[Lifestyle and metabolic control in patients with type 2 diabetes mellitus. Construct validation of IMEVID questionnaire]. / Estilo de vida y control metabólico en pacientes con diabetes mellitus tipo 2. Validación por constructo del IMEVID.

OBJECTIVE: To evaluate construct validity of an instrument to measure lifestyle in patients with type 2 diabetes mellitus (IMEVID questionnaire) DESIGN: Comparative cross-sectional study. SETTING: Six family medicine units (primary care). PATIENTS: 412 adults with type 2 diabetes. MEASUREMENTS: The IMEVID was applied by self-administration and the following metabolic control parameters values were measured: body mass index (BMI), waist/hip index (WHI), hemoglobin A1C (HbA1C), total cholesterol (TC), triglycerides (TG), systolic blood pressure (SBP), diastolic blood pressure (DBP), and the average of fasting plasma glucose in the last three months (FG). The test hypothetic construct was that higher total scores in the IMEVID (better lifestyle) would be associated with lower values in the metabolic control parameters. Three groups of subjects were formed based on the total score: group one (quartile 75). Differences on these parameters between groups were researched. RESULTS: 389 subjects completed the study, 69,2% were women. Seven IMEVID domains had weak correlations at least with two of eight parameters (r between 0.22 and 0.16; P<.05). The total score had correlation with six of eight parameter (r between 0.18 and 0.10; P< or =.05). The group three subjects had lower levels of BMI, WHI, HbA1C, FG, TC and TGL than group one subjects (P<.05). CONCLUSIONS: IMEVID has construct validity to measure the lifestyle in subjects with DM2. Its total score discriminates outstanding clinical characteristics in these patients.

Estilo de vida y control metabólico en pacientes con diabetes mellitus tipo 2. Validación por constructo del IMEVID / Lifestyle and metabolic control in patients with type 2 diabetes mellitus. Construct validation of IMEVID questionnaire

Objetivo. Evaluar la validez de constructo de un instrumento para medir el estilo de vida en los pacientes con diabetes mellitus tipo 2 (cuestionario IMEVID).Diseño. Estudio observacional transversal comparativo. Emplazamiento. Seis unidades de medicina familiar (atención primaria).Participantes. Un total de 412 adultos con diabetes mellitus tipo 2.Mediciones principales. Se aplicó el IMEVID por autoadministración y se midió el índice de masa corporal (IMC), índice cintura/cadera (ICC), hemoglobina glucosilada (HbA1C), colesterol total (CT), triglicéridos (TG), presión arterial (PA) y glucemia en ayunas (GA). El constructo hipotético de prueba fue que las mayores calificaciones totales en el IMEVID (mejor estilo de vida) estarían asociadas a valores menores de estas variables clínicas. Se dividió a los sujetos en tres grupos según su calificación total: grupo uno ( cuartil 75) y se buscaron diferencias intergrupo en los valores de los parámetros medidos. Resultados. Completaron el estudio 389 sujetos, y un 69,2 por ciento eran mujeres. Siete dimensiones del IMEVID tuvieron correlaciones débiles al menos con dos de los ocho parámetros (r, -0,22 a 0,16; p 0,05). La calificación total se correlacionó con seis de ocho parámetros (r, -0,18 a 0,10; p 0,05). Los sujetos del grupo tres tuvieron valores menores de IMC, ICC, HbA1C, GA, CT y TGL que los del grupo 1 (p < 0,05).Conclusiones. El IMEVID tiene validez de constructo para medir el estilo de vida en los sujetos con diabetes tipo 2. Su calificación total discrimina las características clínicamente relevantes (AU)

[Treatment of diabetic neuropathy]. / Tratamiento de la neuropatía diabética.

Diabetic polyneuropathy is a complication, that affects most patients with longstanding diabetes mellitus, deteriorating their quality of life. In the last few years, new therapeutic approaches have been developed that can improve symptoms and neurologic function, and which may prevent and in some cases stop nerve damage, and even, promote nerve fiber regeneration. These treatments are supported by several investigations in animals and humans: a) thigh glycemic control (insulin), b) aldose reductase inhibition (tolrestat), c) prevention of protein glycation (amino-guanidine), d) improvement of nerve ischemia (vaso-dilators, gamma-linolenic acid), and e) administration of neurotrophic factors (gangliosides). Most evidence support the usefulness for glycemic control. Early treatment is suggested, because marked nerve fiber loss is present in advanced neuropathy.

[Primary hypokalemic periodic paralysis. Presentation of 18 cases]. / Parálisis periódica hipokalémica primaria. Presentación de 18 casos.

The clinical features of 16 males and 2 females with hypokalemic periodic paralysis (HPP) are presented. Five patients had familial HPP, 4 thyrotoxic HPP and 9 sporadic disease. The age of onset ranged from 6 to 42 years. Clinical pictures varied from paraparesis to severe quadriplegia. The disease onset was earlier in familial HPP (p < 0.05) while sporadic cases showed the most severe, albeit shorter paralysis (p < 0.05). On admission, serum potassium levels ranged from 1.5 to 3.3 mEq/L; they did not correlate with the severity of paralysis. Glucose-insulin provocation test was positive in 5/5 patients. Oral potassium chloride and amiloride were useful to prevent paralysis. Contrasting with reports from USA and Europe, in México, HPP is not exceptional, and should be considered in the differential diagnosis of acute paralysis.

[Evaluation of nopal capsules in diabetes mellitus]. / Evaluación de cápsulas de nopal en diabetes mellitus.

