Visual impairment associated with diabetic retinopathy and macular edema: a hospital-based study.

BACKGROUND: Data on visual impairment (VI) in patients with diabetes are necessary in order to guide economic and human resources for reducing its prevalence. OBJECTIVE: To estimate the prevalence of diabetic retinopathy-related VI in patients with type 2 diabetes in a hospital-based setting. MATERIAL AND METHODS: Cross-sectional study carried out from 2014 to 2019 in an ophthalmology outpatient clinic. Any VI was defined as corrected pin-hole visual acuity in the better eye of ≥ 0.24 logMAR. The presence of diabetic retinopathy (DR), diabetic macular edema (DME) and cataract was evaluated. RESULTS: A total of 840 patients were included; median diabetes duration was 15 years. The prevalence of VI was 30%. DR was found in 62% of patients (30% had sight-threatening DR [STDR]), 17% had referable DME, and 3%, cataracts. The odds ratio for moderate or worse VI was 9.02 for STDR (p < 0.001), 5.89 for referable DME (p = 0.001), and 2.51 for cataract (p = 0.006). CONCLUSION: Thirty percent of participants had some degree of VI. Moderate or worse VI showed a strong association with STDR and referable DME.

ANTECEDENTES: Los datos sobre discapacidad visual (DV) en pacientes con diabetes son necesarios para orientar los recursos económicos y humanos que disminuyan su prevalencia. OBJETIVO: Estimar la prevalencia de DV relacionada con retinopatía diabética en pacientes con diabetes tipo 2 en un entorno hospitalario. MATERIAL Y MÉTODOS: Estudio transversal realizado de 2014 a 2019 en una consulta externa de oftalmología. Cualquier DV se definió como agudeza visual corregida con agujero estenopeico en el ojo con mejor visión (≥ 0.24 logMAR). Se evaluó la presencia de retinopatía diabética, edema macular diabético (EMD) y cataratas. RESULTADOS: Se incluyeron 840 pacientes; la mediana de duración de la diabetes fue de 15 años. La prevalencia de DV fue de 30 %. Se encontró retinopatía diabética en 62 % (30 % tenía retinopatía diabética que amenazaba la visión [RDAV]); 17 %, EMD y 3 %, cataratas. La razón de momios para DV moderada o de mayor gravedad fue de 9.02 para RDAV (p < 0.001), 5.89 para EMD referible (p = 0.001) y 2.51 para catarata (p = 0.006). CONCLUSIÓN: Treinta por ciento de los participantes tenía algún grado de DV. La DV moderada o de mayor gravedad mostró una fuerte asociación con RDAV y EMD referible.

Discapacidad visual asociada a retinopatía diabética y edema macular: un estudio de base hospitalaria / Visual impairment associated with diabetic retinopathy and macular edema: a hospital-based study

Resumen Antecedentes: Los datos sobre discapacidad visual (DV) en pacientes con diabetes son necesarios para orientar los recursos económicos y humanos que disminuyan su prevalencia. Objetivo: Estimar la prevalencia de DV relacionada con retinopatía diabética en pacientes con diabetes tipo 2 en un entorno hospitalario. Material y métodos: Estudio transversal realizado de 2014 a 2019 en una consulta externa de oftalmología. Cualquier DV se definió como agudeza visual corregida con agujero estenopeico en el ojo con mejor visión (≥ 0.24 logMAR). Se evaluó la presencia de retinopatía diabética, edema macular diabético (EMD) y cataratas. Resultados: Se incluyeron 840 pacientes; la mediana de duración de la diabetes fue de 15 años. La prevalencia de DV fue de 30 %. Se encontró retinopatía diabética en 62 % (30 % tenía retinopatía diabética que amenazaba la visión [RDAV]); 17 %, EMD y 3 %, cataratas. La razón de momios para DV moderada o de mayor gravedad fue de 9.02 para RDAV (p < 0.001), 5.89 para EMD referible (p = 0.001) y 2.51 para catarata (p = 0.006). Conclusión: Treinta por ciento de los participantes tenía algún grado de DV. La DV moderada o de mayor gravedad mostró una fuerte asociación con RDAV y EMD referible.

