RESUMEN

BACKGROUND: The SARS-CoV-2 pandemic brought a radical shift in the healthcare system and suboptimal care for vulnerable patients, such as those with Type 2 Diabetes Mellitus (T2D). Therefore, we compared metabolic control and macro/microvascular complications of patients with T2D before and throughout the three-year SARS-CoV-2 pandemic. RESEARCH DESIGN AND METHODS: A retrospective observational cohort of subjects with T2D studied from 2018 to 2022 in Northern Mexico was treated by a dynamic multidisciplinary team. Levels of Glycated hemoglobin (HbA1c), fasting serum glucose (FG), LDL-Cholesterol (LDL-C), blood pressure (BP), albuminuria, triglycerides, Body Mass Index (BMI), and FIB-4 score, micro and macrovascular complications were evaluated. RESULTS: A total of 999 patients were studied, 51.7% males with a mean (SD) age of 60.1 (12.7) years. Adequate glycemic control based on HbA1c increased by 15.2% and 42.3% in FSG (p < 0.001) between the beginning 2018 and the end of 2022. LDL-C control decreased by 5.1% between 2018 and 2022 (p < 0.001). Systolic BP control decreased by 2.6% (p < 0.001), whereas diastolic BP control increased by 1.8% (p = 0.01) between 2018 and 2022. Albuminuria control increased by 8.5% (p = 0.002). When comparing the Area Under the Curve (AUC) of metabolic parameters between patients who developed SARS-CoV-2 vs. those who did not, AUC was statistically higher in those who developed SARS-CoV-2 (p < 0.05). Diabetic neuropathy was the most prevalent microvascular complication (n = 35; 3.6%); ischemic heart disease was the most frequent macrovascular complication (n = 11;1.1%). CONCLUSIONS: A multidisciplinary dynamic team that adapts to the pandemic SARS-CoV-2 maintains and increases metabolic control in subjects with type 2 diabetes in Mexico. This represents a low percentage of chronic complications. The AUC of metabolic parameters of subjects with SARS-CoV-2 infection is higher, reflecting more variability in metabolic control.

RESUMEN

Introduction: Obesity (OB), type 2 diabetes mellitus (T2D), and hypertension (HTN) are health issues in Mexico linked to unhealthy behaviors. This study investigates the relationship between behavior change indicators and metabolic control in Mexican adults with OB, T2D, and HTN. Methods: We used data from the 2016 National Health and Nutrition Survey Midway (ENSANUT MC-2016), representing ∼59.5 million Mexican adults aged 20-59 with these conditions. We assessed behavior change indicators, including stages of change, self-efficacy, and perceptions of benefits and barriers. In addition, we conducted descriptive analyses and used statistical tests, such as Pearson's chi-squared test and logistic regression models, adjusted for multiple variables. Results: We found that adults in the action and maintenance stages of physical activity (PA) were four times more likely to have adequate HTN control than those in the precontemplation stage. Self-efficacy for PA was related to better control in T2D and HTN. Self-efficacy for reducing the consumption of sugary beverages was positively associated with control in OB and T2D. No significant association was observed with self-efficacy for consuming fruits and vegetables. Conclusion: Behavior-change indicators are significantly linked to metabolic control in adults with HTN. These results support the importance of these indicators in managing chronic diseases such as HTN and their potential use in public health strategies.

Asunto(s)

RESUMEN

INTRODUCTION: Robust evidence exists regarding initiation, intensification or modification of treatments. Recommendations to de-escalate therapy are lacking, specifically in diabetes. A successful treatment de-intensification reduces overtreatment, polypharmacy, and risk of adverse effects. OBJECTIVE: To encompass current recommendations for deprescribing common drugs and create a consensus among health professionals. METHODS: We reviewed four databases for deprescribing approaches published between 2010 and 2022. Articles were divided into different groups of drugs (for uric-acid, hypoglycemic, lipid-lowering, and psychotropic drugs). RESULTS: Hypoglycemic agents: strategies were limited to newer agents and insulin regimens for elderly individuals. Reducing insulin was associated with 1.1% reduction of A1c over time. SGLT2i and GLP-1RAs dose reduction depends on adverse events. Lipid-lowering agents: studies show that patients with very low cholesterol have fewer cardiovascular events without associated increased risk. Antihypertensive agents: Younger patients, lower systolic blood pressure, and few comorbidities are ideal characteristics for discontinuation. Uric acid therapy: we found no recommendation for dose de-escalation. Poor treatment adherence is associated with episodes of gout and deforming arthritis in the long term. CONCLUSION: Deprescribing hypoglycemic, statins, antihypertensives, and urate-lowering agents may be feasible in selected patients, but periodic surveillance is important. More evidence is necessary to support this decision entirely.

