Inequalities in diabetes mortality in Mexico: 2010-2019.

BACKGROUND: The impact of diabetes mellitus has been shown to be differentially expressed between social groups. OBJECTIVE: To estimate inequality gaps in diabetes mellitus mortality through absolute and relative measures according to geographic distribution and social conditions. MATERIAL AND METHODS: Diabetes mellitus-related deaths recorded in Mexico between 2010 and 2019 were analyzed, and inequality measurements at the state level were calculated by gender. RESULTS: National age-adjusted diabetes mellitus mortality rate showed an increase during the study period. CONCLUSION: The inequalities present in diabetes mortality should be considered for the design of health strategies.

ANTECEDENTES: Se ha demostrado que el impacto de la diabetes mellitus se expresa de manera diferenciada entre los grupos sociales. OBJETIVO: Estimar las brechas en la desigualdad en la mortalidad por diabetes mellitus a través de medidas absolutas y relativas según distribución geográfica y condiciones sociales. MATERIAL Y MÉTODOS: Se analizaron las muertes registradas en México por diabetes mellitus entre 2010 y 2019 y se calcularon las mediciones de desigualdad a nivel estatal por sexo. RESULTADOS: La tasa de mortalidad nacional por diabetes mellitus ajustada por edad mostró un incremento durante el periodo estudiado. CONCLUSIÓN: Las desigualdades presentes en la mortalidad por diabetes deben considerarse para el diseño de estrategias de salud.

Increased body fat, physical inactivity, and hypertension are associated with poor quality of life in patients with type 2 diabetes.

BACKGROUND: Diabetes is a significant health problem that affects quality of life in the medium and long term. OBJECTIVE: To identify the association between quality of life with comorbidity, metabolic control, and lifestyle in patients with type 2 diabetes. METHOD: A cross-sectional study was performed in 392 patients. Glycosylated hemoglobin, fasting glucose, lipid profile, blood pressure, weight, waist circumference and body composition were measured. Diabetic neuropathy, renal disease, visual health, diet and physical exercise were measured. Health-related quality of life (HRQoL) was measured with the 36-item Short Form survey (SF-36). RESULTS: The mean age was 54.6 years, 68 % were women, median years of diabetes diagnosis was 7 years. Eighty percent had a good HRQoL (SF-36 ≥ 50). The dimension with the highest score was physical function (81.0), and vitality the lowest (46.5). Body fat was associated with more impairments in the SF-36 dimensions (p < 0.05). Factors associated with worse HRQOL are physical inactivity (odds ratio [OR]: 2.7; 95% confidence interval [95%CI]: 1.10-6.62; p = 0.009), arterial hypertension (OR: 1.78; 95% CI: 1.05-3.02; p = 0.032) and being female (OR: 2.7; 95% CI: 1.45-5.27; p = 0.002). CONCLUSIONS: Poor quality of life is associated with higher fat percentage, physical inactivity and hypertension in patients with type 2 diabetes.

ANTECEDENTES: La diabetes es un importante problema de salud que afecta la calidad de vida a mediano y largo plazo. OBJETIVO: Identificar la asociación entre la calidad de vida y la comorbilidad, el control metabólico y el estilo de vida de pacientes con diabetes tipo 2. MÉTODO: Se realizó un estudio transversal en 392 pacientes. Se midieron la hemoglobina glucosilada, la glucosa de ayuno, el perfil de lípidos, la presión arterial, el peso, la circunferencia de la cintura y la composición corporal. Se evaluaron la neuropatía diabética, la enfermedad renal, la salud visual, la dieta y el ejercicio físico. La calidad de vida relacionada con la salud (CVRS) se midió con la encuesta en su versión corta de 36 ítems (SF-36). RESULTADOS: La edad promedio fue de 54.6 años, el 68% fueron mujeres y la mediana de años de diagnóstico de diabetes fue de 7 años. Un 80% tienen una buena CVRS (SF-36 ≥ 50). La dimensión con mayor puntaje fue función física (81.0), y la más baja fue vitalidad (46.5). La grasa corporal se asoció a más afectaciones en las dimensiones del SF-36 (p < 0.05). Los factores asociados a una peor CVRS son la inactividad física (odds ratio [OR]: 2.7; intervalo de confianza del 95% [IC95%]: 1.10-6.62; p = 0.009), la hipertensión arterial (OR: 1.78; IC95%: 1.05-3.02; p = 0.032) y ser mujer (OR: 2.7; IC95%: 1.45-5.27; p = 0.002). CONCLUSIONES: Una pobre calidad de vida se asocia con mayor porcentaje de grasa, inactividad física e hipertensión en pacientes con diabetes tipo 2.

