Risk factors for type 2 diabetes mellitus and cardiovascular diseases in Hispanic adolescents

This cross-sectional study evaluated risk factors (RF) for type 2 diabetes (T2DM) and cardiovascular diseases (CVD) in 100 Hispanic adolescents(50 overweight, 50 non-overweight) aged 12-16 years, and their associations with body mass index (BMI), diet, physical activity (PA), gender, and birth weight (BW). The RF studied were fasting plasma glucose (FPG), insulin sensitivity (IS), total cholesterol (TC), triacylglycerols (TG), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), acanthosis nigricans (AN), and blood pressure (BP). Dietary intakes were assessed using the Block Kids Questionnaire, fat-related intake behavior (FB) using the Fat-Related Diet Habits Questionnaire, and PA using the Modifiable Activity Questionnaire for Adolescents. Blood was collected after an overnight fast of 12 hours. All statistical analyses used SPSS 14.0. Overweight adolescents had presence of AN, higher BP, TC, TG, and LDL, and lower IS, ps < .001, as compared to non-overweight adolescents. Overweight adolescents were more likely to have 1 and 2 RF for T2DM and CVD as compared to having 0, ps < .001, and 2 RF as compared to having 1, p =.033. Adolescents with kilocalorie (Kcal) intake above requirements for age gender, and PA level were 4.6 times more likely to be overweight, p = .005. Overweight adolescents had worse FB, p = .011, and lower PA, p < .001. Adolescents with worse FB had higher BP, p = .016. Fiber below recommendations (14g/1,000 Kcal) was associated with being overweight, p = .012, and lower IS, p = .040. Adolescents with higher BW had higher FPG, p = .013. Our findings point to an association between being overweight and RF for T2DM and CVD, suggesting that overweight during adolescence may have serious health consequences for Hispanic adolescents. Also, our results indicate that Hispanic overweight adolescents eat more Kcal and less fiber than required, have worst FB, and less PA levels than their non-overweight counterparts. In addition, high BW and dietary habits of Hispanic adolescents, such as low fiber and FB, increase their risk for T2DM and CVD. We conclude that BMI can serve as a useful tool to identify Hispanic adolescents at risk for T2DM and CVD.

Psychosocial barriers to self -care among Hispanic women with type 2 diabetes mellitus

This cross-sectional survey-designed study investigated the presence and influence of psychosocial barriers to diabetes self-management practices among Hispanic women with type 2 diabetes mellitus. Women (n = 128) who were diagnosed and being treated for type 2 diabetes were recruited from the Miami-Dade area in South Florida. A Beck Depression Inventory-II, Diabetes Care Profile, Diabetes Knowledge Test, Diabetes Empowerment, Multidimensional Health Locus of Control, and Perceived Stress Scales were administered, along with assessment of diet through a 24-hour recall and anthropometric evaluation by body composition analysis and body mass index computation. ^ Mean (± SD) age for subjects was 50.15 ± 15.93 and age at diagnosis was 42.46 ± 14.69. Mean glycosylated hemoglobin (A 1C) was 8.55 ± 1.39. Diabetes education had not been received by 46.9% of subjects. Psychosocial status had previously been evaluated in only 4 participants. Forty percent of participants were assessed as depressed and 17% moderately to severely so. Depression correlated significantly (p < 0.01) with A1C (r = 0.242), perceived stress (r = 0.566), and self-rated health (r = −0.523). Perceived stress correlated significantly (p < 0.01) with A1C (r = 0.388), understanding of diabetes (r = 0.282), self-rated health (r = −0.372) and diabetes empowerment (r = −0.366). For Cuban women, perceived stress (β = 0.418, p = 0.033) was the only significant predictor of A1C, while among non-Cuban Hispanic women, self-reported health (β = −0.418, p = 0.003) and empowerment (β = 0.432, p = 0.004) were better predictors. The most desirable DM status among the women surveyed (high diet adherence, low exercise barriers, and A1C ≤ 7) was associated with superior self-rated health, more support from family and friends, and greater empowerment. ^ This study revealed the error in considering Hispanics a homogenous entity in treating disease, as their cultural backgrounds and concentration in a community can greatly influence management of a chronic disease like diabetes. The strong correlations found between diabetes-related health indicators and psychosocial factors such as depression and perceived stress suggest that psychosocial assessment of patients must be more strongly advocated in diabetes care. Psychosocial assessment of ethnically diverse diabetic populations is especially vital if greater knowledge is to be gained about their barriers to self-care so that diabetes treatment and thus outcomes are enhanced. ^