Asunto(s)

RESUMEN

Purpose: To evaluate the risk factors associated with diabetic macular edema (DME) in patients with a recent type 2 diabetes mellitus (T2DM) diagnosis. Patients and Methods: We conducted a case-control study at a third-level hospital in Mexico City. We enrolled patients ≥18 years old, with T2DM less than five years of diagnosis, without disabling complications, and non-smokers. The control group was patients with diabetic retinopathy and without macular edema (DR-DME). Cases were patients with DR+DME. We measured fasting glucose, creatinine, lipid profile, urinary albumin/creatinine ratio (ACR), and HbA1c. An ophthalmological examination consisted of visual acuity measurement, digital three-field fundus photography with an automatic non-mydriatic camera, slit lamp, and Optical coherence tomography (OCT) examination. Results: 183 and 61 patients with DR-DME and DR+DME, respectively, were included in the analysis. The prevalence of mild DR was higher in the DR-DME group, but the frequencies of moderate and severe retinopathy were higher in the DR+DME group. Patients in the DR-DME group had better vision than those in the DR+DME group. Logistic regression analysis revealed that age (OR, 1.07), HbA1c (OR, 1.19), and Albumin-to-Creatinine Ratio (ACR) > 30 mg/g (OR, 3.37) were associated with an increased possibility of DME compared to DR-DME. Conclusion: Our study provides insights into the association between risk factors and DME. We found a statistically strong association between HbA1c levels, age, and ACR. Patients with poor metabolic control should undergo an extensive medical examination to screen for DME, which may be related to the chronicity of DM and renal damage.

RESUMEN

OBJETIVO: determinar el nivel de control metabólico de las personas con hipertensión arterial (HTA) y diabetes mellitus (DM) que se atienden en el Programa de Salud Cardiovascular en la red de Atención Primaria en Salud (APS) a nivel nacional y establecer su relación con algunas características de la atención de salud. MÉTODO: diseño descriptivo, correlacional y de corte transversal. Se realizó estadística descriptiva del control metabólico de las personas con HTA y DM, se utiliza Prueba T para Muestras pareadas. Se calcula la asociación entre el control metabólico y la variable de población beneficiaria por comuna utilizando el Coeficiente de Correlación de Pearson. RESULTADOS: en el control metabólico, de las personas con HTA, el 56,02% y 55,75% logran una presión arterial <140/90 mmHg en el año 2018 y 2019; con respecto a las personas con DM, el 38,73% y el 38,51% alcanzan niveles de hemoglobina glicosilada <7% para los años 2018 y 2019 respectivamente. Se evidencia una correlación positiva entre el control metabólico de HTA y DM, con un R de Pearson = 0,719, un IC 95% [0,453 ­ 0,868] y p<0,001 en el año 2018 y un R de Pearson = 0,647, un IC 95% [0,330 ­ 0,833] y p<0,001 en el año 2019. CONCLUSIONES: adoptar un enfoque integral y de género en el manejo de las enfermedades crónicas en la Atención Primaria en Salud es fundamental, dirigiendo las estrategias con el fin de lograr el control metabólico. Las políticas públicas deben orientarse a la disminución de las brechas en salud.

OBJECTIVE: to determine the level of metabolic control of people with high blood pressure (HBP) and diabetes mellitus (DM) who are treated in the Cardiovascular Health Program within the primary care network at the national level and to establish their relationship with some characteristics of health care provision. METHOD: cross-sectional correlational descriptive design. Descriptive statistics of the metabolic control of people with HBP and DM were performed, using the T Test for Paired Samples. The association between metabolic control and the beneficiary population variable by commune is calculated using the Pearson Correlation Coefficient. RESULTS: in relation to the metabolic control, 56.02% and 55.75% of people with hypertension, in 2018 and 2019, achieved a blood pressure <140/90 mmHg; regarding people with DM, 38.73% and 38.51%, obtained glycosylated hemoglobin levels <7%, for the year 2018 and 2019. A positive correlation is evidenced between the metabolic control of HBP and DM, with a Pearson's R = 0.719, a 95% CI [0.453 - 0.868] and p<0.001 in the year 2018 and a Pearson's R = 0.647, a 95% CI [0.330 - 0.833] and p<0.001 in the year 2019. CONCLUSIONS: adopting a comprehensive and gender approach in the management of chronic diseases in Primary Health Care is essential, directing strategies to achieve metabolic control. Public policies must be aimed at reducing health gaps.

