadísticos SPSS. Se utilizó la escala Finnish Diabetes Risk Score para calcular el riesgo de padecer diabetes mellitus tipo 2. Resultados: 40 pacientes pertenecían al sexo masculino; 29,7 por ciento estaban entre 55 y 64 años; obesidad, sedentarismo y hábitos alimentarios inadecuados estuvieron presentes en más del 50 por ciento de los pacientes; 59,5 por ciento tenían antecedentes familiares de diabetes mellitus de 2do grado; 52,7 por ciento presentaron riesgo de padecer diabetes mellitus tipo 2 alto o muy alto. Conclusiones: En pacientes con hipertensión arterial de debut el riesgo de padecer diabetes mellitus tipo 2 es predominantemente alto y muy alto(AU)

Introduction: Diabetes mellitus is a challenge for the public health systems of all nations. Objective: To identify the risk of suffering type 2 diabetes mellitus in patients who debuted with arterial hypertension under pharmacological treatment. Methods: An observational, descriptive study pf case series was carried out. The universe was made up of the 74 patients belonging to the health area of Alex Urquiola Marrero University Teaching Polyclinic who debuted with arterial hypertension in 2019. The entire universe was studied. The variables studied were age, sex, risk factors associated with diabetes mellitus, family history of diabetes mellitus, and risk of suffering from diabetes mellitus. After collecting the information, it was entered into computer software for further processing. The database was processed using the SPSS statistical software package. The Finnish Diabetes Risk Score was used to calculate the risk of suffering from type 2 diabetes mellitus. Results: Of the total of patients, 40 belonged to the male sex. 29.7 percent were aged 55-64 years. Obesity, sedentary lifestyle and inadequate eating habits were present in more than 50 percent of the patients. 59.5 percent had a family history of diabetes mellitus, through a second-degree relative. 52.7 percent had a high or very high risk of suffering from type 2 diabetes mellitus. Conclusions: In patients who debuted with hypertension, the risk of suffering from type 2 diabetes mellitus is predominantly high or very high(AU)