Atividade Física e Diabetes tipo 1 em crianças: estudo de caso para análise de variações das concentrações glicémicas ao longo de 6 meses

Considerada como uma das mais importantes doenças crónicas na infância, a diabetes mellitus tipo 1 foi a base para a realização deste estudo de caso. A fim de conhecer e compreender as variações das concentrações glicémicas numa criança desportista com diabetes tipo 1, ao longo de 6 meses, foram efetuados registos diários das suas concentrações de glicémia em 5 diferentes momentos do dia (antes das refeições e durante o sono); registo dos momentos de prática de exercício físico; entrevista à enfermeira responsável pelo acompanhamento do referido indivíduo; conversas com os progenitores e uma recolha bibliográfica que esclarecesse toda a dinâmica e rotinas de crianças com diabetes mellitus tipo 1, bem como o seu efeito na prática desportiva, tentando perceber os benefícios que poderá induzir perante esta condição de saúde. Através da associação entre os resultados obtidos e a revisão literária, foi possível perceber a causa de ocorrência de híper e hipoglicémias. Ademais, foi possível inferir que a prática desportiva em crianças com diabetes mellitus tipo 1 é, na grande maioria dos casos, benéfica. Concluindo, o desporto proporciona, para além dos efeitos já conhecidos, uma diminuição na insulina necessária para um adequando equilíbrio glicémico e adaptações fisiológicas que melhoram a condição de saúde.

Fear of Falling and Balance Confidence in Older Adults with Diabetes Mellitus

Several determinants of fear of falling (FoF) and low balance confidence overlap with the consequences/complications of diabetes mellitus (DM). FoF is strongly associated with low balance confidence, and balance confidence mediates the relationship between FoF and balance and physical function. The purpose of this thesis was two-fold: (1) to examine the prevalence, severity and determinants of FoF in older adults (aged≥65) with DM, and (2) to evaluate the validity of the short version of the Activities-specific Balance Confidence scale (ABC-6) and its association with balance and postural control in older adults with DM. Three separate studies were conducted of older adults with DM (DM-group) and without DM (noDM-group). Study I revealed that although FoF prevalence adjusted for age and sex was not different between-groups, the DM-group had 8.8% fewer participants in the low and 8.4% more in the high Falls-Efficacy Scale International categories when compared to the noDM-group. Higher FoF severity in the DM-group was associated with poor physical performance, being female, fall history and clinical depressive symptoms. Study II provided evidence of convergent, discriminant and concurrent validity of the ABC-6 for use in older adults with DM with and without diabetic peripheral neuropathy (DPN). Notably, the ABC-6 was more sensitive in detecting subtle differences in balance confidence between the DM-group and noDM-group when compared to the original ABC scale (ABC-16), and can be administered in less time. Study III explored balance confidence (ABC-6) and its association with balance and postural control in older adults with DM. Subtle differences in axial segmental control (i.e., lower trunk roll velocity and higher head-trunk correlations) while walking and lower balance confidence were apparent in the DM-group, even in the absence of DPN, when compared to the noDM-group. Balance confidence partially explained the variance in head-trunk stiffening between-groups, and consequently low balance confidence in older adults with DM may contribute to the dependence on postural control strategies that are normally only utilized in high-risk situations. Findings from this thesis will help to guide the development of protocols for screening and intervention recommendations of patient education and targeted rehabilitation programs for older adults with DM.

