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AIM: To evaluate the use of intermittently scanned continuous glucose monitoring (isCGM) in patients with liver cirrhosis (LC). METHODS: Observational study including 30 outpatients with LC (Child-Pugh B/C): 10 without diabetes (DM) (G1), 10 with newly diagnosed DM by oral glucose tolerance test (G2), and 10 with a previous DM diagnosis (G3). isCGM (FreeStyle Libre Pro) was used for 56 days (four sensors/patient). Blood tests were performed at baseline and after 28 and 56 days. RESULTS: No differences were found in the baseline characteristics, except for higher age in G3. There were significant differences between G1, G2 and G3 in glucose management indicator (GMI) (5.28 ± 0.17, 6.03 ± 0.59, 6.86 ± 1.08%, P < .001), HbA1c (4.82 ± 0.39, 5.34 ± 1.26, 6.97 ± 1.47%, P < .001), average glucose (82.79 ± 7.06, 113.39 ± 24.32, 149.14 ± 45.31mg/dL, P < .001), time in range (TIR) (70.89 ± 9.76, 80.2 ± 13.55, 57.96 ± 17.96%, P = .006), and glucose variability (26.1 ± 5.0, 28.21 ± 5.39, 35.31 ± 6.85%, P = .004). There was discordance between GMI and HbA1c when all groups were considered together, with a mean difference of 0.35% (95% SD 0.17, 0.63). In G1, the mean difference was 0.46% (95% SD 0.19, 0.73) and in G2 0.69% (95% SD 0.45, 1.33). GMI and HbA1c were concordant in G3, with a mean difference of -0.10 % (95% SD [-0.59, 0.38]). CONCLUSION: Disagreements were found between the GMI and HbA1c levels in patients with LC. isCGM was able to detect abnormalities in glycemic control that would not be detected by monitoring with HbA1c, suggesting that isCGM can be useful in assessing glycemic control in patients with LC.
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This is a two-part paper: in the first one, a personal story serves as a conceptual prism through which I address the issue of how a queer analyst can be a problem for analytical psychology; in the second, I present some readings and images-mostly from decolonial feminisms-that have been of interest to me lately in my path to queer Jungian psychology, that is, to de-essentialize and de-individualize its theory and practice. By borrowing (and altering) the title from Gloria Anzaldúa's (1991/2009a) essay "To(o) queer the writer", this paper explores some themes she has elaborated there on solidarity, theorization and ways of writing and reading from othered points of view. In dialogue with Donna Haraway's (2016) Staying with the Trouble and Ursula K. Le Guin's (1989/2000) The Carrier Bag Theory of Fiction, together with the imagery of bags, weaving and string figures game, this paper aims to explore the potential of what I have called "woven onto-epistemologies". By imagining and developing this new condition of knowledge, other stories and theories in analytical psychology may have an opportunity to be told.
Cet essai est composé de deux parties : dans la première, une histoire personnelle sert de prisme conceptuel à travers lequel j'aborde la question de savoir comment un analyste queer peut être un problème pour la psychologie analytique ; dans la seconde, je présente quelques lectures et images principalement issues des féminismes décoloniaux auxquelles je me suis intéressée ces derniers temps, afin de rendre la psychologie jungienne plus queer, c'estàdire désessentialiser et désindividualiser cette théorie et cette pratique. En empruntant (et en modifiant) le titre de l'essai de Gloria Anzaldúa « To(o) queer the writer ¼, cet article explore certains thèmes qu'elle y a développés sur la solidarité, la théorisation et les manières d'écrire et de lire à partir du point de vue d'autrui. En dialoguant avec Staying with the Trouble de Donna Haraway et Carrier Bag of Fiction d'Ursula K. Le Guin, ainsi qu'avec l'imagerie des sacs, du tissage et du jeu avec des figurines en ficelle, cet article vise à explorer le potentiel de ce que j'ai appelé les ontoépistémologies tissées. En imaginant et en développant cette nouvelle condition de la connaissance, d'autres histoires et théories de la psychologie analytique auront peutêtre l'occasion d'être racontées.
Este ensayo consta de dos partes: en la primera, una historia personal sirve como prisma conceptual a través del cual abordo la cuestión de cómo una analista 'queer' puede ser un problema para la psicología analítica; en la segunda, presento algunas lecturas e imágenes principalmente de los feminismos decoloniales que me han interesado últimamente, con el fin de 'queerizar' la psicología junguiana, es decir, desesencializar y desindividualizar esta teoría y práctica. Tomando prestado (y alterando) el título del ensayo de Gloria Anzaldúa "To(o) queer the writer", este artículo explora algunos temas allí elaborados acerca de la solidaridad, la teorización y las formas de escribir y leer desde otros puntos de vista. En diálogo con 'Staying with the Trouble' de Donna Haraway y 'Carrier Bag of Fiction' de Ursula K. Le Guin, junto con las imágenes de bolsas, tejidos y juegos de cuerdas, este artículo busca explorar el potencial de lo que he denominado ontoepistemologías tejidas. Imaginando y desarrollando esta nueva condición para el conocimiento, otras historias y teorías en psicología analítica pueden tener la oportunidad de ser contadas.