RESUMEN

Data on protein post-translational modifications (PTMs) increased exponentially in the last years due to the refinement of mass spectrometry techniques and the development of databases to store and share datasets. Nevertheless, these data per se do not create comprehensive biochemical knowledge. Complementary studies on protein biochemistry are necessary to fully understand the function of these PTMs at the molecular level and beyond, for example, designing rational metabolic engineering strategies to improve crops. Phosphoenolpyruvate carboxykinases (PEPCKs) are critical enzymes for plant metabolism with diverse roles in plant development and growth. Multiple lines of evidence showed the complex regulation of PEPCKs, including PTMs. Herein, we present PEPCKs as an example of the integration of combined mechanisms modulating enzyme activity and metabolic pathways. PEPCK studies strongly advanced after the production of the recombinant enzyme and the establishment of standardized biochemical assays. Finally, we discuss emerging open questions for future research and the challenges in integrating all available data into functional biochemical models.

RESUMEN

BACKGROUND: Noncommunicable diseases such as diabetes mellitus (DM) have gained attention worldwide. Latin America experienced a rise in rates of DM. During the COVID-19 pandemic, a telemedicine program was implemented in a quaternary care academic complex in Latin America to continue the follow-up of patients with diabetes. OBJECTIVE: The aim of this study is to describe the clinical experience of DM patient management through telemedicine and the HbA1c behavior of patients followed-up through this modality. MATERIALS AND METHODS: We conducted a retrospective cohort study including all patients with type 1 or 2 diabetes who were treated via telemedicine from March to December 2020. A Wilcoxon statistical test was used to compare the changes in glycosylated hemoglobin between the first teleconsultation and after 6 months of telemedicine follow-up. RESULTS: A total of 663 patients were included, 17.65% (117) of whom had type 1 diabetes and 82.35% (546) of whom had type 2 diabetes. Patients with both types of diabetes, presented with stable HbA1c values regardless of the length of follow-up. CONCLUSION: The use of telemedicine can be a helpful tool for both patients and health care providers to support the continuity of care to maintain acceptable control levels within glycemic control goals.

Asunto(s)

RESUMEN

INTRODUCTION: An important challenge in the secondary prevention of cardiovascular diseases is the optimization of risk factors (RFs) after hospital discharge. These have been shown to be insufficiently controlled in clinical practice. AIM: To evaluate whether secondary prevention goals were met at our institution at 12 months after an acute coronary syndrome (ACS) index event, as well as analyzing if achieving these goals was associated with a lower incidence of major adverse cardiovascular events (MACE). METHODS: Retrospective cohort of patients with a former diagnosis of ACS over a period of 4 years. To evaluate the proportion of patients who met RF control goals at 12 months after the index event, we used two sets of preestablished goals: stringent and lenient. During follow-up we evaluated the occurrence of MACE, defined by the following: ACS, coronary revascularization, stroke, hospitalization because of acute heart failure and cardiovascular death. RESULTS: We included 468 patients during the study period. The mean age of the patients was 60 ± 10.76 years, 20.5% were women, and mean follow-up was 41.8 ± 22.0 months. The proportion of patients that met all secondary prevention stringent and lenient goals accounted for 5.5% and 17.2%, respectively, and 8% did not achieve any target. Overall, 9.6% presented the composite of MACE during follow-up. The number of RFs in control at 12 months was associated with a lower rate of MACE, both with stringent and lenient goals. CONCLUSION: Achieving established goals for modifiable RFs can lower the incidence of MACE during long-term follow-up.

Asunto(s)

