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BACKGROUND: The prevalence of obesity has increased in patients with type 1 diabetes (T1D) and latent autoimmune diabetes of the adult (LADA), limiting the use of clinical features such as the body mass index for its differentiation with type 2 diabetes (T2D). Additionally, some patients with maturity-onset diabetes of the young (MODY) or LADA are misdiagnosed as having T2D. The evaluation of autoantibodies and genetic testing are not fully available. We aimed to evaluate the utility of a widely available and less expensive diagnostic tool such as C-peptide to differentiate between T1D, T2D, MODY, and LADA. METHODS: Our study included 38 patients with T1D, 49 with T2D, 13 with MODY, and 61 with LADA. We recorded anthropometric measurements, biochemical profiles, and antidiabetic treatment and determined C-peptide, anti-GAD65, and anti-IA2 antibodies. RESULTS: C-peptide concentration differed significantly among populations (T1D: 0.2 ng/mL; T2D: 2.4 ng/mL; MODY: 1.14 ng/mL; LADA: 1.87 ng/mL). Through a ROC curve, we observed that the C-peptide cut-off point of 0.95 ng/mL allows differentiation between T1D and T2D (sensitivity 82%, specificity 77%); 0.82 ng/mL between T1D and LADA (sensitivity 82%, specificity 77%); and 1.65 ng/mL between T2D and MODY (sensitivity 72%, specificity 72%). CONCLUSIONS: C-peptide is useful for the diagnostic differentiation of patients with type 1, type 2 diabetes, MODY, and LADA.

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BACKGROUND: The concept of food addiction describes the difficulties of some individuals with regard to food consumption. OBJECTIVE: To determine the frequency of food addiction and its association with body mass index (BMI), calorie consumption and therapeutic control in patients with newly-diagnosed type 2 diabetes mellitus (T2DM). MATERIAL AND METHODS: A total of 1,080 patients with T2DM were included. The degree of metabolic control was determined with the levels of glycated hemoglobin, low-density lipoprotein cholesterol and blood pressure. Daily caloric consumption was estimated with a semi-quantitative questionnaire of food consumption frequency. RESULTS: Nearly all patients showed overweight (40.5 %) and obesity (49.1 %). The frequency of food addiction was 54.2 % (56.9 % in women and 48.9 % in men). Food addiction was associated with BMI (OR = 1.89, p ≤ 0.05), high caloric intake (OR = 1.14, p ≤ 0.05) and glycated hemoglobin > 7 % (OR = 1.43, p ≤ 0.05). CONCLUSIONS: Food addiction is common in patients with overweight/obesity and newly-diagnosed T2DM, and is associated with higher-than-recommended caloric consumption, obesity degree and poor metabolic control.

ANTECEDENTES: El concepto de adicción a la comida describe las dificultades de algunos individuos respecto al consumo de comida. OBJETIVO: Determinar la frecuencia de la adicción a la comida y su asociación con el índice de masa corporal (IMC), consumo de calorías y control terapéutico en pacientes con diabetes mellitus tipo 2 (DMT2) de diagnóstico reciente. MATERIAL Y MÉTODOS: Se incluyeron 1080 pacientes con DMT2. Se determinó el grado de control terapéutico con niveles de hemoglobina glicada, colesterol de baja densidad y presión arterial. El consumo diario de calorías fue estimado con un cuestionario semicuantitativo de frecuencia de consumo de alimentos. RESULTADOS: Casi todos los pacientes mostraron sobrepeso (40.5 %) y obesidad (49.1 %). La frecuencia de adicción a la comida fue de 54.2 % (56.9 % en mujeres y 48.9 % en hombres). La adicción a la comida se asoció a IMC (RM = 1.89, p ≤ 0.05), alto consumo calórico (RM = 1.14, p ≤ 0.05) y hemoglobina glicada > 7 % (RM = 1.43, p ≤ 0.05). CONCLUSIONES: La adicción a la comida es frecuente en pacientes con sobrepeso/obesidad y DMT2 recientemente diagnosticada y se asocia al consumo calórico superior a lo recomendado, grado de obesidad y pobre control terapéutico.