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Teoria Junguiana , Feminino , Humanos , PsicoterapiaRESUMO
The progression from prediabetes to type-2 diabetes depends on multiple pathophysiological, clinical, and epidemiological factors that generally overlap. Both insulin resistance and decreased insulin secretion are considered to be the main causes. The diagnosis and approach to the prediabetic patient are heterogeneous. There is no agreement on the diagnostic criteria to identify prediabetic subjects or the approach to those with insufficient responses to treatment, with respect to regression to normal glycemic values or the prevention of complications. The stratification of prediabetic patients, considering the indicators of impaired fasting glucose, impaired glucose tolerance, or HbA1c, can help to identify the sub-phenotypes of subjects at risk for T2DM. However, considering other associated risk factors, such as impaired lipid profiles, or risk scores, such as the Finnish Diabetes Risk Score, may improve classification. Nevertheless, we still do not have enough information regarding cardiovascular risk reduction. The sub-phenotyping of subjects with prediabetes may provide an opportunity to improve the screening and management of cardiometabolic risk in subjects with prediabetes.
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Metabolic dysfunction is highly prevalent and contributes to premature mortality among people with schizophrenia (PwS), especially in Hispanic/Latino/a/x/e PwS, compared to non-Hispanic White (NHW) PwS. This study evaluated the relative contributions of Mexican descent and schizophrenia diagnosis to metabolic biomarker levels. This cross-sectional study included 115 PwS and 102 non-psychiatric comparison (NC) participants - English-speakers aged 26-66 years, 27% Mexican descent, and 52% women across both groups. Assessments included evaluations of BMI, psychopathology, and fasting metabolic biomarkers. We used ANOVA analyses to compare metabolic outcomes between diagnostic and ethnic subgroups, linear regression models to examine associations between Mexican descent and metabolic outcomes, and Spearman's correlations to examine relationships between metabolic outcomes and illness-related variables in PwS. Mexican PwS had higher hemoglobin A1c levels, insulin resistance, and body mass index than NHW PwS. Mexican descent was associated with higher hemoglobin A1c levels, insulin resistance, body mass index, and leptin levels, controlling for age, sex, depression, education, and smoking. Among Mexican PwS, worse negative symptoms were associated with greater insulin resistance. These findings support the possibility of ethnicity-based differences in metabolic dysregulation, though further investigation is warranted to create targeted health interventions for Hispanic PwS.
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Resistência à Insulina , Esquizofrenia , Feminino , Humanos , Masculino , Biomarcadores , Estudos Transversais , Etnicidade , Hemoglobinas Glicadas , Americanos Mexicanos , Brancos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , IdosoRESUMO
SUMMARY OBJECTIVE: Our research objective was to validate and contribute further evidence to the studies regarding large for gestational age and birthweight percentile by examining oral glucose tolerance test and glycosylated hemoglobin levels in both healthy women and those with gestational diabetes mellitus. METHODS: This retrospective cohort study was conducted at a tertiary care hospital involving 106 women who delivered at gestational week 36 or later between February 2022 and February 2023. Maternal, obstetric, and neonatal data were collected from the participant's medical records. Large for gestational age and non-large for gestational age groups were compared. Correlation analysis was used to determine associations among oral glucose tolerance test, glycosylated hemoglobin levels, and the birthweight percentile. RESULTS: Mothers of neonates in the large for gestational age category had higher body mass indexes before pregnancy (p=0.002) and delivery (p=0.003), as well as a higher incidence of gestational diabetes mellitus (p=0.027). Mothers of male large for gestational age infants had higher fasting plasma glucose and glycosylated hemoglobin levels compared to male non-large for gestational age infants (p=0.007 and p=0.004, respectively). There was a weak positive correlation between fasting plasma glucose levels and birthweight percentile in the overall group (r=0.342, p<0.006). Further analysis by gender showed a weak positive correlation between birthweight percentile and fasting plasma glucose and glycosylated hemoglobin values in male newborns (r=0.393, p=0.004 and r=0.373, p=0.006, respectively). CONCLUSION: Our study has established a clear association between the birthweight percentile in male infants and the levels of glycosylated hemoglobin and fasting plasma glucose measured during oral glucose tolerance test. It is imperative to devise potential strategies aimed at achieving optimal glycosylated hemoglobin and fasting plasma glucose parameters to effectively reduce the frequency of large for gestational age in male infants.