Abstract Background: Data on visual impairment (VI) in patients with diabetes are necessary in order to guide economic and human resources for reducing its prevalence. Objective: To estimate the prevalence of diabetic retinopathy-related VI in patients with type 2 diabetes in a hospital-based setting. Material and methods: Cross-sectional study carried out from 2014 to 2019 in an ophthalmology outpatient clinic. Any VI was defined as corrected pin-hole visual acuity in the better eye of ≥ 0.24 logMAR. The presence of diabetic retinopathy (DR), diabetic macular edema (DME) and cataract was evaluated. Results: A total of 840 patients were included; median diabetes duration was 15 years. The prevalence of VI was 30 %. DR was found in 62 % of patients (30 % had sight-threatening DR [STDR]), 17 % had referable DME, and 3 %, cataracts. The odds ratio for moderate or worse VI was 9.02 for STDR (p < 0.001), 5.89 for referable DME (p = 0.001), and 2.51 for cataract (p = 0.006). Conclusion: Thirty percent of participants had some degree of VI. Moderate or worse VI showed a strong association with STDR and referable DME.

Cognitive behavioral treatment to improve psychological adjustment in people recently diagnosed with type 2 diabetes: Psychological treatment in type 2 diabetes.

Type 2 diabetes mellitus (T2DM) is a chronic disease that affects a person's general well-being. Current evidence sets an association between psychological well-being and controlled metabolic parameters. People newly diagnosed with T2DM show higher prevalence of depression and anxiety symptoms. Cognitive behavioral therapy (CBT) has effectively improved psychological adjustment, but most studies do not specifically address recently diagnosed people nor usually include long-term follow-up measures. Objective: We sought to assess changes in psychological variables in people with newly diagnosed diabetes who received a cognitive-behavioral intervention, within a comprehensive care program. Method: 1208 adults with T2DM (≤5 years) who attended a national health institute in Mexico received a cognitive-behavioral intervention aimed at improving quality of life and reducing emotional distress that often interferes with diabetes control, as well as evaluating cognitive and emotional resources and social support. Measures of quality of life, diabetes-related distress, anxiety and depression questionnaires were compared at pre-test, post-test and follow up using Friedman's ANOVAs. Multiple logistic regression models evaluated glycosylated hemoglobin (HbA1c) and triglycerides control at post-test and follow up. Results: Questionnaire measures and metabolic variables significantly decreased symptomatology at post-test and these changes maintained at follow-up. Significant associations were found between quality-of-life scores and HbA1c and triglycerides levels in post-test and follow-up. Diabetes-related distress scores increased the odds of having adequate HbA1c control at post-test. Conclusion: This study contributes to the evidence on the importance of considering psychological factors as part of comprehensive diabetes care to improve quality of life and emotional burden and facilitate the achievement of metabolic goals.

Long-Term Effects of Anxiety on the Metabolic Control of Recently Diagnosed Type 2 Diabetes Patients: Results from the CAIPaDi Cohort Study.

Introduction: Anxiety disorders (AXD) are among the most prevalent mental health conditions in patients with type 2 diabetes (T2D). Previous data have established an association of other psychiatric conditions with poor metabolic control and increased odds of diabetes-related complications. Nonetheless, follow-up information about the effects of AXD on the metabolic control of patients with TD2 is still limited. Objective: Evaluate the effects of AXD on the metabolic parameters of patients with T2D over 12 months of follow-up in a multidisciplinary comprehensive care model. Methods: Prospective study of T2D subjects enrolled in a comprehensive care program with follow-up at 3 and 12 months of treatment. Patients were assessed using the Mini-International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale (HADS). We registered clinical and metabolic characteristics from each visit. Metabolic parameters over time were analyzed with a mixed model of repeated measures using AXD and time as interaction variables. Results: Our sample included 2703 patients at baseline, and 1161 (43%) subjects continued the follow-up at 12 months. The AXD group had more females, lower age, and fewer years of formal education compared with subjects without AXD at baseline, 3 and 12 months. Patients with AXD also reported higher mean fasting glucose at three months, and higher HbA1c at three and 12 months. Our MMRM for HbA1c reported significant differences over time in subjects with and without AXD. The differences in means between groups increased from 0.17% at three months to 0.31% at 12 months. The variables from the HADS anxiety score, sex, age, years of diagnosis, and insulin treatment were also associated with HbA1c parameters over time. Conclusion: Patients with AXD had the worst glycemic control at 3 and 12 months of follow-up. HbA1c differences in patients with AXD compared with non-AXD subjects increases over time in association with anxiety symptoms.