Alleles that increase risk for type 2 diabetes mellitus are not associated with increased risk for Alzheimer's disease

Although epidemiological studies suggest that type 2 diabetes mellitus (T2DM) increases the risk of late-onset Alzheimer's disease (LOAD), the biological basis of this relationship is not well understood. The aim of this study was to examine the genetic comorbidity between the 2 disorders and to investigate whether genetic liability to T2DM, estimated by a genotype risk scores based on T2DM associated loci, is associated with increased risk of LOAD. This study was performed in 2 stages. In stage 1, we combined genotypes for the top 15 T2DM-associated polymorphisms drawn from approximately 3000 individuals (1349 cases and 1351 control subjects) with extracted and/or imputed data from 6 genome-wide studies (>10,000 individuals; 4507 cases, 2183 controls, 4989 population controls) to form a genotype risk score and examined if this was associated with increased LOAD risk in a combined meta-analysis. In stage 2, we investigated the association of LOAD with an expanded T2DM score made of 45 well-established variants drawn from the 6 genome-wide studies. Results were combined in a meta-analysis. Both stage 1 and stage 2 T2DM risk scores were not associated with LOAD risk (odds ratio = 0.988; 95% confidence interval, 0.972-1.004; p = 0.144 and odds ratio = 0.993; 95% confidence interval, 0.983-1.003; p = 0.149 per allele, respectively). Contrary to expectation, genotype risk scores based on established T2DM candidates were not associated with increased risk of LOAD. The observed epidemiological associations between T2DM and LOAD could therefore be a consequence of secondary disease processes, pleiotropic mechanisms, and/or common environmental risk factors. Future work should focus on well-characterized longitudinal cohorts with extensive phenotypic and genetic data relevant to both LOAD and T2DM.

Type 2 Diabetes Mellitus: Risk Evaluation and Advice in Undergraduate Students in Ashrafieh, Lebanon

Type 2 diabetes mellitus (T2DM) is a chronic lifestyle disease. It has become evident that T2DM occurs even among the younger age groups.1 In Lebanon, T2DM has a major public health impact through high disease prevalence, significant downstream pathophysiologic effects, and enormous financial liabilities.2

Cost-effectiveness Study of Antidiabetic Drugs in Type 2 Diabetes Mellitus Patients From Mumbai, India

Diabetes is fast gaining the status of a potential epidemic in India, with >62 million individuals currently diagnosed with the disease.1 India currently faces an uncertain future in relation to the potential burden that diabetes may impose on the country. An estimated US$ 2.2 billion would be needed to sufficiently treat all cases of type 2 diabetes mellitus (T2DM) in India.2 Many interventions can reduce the burden of this disease. However, health care resources are limited; thus, interventions for diabetes treatment should be prioritized.

Dickkopf1 (DKK1), metabolismo óseo y enfermedad ateroesclerótica en pacientes con diabetes mellitus tipo 2