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AIM: To evaluate the impact of multicomponent integrated care (MIC) delivery program in a primary care real-life setting on diabetes care goals. METHODS: Patients with T2D and usual primary care from the public health system in Mexico were invited to participate in a five-month ambulatory MIC quality initiative (DIAbetes Empowerment and Improvement of Care program, DIABEMPIC). RESULTS: 841 patients who finished the program and with complete data were analyzed. The patients had a mean decrease in hemoglobin A1c, systolic and diastolic pressure, and LDL-cholesterol of 2.4%, 9 mmHg, 3 mmHg, and 22.5 mg/dL, respectively (p < 0.001). The achievement of the optimal triple target goal increased from 1.8% to 26.7% (p < 0.001). In the adjusted analysis, the diabetes knowledge and global self-care behavior score post-intervention, as well as the increment of global self-care behavior score were associated with the optimal composite risk factor control achievement. CONCLUSION: The incorporation of diabetes therapeutic education interventions to improve self-care behaviors along with adequate treatment intensification in diabetes care are fundamental to attaining optimal risk factor control and attenuating disease burden.
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Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Melhoria de Qualidade , Hemoglobinas Glicadas , Pressão Sanguínea , Planejamento de Assistência ao Paciente , Atenção Primária à SaúdeRESUMO
AIMS: To determine the association between sleep quality and lack of glycemic control in a Mexican population of type 2 diabetes patients. METHODS: Cross-sectional study. Two hundred two patients between 20 and 60 years old with a previous diagnosis of diabetes were included. Sleep quality was assessed with the Pittsburgh Sleep Quality Index and lack of glycemic control as a glycated hemoglobin A1c level ≥ 7 %. Univariate and multivariate analyses using logistic regression were performed. RESULTS: The study population showed poor sleep quality and a lack of glycemic control of 70.3 % and 69.8 %, respectively. The prevalence of patients with both conditions was 52.5 %. In multivariate analysis, poor sleep quality was significantly associated with a lack of glycemic control (OR = 2.3, p = 0.030). Other associated variables were napping (p = 0.015), diabetes duration (p = 0.011), insulin use (p = 0.024), and diastolic blood pressure ≥ 85 mmHg (p = 0.029). CONCLUSIONS: The prevalence of lack of glycemic control in the study population is high. Poor sleep quality significantly doubles the risk of lack of glycemic control, even in the presence of other risk factors.
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Diabetes Mellitus Tipo 2 , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Qualidade do Sono , Estudos Transversais , Controle Glicêmico , Sono/fisiologia , Glicemia/análiseRESUMO
La estandarización de la hemoglobina A1c (HbA1c) permitió en algunos países su uso para el diagnóstico de la diabetes mellitus (DM) y la prediabetes, además de su empleo en el seguimiento del paciente con DM. Es importante recordar que se trata de una medida indirecta del promedio glucémico durante el tiempo de vida media del eritrocito, pudiendo verse afectada por variables no glucémicas, como también por interferencias analíticas según la metodología empleada para su determinación. A continuación, se describen las recomendaciones y consideraciones a tener en cuenta para la determinación de la HbA1c cuando se emplea como criterio diagnóstico de la DM, teniendo en cuenta que al utilizarla para tal fin es necesario que la medida se realice con métodos certificados y estandarizados al ensayo utilizado en el Diabetes Control and Complications Trial (DCCT).
The standardization of hemoglobin A1c (HbA1c) allowed in some countries its use for the diagnosis of diabetes mellitus (DM) and prediabetes, in addition to its use in the follow-up of patients with DM. It is important to highlight that it is an indirect measurement of the glycemic average during the halflife of the erythrocyte, and may be affected by non-glycemic variables, as well as by analytical interferences depending on the methodology used for its determination. The recommendations and considerations to take into account for the determination of HbA1c when it is used as a diagnostic criterion for diabetes are described below. In addition, it is important to emphasize that it is essential that the HbA1c measurement be performed with certified and standardized methods to the Diabetes Control and Complications Trial (DCCT)results.
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Estado Pré-Diabético , Diabetes MellitusRESUMO
Diabetes is one of the top 5 non-communicable diseases that occur worldwide according to the World Health Organization. Despite not being a fatal disease, a late diagnosis as well as poor control can cause a fatal outcome, because of that, several studies have been carried out with the aim of proposing additional techniques to the gold standard to assist in the diagnosis and control of this disease in a non-invasive way. Considering the above, and in order to provide a solid starting point for future researches, we share a primary research dataset with 1040 saliva samples obtained by Fourier Transform Infrared Spectroscopy considering the Attenuated Total Reflectance method. Database include: gender, age, individuals (patients) with/without diabetes, the glucose value, and the result to the A1C test for the diabetic population. We believe that sharing dataset as is could increase experimentation, research, and analysis of spectra through different strategies broaden its range of applicability by chemists, doctors, physicists, computer scientists, among others, to identify the effects that the virus causes in the body and to propose possible clinical treatments as well as to develop devices that allow us to assist in the characterization of possible carriers.