RESUMEN

Objective: The magnitude of the mortality benefit conferred by good integral metabolic control in diabetes in not sufficiently known, especially among Latin American patients. We prospectively studied the association between sustained control of blood glucose (HbA1c<7%), systolic blood pressure (SBP) (<130 mmHg) and LDL (LDLc, <100mg/dL) and non-HDL (non-HDLc, <130 mg/dL) cholesterol, and death from any cause among all adult patients with diagnosed diabetes in Colombia. Methods: We retrospectively analyzed data from a nationwide, centralized, mandatory registry of all patients with diagnosed diabetes assisted by the Colombian health system between July 1, 2015, and June 30, 2019. We estimated the associations of sustained achievement of each goal, and of the joint triple goal (HbA1c + SBP + LDLc) with all-cause death. Associations were assessed after adjustment for sex, age, race, insurance type and BMI in multivariable logistic models. Results: We studied 1 352 846 people with diabetes. Sustained SBP (OR 0.42 [0.41-0.43]), HbA1c (OR 0.25 [0.24-0.26]) and LDLc (OR 0.28 [0.27-0.29]) control had strong negative associations with death. Moreover, among the 5.4% of participants who achieved joint, sustained metabolic control, the OR for death was 0.19 (0.18-0.21). Importantly, the impact of sustained, joint metabolic control was significantly smaller for patients of black race compared to other races (OR 0.31 [0.23-0.43] versus 0.18 [0.17-0.20], p-value for interaction <0.001), mostly at the expense of a smaller impact of LDLc control. The results were similar across body-mass index categories. Conclusions: Sustained and simultaneous metabolic control was associated with remarkably lower odds of death.

Asunto(s)

RESUMEN

Hypomagnesemia and unhealthy eating patterns are associated with poor glycemic control in individuals with type 2 diabetes mellitus (T2DM). This study aimed to associate magnesium status and dietary patterns with glycemic control in T2DM individuals. This cross-sectional study included 147 individuals with T2DM, aged between 19 and 59 years, of both sexes, residents in Sergipe/Brazil. The BMI, waist circumference, %body fat, plasma magnesium, serum glucose, insulin, %HbA1c, triacylglycerol, total cholesterol, LDL-c, and HDL-c were analyzed. Eating patterns were identified using a 24-h recall method. Logistic regression models were used to verify the association of magnesium status and dietary patterns with markers of glycemic control by adjusting for sex, age, time of T2DM diagnosis, and BMI. A P value < 0.05 was considered significant. Magnesium deficiency increased the chance of elevated %HbA1c by 5.893-fold (P = 0.041). Three main dietary patterns were identified: mixed (MDP), unhealthy (UDP), and healthy (HDP). UDP also increased the chance of elevated %HbA1c levels (P = 0.034). T2DM individuals' who presented magnesium deficiency had a higher chance of elevated %HbA1c levels (8.312-fold) and those in the lowest quartile (Q) of the UDP (Q1: P = 0.007; Q2: P = 0.043) had a lower chance of elevated %HbA1c levels. However, the lower quartiles of the HDP were associated with a greater chance of alterations in the %HbA1c level (Q1: P = 0.050; Q2: P = 0.044). No association was observed between MDP and the variables studied. Magnesium deficiency and UDP were associated with a higher chance of inadequate glycemic control in T2DM individuals.

Asunto(s)

RESUMEN

Context: The relative importance of the control of different metabolic risk factors for the prevention of chronic kidney disease among patients with diabetes in real life conditions is insufficiently understood. Objective: We evaluated the effect of the achievement of glycated hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDLc) or non-high-density lipoprotein cholesterol (non-HDLc) goals (ABC goals) on the development of incident chronic kidney disease (iCKD) among patients with diabetes. Methods: In a nationwide registry of all individuals diagnosed with diabetes assisted by the health system in Colombia, we analyzed the association between baseline or sustained goal achievement and development of iCKD over a 4-year follow-up. iCKD was defined as a new occurrence of an estimated glomerular filtration rate less than 60 mL/min/1.73 m2, hemodialysis, peritoneal dialysis, or kidney transplant. Results: The study included 998 790 adults with diabetes (56% female, mean age 59). There were 125 626 cases of iCKD. After adjustment for multiple confounders, a baseline SBP less than 130 mm Hg (odds ratio [OR] 0.79 [0.78-0.80]) and a baseline HbA1c less than 7.0% (OR 0.86 [0.85-0.87]) were negatively associated with iCKD. Sustained achievement showed stronger negative associations with iCKD than just baseline achievement. Considering each goal separately, sustained non-HDLc less than 130 mg/dL had the strongest negative association with iCKD (OR 0.67 [0.65-0.69]). Patients who maintained the triple ABC goal over the entire follow-up had 32% (29-34) lower odds of developing CKD, 38% (34-42) if they additionally kept a normal body mass index (BMI). Sustained ABC control including a normal BMI was more strongly associated with a lower incidence of CKD in patients of Black race (OR 0.72 vs 0.89; P for interaction = .002). Conclusion: At the country level, sustained achievement of ABC goals and most especially non-HDLc were associated with substantial reductions in iCKD.