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Resumen Antecedentes: El concepto de adicción a la comida describe las dificultades de algunos individuos respecto al consumo de comida. Objetivo: Determinar la frecuencia de la adicción a la comida y su asociación con el índice de masa corporal (IMC), consumo de calorías y control terapéutico en pacientes con diabetes mellitus tipo 2 (DMT2) de diagnóstico reciente. Material y: métodos: Se incluyeron 1080 pacientes con DMT2. Se determinó el grado de control terapéutico con niveles de hemoglobina glicada, colesterol de baja densidad y presión arterial. El consumo diario de calorías fue estimado con un cuestionario semicuantitativo de frecuencia de consumo de alimentos. Resultados: Casi todos los pacientes mostraron sobrepeso (40.5 %) y obesidad (49.1 %). La frecuencia de adicción a la comida fue de 54.2 % (56.9 % en mujeres y 48.9 % en hombres). La adicción a la comida se asoció a IMC (RM = 1.89, p ≤ 0.05), alto consumo calórico (RM = 1.14, p ≤ 0.05) y hemoglobina glicada > 7 % (RM = 1.43, p ≤ 0.05). Conclusiones: La adicción a la comida es frecuente en pacientes con sobrepeso/obesidad y DMT2 recientemente diagnosticada y se asocia al consumo calórico superior a lo recomendado, grado de obesidad y pobre control terapéutico.

Abstract Background: The concept of food addiction describes the difficulties of some individuals with regard to food consumption. Objective: To determine the frequency of food addiction and its association with body mass index (BMI), calorie consumption and therapeutic control in patients with newly-diagnosed type 2 diabetes mellitus (T2DM). Material and methods: A total of 1,080 patients with T2DM were included. The degree of metabolic control was determined with the levels of glycated hemoglobin, low-density lipoprotein cholesterol and blood pressure. Daily caloric consumption was estimated with a semi-quantitative questionnaire of food consumption frequency. Results: Nearly all patients showed overweight (40.5 %) and obesity (49.1 %). The frequency of food addiction was 54.2 % (56.9 % in women and 48.9 % in men). Food addiction was associated with BMI (OR = 1.89, p ≤ 0.05), high caloric intake (OR = 1.14, p ≤ 0.05) and glycated hemoglobin > 7 % (OR = 1.43, p ≤ 0.05) Conclusions: Food addiction is common in patients with overweight/obesity and newly-diagnosed T2DM, and is associated with higher-than-recommended caloric consumption, obesity degree and poor metabolic control.

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BACKGROUND: Simple surrogate indexes (SSI) to assess beta-cell function, insulin sensitivity (IS) and insulin resistance (IR) are an easy and economic tool used in clinical practice to identify glucose metabolism disturbances. AIM: To evaluate the validity and reliability of SSI that estimate beta-cell function, IS and IR using as a reference the parameters obtained from the frequently sampled intravenous glucose tolerance test (FSIVGTT). MATERIAL AND METHODS: We included 62 subjects aged 20-45 years, with a normal body mass index and without diabetes or prediabetes. SSI were compared with the acute insulin response to glucose (AIRg), insulin sensitivity index (Si) and disposition index (DI) obtained from the FSIVGTT using the minimal model approach. Half of the participants (n = 31) were randomly selected for a second visit two weeks later to evaluate the reliability of all the variables. RESULTS: HOMA1-%B and HOMA2-%B had a significant correlation with AIRg (Spearman Rho (rs) = 0.33 and 0.37 respectively, p 0.50) with Si were fasting insulin, HOMA1-IR, HOMA2-IR, HOMA1-%S, HOMA2-%S, QUICKI, and the McAuley index. The parameters that showed good reliability with an intraclass correlation coefficient (ICC) > 0.75 were AIRg, HOMA1-%S, HOMA2-%S, and QUICKI. Conclusions: Our results suggest that most of the SSI are useful and reliable.