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This paper presents the narrative of vice-chief Meireles Karitiana, with the participation of chief-shaman Cizino Karitiana, who discusses the Karitiana people's origin myth, particularly in relation to the tension between God and Orá, his brother - a tension between good and evil. The paper describes what can be understood of ancestral life, and the value of connecting life and earth today, especially the forest. It highlights some aspects of the myth related particularly to consumption, domination, anthropocentricity, and the transcendent emergence of a third energy from the tension between the 'good' God and his 'bad' brother; this is related to Jungian thinking.
Cet article traite du récit du vice-chef Meireles Karitiana - avec la participation du chamane-chef Cizino Karitiana - qui aborde le mythe d'origine du peuple Karitiana, particulièrement en ce qui concerne la tension entre Dieu et Ora, son frère - une tension entre le bien et le mal. L'article décrit ce que l'on peut comprendre de la vie ancestrale, et l'importance de mettre en lien la vie et la terre aujourd'hui, et tout particulièrement la forêt. L'article souligne certains aspects du mythe, particulièrement ceux qui se rapportent à la consommation, la domination, l'anthropocentricité, et l'émergence transcendante d'une troisième énergie à partir de la tension entre le 'bon' Dieu et son 'mauvais' frère. Ceci est mis en lien avec la pensée Jungienne.
El siguiente trabajo presenta la narrativa del vice-jefe Meireles Karitiana con la participación del chamán Cizino Karitiana, quienes debaten acerca del mito de origen de la población Karitiana, particularmente con relación a la tensión entre Dios y Orá, su hermano - una tensión entre el bien y el mal. El trabajo describe la comprensión que podemos ganar de la vida ancestral, y el valor de conectar la vida y la tierra hoy, especialmente la selva. Destaca algunos aspectos del mito relacionados particularmente al consumo, la dominación, el antropocentrismo, y la emergencia trascendente de una tercera energía a partir de la tensión entre el 'buen' Dios y su hermano 'malo', lo cual se relaciona con el pensamiento Junguiano.
Este artigo apresenta a narrativa do vice-chefe Meireles Karitiana, com a participação do xamã-chefe Cizino Karitiana, que discute o mito de origem do povo Karitiana, particularmente em relação à tensão entre Deus e Orá, seu irmão - uma tensão entre o bem e o mal. O artigo descreve o que pode ser entendido sobre a vida ancestral e o valor de conectar a vida e a terra hoje, especialmente a floresta. Ele destaca alguns aspectos do mito relacionados particularmente ao consumo, dominação, antropocentricidade e ao surgimento transcendente de uma terceira energia da tensão entre o Deus "bom" e seu irmão "ruim" isso está relacionado ao pensamento junguiano.
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Teoria Junguiana , Etnicidade , Humanos , Masculino , NarraçãoRESUMO
In recent decades, music therapy in the Neonatal Intensive Care Unit (NICU) has been shown to regulate preterm infant's physiological responses and improve maternal mental health. This study investigated the effects of the music therapy intervention for the mother-preterm infant dyad (MUSIP) for maternal anxiety, postnatal depression, and stress, and preterm infants' weight gain, length of hospitalization, heart rate (HR), and oxygen saturation (So2 ). A pre-experimental design was used with 33 mother-preterm infant dyads in a Brazilian NICU: 16 dyads in the Music Therapy Group (MTG) and 17 dyads in the Control Group (CG). The MTG took part in the MUSIP, aimed at supporting maternal singing with the preterm baby. Infants' HR and So2 were recorded at each minute from 10 min before to 10 min after sessions 1, 3, and 6. Before infants' discharge, maternal anxiety and depression scores were lower in the MTG compared to the CG. Anxiety, depression, and stress levels decreased significantly after the intervention in the MTG. With regard to infants, HR and So2 ranges were higher during music therapy, compared to before and after sessions. MUSIP improved maternal mental health and affected preterm infants' emotional arousal, with positive trends in decreasing HR, stabilizing So2 , and reducing length of hospitalization.