Objetivos: La diabetes mellitus tipo 2 (DM2) se asocia a un incremento del riesgo de fracturas y de enfermedades cardiovasculares. Los objetivos de nuestro estudio fueron evaluar los niveles séricos de Dickkopf-1 (DKK1) en una cohorte de pacientes con DM2 y analizar su relación con el metabolismo óseo y la enfermedad ateroesclerótica (EA). Pacientes y métodos: Se estudiaron 126 sujetos: 72 pacientes con DM2 (edad media de 58,2±6 años) y 54 sujetos no diabéticos (edad media de 55,4±7 años). Se midió DKK1 mediante ensayo de inmunoabsorción ligado a enzimas (ELISA, Biomedica Gruppe), se determinó la densidad mineral ósea (DMO) mediante absorciometría dual de rayos X (DXA), se registró la presencia de EA (enfermedad cerebrovascular, enfermedad arterial periférica, cardiopatía isquémica) y se evaluó el grosor de la íntima-media (GIM, ultrasonografía doppler) y la calcificación aórtica (radiología simple). Resultados: No se encontraron diferencias significativas en DKK1 entre diabéticos y no diabéticos. Las concentraciones séricas de DKK1 fueron significativamente mayores en las mujeres de la muestra total (24,3±15,2 vs. 19,6±10,2 pmol/L, p=0,046) y del grupo DM2 (27,5±17,2 vs. 19,8±8,9 pmol/L, p=0,025). Hubo una correlación positiva entre DKK1 y DMO lumbar en la muestra total (r=0,183, p=0,048). Sin embargo, no se encontraron diferencias en función del diagnóstico de osteoporosis o presencia de fracturas vertebrales morfométricas. Los valores de DKK1 fueron significativamente mayores en los pacientes con DM2 y EA (26,4±14,5 pmol/L vs. 19,1±11,6 pmol/L, p=0,026) y también en pacientes con GIM anormal (26,4±15,1 pmol/L vs. 19,8±11,3 pmol/L, p=0,038). En el análisis de la curva ROC para evaluar la utilidad de DKK1 como un marcador de alto riesgo de EA, el área bajo la curva fue de 0,667 (intervalo de confianza -IC- del 95%: 0,538-0,795; p=0,016). Una concentración de 17,3 pmol/L o superior mostró una sensibilidad del 71,4% y una especificidad del 60% para identificar un mayor riesgo de EA. Conclusiones: Los niveles circulantes DKK1 son más altos en los diabéticos con EA y se asocian con un GIM patológico. Por tanto, consideramos que DKK1 puede estar implicado en la enfermedad vascular de los pacientes con DM2.

Cambios y/o potencialización de los estilos de vida que practican familiares con enfermedades metabólicas: diabetes mellitus tipo2, hipertensión arterial Fundación DONUM 2002-2003

Con el objetivo de evaluar la efectividad de las modificaciones en los estilos de vida, en la prevención o retardo de la aparición de enfermedades metabólicas. Es un estudio de investigación acción participativa cuyo universo comprendió los usuarios preferidos de la fundación y la muestra es por conveniencia. El grupo de estudio participó en 8 talleres, para modificar y/o reforzar los CAPs sobre estilos de vida. Resultados: de las 24 personas estudiadas, el 66.7son mujeres, el 33.3son hombres, todos residen en el área urbana del cantón Cuenca, el 100tienen familiares con diabetes mellitus tipo 2. Se realizó una valoración inicial y una valoración final encontrándose: un 29.9de conocimientos buenos sobre estilos de vida al inicio de la investigación, un 100al terminar la misma. Actitud muy de acuerdo sobre beneficios y prácticas de alimentación saludable encontrando al inicio un 0, y 41.7al final; actitud muy de acuerdo sobre beneficios y prácticas de actividad física con un 0al inicio, y un 33.3al final del estudi, actitud muy en edsacuerdo sobre consumo de alchohol y tabaco en un 20.8inicialmente y 95.8al final de la investigación; prácticas muy buenas sobre estilos de vida 20.8al inicio y 83.3al final; preferencias alimenticias por el grupo 1, 29.2al inicio y 75.0al final; hábito de fumar negativo 83.3al inicio y 91.7al final, hábito alcohólico negativo 93.7al inicio y 100.0al final; actividad física no sedentarios 16.7al inicio y 54.2al final; promedio de índice de masa corporal 28 al inicio y 27.2 al final; colesterol promedio 219 mg/dl al final; sin riesgo de síndrome metabólico 25al inicio y 33.3al final; integración familiar cada fin de semana 4.2al inicio y 50& al final. Conclusiones: se sonfirma que los investigados han modificado favorablemente sus estilos de vida, asi como también, han mejorado sus indicadores del estado nutricional

Inercia clínica en pacientes con Diabetes Mellitus en la Clínica Metabólica Unidad Médica Soyapango 2013