ANTECEDENTES: Los índices simples subrogados (ISS) que evalúan la función de célula beta, sensibilidad a la insulina (SI) y resistencia a la insulina (RI) son herramientas sencillas y económicas que se usan en la práctica clínica para identificar alteraciones del metabolismo de la glucosa. OBJETIVO: Evaluar la validez y confiabilidad de ISS para estimar la función de célula beta, SI y RI usando como referencia los parámetros de la prueba de tolerancia a la glucosa intravenosa con muestreo frecuente (FSIVGTT). MATERIAL Y MÉTODOS: Se incluyeron 62 sujetos de 20-45 años, con índice de masa corporal normal y sin diabetes mellitus o prediabetes. Los ISS se compararon con la respuesta aguda de la insulina a la glucosa (AIRg), índice de sensibilidad a la insulina (Si) e índice de disposición (DI) obtenidos de la FSIVGTT en base al modelo mínimo. La mitad de los participantes (n = 31) se seleccionaron aleatoriamente para acudir dos semanas después y evaluar la confiabilidad de todas las variables. RESULTADOS: HOMA1-%B y HOMA2-%B presentaron una correlación significativa con AIRg (Rho de Spearman (rs) = 0,33 and 0,37, respectivamente, p 0,50) con Si fueron insulina en ayuno, HOMA1-IR, HOMA2-IR, HOMA1-%S, HOMA2-%S, QUICKI y el índice de McAuley. Los parámetros que tuvieron buena confiabilidad (coeficiente de correlación intraclase > 0,75) fueron AIRg, HOMA1-%S, HOMA2-%S y QUICKI. Conclusiones: La mayoría de los ISS son instrumentos útiles y confiables.

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PURPOSE: The COVID-19 Fear Scale (FCV-19S) allows screening in general population; however, there is no specific instrument in our population for screening in the perinatal period that considers fear related with COVID-19 and offspring well-being. We aimed to validate the FCV-19S modified for application during the perinatal period. MATERIALS AND METHODS: Analytical, cross-sectional design. After signing consent, women 18-45 years were included. Internal consistency was calculated with Cronbach's alpha, external validity using the Hospital Anxiety and Depression Scale (HADS), factorial analysis and intraclass correlation coefficient for re-test. RESULTS: The sample included 178 women, mean age 31.04 ± 5.9. We obtained internal consistency with Cronbach's alpha = 0.873 (95%CI, 0.842-0.899). Spearman's Rho coefficient was 0.207 (p= .013). All the elements were statistically significant for the polychoric correlation (p<.001). Reliability test-retest with intraclass correlation was 0.873. CONCLUSIONS: The version of FCV-19S modified with eight items is a valid measurement instrument for application during the perinatal period, showing adequate internal consistency and external validity with HADS as measure of concurrence to identify anxiety related with COVID-19 during the perinatal period.

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Primary hyperlipidemias include a heterogeneous set of monogenic and polygenic conditions characterized by a strong family aggregation, severe forms of hypercholesterolemia and/or hypertriglyceridemia, appearance early on life, and a high risk of cardiovascular events and/or recurrent pancreatitis. In real life, a small proportion of the primary hyperlipidemia cases is recognized and treated properly. Our goal is to present an update of current and upcoming therapies for patients with primary hyperlipidemia. Recently, new lipid-lowering medications have obtained authorization from the U.S. Food and Drug Administration and the European Medicines Agency. These drugs target metabolic pathways, including (adenosine 5'-triphosphates)-citrate lyase (bempedoic acid), proprotein convertase subtilisin/kexin 9 (inclisiran), apolipoprotein CIII (volanesorsen), and angiopoietin-like 3 (volanesorsen), that have additive effects with the actions of the currently available therapies (i.e., statins, ezetimibe or fibrates). We discuss the potential clinical indications for the novel medications. To conclude, the addition of these new medications to the therapeutic options for primary hyperlipidemia patients may increase the likelihood of achieving the treatment targets. Also, it could be a safer alternative for patients with side effects for the currently available drugs.