En décadas recientes, la terapia musical de la Unidad de Cuidados Intensivos Neonatales ha demostrado poder regular las respuestas fisiológicas del infante nacido prematuramente y mejorar la salud mental materna. Este estudio investigó los efectos de la Intervención de Terapia Musical para la Díada Madre-Infante Prematuro (MUSIP) en cuanto a la ansiedad materna, la depresión posnatal y el estrés, así como el aumento del peso de los infantes prematuros, el tiempo de hospitalización, el ritmo cardíaco (HR) y la saturación de oxígeno (SO2). Un diseño preexperimental se usó con 33 díadas de madre-infante prematuro en una Unidad brasileña de Cuidados Intensivos Neonatales: 16 díadas en el Grupo de Terapia Musical (MTG) y 17 díadas en el Grupo de Control (CG). El MTG participó en MUSIP, con la finalidad de apoyar el canto materno con el bebé prematuro. Se anotó el HR y SO2 de los infantes en cada minuto a partir de 10 minutos antes hasta 10 minutos después de la Sesión 1, 3 y 6. Antes de darles de alta a los infantes, se redujeron los puntajes de ansiedad y depresión maternas en el MTG tal como se le comparó con el CG. Los niveles de ansiedad, depresión y estrés se redujeron significativamente después de la intervención en el MTG. Con respecto a los infantes, los intervalos de HR y SO2 fueron más altos durante la terapia musical, tal como se les comparó con los momentos antes y después de las sesiones. MUSIP ayudó a mejorar la salud mental materna y afectó el despertar emocional de los infantes prematuros, con tendencias a reducir el HR, estabilizar el SO2 y reducir el tiempo de hospitalización.
Dans les vingt et trente dernières années, il a été démontré que la thérapie musicale en Réanimation Néonatale régule les réponses physiologiques du bébé prématuré et améliore la santé mentale maternelle. Cette étude a étudié les effets de l'Intervention de Thérapie Musicalepour la dyade Mère-Bébé Prématurés (MUSIP) pour l'anxiété maternelle, la dépression postnatale, et le stress, ainsi que la prise de poids des bébés prématurés, la longueur de l'hospitalisation, le rythme cardiaque (RC ici) et la saturation d'oxygène (sO2). Une structure pré-expérimentale a été utilisée avec 33 dyades mère-nourrisson prématuré dans une Réanimation Néonatale au Brésil: 16 dyades dans le Groupe Thérapie Musicale (GTM en français) et 17 dyades dans le Groupe de Contrôle (GC en français). Le groupe GTM a pris part à la MUSIP, destiné à aider et soutenir les mères à chanter avec leur bébé prématuré. Le RC et la sO2 des nourrissons ont été enregistrés à chaque minute pendant 10 minutes avant jusqu'à 10 minutes après la Session 1, 3, et 6. Les scores d'évacuation des nourrissons, de l'anxiété maternelle et de dépression maternelle étaient moins élevés dans le GTM que dans le GC. L'anxiété, la dépression et les niveaux de stress ont baissé de manière importante durant l'intervention dans le groupe GTM. Pour ce qui concerne les nourrissons, les éventails de RC et de sO2 était plus élevés durant la thérapie musicale, comparés à avant et après les sessions. La MUSIP a amélioré la santé mentale maternelle et affecté la stimulation émotionnelle des nourrissons prématurés, avec des tendances positives dans la baisse du RC, la stabilisation sO2 et la réduction de la longueur de l'hospitalisation.
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Unidades de Terapia Intensiva Neonatal , Musicoterapia , Nível de Alerta , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Saúde Mental , MãesRESUMO
Background: Information regarding diagnosis, treatment, and follow-up of patients with type 1 diabetes (PWT1D) in Mexico is limited. We developed an on-line platform Registro Nacional de Pacientes con Diabetes Tipo 1 (RENACED-DT1). Objective: The objective of the study was to describe the characteristics and healthcare of PWT1D registered in RENACED-DT1. Methods: Analyses of 965 PWT1D from July 2014 to January 2018 in different endocrinology clinics around Mexico. Results: Sixty-one percent were female with median age of 21 years, age at diagnosis 11 years, and disease duration at inclusion 8.2 years. Treatment regimen was basal-bolus in 61% and insulin-pumps in 21% (mainly in the private sector); 33.3% with self-monitoring of blood-glucose (SMBG) ≥4 times/day. Mean HbA1c at last follow-up was 8.7 ± 2.1% (72±23 mmol/mol), 18% had HbA1c < 7% (53 mmol/mol), and 35% > 9% (75 mmol/mol). SMBG ≥ 4 times/day was associated with HbA1c < 7%. Time since diagnosis > 10 years, female sex, BMI ≥ 30 kg/m2, SMBG < 4 times/day, and any hypoglycemia were associated with microvascular complications (p < 0.05). Conclusions: Percentage of patients achieving HbA1c < 7% is low; increased blood glucose monitoring is associated with better glycemic control. The achievement of optimal glycemic control must be increased to reduce the incidence of chronic complications and improve quality of life in PWT1D.