RESUMEN

BACKGROUND AND AIMS: The diabetes eating problem survey-revised (DEPS-R) questionnaire is a specific and valuable tool for assessing disturbed eating behavior in type 1 diabetes mellitus. The literature suggests an association between a higher DEPS-R score and worse metabolic control; however, these figures have not been described in patients from Latin America. METHODS: We evaluated 58 patients with type 1 diabetes mellitus from a Brazilian outpatient clinic using the DEPS-R questionnaire. RESULTS: Overall, 23 participants with a high risk for high eating disorder behaviors exhibited significantly increased hemoglobin A1c levels compared with 35 patients with a DEPS-R score <20. CONCLUSIONS: Our data support that the presence of a DEPS-R score >20 negatively affects the metabolic control of patients with type 1 diabetes mellitus in Brazil.

Asunto(s)

RESUMEN

Introducción: el ejercicio físico constituye uno de los pilares fundamentales en el tratamiento de las personas con diabetes. Ajustar el régimen terapéutico permite una participación segura y un alto desempeño de la actividad física. Objetivo: describir los efectos y la importancia del ejercicio físico en las personas con diabetes mellitus. Método: se realizó una investigación documental, se utilizó como buscador de información científica Google Académico. Se evaluaron libros, artículos de investigación y de revisión de diferentes bases de datos: LILACS, PubMed, SciElo, Cochrane y páginas web, en idioma español, inglés o portugués. Resultados: en las personas con diabetes se recomiendan los ejercicios físicos aeróbicos, los mismos incrementan la sensibilidad a la insulina influyendo favorablemente sobre el control metabólico; los ejercicios de resistencia también son beneficiosos con el objetivo de mejorar la fuerza muscular. Antes de desarrollar un programa de ejercicios, la persona con diabetes mellitus debe someterse a una evaluación médica detallada. La indicación del tipo de ejercicio, su intensidad y duración debe ser personalizada. El control glucémico antes, durante y después del ejercicio es fundamental. En los niños pequeños fomentar el juego es la mejor manera de garantizar una actividad física placentera. Conclusiones: el ejercicio físico debe indicarse en las personas con diabetes mellitus por sus múltiples beneficios relacionados con la salud. Su indicación debe ser individualizada

Introduction: Physical exercise is one of de fundamental pillars in the treatment of people with diabetes. Adjusting the therapeutic regimen allows safe participation and high performance of physical activity. Aim: To describe the effects and importance of physical exercise in people with diabetes mellitus. Method: A documentary investigation was carried out. It was used as a search engine for scientific information Google Academic. Books, research and review articles from different databases were evaluated: LILACS, PubMed, SciElo, Cochrane and web pages in Spanish, English and Portuguese. Results: In people with diabetes, aerobic physical exercises are recommended, they increase insulin sensitivity and have a favorable influence on metabolic control. Resistance exercises are also beneficial in order to improve muscle strength. Before developing an exercise program, the person with diabetes mellitus must undergo a detailed medical evaluation. The indication of the type of exercise, its intensity and duration must be personalized. Glycemic control before, during and after exercise is essential. Encouraging play in young children is the best way to ensure enjoyable physical activity. Conclusions: The physical exercise should be indicated in people with diabetes mellitus due to its multiple health- related benefits; its indication must be individualized.

Asunto(s)

RESUMEN

ABSTRACT Objective: A study at Centro Hospitalar Universitário do Porto in 2011 revealed suboptimal control of inpatient hyperglycemia and a similar one was carried out in 2020. This study compares the results of 2011 and 2020 regarding prevalence of hyperglycemia, metabolic control, treatment and glycemic profile by infection/non-infection diagnosis. Subjects and methods: We performed two cross-sectional studies on 13th December 2011 and 9th October 2020 that included all non-critical adults with at least 24 hours of hospitalization, with no specific intervention between them. Glycemic control evaluated by minimum and maximum capillary blood glucose (CBG) in the previous day categorized as hypoglycemia (<70 mg/dL), normoglycemia (70-179 mg/dL) and hyperglycemia (≥180 mg/dL) (SPSS v.20). Results: A total of 418 and 445 patients were respectively included in 2011 and 2020 studies and the prevalence of hyperglycemia was similar. Glycemic control improved numerically although not significantly in 2020: increase in normoglycemia, reduction in hyperglycemia and reduction in hypoglycemia. There was an increase in the use of basal-bolus regimens (19.6% vs. 7.3%, p = 0.009) and a decrease in human basal (p < 0.01) and rapid-acting insulin use (p = 0.001) with a proportional increase in long-acting (p = 0.002) and rapid-acting analogs (p < 0.001) use. There was a higher prevalence of infection (39.8% vs. 23.1%, p = 0.006) in 2020 and, in the infection subgroup, there were higher insulinization rates (37.3% vs. 10.7%, p = 0.017) and a trend to glycemic control improvement. Conclusion: Despite the higher insulinization rates, the preference for new insulin analogs and a trend to better glycemic control, we have not yet reached targets, so education still remains necessary.