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BACKGROUND: Simple surrogate indexes (SSI) to assess beta-cell function, insulin sensitivity (IS) and insulin resistance (IR) are an easy and economic tool used in clinical practice to identify glucose metabolism disturbances. AIM: To evaluate the validity and reliability of SSI that estimate beta-cell function, IS and IR using as a reference the parameters obtained from the frequently sampled intravenous glucose tolerance test (FSIVGTT). MATERIAL AND METHODS: We included 62 subjects aged 20-45 years, with a normal body mass index and without diabetes or prediabetes. SSI were compared with the acute insulin response to glucose (AIRg), insulin sensitivity index (Si) and disposition index (DI) obtained from the FSIVGTT using the minimal model approach. Half of the participants (n = 31) were randomly selected for a second visit two weeks later to evaluate the reliability of all the variables. RESULTS: HOMA1-%B and HOMA2-%B had a significant correlation with AIRg (Spearman Rho (rs) = 0.33 and 0.37 respectively, p < 0.01). The SSI evaluating IS/IR that showed stronger correlation (rs > 0.50) with Si were fasting insulin, HOMA1-IR, HOMA2-IR, HOMA1-%S, HOMA2-%S, QUICKI, and the McAuley index. The parameters that showed good reliability with an intraclass correlation coefficient (ICC) > 0.75 were AIRg, HOMA1-%S, HOMA2-%S, and QUICKI. CONCLUSIONS: Our results suggest that most of the SSI are useful and reliable.

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Whole body vibration (WBV) has been suggested as improving skin and blood flow. This study aimed to determine the effect of exposure to WBV on levels of partial transcutaneous oxygen pressure (TcPO2) in the foot of patients with type 2 diabetes (T2D) within the metabolic control goals. A block randomized, open, two-arm, parallel and controlled clinical trial was conducted. Participants recruited from the Center of Comprehensive Care for the Patient with Diabetes were assessed at the National Institute of Rehabilitation, Mexico City. Control group underwent multidisciplinary care for T2D; experimental group, in addition to the comprehensive diabetes care, was exposed to WBV through an exercise program, attending three times a week for a period of 3 months. TcPO2 was measured in the feet of the participants at baseline and after 12 weeks. A sample of 50 volunteers with recently-diagnosed T2D and similar baseline characteristics (demographic, cardiovascular risk, presence of diabetic polyneuropathy, and indicators of glycemic control and TcPO2) was recruited. The experimental group (n = 27) showed a mean value of 47.7 ± 6.1 mmHg in TcPO2, significantly higher (p = 0.028) than the 44.3 ± 7.5 mmHg of control group (n = 23), at the end of intervention. In conclusion, exposure to WBV promoted an increase and a significant 3 mmHg difference in the foot TcPO2 levels between those subjects with T2D that underwent the 12-week exercise program and those not exposed to the treatment.

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INTRODUCTION: The fear of COVID-19 scale (FCV-19S) is used to screen for symptoms of anxiety and depression related to COVID-19 in the general population; it consists of seven questions with Likert-type answers (1-5). Our objective was to validate FCV-19S Spanish version in the Mexican general population. MATERIAL AND METHODS: Analytical, cross-sectional design. Three-hundred and six subjects from the general population were included during 2020 after having signed informed consent. Barlett and Kaiser-Meyer-Olkin (KMO) sphericity tests were applied. Reliability was calculated with Cronbach's alpha, and external validity, using the Hospital Anxiety and Depression Scale and Pearson's correlation coefficient for retest. RESULTS: The general population sample included 306 participants; 64.4 % were women (n = 197), mean age was 32 years (18-68). We obtained a KMO = 0.848, internal consistency with Cronbach's alpha = 0.870 (95% CI: 0.848-0.891), a rho coefficient of 0.508 (p < 0.001) and external validity of 0.151 (p = 0.008). Confirmatory analysis showed: χ2 = 22.802 (df = 13) with CMIN-DF = 1.900 (p ≤ 0.001), GFI = 0.972, CFI = 0.901, RMSEA = 0.062 (90% CI: 0.019-0.100) and TLI = 0.827. CONCLUSIONS: According to our findings, the scale shows adequate psychometric properties: reliability, internal consistency, correlation with subsequent measurements and convergence validity, for initial screening of the Mexican general population.