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Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 1/epidemiologia , Qualidade de Vida , Glicemia , Hemoglobinas Glicadas/análise , Automonitorização da Glicemia , Sistema de Registros , Hipoglicemiantes , Insulina , México/epidemiologiaRESUMO
OBJECTIVE: The objective of this study was to characterize the composition of the gut microbiota in type 2 Diabetes Mellitus (T2DM) patients with adequate and inadequate metabolic control, and its relationship with fiber consumption. RESULTS: A total of 26 patients with type 2 diabetes mellitus (T2DM) were enrolled, of which 7 (26.9%) cases had adequate metabolic control (HbA1c < 7%) and 19 (73.1%) inadequate metabolic control (HbA1c ≥ 7%). It was observed that among patients with controlled T2DM, 2 (28.6%) cases presented good intake of fiber and 5 (71.4%) cases a regular intake. In contrast, in patients with uncontrolled T2DM, 13 (68.4%) patients reported a regular intake and 6 (31.6%) a poor intake. In relation to the identification of the gut microbiota, both groups presented a similar characterization. There were differences in the population of bacteria identified in both groups, however, the results were not statistically significant. The most frequently identified bacteria in controlled and uncontrolled T2DM patients were Prevotella (71.4% vs 52.6%), followed by Firmicutes (71.4% vs 42.1%), Proteobacteria (71.4% vs 36.8%) and Bacteroidetes (57.1% vs 37.8%). On the other hand, Fusobacterium, Actinobacteria were not identified in either of the two groups of study.
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Diabetes Mellitus Tipo 2 , Microbioma Gastrointestinal , Bactérias/genética , Fezes , Firmicutes , HumanosRESUMO
BACKGROUND: Achieving an optimal glycemic control has been described to reduce the incidence of diabetes mellitus (DM) related complications. The association between comorbidities and glycemic control remains unclear. Our aim is to evaluate the effect of comorbidities on glycemic control in people living with DM. METHODS: A retrospective longitudinal study on data from the National Registry of Chronic Kidney Disease from 2014 to 2019 in Colombia. The outcome was poor glycemic control (PGC = HbA1c ≥7.0%). The association between each comorbidity (hypertension (HTN), chronic kidney disease (CKD) or obesity) and PGC was evaluated through multivariate mixed effects logistic regression models. The measures of effect were odds ratios (OR) and their 95% confidence intervals (CI). We also evaluated the main associations stratified by gender, insurance, and early onset diabetes as well as statistical interaction between each comorbidity and ethnicity. RESULTS: From 969,531 people at baseline, 85% had at least one comorbidity; they were older and mostly female. In people living with DM and CKD, the odds of having a PGC were 78% (OR: 1.78, CI 95%: 1.55-2.05) higher than those without CKD. Same pattern was observed in obese for whom the odds were 52% (OR: 1.52, CI 95%: 1.31-1.75) higher than in non-obese. Non-significant association was found between HTN and PGC. We found statistical interaction between comorbidities and ethnicity (afro descendant) as well as effect modification by health insurance and early onset DM. CONCLUSIONS: Prevalence of comorbidities was high in adults living with DM. Patients with concomitant CKD or obesity had significantly higher odds of having a PGC.
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Análise de Dados , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Controle Glicêmico/métodos , Hipoglicemiantes/uso terapêutico , Adulto , Idoso , Colômbia/epidemiologia , Comorbidade , Diabetes Mellitus/tratamento farmacológico , Feminino , Humanos , Nefropatias/sangue , Nefropatias/tratamento farmacológico , Nefropatias/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/tratamento farmacológico , Obesidade/epidemiologia , Estudos Prospectivos , Sistema de Registros , Estudos RetrospectivosRESUMO
BACKGROUND: Information regarding diagnosis, treatment, and follow-up of patients with type 1 diabetes (PWT1D) in Mexico is limited. We developed an on-line platform Registro Nacional de Pacientes con Diabetes Tipo 1 (RENACED-DT1). OBJECTIVE: The objective of the study was to describe the characteristics and healthcare of PWT1D registered in RENACED-DT1. METHODS: Analyses of 965 PWT1D from July 2014 to January 2018 in different endocrinology clinics around Mexico. RESULTS: Sixty-one percent were female with median age of 21 years, age at diagnosis 11 years, and disease duration at inclusion 8.2 years. Treatment regimen was basal-bolus in 61% and insulin-pumps in 21% (mainly in the private sector); 33.3% with self-monitoring of blood-glucose (SMBG) ≥4 times/day. Mean HbA1c at last follow-up was 8.7 ± 2.1% (72±23 mmol/mol), 18% had HbA1c < 7% (53 mmol/mol), and 35% > 9% (75 mmol/mol). SMBG ≥ 4 times/day was associated with HbA1c < 7%. Time since diagnosis > 10 years, female sex, BMI ≥ 30 kg/m2, SMBG < 4 times/day, and any hypoglycemia were associated with microvascular complications (p < 0.05). CONCLUSIONS: Percentage of patients achieving HbA1c < 7% is low; increased blood glucose monitoring is associated with better glycemic control. The achievement of optimal glycemic control must be increased to reduce the incidence of chronic complications and improve quality of life in PWT1D.