RESUMEN

Objective: A study at Centro Hospitalar Universitário do Porto in 2011 revealed suboptimal control of inpatient hyperglycemia and a similar one was carried out in 2020. This study compares the results of 2011 and 2020 regarding prevalence of hyperglycemia, metabolic control, treatment and glycemic profile by infection/non-infection diagnosis. Methods: We performed two cross-sectional studies on 13th December 2011 and 9th October 2020 that included all non-critical adults with at least 24 hours of hospitalization, with no specific intervention between them. Glycemic control evaluated by minimum and maximum capillary blood glucose (CBG) in the previous day categorized as hypoglycemia (<70 mg/dL), normoglycemia (70-179 mg/dL) and hyperglycemia (≥180 mg/dL) (SPSS v.20). Results: A total of 418 and 445 patients were respectively included in 2011 and 2020 studies and the prevalence of hyperglycemia was similar. Glycemic control improved numerically although not significantly in 2020: increase in normoglycemia, reduction in hyperglycemia and reduction in hypoglycemia. There was an increase in the use of basal-bolus regimens (19.6% vs. 7.3%, p = 0.009) and a decrease in human basal (p < 0.01) and rapid-acting insulin use (p = 0.001) with a proportional increase in long-acting (p = 0.002) and rapid-acting analogs (p < 0.001) use. There was a higher prevalence of infection (39.8% vs. 23.1%, p = 0.006) in 2020 and, in the infection subgroup, there were higher insulinization rates (37.3% vs. 10.7%, p = 0.017) and a trend to glycemic control improvement. Conclusion: Despite the higher insulinization rates, the preference for new insulin analogs and a trend to better glycemic control, we have not yet reached targets, so education still remains necessary.

Asunto(s)

RESUMEN

Resumen Objetivos: Describir las características clínicas y de laboratorio de los pacientes diabéticos tipo 2 (DM2) en tratamiento con fibrina rica en plaquetas (FRP) en el Hospital Clínico Herminda Martín entre los años 2014 y 2016. Materiales y Método: Se revisaron las fichas clínicas de todos los pacientes tratados con FRP en el policlínico de biomateriales en busca de los valores de HbA1c y glicemia, además de otras variables clínicas y de laboratorio que pudieren estar relacionadas con la evolución de las heridas de pie diabético. Se estableció tres grupos de comparación según el tiempo de cicatrización en cicatrización rápida (tiempo percentil 75). Resultados: De un universo de 147 pacientes con DM2 se reportan resultados de 85 (58%). El promedio de edad fue de 61 años, con una glicemia promedio de 243 g/dL y HbA1c de 9,4%. Presentaron un contaje plaquetario dentro de los parámetros normales (promedio 279 plaquetas/mm3). Se encontraron diferencias estadísticas en la escala de valoración de heridas, específicamente en la valoración del puntaje total, así como los parámetros como extensión, profundidad, y dolor entre los grupos de cicatrización rápida y lenta. No se evidenciaron diferencias en el nivel de HbA1c o glicemia en los grupos de cicatrización rápida o lenta, como tampoco en otras variables como edad, creatinina, recuento de plaquetas. Conclusión: No se encontró una asociación entre la velocidad de cicatrización y el nivel de HbA1c en individuos tratados con FRP.

Aims: To describe the clinical and laboratory characteristics of type 2 diabetic patients (DM2) treated with Platelet Rich Fibrin (FRP) at Hospital Clínico Herminda Martín between 2014 and 2016. Materials and Method: Analytical study that includes information from a secondary database. The clinical records of all patients treated with FRP at the Biomaterials Polyclinic were reviewed to search the HbA1c and glycemia values, as well as other clinical and laboratory variables that could be related to the evolution of diabetic foot wounds. Three comparison groups were established according to the healing time in rapid (time 75th percentile). Results: From a universe of 147 patients with DM2, results of 85 (58%) are reported. The average age in the included patients was 61 years. They had an average glycaemia of 243 g/dL, and HbA1c of 9.4%. They presented a platelet count within normal range (average 279 platelets/mm3). Statistical differences between the fast and slow healing groups were found in the wound assessment scale, specifically in the assessment of the total score, extension, depth, and pain. There were no differences in the HbA1c or glycemia level in the fast or slow healing groups, nor in other variables such as age, creatinine, and platelet count. Conclusion: No association was found between healing speed and HbA1c level in individuals treated with FRP.