INTRODUCCIÓN: La Escala de temor a la COVID-19 (FCV-19S) se usa en el tamizaje de síntomas de ansiedad y depresión relacionados con la COVID-19 en población general; consta de siete preguntas con respuestas tipo Likert (1-5). Nuestro objetivo fue validar la versión del FCV-19S en la población general mexicana. MATERIAL Y MÉTODOS: Diseño transversal analítico. Se incluyeron 306 sujetos de la población general durante 2020 con firma previa de consentimiento informado. Se aplicaron pruebas de esfericidad de Barlett y Kaiser-Meyer-Olkin (KMO). Se calculó la confiabilidad con el alfa de Cronbach, la validez externa utilizando la Escala hospitalaria de ansiedad y depresión y el coeficiente de correlación de Pearson para retest. RESULTADOS: La muestra de la población general incluyó a 306 participantes, el 64.4% mujeres (n = 197), edad media 32 años (18-68). Obtuvimos un KMO = 0.848, consistencia interna con alfa de Cronbach = 0.870 (IC 95%: 0.848-0.891), coeficiente rho de 0.508 (p < 0.001) y validez externa de 0.151 (p = 0.008). El análisis confirmatorio mostró: χ2 = 22.802 (df = 13) con CMIN-DF= 1.900, p ≤ 0.001, GFI = 0.972, CFI = 0.901, RMSEA = 0.062 (IC 90%: 0.019-0.100) y TLI = 0.827. CONCLUSIONES: La FCV-19S demuestra propiedades psicométricas adecuadas (confiabilidad, consistencia interna, correlación con mediciones subsecuentes y validez de convergencia) para su aplicación en la población general mexicana.

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BACKGROUND AND OBJECTIVE: Cardiovascular disease (CVD) is the main cause of death in children with chronic kidney disease (CKD). Inflammation and endothelial dysfunction (ED) are found in the majority of these patients and are factors associated to CVD. Flow mediated dilatation (FMD) is a surrogate marker validated for evaluating ED. Our objective was to identify risk factors associated to ED in children with CKD. MATERIALS AND METHODS: Children 2-16 years of age were studied. Clinical information and biochemical variables were gathered, including intact parathyroid hormone (iPTH), interleukins 6 and 1b, high sensitivity C reactive protein (hsCRP), reduced glutathione, nitric oxide, malondialdehyde and homocysteine. FMD was measured, and considered altered if <7%. RESULTS: Included were 129 patients aged 13.1 ±â€¯2.6 years. FMD < 7% was found in 69 (52.7%). Patients with altered FMD had higher levels of triglycerides and hsCRP than those with normal FMD (145.5 mg/dl vs. 120.0 mg/dl, P = .042, y 1.24 U/L vs. 0.55 U/L, P = .007, respectively), as well as higher frequency of low iPTH (19.1% vs. 4.9%, P = .036). Levels of hsCRP correlated significantly with FMD (Rho = -0.28, P = .003). Patients with low iPTH (OR = 4.41, 95%CI 1.13-17.27, P = .033) and increased hsCRP (OR = 2.89, 95%CI 1.16-7.17, P = .022) had higher adjusted risk of having FMD < 7%. CONCLUSIONS: Hypertriglyceridemia, inflammation and low iPTH associated significantly with altered FMD. They are frequent, treatable risk factors for CVD.

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OBJECTIVE: The aim of this study was to evaluate the association between glycemic control (hemoglobin (Hb) A1c <7%) and the dietary patterns identified in Mexican patients with type 2 diabetes mellitus (T2DM). METHODS: This was a secondary analysis conducted with 4838 patients with T2DM in Mexico. Biochemical blood profiles, socioeconomic level, anthropometric measurements, and dietary data were obtained. Dietary data from a food frequency questionnaire were used to derive dietary patterns. Factor analysis was conducted to ascertain dietary patterns, and multivariate analysis was fitted to assess the relationship between glycemic control and consumption of dietary patterns. RESULTS: Three dietary patterns were identified. After control for potential cofounders (age, sex, duration of T2DM, body mass index, pharmacologic treatment, intensity of physical activity, socioeconomic level, and kcal/kg ideal weight), we found that consuming a Western-style diet (odds ratio [OR], 1.533, 95% confidence interval [CI], 1.253-1.875; P < 0.000), and the sweets and dairy diet (fats and sugars; OR, 1.444; 95% CI, 1.133-1.841; P = 0.003) patterns were associated with HbA1c ≥7%, whereas consuming a healthy dietary patter (OR, 0.800; 95% CI, 0.642-0.998; P = 0.048) was associated with HbA1c <7%. CONCLUSIONS: Consuming a healthy diet was associated with glycemic control; whereas the Western-style or sweets and dairy patterns promoted a lack of metabolic control. These results support the promotion of a healthy pattern in the Mexican population with T2DM.