La falta en iniciar o intensificar la terapia cuando esta está indicada es conceptualizada como inercia clínica (IC). Es una causa importante de fracasos en el tratamiento de pacientes con diabetes mellitus tipo 2. La prevalencia de IC se describe entre el 36 a 50% en pacientes con Ddabetes mellitus, y relacionada con el manejo de hipertensión arterial y dislipidemias puede contribuir hasta un 80% de los ataques cardíacos y los accidentes cerebrovasculares. El objetivo de la presente investigación es establecer la proporción de pacientes con diabetes mellitus tipo 2 controlados por medio de hemoglobina glicada y su relación con la inercia clínica (inercia terapéutica) dentro del grupo de pacientes diabéticos del programa de Clínicas Metabólicas en la Unidad Médica Soyapango del Instituto Salvadoreño del Seguro Social durante el año 2013. Se realizó un estudio tipo descriptivo retrospectivo tomando de referencia al universo de pacientes documentados dentro del registro a los que se les indicó HbA1c utilizando muestreo probabilístico de tipo aleatorio, resultando una muestra de 41 sujetos, obteniendo los siguientes resultados;51% del sexo masculino, con una edad promedio 55,9 años (DE +/- 10,9),54% con educación menor a bachillerato, el 46% recibe tratamiento con hipoglucemiantes orales; el 59% se les reportó HbA1c > 7%. Al relacionar la presencia de inercia clínica y el grado de control glucémico se obtuvo p< 0.05, Odds Ratio de Prevalencia 0.01538 (IC 0.034- 0.68). Por lo que concluimos que la relación entre IC y el grado control glucémico no es plausible debido a la escasa muestra obtenida. Sin embargo, la investigación puede orientar a medidas que permitan mejorar el control de los pacientes enfocadas a la atención médica y la organización de la prestación del servicio.

Funcionalidad familiar en pacientes con diabetes mellitus tipo 2 en Hospital ISSS Sonsonate

A pesar de existir diversidad de medicamentos para el manejo del paciente con diabetes mellitus tipo 2, persiste el descontrol. La familia juega un papel importante en la salud integral de cada uno de sus miembros y en la recuperación o en el control adecuado de la enfermedad. Objetivo: conocer la asociación entre el puntaje de evaluación de la funcionalidad familiar medido por el APGAR Familiar y el control glucémico en pacientes que consultan subsecuentemente por diabetes mellitus tipo 2 en el Hospital Regional de Sonsonate ISSS. Material y métodos: tipo de diseño del trabajo de investigación; descriptivo transversal. El universo son todas las personas con diabetes mellitus tipo 2 en el Hospital Regional de Sonsonate ISSS en el período de julio 2015 y la muestra fue de 192 personas, todos aquellos pacientes diabéticos que tienen cita de control subsecuente y a quienes por medio de una entrevista-cuestionario y previo consentimiento informado, se recolectó la información a través de un test de percepción de funcionalidad familiar y cuestionario epidemiológico. Resultados: del total de la población de la investigación, el 62% son del sexo femenino, el 36% se encontraron entre 61 y 70 años de edad, el estado civil correspondió a 72% casados o acompañados, el 28% de la población sabían leer y escribir o tenia estudios primarios y el resto con educación básica, media o superior; el 44% es beneficiaria, el 33% pensionada y el 23% cotizante, el 36% se encontraron con valor de glucosa en ayunas; controlados entre 70 - 120mg/dl y el resto, que es el 64% por arriba de esos valores, el 83% de las familias estudiadas fueron funcionales y 17% se encontraron entre disfunción moderada y severa.