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Diabetes Mellitus Tipo 1 , Adolescente , Glicemia , Automonitorização da Glicemia , Criança , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/terapia , Feminino , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemiantes , Insulina , Masculino , México/epidemiologia , Qualidade de Vida , Sistema de Registros , Adulto JovemRESUMO
OBJECTIVES: Achieving glycated hemoglobin (A1C) and blood pressure targets is an important strategy for preventing chronic vascular complications in diabetes. Our aim in this study was to determine the proportion of type 2 diabetes patients who meet the recommended A1C and arterial blood pressure targets and to identify the determinants of failure to do so. METHODS: A cross-sectional study was conducted in an outpatient endocrine clinic at a university hospital. The A1C goal was 7% in general and 8% for patients with advanced chronic complications. Regarding blood pressure, the overall expected target was 140/90 mmHg. RESULTS: A total of 602 type 2 diabetes patients were analyzed: 62% were female, 14% self-reported as black, mean age was 63±11 years, mean diabetes duration was 17±9 years and median A1C was 8.0% (interquartile range, 7.0% to 9.5%). Macrovascular disease was present in 33% of the patients, diabetic retinopathy in 47%, peripheral neuropathy in 43% and diabetic kidney disease in 56%. Regarding metabolic control, 403 (67%) patients were not at the adjusted target A1C level, and being female, black, young and an insulin user were the main determinants of poor glycemic control. Regarding blood pressure, 348 (58%) patients were not at the recommended targets, and a more advanced age was the main associated factor. CONCLUSIONS: Because more than half of type 2 diabetes outpatients do not meet the recommended A1C and blood pressure target values, there is a major call to overcome the therapeutic inertia and target treatment of patients on an individual basis.
Assuntos
Pressão Sanguínea/fisiologia , Diabetes Mellitus Tipo 2/terapia , Hemoglobinas Glicadas/análise , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCCIÓN: La diabetes mellitus tipo 1 (DM1) es una enfermedad que se perfila para toda la vida. OBJETIVO: Identificar evidencia científica sobre el impacto de la DM1 en la calidad de vida de los adolescentes portadores de esta enfermedad. MÉTODO: Revisión sistemática en las bases bibliografías MEDLINE, LILACS, CINAHL y ScIELO, utilizando los descriptores "Adolescent*", "Teen*", "Diabe tes Mellitus, Type1", "Diabetes, type 1", "Type 1 diabetes", "Quality of life", "Health related quality of life", "Life quality", "Health impact assessment", "Health impact", "Impact assessment, health", "Diabetes Impact Measurement Scales", "PedsQL", "Glycated Hemoglobin A1c", "Glycosylated He moglobin A1c", y "HbA1c". De los 679 artículos localizados, 25 fueron incluidos en el análisis. Al gunos estudios fueron multicéntricos nacionales e internacionales. Los instrumentos más utilizados, relativos a las mediciones de la calidad de vida, fueron el Cuestionario de Calidad de Vida Pediátrica (PedsQL) en su versión genérica y módulo diabetes. RESULTADOS: La calidad de vida evaluada por el adolescente que padece DM1 mediante Escalas de calidad de vida, está significativamente e inversa mente asociada a los valores de HbA1c. Esta vinculación se extiende a una correlación significativa entre los puntajes genéricos totales de calidad de vida y HbA1c, pero no tiene la misma repercusión en los puntajes específicos. CONCLUSIONES: El control metabólico se establece como la piedra angular que incide en el impacto en la relación DM1 y calidad de vida; vinculación que se vislumbra como bidireccional, aunque no se evidencia un consenso absoluto sobre los tipos de factores y los grados que influirían en el control metabólico.