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BACKGROUND: The effect of nonnutritive sweeteners on appetite is controversial. Some studies have found changes in certain appetite control hormones with sucralose intake that may be through interaction with sweet taste receptors located in the intestine. OBJECTIVE: The aim of this study was to evaluate whether sucralose consumption could produce changes in fasting plasma concentrations of appetite-regulating hormones, including glucagon-like peptide 1, ghrelin, peptide tyrosine tyrosine, and leptin, and secondarily in insulin resistance. DESIGN: A 2-week parallel randomized clinical trial with an additional visit conducted 1 week after dosing termination. PARTICIPANTS/SETTING: Sixty healthy, normal-weight individuals, without habitual consumption of nonnutritive sweeteners were recruited from July 2015 to March 2017 in Mexico City. INTERVENTION: Daily sucralose consumption at 15% of the acceptable daily intake by using commercial sachets added to food. The control group followed the same protocol without an intervention. MAIN OUTCOMES MEASURED: Fasting concentrations of appetite regulating hormones before and after the intervention. Fasting glucose and insulin concentrations were measured to assess insulin resistance as a secondary outcome. STATISTICAL ANALYSIS PERFORMED: Basal and final concentrations were compared using Wilcoxon matched-pairs test and Mann-Whitney U test for analysis between groups. Repeated measures analysis of variance was used to evaluate changes in the homeostasis model assessment of insulin resistance. RESULTS: Sucralose was not associated with changes in any of the hormones measured. One week postintervention, an incremental change (P=0.04) in the homeostasis model assessment of insulin resistance was found in the intervention group. CONCLUSIONS: Sucralose intake is not associated with changes in fasting concentrations of glucagon-like peptide 1, ghrelin, peptide tyrosine tyrosine, or leptin. An increase in the homeostasis model assessment of insulin resistance observed only at 1 week postdosing is of unknown clinical significance, if any.

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CONTEXT: Little is known about the association between haptoglobin level and cardiometabolic traits. A previous genome-wide association study identified rs2000999 in the HP gene as the stronger genetic contributor to serum haptoglobin level in European populations. OBJECTIVE AND DESIGN: We investigated the association of HP rs2000999 with serum haptoglobin and childhood and adult obesity in up to 540/697 and 592/691 Mexican cases and controls, respectively. Anthropometric and biochemical data were collected. Serum haptoglobin was measured by an immunoturbidimetry assay. HP rs2000999 was genotyped using the TaqMan technology. Mendelian randomization analysis was performed using the Wald and inverse variance weighting methods. RESULTS: Haptoglobin level was positively associated with childhood and adult obesity. HP rs2000999 G allele was positively associated with haptoglobin level in children and adults. HP rs2000999 G allele was positively associated with childhood but not adult obesity. The association between HP rs2000999 and childhood obesity was removed after adjusting for haptoglobin level. In a Mendelian randomization analysis, haptoglobin level genetically predicted by HP rs2000999 showed a significant causal effect on childhood obesity by the Wald and inverse variance weighting methods. CONCLUSION: Our data provide evidence for the first time for a causal positive association between serum haptoglobin level and childhood obesity in the Mexican population. Our study contributes to the genetic elucidation of childhood obesity and proposes haptoglobin as an important biomarker and treatment target for obesity.