Asunto(s)

RESUMEN

Introducción: La asociación entre la diabetes mellitus y las periodontopatías se ha reportado en numerosos estudios. Se acepta que la interrelación entre ambas es bidireccional. Un alto porcentaje de los estudios epidemiológicos, así como de los estudios en animales de experimentación, sugieren que la presencia de una condición tiende a aumentar el riesgo y la severidad de la otra. Objetivo: Consolidar núcleos teóricos y evidencias clínicas que esclarezcan la relación entre la enfermedad periodontal inmunoinflamatoria crónica y el descontrol metabólico del paciente diabético. Métodos: Se realizó una revisión de la literatura disponible a través de la búsqueda automatizada en las bases de datos: PubMed, Scielo y Google Académico, en el período de enero - junio de 2020. La estrategia de búsqueda se realizó a nivel de título, resumen y palabras clave de los artículos, con el uso de conectores lógicos. Se evaluaron artículos de revisión, de investigación, metaanálisis, de autores cubanos e internacionales que hicieran referencia específicamente al tema de estudio a través del título. Resultados: Fueron seleccionados 29 textos científicos, escritos en idioma español e inglés, publicados entre el año 2005 y el 2019, de los cuales 27 eran artículos científicos de revistas y 2 libros de texto. Conclusiones: La mayor parte de las publicaciones revisadas sobre el tema, avalan la relación entre enfermedad periodontal y descontrol metabólico diabético, basados en estudios clínicos y hemoquímicos. Existen investigadores que sugieren continuidad de estudios para perfeccionar metodologías, esclarecer teorías y sobredimensionamiento de la asociación. La valoración de las periodontopatías, como factor de riesgo para el descontrol metabólico del diabético, debe pasar de una interrogante a una estrategia promocional, preventiva y terapéutica(AU)

Introduction: The association between Diabetes Mellitus and periodontopathies has been reported in numerous studies. It is accepted that the interrelation between the two is bidirectional. A high percentage of epidemiological studies, as well as studies in experimental animals, suggest that the presence of one condition tends to increase the risk and severity of the other. Objective: Consolidate theoretical nuclei and clinical evidence that clarify the relationship between chronic immune-mediated inflammatory periodontal disease and the metabolic decontrol of the diabetic patient. Methods: A review of the available literature was performed through the automated search in the following databases: PubMed, Scielo and Google Scholar, in the period January-June 2020. The search strategy was carried out through the title, abstract and keywords levels of the articles, with the use of logic connectors. Review, research and meta-analysis articles and by Cuban and international authors ones were assessed and that make specific reference to the studied topic through the title. Results: 29 scientific texts were selected; those were written in Spanish and English, published between 2005 and 2019, of which 27 were articles from a scientific journal and 2 were textbooks. Conclusions: Most of the publications reviewed on the subject endorse the relation between periodontal disease and diabetic metabolic decontrol, based on clinical and hemochemical studies. There are researchers who suggest continuity of studies to improve methodologies, clarify theories and oversize the association. The evaluation of periodontopathies as a risk factor for the metabolic decontrol of the diabetic must go from a question to a promotional, preventive and therapeutic strategy(AU)

Asunto(s)

RESUMEN

Resumen Objetivo: evaluar los resultados de una intervención educativa grupal en diabetes mellitus tipo 2 (DM2) para determinar la capacidad de las personas participantes en el control metabólico de la enfermedad. Metodología: se realizaron diferentes análisis estadísticos; a saber, un análisis de correlación y de conglomerados mediante tres procedimientos (K medias con valores estandarizados de las variables involucradas, análisis jerárquico con variables estandarizadas) y una combinación de análisis factorial con K medias. Además, se llevó a cabo un análisis de normalización para determinar la efectividad del Programa de Intervención Nutricional en Enfermedades Crónicas. Resultados: completaron la intervención educativa 702 personas con diabetes, de las cuales la mayoría son mujeres, con edades entre 40 y 64 años. Las variables que resultaron estadísticamente significativas (p<0,001) para el análisis de conglomerados fueron glicemia posprandial, glicemia en ayunas, hemoglobina glicosilada, colesterol total y triglicéridos, donde los valores promedio disminuyeron en todas las pruebas clínicas después de la intervención educativa. Por medio de la combinación del análisis factorial y el análisis de conglomerados se generaron tres grupos: DM2 control bajo, DM2 control medio y DM2 control alto. En el análisis de normalización, se determinó que la intervención educativa del Programa de Intervención Nutricional en Enfermedades Crónicas fue efectiva. Conclusión: los resultados de estudio permitirán enfocar los objetivos terapéuticos de la intervención educativa mediante acciones propias y de seguimiento del tratamiento de una manera más certera.