Hypertension, Diabetes and Obesity, Major Risk Factors for Death in Patients with COVID-19 in Mexico.

BACKGROUND: Mexico has reported high death and case fatality rates due to COVID-19. Several comorbidities have been related to mortality in COVID-19, as hypertension, diabetes, coronary heart disease, chronic obstructive lung disease and chronic kidney disease. AIMS: To describe the main clinical characteristics of COVID-19 in the major social security institution in Mexico, as well as the contribution of chronic comorbidities and the population attributable fraction related to them. METHODS: Data for all patients with a positive test for SARS-CoV-2 in the institutional database was included for analysis. Demographic information, the presence of pneumonia and whether the patient was hospitalized or treated at home as an outpatient as well as comorbidities were analyzed. Case fatality rate was estimated for different groups. Odds ratios with 95% confidence intervals from a logistic regression model were estimated, as well as the population attributable fraction. RESULTS: By November 13, 2020, 323,671 subjects with COVID-19 infection have been identified. Case fatality rate is higher in males (20.2%), than in females (13.0%), and increases with age. Case fatality rate increased with the presence of obesity, hypertension and/or diabetes. Age and sex were major independent risk factors for mortality, as well as the presence of pneumonia, diabetes, hypertension, obesity, immunosuppression, and end-stage kidney disease. The population attributable fraction due to obesity in outpatients was 16.8%. CONCLUSIONS: Major cardiovascular risk factors and other comorbidities increase the risk of dying in patients with COVID-19. Identification of populations with high fatality in COVID-19, provides insight to deal with this pandemic by health services in Mexico.

[La educación multimedia como apoyo en el manejo de pacientes con diabetes tipo 2. Estudio cuasi experimental]. / Multimedia education to support management of type 2 diabetes patients. A quasi-experimental study.

OBJETIVO: Evaluar la eficacia de la educación a través de un sistema de información multimedia en el control del paciente con diabetes tipo 2. MÉTODO: Ensayo clínico abierto aleatorizado. El grupo de intervención fue instruido para consultar una herramienta educativa multimedia en la sala de espera de los consultorios, misma que fue diseñada de acuerdo a las caracteristicas de la población y centrada en automonitoreo de indicadores, información sobre diabetes tipo 2 y nutrición. Se midieron en sangre venosa las concentraciones de glucosa, hemoglobina glucosilada (HbA1c), triglicéridos, colesterol total, colesterol ligado a lipoproteínas de alta densidad (HDL-c) y colesterol ligado a lipoproteínas de baja densidad. Con la t de Student pareada se evaluó el efecto de la intervención. RESULTADOS: Se incluyeron 2334 pacientes, 958 en el grupo de intervención y 1376 en el grupo control. Se observó en el grupo de intervención un incremento del HDL-c (de 40.45 a 47.40 mg/dl; p = 0.001) y una disminución de los triglicéridos (de 227.78 a 210.38 mg/dl; p = 0.001). En el grupo control disminuyeron los triglicéridos (de 232.64 a 210.84 mg/dl; p = 0.016). En ambos grupos se incrementó de forma significativa el colesterol total. No se observaron cambios en los valores de glucosa y HbA1c posterior a la intervención. CONCLUSIÓN: La implementación de un sistema de información multimedia mejora el HDL-c y los triglicéridos del paciente con diabetes. Se requiere un reforzamiento continuo de la intervención educativa por parte del profesional de la salud para incidir en el control glucémico y otros indicadores del control metabólico. OBJECTIVE: To evaluate the efficacy of education through a multimedia information system, in controlling patients with type 2 diabetes. METHODS: Randomized open clinical trial. The intervention group was trained to consult an educative multimedia tool in the waiting room, which was developed according to the population characteristics and centered on monitoring indicators, information on type 2 diabetes and nutrition. Venous blood concentrations of glucose, glycated hemoglobin (HbA1c), triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were measured. Paired t Student was used to assess the effect of the intervention. RESULTS: 2,334 patients were included, 958 in the intervention group and 1,376 in the control group. In the intervention group, an increase in HDL-c values was observed (from 40.45 to 47.40 mg/dL; p=0.001) as well as a descent on triglycerides values (from 227.78 to 210.38 mg/dL; p=0.001). There was a reduction on triglycerides levels in the control group (from 232.64 to 210.84 mg/dL; p=0.016). There was a significative increase in total cholesterol values in both groups. There were no changes in the mean values of glucose and HbA1c after the intervention. CONCLUSION: Implementation of a multimedia information system improves HDL-c and triglycerides in patients with diabetes. There is a need for a continuous reinforcement of the educative intervention by health professionals to improve glycemic and other indicators in metabolic control.