Feasibility and acceptance of a virtual multidisciplinary care programme for patients with type 2 diabetes during the COVID-19 pandemic.

BACKGROUND AND AIMS: Type 2 diabetes mellitus is one of the major public health concerns. The current lifestyle and advances in technology resulted in the development of a virtual mode of professional healthcare, which is an effective alternative method of management of patients. This study aimed to assess the feasibility of implementation of a virtual comprehensive care programme during the COVID-19 pandemic, patients' acceptance and the changes in self-care behaviours, metabolic parameters and emotional factors. METHODS: The programme employed in this study included nine health interventions in 1 day. Due to the COVID-19 pandemic, the mode of interventions, including questionnaires, patient evaluations and a satisfaction survey, was modified to the virtual form in 2020. This study assessed the changes in self-care behaviours, metabolic parameters and emotional factors and compared the data pertaining to patients who received virtual healthcare in 2020 with those who received face-to-face modality of medical care in 2019. RESULTS: During June to November 2020, 130 patients received healthcare by means of the virtual modality. The change in modality of healthcare was feasible and 75% of the patients displayed good acceptance of the same. The evaluation of self-care behaviours included self-monitoring blood glucose (SMBG) levels, foot care and regular exercise. The duration of exercise decreased from 120 to 0 min/week (p < 0.001). However, there was no change in metabolic parameters. Regarding the mental health parameters, we observed an increase in the proportion of patients with anxiety (21.5% versus 11.1%), depressive symptoms (10.8% versus 4.3%), diabetes distress (18.5% versus 11.1%) and prescription of psychotropic drugs (32.8% versus 18.2%) (p < 0.05) in virtual versus face-to-face, respectively. CONCLUSION: The virtual comprehensive care programme for the management of patients with diabetes is a feasible approach that allows healthcare professionals to provide an adequate care during the COVID-19 pandemic.

Barriers to adherence to a nutritional plan and strategies to overcome them in patients with type 2 diabetes mellitus; results after two years of follow-up / Barreras para la adherencia a un plan nutricional y estrategias para solventarlas en pacientes con diabetes tipo 2; resultados tras 2 años de seguimiento

Introduction: Lifestyle changes in medical nutrition therapy (MNT) are associated to HbA1c decreases ranging from 0.3 to 2%. Evidence shows that people with barriers are less likely to adhere to a long-term nutritional plan. Little information is available on the barriers that prevent the implementation of a healthy nutritional plan, and the strategies used to overcome them. Objective: To report the longitudinal changes in perceptions of barriers to adherence to a nutritional plan in T2DM. Methods: A prospective cohort study with intervention. Follow-up was assessed at two years, and all patients received comprehensive care according to the CAIPaDi model. A questionnaire was used to detect the most common barriers to adherence to a nutritional plan at baseline and at 3 months and 1 and 2 years of follow-up. The analysis included data from 320 patients with complete evaluations from baseline to 2 years. Patients with T2DM aged 53.8 ± 9.1 years (55.9% women), BMI 29.2 ± 4.4 kg/m2, and time since the diagnosis 1 (0-5) years were included in the study. Results: At baseline, 78.4% of patients reported any barrier that limited adherence to a nutritional plan. The most common were "Lack of information on an adequate diet" (24.7%), "I eat away from home most of the time" (19.7%), and “Denial or refusal to make changes in my diet” (14.4%). After a structured nutritional intervention including strategies to eliminate each barrier, a 37% reduction (p < 0.001) was seen in barriers at 2 years of follow-up. Patients with persistent barriers at two years had a greater proportion of HbA1c values >7% (24.7%) and triglyceride levels >150 mg/dL (27.5%) out of the control range as compared to those with no barriers (11.6% and 14.4% respectively, p < 0.05). Conclusions: Identification of barriers to adherence to a nutritional plan may allow healthcare professionals design interventions with the specific behavioral components needed to overcome such barrier, thus improving adherence to the nutritional plan with the resultant long-term changes