Abstract Objective: Evaluate the results of a group educational intervention in type 2 diabetes mellitus (DM2) to determine the capacity of the participants in the metabolic control of the disease. Methodology: Different statistical analyzes were performed: correlation and cluster analysis using three procedures (K means with standardized values of the variables involved, hierarchical analysis with standardized variables) and a combination of factor analysis with K means. In addition, a normalization analysis was carried out to determine the effectiveness of the Nutritional Intervention Program in Chronic Diseases. Results: 702 people with diabetes completed the educational intervention, of which the majority are women, ages between 40 and 64 years old. The variables that were statistically significant (p <0.001) for the cluster analysis were postprandial glycemia, fasting glycemia, glycated hemoglobin, total cholesterol and triglycerides, where the average values decreased in all the clinical tests after the educational intervention. Three groups were generated by combining factorial analysis and cluster analysis: low control DM2, medium control DM2 and high control DM2. In the normalization analysis, it was determined that the educational intervention of the Nutritional Intervention Program in Chronic Diseases was effective. Conclusion: The results of this study will allow us to focus on the therapeutic objectives of the educational intervention through our own actions and by monitoring the treatment in a more accurate way.

Asunto(s)

RESUMEN

Introducción: La Spirulina platensis es una cianobacteria planctónica filamentosa, que contiene un espectro natural de mezclas de pigmentos de caroteno, xantofila y ficocianina, con actividad antioxidante y la posibilidad de inducir un mejor control de la glucemia en las personas con diabetes mellitus. Objetivo: Describir los efectos del uso del producto logrado a partir de la bacteria Spirulina platensis en el paciente con diabetes mellitus. Método: Se utilizaron como buscadores de información científica a PubMed, SciELO, Google y Google Académico. Las palabras claves utilizadas fueron: espirulina, Spirulina platensis, Arthrospira platensis, diabetes mellitus y control metabólico. Se evaluaron artículos de revisión, de investigación y páginas web que, en general, tenían menos de 10 años de publicados en idioma español, portugués e inglés, cuyos títulos estaban relacionados con el tema de estudio. Se obtuvieron 70 referencias bibliográficas, de las cuales 49 se citaron en el presente artículo. Conclusiones: La espirulina tiene varios efectos benéficos que permiten su uso como coadyuvante en la prevención y tratamiento de la diabetes mellitus. Es un nutriente con bondades nutraceúticas y funcionales, con potente actividad antioxidante, que incide en un mejor control glucémico y puede ser útil en el manejo de las posibles complicaciones y comorbilidades que acompañan a la diabetes mellitus. Su uso conlleva la posibilidad de algunas reacciones adversas, sobre todo de tipo digestivas, aunque no son frecuentes si se emplean las dosis recomendadas; en general, es considerada un producto seguro(AU)

Introduction: Spirulina platensis is a plankton filamentous cyanobacteria that has a natural spectrum of carotene, xanthophyll and phycocyanin pigments´mix, with antioxidant activity and the possibility of inducing a better control of glycemia in patients with diabetes mellitus. Objective: Describe the effects of the use in patients with diabetes mellitus of a product made from Spirulina platensis bacteria. Method: There were used as scientific information searchers: PubMed, SciELO, Google and Google Scholar. The keywords used were: Spirulina, Spirulina platensis, Arthrospira platensis, diabetes mellitus and metabolic control. There were assessed review articles, research articles and web pages, that in general had less than 10 years of being published in Spanish, Portuguese or English language, and whose titles were related with the studied topic. 70 bibliographic references were collected, and 49 of them were quoted in this article. Conclusions: Spirulina has different beneficial effects that allow its use as coadjuvant agent in the prevention and treatment of diabetes mellitus. It is a nutrient with functional and nutraceutical mildness, with a powerful antioxidant activity which has incidence in a better glycemic control and can be useful in the management of possible complications and comorbidities that accompany diabetes mellitus. Its use entails the possible adverse reactions, mainly digestive ones; although they are not frequent if the recommended doses are used. In general terms, it is considered a safe product(AU)

Asunto(s)