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Objetivo: Valorar el grado de control metabólico y la presencia de complicaciones dela diabetes mellitus tipo 2 (DM2) en diabéticos inmigrantes. Material y métodos:Estudio transversal y observacional de casos y controles, apareados por grupos deedad y sexo. Casos: pacientes con DM2 inmigrantes indostanos (n= 116) y no indostanos(n= 113). Controles: pacientes autóctonos con DM2 (n= 229). La relaciónhombre/mujer fue de 6,7, 0,8 y 2, respectivamente. Se valora el control metabólico yla presencia de complicaciones crónicas. Resultados: Los diabéticos inmigrantestienen una media de edad menor (51,9 frente a 60,7 años en pacientes diabéticosnativos), pero un mayor tiempo de evolución de la DM (5,5 frente a 4,4 años). Lospacientes indostanos presentaron signifi cativamente mayores niveles de hemoglobinaglucosilada (del 8 frente al 7,4%). Los pacientes diabéticos inmigrantes presentan unmejor perfi l lipídico (colesterol-LDL de 120,4 frente a 146 mg/dL, y colesterol-HDLde 46,3 frente a 42,5 mg/dL) y tensional (135/79 frente a 141/82 mmHg) que losdiabéticos autóctonos (p <0,001). También tienen menor índice de masa corporal(27,5 frente a 29,3). Los pacientes diabéticos inmigrantes tienen menor frecuencia deneuropatía que los autóctonos (odds ratio [OR] ajustado por edad = 0,22; intervalo deconfi anza [IC] del 95%: 0,11-0,54) y, en el caso de los no indostanos, menos cardiopatíaisquémica (OR= 0,36; IC del 95%: 0,14-0,88). Conclusiones: Los pacientesdiabéticos inmigrantes tienen un perfi l de riesgo metabólico distinto de los autóctonos,entre los que destaca un mal control glucémico, especialmente en los indostanos(AU)

Objective: To assess the degree of metabolic control and the presence oftype 2 diabetes complications in diabetic immigrants. Methods: Cross-sectionalcase-control observational study, matched by age and sex. Cases: Hindustanidiabetic immigrants (n= 116) and non-hindustani (n= 113). Controls:native diabetic patients with type 2 diabetes (n= 229). The relation male/femalewas 6.7, 0.8 y 2, respectively. Metabolic control and presence of chroniccomplications were assessed. Results: Compared to native diabetics, immigrantdiabetics had a lower average age (51.9 vs. 60.7 years), with longerdiabetes duration (5.5 vs. 4.4 years). Hindustani immigrants presented statisticallysignificant higher HbA1c figures (8 vs. 7.4%). In general, diabetic immigrantspresented a better lipid profile (LDL 120.4 vs. 146 and HDL 46.3 vs.42.5 mg/dL) and better blood pressure figures (135/79 vs. 141/82 mmHg)than native diabetics (p <0.001). As well, immigrants had lower BMI (27.5 vs.29.3). Considering age-adjusted complications, immigrant diabetics had fewerneuropathy than native (OR= 0.22; IC: 0.11-0.54) and considering non-hindustanidiabetics, fewer coronary heart disease (OR= 0.36; IC: 0.14-0.88).Conclusions: Immigrant diabetics have a different metabolic risk profile comparedto native diabetics, with poor glycaemic control, especially among hindustaniimmigrants(AU)

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OBJECTIVE: To determine the validity of glycosylated hemoglobin (HbA1c) values as a method to diagnose type 2 diabetes mellitus (DM2) in a population at risk seen in primary care. DESIGN: Cross-sectional analytical study. SETTING: Data were obtained for the Raval Sud study population (epidemiologic study of alterations in glucose metabolism in a population at risk). PARTICIPANTS: 454 subjects from this population (mean age, 65 +/- 3 years; 52% male) at high risk for DM2, seen at a primary care center, were included in the study. MAIN MEASURES: We recorded demographic data and laboratory values for fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), and HbA1c. The diagnostic criteria used for DM2 were those published by the WHO in 1999. Values for HbA1c were expressed as the number of standard deviations (SD) above the mean. RESULTS: Levels of HbA1c correlated with FPG (r=0.72) and glucose levels 2 h after oral glucose overload (r=0.43). Thirty percent of the patients with FPG between 110 and 125 mg/dL had HbA1c values higher than the reference limits. A combined technique based on FPG>125 mg/dL or FPG 110-125 mg/dL with HbA1c > or = 3 SD (5.94%) showed a sensitivity of 92% and a specificity of 95%. CONCLUSIONS: When FPG is inconclusive (110-125 mg/dL), an HbA1c value more than 3 standard deviations above the mean (>5.94%) is useful in suggesting a likely diagnosis of diabetes and identifying patients who require treatment.