Introducción: Los cambios en el estilo de vida en la terapia médica nutricional (TMN), se asocian con una disminución en la hemoglobina glucosilada A1c (HbA1c) del 0,3–2%. La evidencia muestra que las personas con barreras tienen menos probabilidades de adherirse a un plan nutricional a largo plazo. Hay información limitada sobre las barreras que impiden la implementación de un plan nutricional saludable y sobre las estrategias utilizadas para superarlas. Objetivo: Describir los cambios longitudinales en las percepciones de las barreras para la adherencia a un plan nutricional con diabetes tipo 2 (T2D). Métodos: Estudio prospectivo de cohorte con intervención, se evaluó el seguimiento a 2 años, todos los pacientes recibieron atención integral de acuerdo con el estudio CAIPaDi. Se utilizó un cuestionario para detectar las barreras más comunes para realizar un plan nutricional al inicio del estudio a los 3 meses, uno y 2 años de seguimiento. El análisis incluyó datos de 320 pacientes que tenían evaluaciones completas desde el basal hasta 2 años. Se incluyeron pacientes con T2D de 53,8 ± 9,1 años, 55,9% mujeres, IMC 29,2 ± 4,4 kg/m2 y tiempo desde el diagnóstico de 1 (0-5) año. Resultados: Al inicio del estudio, el 78,4% de los pacientes refirieron alguna barrera que limita la adherencia a un plan nutricional. Las barreras más frecuentes fueron «Falta de información sobre una dieta correcta» (24,7%), «Como fuera de casa la mayor parte del tiempo» (19,7%) y «Negación o rechazo a hacer cambios en mi dieta» (14,4%). Después de una intervención nutricional estructurada, que incluyó estrategias para reducir cada barrera, observamos un porcentaje de reducción del 37% (p < 0,001). Los sujetos que presentaban barreras persistentes a los 2 años de seguimiento, muestran una mayor proporción fuera del rango de control para la HbA1c el 24,7% (>7%) y triglicéridos el 27,5% (>150 mg/dl) en comparación con aquellos sin barreras (11,6 y 14,4%, respectivamente) p < 0,05. Conclusiones: La identificación de las barreras para la adherencia a un plan de alimentación puede permitir a los profesionales de la salud diseñar intervenciones con los componentes de comportamiento específicos necesarios para superar dicha barrera, mejorando la adherencia al plan de alimentación con cambios sostenidos a largo plazo

Barriers to adherence to a nutritional plan and strategies to overcome them in patients with type 2 diabetes mellitus; results after two years of follow-up.

INTRODUCTION: Lifestyle changes in medical nutrition therapy (MNT) are associated to HbA1c decreases ranging from 0.3 to 2%. Evidence shows that people with barriers are less likely to adhere to a long-term nutritional plan. Little information is available on the barriers that prevent the implementation of a healthy nutritional plan, and the strategies used to overcome them. OBJECTIVE: To report the longitudinal changes in perceptions of barriers to adherence to a nutritional plan in T2DM. METHODS: A prospective cohort study with intervention. Follow-up was assessed at two years, and all patients received comprehensive care according to the CAIPaDi model. A questionnaire was used to detect the most common barriers to adherence to a nutritional plan at baseline and at 3 months and 1 and 2 years of follow-up. The analysis included data from 320 patients with complete evaluations from baseline to 2 years. Patients with T2DM aged 53.8±9.1 years (55.9% women), BMI 29.2±4.4kg/m2, and time since the diagnosis 1 (0-5) years were included in the study. RESULTS: At baseline, 78.4% of patients reported any barrier that limited adherence to a nutritional plan. The most common were "Lack of information on an adequate diet" (24.7%), "I eat away from home most of the time" (19.7%), and "Denial or refusal to make changes in my diet" (14.4%). After a structured nutritional intervention including strategies to eliminate each barrier, a 37% reduction (p<0.001) was seen in barriers at 2 years of follow-up. Patients with persistent barriers at two years had a greater proportion of HbA1c values >7% (24.7%) and triglyceride levels >150mg/dL (27.5%) out of the control range as compared to those with no barriers (11.6% and 14.4% respectively, p<0.05). CONCLUSIONS: Identification of barriers to adherence to a nutritional plan may allow healthcare professionals design interventions with the specific behavioral components needed to overcome such barrier, thus improving adherence to the nutritional plan with the resultant long-term changes.