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AIMS: To describe the annual incidence of type 1 diabetes in children and adolescents insured by the Mexican Institute of Social Security, the main health provider in Mexico, during 2000-2018. METHODS: We conducted a secondary data analyses using the incidence registers from the Epidemiological Surveillance Coordination of the Mexican Institute of Social Security collected during 2000-2018. Incident type 1 diabetes cases (age 19 years old and below) were identified using ICD-10-CM E10 diagnostic codes. Age, sex, and geographical region and seasonal-specific incidence were calculated with their corresponding annual percentage change (APC) as well. RESULTS: In the period 2000-2018, the number of incident cases with type 1 diabetes decreased from 3.4 to 2.8 per 100,000 in insured for subjects below 20 years old. We observed an increase in the 2000-2006, followed by a decrease for the 2006-2018 period (APC +16.1 and -8.7 respectively). Females and children <5 years old had a significant decrease in the incidence rate, while inhabitants in Central Mexico showed a significant increase. No difference was found in incidence between seasons. CONCLUSIONS: Our study describes significant fluctuations of the incidence of type 1 diabetes during the period 2000-2018, which appeared to correspond to influenza outbreaks, among Mexican children and adolescents.

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Prevalence of elevated blood pressure in pediatric population has been increasing worldwide. Thus, the aim of this study was to examine whether the triglycerides and glucose (TyG) index is associated with the presence of prehypertension or hypertension in children and adolescents. Apparently healthy children aged 6 to 15 years were enrolled in a population-based cross-sectional study. Participants were allocated into groups with normal blood pressure (NBP), prehypertension, and hypertension. Smoking, alcohol intake, pregnancy, previous diagnosis of diabetes, kidney, hepatic, or endocrine diseases were exclusion criteria. NBP was defined by systolic and/or diastolic blood pressure < 90th percentile, prehypertension by systolic and/or diastolic blood pressure ≥ 90th < 95th percentile, and hypertension by systolic and/or diastolic blood pressure ≥ 95th percentile, according to age, sex, and height percentiles. A total of 3589 children were enrolled, 1748 (49%) girls and 1841 (51%) boys, and allocated into groups with NBP (n = 2874), prehypertension (n = 271), and hypertension (n = 444). The multiple logistic regression analysis stratified by age and adjusted by the Z-score/SDS of body mass index and waist circumference showed that elevated TyG index was significantly associated with prehypertension (OR = 1.48; 95% CI: 1.08-2.05) and hypertension (OR = 1.63; 95% CI: 1.26-2.11).Conclusion: The results of the present study shows that the elevated TyG index is significantly associated with the presence of prehypertension and hypertension in children and adolescents. What is Known: • Prevalence of elevated blood pressure in children and adolescents has been increasing worldwide. • Insulin resistance plays a key role in the pathogenesis of hypertension. What is New: • The elevated TyG index is significantly associated with the presence of prehypertension in children aged 6-9 years and adolescents aged 10-15 years. • The elevated TyG index is significantly associated with the presence of hypertension in children aged 6-9 years and adolescents aged 10-15 years.

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Given that adipocytokines may play an important role in the pathophysiology of high blood pressure (HBP) and because related reports in children are scarce and controversial, we evaluated the relationship of leptin, resistin, tumor necrosis factor-α, interleukin-6, adiponectin, and interferon-γ with HBP. Materials and Methods. A total of 129 (53.8%) girls and 111 (46.2%) boys, with average ages of 10.8 ± 0.9 and 10.6 ± 1.0 years, respectively, were enrolled in a cross-sectional study. HBP was defined by systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) between the 90th and 95th percentiles. A multivariate logistic regression backwards-stepwise analysis adjusted for body mass index, waist circumference, and triglyceride levels was performed to compute the association between adipocytokines and HBP. Results. Seventy-two (30.0%) participants showed HBP: 44 (61.1%) girls and 28 (38.9%) boys. Multivariate analysis showed that, irrespective of obesity, serum levels of adiponectin, but not those of other adipocytokines, are inversely associated with HBP (odds ratio 0.93; 95% CI 0.77 to 0.98, p = .04). Conclusions. Our results show that low serum adiponectin levels, but not those of other adipocytokines, are inversely associated with HBP; this association is independent of obesity.