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OBJECTIVE: To study the association of dyslipemia with macroangiopathy in patients with type II diabetes mellitus. DESIGN: Descriptive crossover study. SETTING: An urban health district with a socially and economically depressed elderly population. PATIENTS: A randomised sample among the diabetics registered in the health district (n = 449). MEASUREMENTS AND MAIN RESULTS: Different factors in the lipidic profile were studied, as was the presence of diabetic macroangiopathy and some of the associated risk factors. The following were considered cut-off figures with a predictive value of cardiovascular risk: overall cholesterol >or= 240 mg/dl (40% of the sample), HDL < 35 mg/dl (27%), LDL >or= 160 mg/dl (43%), triglycerides >or= 200 mg/dl (25%), atherogenic index >or= 4.5 (73%) and HDL/LDL balance >or= 0.2 (83%). 85.5% of the diabetics in the sample presented one of the lipidic disorders mentioned above. In the multivariant analysis only hypertriglyceridaemia was associated with a higher prevalence of peripheral vasculopathy. CONCLUSIONS: A high percentage of patients with type II DM presented disorders in their lipidic profile. But, unlike the norm in the general population, only hypertriglyceridaemia displayed a statistically significant association with diabetic macroangiopathy. The role of the other dyslipemic factors was limited.

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OBJECTIVE: To study the population receiving care to find the prevalence of diabetic Nephropathy (DNP) and its association with possible risk factors in type 2 Diabetes Mellitus. DESIGN: A descriptive crossover study. SETTING: An urban health district with an aged and socio-economically depressed population. PATIENTS: Randomised sampling among the health district's registered diabetics (n = 198). MEASUREMENTS AND MAIN RESULTS: Among other parameters, the values of Proteinuria and Microalbuminuria in 24 hour's urine and of serum Creatinine were analysed. On the basis of these values the four stages of DNP were established: I) Normality, II) Microalbuminuria, III) Proteinuria, IV) Renal failure. The prevalences recorded were 33.8%, 51%, 11.1% and 4%, respectively. Also studied was the value of Microalbuminuria measured at random by reactive strips dipped in urine, which displayed 78% sensitivity and 68% specificity. The most notable of the DNP risk factors were how long the DM had evolved (p = 0.005). Age (p = 0.02), the value of the glucosilated haemoglobin (p = 0.03) and of the triglycerides (p = 0.03) were also related factors. On analysing the association of DNP with other chronic complications of DM, a statistical relationship to the presence of Retinopathy (p < 0.001) and peripheric Vasculopathy (p < 0.001) was observed. CONCLUSIONS: The presence of some stage of DNP among the type 2 DM population is very common. Only 33.8% of the sample was normal regarding the urinary excretion of proteins. Microalbuminuria quantified at random with reactive strips has low specificity. The highest risk factor for DNP is the length of the DM's evolution, with age and metabolic control of the disease also being important.

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OBJECTIVE: The objective of the study is to accomplish an analysis of the prevalence of the diabetic complications in relationship to the evolution years of the Diabetes Mellitus Non-Insulin-Dependent (DMNID). RESEARCH DESIGN AND METHODS: It is designing a transverse descriptive study through a random sampling among the population with DMNID of our center (n = 315). In addition to the age, the sex and the year of the diagnostic, is studied the presence of microangiopathy (retinopathy and nephropathy), macroangiopathy (peripheric, cerebral and coronary disease) and of the complications by diabetic neuropathy (NP) (peripheral and vegetative). RESULTS: The prevalence global obtained for each complication was the following: Retinopathy: 33%, Nephropathy: 17%, peripheric vasculopathy: 21%, cerebral vasculopathy: 10%, coronary disease: 14%, peripheral neuropathy: 40%, vegetative neuropathy: 20%. It is analysing the relationship among the presence of the complications with the age, the sex and the years from the diagnosis of the DMNID. CONCLUSIONS: Except in the coronary disease (possibly by the mortality of the process), the other complications showed a clear increase to the evolution years of the DMNID. 52% of the diabetics were already presenting some complication in the moment of the diagnostic.

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OBJECTIVE: To study the prevalence of clinical forms of diabetic macroangiopathy (DM) and its risk factors. DESIGN: A descriptive crossover study. SETTING: An elderly and socio-economically very depressed population in Raval Sud Health District (HD), Barcelona. PATIENTS AND OTHER PARTICIPANTS: Random sampling of type II diabetes patients (n = 387) registered in the HD (6.6% prevalence). MEASUREMENTS AND MAIN RESULTS: Each patient was examined for the presence of diagnostic criteria of peripheric, cerebral or coronary vasculopathy (VP); as well as for the possible risk factors (age, gender, years of the DM's evolution, tobacco, hypertension, obesity, glycosilated haemoglobin and dyslipemia). Prevalences obtained were: peripheric VP = 24.5%, cerebral VP = 9.5%, coronary VP = 18.1%. 30.5% of the diabetics had some form of macroangiopathy. The main risk factors for all the clinical forms (p < 0.001) were age and the length of evolution of DM, tobacco mainly for peripheric VP (p < 0.001), systolic Hypertension for cerebral VP (p = 0.03) and Hypertriglyceridaemia for peripheric VP (p < 0.01). CONCLUSIONS: Macroangiopathy affects a high percentage (30.5%) of type 2 diabetics. The principal risk factors are those associated with tobacco, hypertension and hypertriglyceridaemia, all of which we can affect and control.

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