Avaliação do retinol em parturientes com diabetes mellitus gestacional no pós parto imediato

Micronutrient deficiencies affect individuals mainly in developing countries, where vitamin A deficiency is a public health problem worldwide more worrying, especially in groups with increased physiological needs such as children and women of reproductive age. Vitamin A is supplied to the body through diet and has an important role in the visual process, cell differentiation, maintenance of epithelial tissue, reproductive and resistance to infection. The literature has demonstrated the relationship between vitamin A and diabetes, including gestational, leading to a risk to both mother and child. Gestational diabetes is any decrease in glucose tolerance of variable magnitude diagnosed each the first time during pregnancy, and may or may not persist after delivery. Insulin resistance during pregnancy is associated with placental hormones, as well as excess fat. Studies have shown that retinol transport protein produced in adipose tissue in high concentrations, this would be associated with resistance by interfering with insulin signaling. Therefore, this study aimed to evaluate the concentration of retinol in serum and colostrum from healthy and diabetic mothers in the immediate postpartum period. One hundred and nine parturient women were recruited, representing seventy-three healthy and thirty-six diabetic. Retinol was extracted and subsequently analyzed by High Performance Liquid Chromatography. Among the results highlights the mothers with gestational diabetes were older than mothers healthy, had more children and a higher prevalence of cases of cesarean section. Fetal macrosomia was present in 1.4% of healthy parturient women and in 22.2% of diabetic mothers. The maternal serum retinol showed an average of 39.7 ± 12.5 mg/dL for healthy parturients 35.12 ± 15 mg/dL for diabetic and showed no statistical difference. It was observed that in the group of diabetic had 17% vitamin A deficiency, whereas in the healthy group, only 4% of the women were deficentes. Colostrum, the concentration of retinol in healthy was 131.3 ± 56.2 mg/dL and 125.3 ± 41.9 mg/dL in diabetic did not differ statistically. This concentration of retinol found in colostrum provides approximately 656.5 mg/day for infants born to healthy mothers and 626.5 mg/day for infants of diabetic mothers, based on a daily consumption of 500 mL of breast milk and need Vitamin A 400 mg/day, thus reaching the requirement of the infant. The diabetic mothers showed significant risk factors and complications related to gestational diabetes. Although no 11 difference was found in serum retinol concentration and colostrum among women with and without gestational diabetes, the individual analysis shows that parturients women with diabetes are 4.9 times more likely to develop vitamin A deficiency than healthy parturients. However, the supply of vitamin A to the newborn was not committed in the presence of gestational diabetes

Relationship between religiosity, religious coping and socio-demographic variables among out-patients with depression or diabetes mellitus in Enugu, Nigeria.

Background: Religion is a powerful coping strategy. Diabetes and depression are common conditions in our environment that induce psychological distress, thus requiring coping for better outcome. Studies indicate that increased religiosity is associated with better outcome in clinical and general populations. Therefore, studies of the distribution of religiosity and religious coping among these populations are essential to improve outcome. Objectives: To assess the association between religiosity, religious coping in depression and diabetes mellitus, and selected sociodemographic variables (age, gender and occupational status). Methods:Using simple random sampling we recruited 112 participants with diabetes and an equal number with depression consecutively, matching for gender. Religiosity was determined using religious orientation scale (revised), religious coping with brief religious coping scale and socio-demographic variables with a socio-demographic questionnaire. Results: Intrinsic religiosity was greater among older people with depression than among older people with diabetes(t=5.02,p<0.001); no significant difference among young people with depression and diabetes(t=1.47,p=0.15).Positive religious coping was greater among older people with depression than among older people with diabetes(t=2.31,p=0.02); no difference among young people with depression and diabetes(t=0.80,p=0.43). Females with depression had higher intrinsic religiosity scores than males with depression(t=3.85,p<0.001); no difference in intrinsic religiosity between females and males with diabetes(t=0.99,p=0.32).Positive religious coping was greater among participants with diabetes in the low occupational status(t=2.96,p<0.001) than those in the high occupational status. Conclusion: Religion is indeed a reliable coping method, most commonly used by the elderly and females with depression. Positive religious coping is more common among diabetic patients who are in the low occupational status.