Divergences in the perception of parental practices, positive behavior and problems between parents and children / Divergências na percepção de práticas parentais, comportamento positivo e problemáticas entre pais e filhos / Divergencias en la percepción de prácticas parentales, comportamiento positivo y problemáticas entre padres e hijos

Abstract The purpose of this study was to analyze the divergences in perception of parental practices, positive behavior and problems between parents and children. The participants, parents and adolescents, collaborated voluntarily and were examined in the following dyads: 248 fathers-sons, 241fathers-daughters, 237 mothers-sons, and 241 mothers-daughters. The psychometric instruments used were the Strengths and Difficulties Scale and the Parental Practices Scale for mothers and fathers. To achieve the main objective, correlation analysis, path analysis and differences of means with related samples were performed. The results showed correlations, from moderate to low, between parental practices, problems and prosocial behavior. In addition, different predictive factors of the children's behaviors were obtained, according to the sex of the parents and the parental practices they implemented. Finally, there were divergences between reports of parental practices, prosocial behavior and problems between parents and their children. Therefore, it is concluded that parental behavior is oriented according to the sexual role of their children, which involves social desirability.

Resumo O presente estudo teve como finalidade analisar as divergências na percepção das práticas parentais, no comportamento positivo e nas problemáticas entre pais e filhos. Os participantes, pais e adolescentes, colaboraram de maneira voluntária e foram avaliados nas seguintes díades: 248 pais-filhos, 241 pais-filhas, 237 mães-filhos e 241 mães-filhas. Os instrumentos utilizados foram a Escala de Capacidades e Dificuldades e a Escala de Práticas Parentais para mães e pais. Para alcançar o objetivo principal, realizaram-se análises de correlação, análises de caminhos e diferenças de médias com amostras relacionadas. Os resultados mostraram correlações - de moderadas a baixas - entre as práticas parentais, os problemas e a conduta pró-social, além de diferentes fatores preditivos das condutas dos filhos a partir do gênero dos pais e das práticas parentais exercidas. Houve divergências entre os relatórios de práticas parentais, conduta pró-social e problemas entre os pais e seus filhos. Conclui-se que a conduta parental é orientada de acordo com o gênero dos filhos, o que implica certa desejabilidade social relacionada com seu papel como homens ou como mulheres.

Resumen El presente estudio tuvo como finalidad analizar las divergencias en la percepción de las prácticas parentales, el comportamiento positivo y las problemáticas entre padres e hijos. Los participantes, padres y adolescentes, colaboraron de manera voluntaria y se evaluaron en las siguientes díadas: 248 padres-hijos, 241 padres-hijas, 237 madres-hijos, y 241 madres-hijas. Los instrumentos utilizados fueron la Escala de Capacidades y Dificultades y la Escala de Prácticas Parentales para madres y padres. Para lograr el objetivo principal se realizaron análisis de correlación, análisis de senderos y diferencias de medias con muestras relacionadas. Los resultados mostraron correlaciones -de moderadas a bajas- entre las prácticas parentales, los problemas y la conducta prosocial, además de diferentes factores predictores de las conductas de los hijos a partir del sexo de los padres y las prácticas parentales ejercidas. Se presentaron divergencias entre los reportes de prácticas parentales, conducta prosocial y problemas entre los padres y sus hijos. Se concluye que la conducta parental se orienta según el sexo de los hijos, lo cual implica cierta deseabilidad social relacionada con su rol como hombres o como mujeres.