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INTRODUCTION: Refusal of physicians to prescribe insulin to their patients has been scarcely evaluated; the delay in treatment intensification hinders adequate and quality care. OBJECTIVE: To identify the perception of primary care physicians about barriers to initiate insulin treatment in patients with diabetes. METHOD: Using the Smith Index and multivariate analysis, the relevance and grouping of concepts related to barriers to insulin prescription were assessed in 81 family doctors. RESULTS: Only 35.8% of physicians showed confidence for prescribing insulin; almost half of them rated treatment intensification between moderately and little important (39.5% and 6.2%). Barriers were related to the physician (39.5%), the patient (37%), insulin treatment (11.1%) and the institution (6.2%); 6.2 % of physicians did not perceive any barrier. The barriers were grouped in 5 factors that explained 62.48% of the variance: patient cultural level, lack of medical skills, fear of adverse events, insecurity and lack of training. CONCLUSION: Clinical inertia was not the result of a complex medical condition or patient comorbidities, but of doctor's perception and confidence in his/her clinical and communication skills.

INTRODUCCIÓN: Poco se ha evaluado el rechazo de los médicos a prescribir insulina a sus pacientes; el retraso en intensificar el tratamiento impide una atención adecuada y de calidad. OBJETIVO: Identificar la percepción de los médicos acerca de las barreras para iniciar la insulina en los pacientes con diabetes. MÉTODO: Por Índice Smith y análisis multivariado, en 81 médicos familiares se evaluó la relevancia y agrupación de los conceptos relacionados con las barreras para la prescripción de insulina. RESULTADOS: 35.8 % de los médicos mostró confianza en prescribir insulina; casi la mitad calificó la intensificación del tratamiento entre moderadamente y poco importante (39.5 y 6.2 %). Las barreras se relacionaron con el médico (39.5 %), el paciente (37 %), el tratamiento con insulina (11.1 %) y la institución (6.2 %); 6.2 % de los médicos no percibió ninguna barrera. Las barreras se agruparon en cinco factores, que explicaron 62.48 % de la varianza: cultura de los pacientes, falta de habilidades, miedo a los eventos adversos, inseguridad y falta de capacitación. CONCLUSIÓN: La inercia clínica no resultó de una condición clínica compleja o comorbilidades del paciente, sino de la percepción del médico y de su confianza en sus habilidades clínicas y comunicativas.

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Resumen Introducción: Poco se ha evaluado el rechazo de los médicos a prescribir insulina a sus pacientes; el retraso en intensificar el tratamiento impide una atención adecuada y de calidad. Objetivo: Identificar la percepción de los médicos acerca de las barreras para iniciar la insulina en los pacientes con diabetes. Método: Por Índice Smith y análisis multivariado, en 81 médicos familiares se evaluó la relevancia y agrupación de los conceptos relacionados con las barreras para la prescripción de insulina. Resultados: 35.8 % de los médicos mostró confianza en prescribir insulina; casi la mitad calificó la intensificación del tratamiento entre moderadamente y poco importante (39.5 y 6.2 %). Las barreras se relacionaron con el médico (39.5 %), el paciente (37 %), el tratamiento con insulina (11.1 %) y la institución (6.2 %); 6.2 % de los médicos no percibió ninguna barrera. Las barreras se agruparon en cinco factores, que explicaron 62.48 % de la varianza: cultura de los pacientes, falta de habilidades, miedo a los eventos adversos, inseguridad y falta de capacitación. Conclusión: La inercia clínica no resultó de una condición clínica compleja o comorbilidades del paciente, sino de la percepción del médico y de su confianza en sus habilidades clínicas y comunicativas.

Abstract Introduction: Refusal of physicians to prescribe insulin to their patients has been scarcely evaluated; the delay in treatment intensification hinders adequate and quality care. Objective: To identify the perception of primary care physicians about barriers to initiate insulin treatment in patients with diabetes. Method: Using the Smith Index and multivariate analysis, the relevance and grouping of concepts related to barriers to insulin prescription were assessed in 81 family doctors. Results: Only 35.8% of physicians showed confidence for prescribing insulin; almost half of them rated treatment intensification between moderately and little important (39.5% and 6.2%). Barriers were related to the physician (39.5%), the patient (37%), insulin treatment (11.1%) and the institution (6.2%); 6.2 % of physicians did not perceive any barrier. The barriers were grouped in 5 factors that explained 62.48% of the variance: patient cultural level, lack of medical skills, fear of adverse events, insecurity and lack of training. Conclusion: Clinical inertia was not the result of a complex medical condition or patient comorbidities, but of doctor’s perception and confidence in his/her clinical and communication skills.

Assuntos