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BACKGROUND: Although important advances in treatment strategies have been developed in type 2 diabetes mellitus (T2DM), large gaps exist in achieving glycemic control and preventing complications, particularly in low-and middle-income countries, which suggests a potential effect of social determinants of health (SDH, i.e., education level and socioeconomic status). However, few studies have determined the role of SDH and other determinants of health (ODH, i.e., diabetes knowledge and self-care scores) in achieving T2DM goals during effective multidisciplinary interventions. We aimed to examine a multicomponent integrated care (MIC) program on diabetes care goals and determine the effect of SDH and ODH on T2DM patients. METHODS: A before-and-after design (a pretest, a 5-month intervention, and a follow-up) was used in a T2DM population from Mexico City. The SDH included education level and socioeconomic status; the ODH included diabetes knowledge, self-care scores, and deltas (i.e., differences between baseline and follow-up scores). The triple-target goal (glycated hemoglobin, blood pressure, and LDL-cholesterol) was established as a measurement of T2DM goals. RESULTS: The DIABEMPIC (DIABetes EMPowerment and Improvement of Care) intervention (n = 498) reduced the glycated hemoglobin levels (mean reduction 2.65%, standard deviation [SD]: 2.02%) and cardiometabolic parameters; it also improved health-related quality of life. From 1.81% at baseline, 25.9% of participants (p-value< 0.001) achieved the triple-target goal. We found a significant association between education level (p-value = 0.010), diabetes knowledge at baseline (p-value = 0.004), and self-care scores at baseline (p-value = 0.033) in the delta (change between baseline and follow-up assessments) of HbA1c levels. Improvements (increase) in diabetes knowledge (p-value = 0.006) and self-care scores (p-value = 0.002) were also associated with greater reductions in HbA1c. CONCLUSIONS: MIC strategies in urban primary care settings contribute to control of T2DM. SDH, such as education level, and ODH (diabetes knowledge and self-care scores at baseline) play a key role in improving glycemic control in these settings.

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Reverse cholesterol transport is a process of high antiatherogenic relevance in which apolipoprotein AI (apoA-I) plays an important role. The interaction of apoA-I with peripheral cells produces through mechanisms that are still poorly understood the mobilization of intracellular cholesterol depots toward plasma membrane. In macrophages, these mechanisms seem to be related to the modulation of the activity of acyl-CoA cholesterol acyltransferase (ACAT), the enzyme responsible for the intracellular cholesterol ester biosynthesis that is stored in lipid droplets. The activation of ACAT and the accumulation of lipid droplets play a key role in the transformation of macrophages into foam cells, leading to the formation of atheroma or atherosclerotic plaque. ApoA-I Helsinki (or ∆K107) is a natural apoA-I variant with a lysine deletion in the central protein region, carriers of which have increased atherosclerosis risk. We herein show that treatment of cultured RAW macrophages or CHOK1 cells with ∆K107, but not with wild-type apoA-I or a variant containing a similar deletion at the C-terminal region (∆K226), lead to a marked increase (more than 10 times) in the intracellular ACAT1 protein level as detected by western blot analysis. However, we could only detect a slight increase in cholesteryl ester produced by ∆K107 mainly when Chol loading was supplied by low-density lipoprotein (LDL). Although a similar choline-phospholipid efflux is evoked by these apoA-I variants, the change in phosphatidylcholine/sphyngomyelin distribution produced by wild-type apoA-I is not observed with either ∆K107 or ∆K226.

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El objetivo de este estudio fue determinar los efectos inmediatos y tardíos de una competencia de triatlón sobre lípidos y lipoproteínas plasmáticos en mujeres entrenadas. Fueron estudiadas 8 triatletas mujeres. Todas compitieron en una triatlón internacional que consistió en 1,9 km. de natación, 90 km. de ciclismo y 21 km. de carrera. Se obtuvieron muestras de plasma venoso 24 horas antes de la triatlón y a los 10 minutos, 24 horas , 48 horas y 72 horas después. Los análisis incluyeron la determinación de triglicéridos TG, glicerol G, colesterol HDL C-HDL, colesterol LDL LDL-C y colesterol total CT. No se encontraron cambios significativos inmediatos en los TG. El G plasmático aumentó alos 10 minutos después de la triatlón 65,8 a 177,6 u mol/L; p<0,006, mientras que el C-LDL disminuyó 126 a 77 mg/d L; p<0,05. Además se obtuvo un aumento tardío en los TG a las 72 horas después de la competencia 51,6 mg/dl a 70,3 mg/dl; p<0,05. Finalmente se encontró una disminución significatica en CT 196,9 a 159 mg/dl; p<0,04 a las 24 horas después de la triatlón. Estos datos demuestran que la competencia de triatlón induce modificaciones inmediatas y tardías en lípidos y lipoproteínas plasmáticos en mujeres altamente entrenadas

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Se presenta la experiencia con 24 pacientes constipados crónicos idiopáticos tratados por un año con 30 gramos día de fibra vegetal suplemetando su dieta habitual. Luego del período de estudio, se aprecian diferencias significativas en la calidad de vida de los afectados al aumentar en promedio sus evacuaciones de 2,12 a 4,7 por semana. También se observó una disminución subjetiva de la dificultad para evacuar el bolo fecal y una mejoría en el pérfil lipídico de dichos pacientes

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