To find out if commercial capsules with dried nopal (prickle-pear cactus, Opuntia ficus indica may have a role in the management of diabetes mellitus, three experiments were performed: 30 capsules where given in fasting condition to 10 diabetic subjects and serum glucose was measured through out 3 hours; a control test was performed with 30 placebo capsules. OGTT with previous intake of 30 nopal or placebo capsules was performed in ten healthy individuals. In a crossover and single blinded study 14 diabetic patients withdrew the oral hypoglycemic treatment and received 10 nopal or placebo capsules t.i.d. during one week; serum glucose, cholesterol and tryglycerides levels were measured before and after each one-week period. Five healthy subjects were also studied in the same fashion. Opuntia capsules did not show acute hypoglycemic effect and did not influence OGTT. In diabetic patients serum glucose, cholesterol and tryglycerides levels did not change with Opuntia, but they increased with placebo (P < 0.01 glucose and cholesterol, P = NS triglycerides). In healthy individuals glycemia did not change with nopal, while cholesterol and triglycerides decreased (P < 0.01 vs. placebo). The intake of 30 Opuntia capsules daily in patients with diabetes mellitus had a discrete beneficial effect on glucose and cholesterol. However this dose is unpractical and at present it is not recommended in the management of diabetes mellitus.

Delayed insulin absorption due to subcutaneous edema.

A prospective study to determine if subcutaneous edema interferes with insulin absorption was performed. Forty-six patients entered the study. Three groups were formed. Twenty patients with generalized edema (Group 1), ten of them with non-insulin dependent diabetes mellitus (NIDDM). Twenty patients without edema (Group II). 10 of them with NIDDM; and six patients with mild edema (Group III). The disappearance of I125-insulin was measured throughout 360 minutes. The rate of absorption in group I was significantly lower and delayed than in group II. The amount of insulin absorbed at 360 minutes was 3 to 4 fold lower in group I than in group II (p 0.001). Group III had intermediate values. The peak of plasma I125-insulin level was 3 to 4 fold lower in group I than group II. The impairment of insulin absorption in subjects with edema was more evident in those with NIDDM. In conclusion, this study demonstrates that subcutaneous edema impairs insulin absorption. Insulin absorption from subcutaneous tissue varies due to several conditions, resulting in a difficult glycemic control. Previous studies have shown that insulin absorption is affected by several factors as the site of injection, room and skin temperature, physical exercise, the thickness of adipose tissue, local massage, and local degradation of insulin. Edema due to chronic complications such as nephropathy and cardiopathy often occurs in long-standing diabetic subjects. However, the effects of edema of the skin and subcutaneous tissue on insulin absorption has not been previously examined. The aim of this study was to assess if edema affects the absorption of insulin.

[Duration of the hypoglycemic action of Opuntia streptacantha Lem]. / Duración de la acción hipoglucemiante de Opuntia streptacantha Lem.

To assess the duration of Opuntia streptacantha Lem. hypoglycemic effect, two tests in fasting conditions, one with the intake of 500 g of broiled Opuntia stems and the other one with 400 ml of water as control, were performed in eight type II diabetics. Serum glucose levels were measured hourly during six hours. In the Opuntia test the decrease of serum glucose levels was more pronounced at the fourth hour (P less than 0.01 vs control test), serum glucose levels remained unchanged the following two hours. No significant changes on glycemia occurred in the control test. Difference between both tests was significant from the second to the sixth hour.

[Hypoglycemic action of different doses of nopal (Opuntia streptacantha Lemaire) in patients with type II diabetes mellitus]. / Acción hipoglucemiante de diferentes dosis de nopal (Opuntia streptacantha Lemaire) en pacientes con diabetes mellitus tipo II.

To assess the relationship between the doses of O. streptacantha Lem. and its acute hypoglycemic action in diabetics, eight patients with type II diabetes mellitus were studied. Four test were performed to each patient with the intake of: (a) 400 ml of water, (b) 100 g (c) 300 g and (d) 500 g of broiled stems of O. streptacantha Lem. Serum glucose was measured at 0, 60, 120 and 180 minutes. Maximal decrease of serum glucose was noticed at 180 minutes, with a mean of 2.3, 10, 30.1 and 46.7 mg/dl less than basal value with 0, 100, 300 and 500 g respectively (P = NS, less than 0.05, less than 0.001 and less than 0.001 respectively). A significant direct correlation (r = 0.690, P less than 0.001) was noticed between the doses and the hypoglycemic effect.

Herpes zoster diseminado tratado con aciclovir. / Dissseminated herpes zoster treated with acyclovir

Se presenta una paciente de 39 anos de edad con insuficiencia renal cronica que se complico con herpes zoster diseminado.Se trato con aciclovir endovenoso, con lo que la diseminacion se limito en 24 horas y la curacion total se obtuvo en ocho dias Debe considerarse el tratamiento con aciclovir en los casos de herpes zoster diseminado, especialmente en los individuos con alteracion de los mecanismos de resistencia a la infeccion

Disminucion de glucosa e insulina sanguineas por nopal (Opuntia sp.). / Decreased blood glucose and insulin by nopal (Opuntia sp.)

En un intento por esclarecer la accion hipoglucemiante del nopal (Opuntia sp.), se practicaron en cinco individuos sanos dos curvas de tolerancia a la glucosa oral, con medicion de insulina, una de ellas 20 minutos despues de la ingestion de 100g de tallos de nopal. Se encontraron cifras significativamente menores de glucosa e insulina a los minutos 0,60 (excepto glucosa), 90 y 120. Los resultados hacen sospechar una mayor sensibilidad a la insulina ademas del posible retardo en la absorcion de la glucosa