INTRODUCTION: Type 1 diabetes mellitus (DM1) is a chronic disease. OBJECTIVE: To identify scientific evidence on the impact of DM1 on the quality of life of adolescents with this disease. METHOD: Sys tematic review in the bibliographic databases MEDLINE, LILACS, CINAHL, and ScIELO, using the following descriptors: "Adolescent *", "Teen *", "Diabetes Mellitus, Type1", "Diabetes, type 1", "Type 1 diabetes", "Quality of life", "Health related quality of life", "Life quality", "Health impact assessment", "Health impact", "Impact assessment, health", "Diabetes Impact Measurement Scales", "PedsQL", "Glycated Hemoglobin A1c", "Glycosylated Hemoglobin A1c", and "HbA1c". Out of 679 articles identified, 25 were included in the analysis. Some studies were national and international multicenter. The most widely used instruments related to quality of life measurements were the Pediatric Quality of Life Questionnaire (PedsQL) in its generic version and the diabetes module. RESULTS: The quality of life assessed by the adolescent with DM1 using Quality of Life Scales is significantly and inversely associated with HbA1c values. This association includes a significant correlation between the total generic quality of life scores and HbA1c but does not have the same impact on specific sco res. CONCLUSIONS: Metabolic control appears to be the cornerstone that influences the impact on the bidirectional relationship between DM1 and quality of life, however, there is no absolute consensus on the types of factors and degrees that would influence metabolic control.
Assuntos
Humanos , Adolescente , Qualidade de Vida , Hemoglobinas Glicadas/metabolismo , Diabetes Mellitus Tipo 1/fisiopatologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To describe patient preparation for routine outpatient blood work and examine the implications of surreptitious fasting on interpretation of glucose results. PATIENTS AND METHODS: We designed a survey and administered it between September 1, 2016, and April 30, 2017, to assess fasting behaviors in a convenience sample of 526 adults presenting for outpatient blood work in 2 health systems between 7 am and 12 pm. We reviewed the electronic health records to extract glucose results. We describe the frequency of clinician-directed fasting and surreptitious fasting. In those surreptitiously fasting, we describe the frequency of missed diagnoses of prediabetes and diabetes. RESULTS: Of 526 participants, 330 (62.7%) self-identified as fasting, and 304 (92.1%) of those fasting met American Diabetes Association fasting criteria. Only 131 (24.9%) of those fasting were told to fast by their health care team. Almost 50% (257 of 526) believed it was important to fast for every blood test. Of the 64 patients with diabetes who were taking insulin, 37 (57.8%) fasted and took their insulin as prescribed. Among the 89 patients without diabetes who fasted without knowledge of their health care team and had glucose tested, 2 (2.2%) had a missed diagnosis of diabetes and 18 (20.2%) had a missed diagnosis of prediabetes. CONCLUSION: Fasting for outpatient blood work is common, and patients frequently fast without awareness of their health care team. Failure to capture fasting status at the time of glucose testing is a missed opportunity to identify undiagnosed cases of diabetes and prediabetes.
RESUMO
BACKGROUND: Indoor air pollution is an important risk factor for health in low- and middle-income countries. METHODS: We measured indoor fine particulate matter (PM2.5) and carbon monoxide (CO) concentrations in 617 houses across four settings with varying urbanisation, altitude, and biomass cookstove use in Peru, between 2010 and 2016. We assessed the associations between indoor pollutant concentrations and blood pressure (BP), exhaled carbon monoxide (eCO), C-reactive protein (CRP), and haemoglobin A1c (HbA1c) using multivariable linear regression among all participants and stratifying by use of biomass cookstoves. RESULTS: We found high concentrations of indoor PM2.5 across all four settings (geometric mean ± geometric standard deviation of PM2.5 daily average in µg/m3): Lima 41.1 ± 1.3, Tumbes 35.8 ± 1.4, urban Puno 14.1 ± 1.7, and rural Puno 58.8 ± 3.1. High indoor CO concentrations were common in rural households (geometric mean ± geometric standard deviation of CO daily average in ppm): rural Puno 4.9 ± 4.3. Higher indoor PM2.5 was associated with having a higher systolic BP (1.51 mmHg per interquartile range (IQR) increase, 95% CI 0.16 to 2.86), a higher diastolic BP (1.39 mmHg higher DBP per IQR increase, 95% CI 0.52 to 2.25), and a higher eCO (2.05 ppm higher per IQR increase, 95% CI 0.52 to 3.57). When stratifying by biomass cookstove use, our results were consistent with effect measure modification in the association between PM2.5 and eCO: among biomass users eCO was 0.20 ppm higher per IQR increase in PM2.5 (95% CI - 2.05 to 2.46), and among non-biomass users eCO was 5.00 ppm higher per IQR increase in PM2.5 (95% CI 1.58 to 8.41). We did not find associations between indoor air concentrations and CRP or HbA1c outcomes. CONCLUSIONS: Excessive indoor concentrations of PM2.5 are widespread in homes across varying levels of urbanisation, altitude, and biomass cookstove use in Peru and are associated with worse BP and higher eCO.