Self-reported adherence to diet and preferences towards type of meal plan in patient with type 2 diabetes mellitus. A cross-sectional study.

BACKGROUND AND AIMS: Few studies have evaluated the attitudes of patients with type 2 diabetes mellitus (T2DM) towards the given dietary plans. In this study, we aimed to evaluate: i) the self-reported adherence of T2DM patients to the prescribed diets; ii) the use of other types of diet schemes; iii) the patients' preferences towards the type of meal plans. METHODS AND RESULTS: A 16 multiple-choice items questionnaire was administered to 500 T2DM patients; 71.2% (356/500) of them had the perception of having received a dietary plan; only 163/356 declared to be fully adherent. The latter had lower BMI (25.8 ± 4.5 vs 29.1 ± 4.5 kg/m2, p < 0.001) than patients who were partly adherent. Among patients not following the given diet, 61.8% was eating in accordance to a self-made diet and 20.9% did not follow any diet. Only a few patients (2.4%) had tried a popular diet/commercial program. Most patients preferred either a "sufficiently free" (201/500) or a "free" (218/500) scheme. The use of supplements attracted younger, obese individuals, with higher education, and most managers. In a multinomial regression model, age and diabetes duration were inversely associated with the choice of a "rigid" scheme, diabetes duration and glycated hemoglobin levels were inversely correlated with a "free" diet choice, obesity was associated with a "strategic" scheme choice, while lower education (inversely) and obesity (directly) correlated with the preference for "supplement use". CONCLUSIONS: Socio-cultural/individual factors could affect attitudes and preferences of T2DM patients towards diet. These factors should be considered in order to draw an individually tailored dietary plan.

[Evaluation of renal stone disease: metabolic study]. / Evaluación de la enfermedad renal litiásica. Estudio metabólico.

Renal stone formation is a multifactorial process in which all the information obtained from the patient (medical history, imaging tests, stone analysis, metabolic study and physicochemical urine analysis) shows a different facet of the same process. Consequently, all these investigations should be evaluated together. In half of all patients, stone formation is secondary to the presence of metabolic alterations in urine, of which the most frequent is idiopathic hypercalciuria. The second most frequent cause is infection and/or urinary malformations, while hereditary enzyme defects are highly unusual. Reference values for urinary excretion of lithogenic metabolites (calciuria, uricosuria, oxaluria, citraturia, etc.) are essential for an adequate metabolic study, since urinary excretion depends on multiple factors, which have been described in the various publications in the literature. Physicochemical study evaluating saturation of the various salts dissolved in urine should be performed. These saturations are currently considered to be a highly useful index for determining the risk of crystallization and stone formation in patients with lithiasis and for evaluating the effectiveness of treatment. Lastly, the metabolic profile of renal lithiasis in children resembles that in adults, suggesting that predisposition to renal lithiasis begins in childhood. The early detection of the metabolic alterations observed in these patients will reduce the incidence of this disease in both children and adults.

Evaluación de la enfermedad renal litiásica. Estudio metabólico / Evaluation of renal stone disease: metabolic study

La litiasis renal es un proceso multifactorial en donde cada uno de los datos obtenidos del paciente (historia clínica, estudio por técnicas de imagen, análisis del cálculo, estudio metabólico y estudio fisicoquímico de la orina) muestra una faceta diferente de un mismo proceso, por lo que todos ellos deben ser valorados de forma conjunta. En la mitad de los pacientes, la formación de cálculos es secundaria a la presencia de alteraciones metabólicas en la orina, la más frecuente de las cuales es la hipercalciuria idiopática. La segunda causa es la infección y/o las malformaciones urinarias, mientras que los defectos enzimáticos hereditarios son muy poco frecuentes. Para poder realizar un estudio metabólico correcto, es imprescindible disponer de valores de referencia propios de la excreción urinaria de los metabolitos litogénicos (calciuria, uricosuria, oxaluria, citraturia, etc.), ya que dicha excreción depende de múltiples factores, variando entre las distintas publicaciones de la bibliografía. Debe realizarse un estudio fisicoquímico que valore las saturaciones de las distintas sales disueltas en la orina. Actualmente se considera que dichas saturaciones son un índice de gran utilidad para conocer el riesgo de cristalización y el riesgo litógeno de un paciente con litiasis, y para comprobar la eficacia del tratamiento. Por último, el perfil metabólico de la litiasis renal en el niño recuerda al descrito en el adulto, lo que sugiere que la predisposición a la litiasis renal comienza en la niñez. La detección precoz de las alteraciones metabólicas que existen en estos pacientes no solamente conseguirá disminuir la incidencia de la litiasis renal en el niño, sino también en el paciente adulto (AU)