1
|
Goodman-Palmer D, González-Rivas JP, Jaacks LM, Duran M, Marulanda MI, Ugel E, Chavarro JE, Danaei G, Nieto-Martinez R. The diabetes care continuum in Venezuela: Cross-sectional and longitudinal analyses to evaluate engagement and retention in care. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002763. [PMID: 38232087 PMCID: PMC10793920 DOI: 10.1371/journal.pgph.0002763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/07/2023] [Indexed: 01/19/2024]
Abstract
The impact of the humanitarian crisis in Venezuela on care for noncommunicable diseases (NCDs) such as diabetes is unknown. This study aims to document health system performance for diabetes management in Venezuela during the humanitarian crisis. This longitudinal study on NCDs is nationally representative at baseline (2014-2017) and has follow-up (2018-2020) data on 35% of participants. Separate analyses of the baseline population with diabetes (n = 585) and the longitudinal population with diabetes (n = 210) were conducted. Baseline analyses constructed a weighted care continuum: all diabetes; diagnosed; treated; achieved glycaemic control; achieved blood pressure, cholesterol, and glycaemic control; and achieved aforementioned control plus non-smoking. Weighted multinomial regression models controlling for region were used to estimate the association between socio-demographic characteristics and care continuum stage. Longitudinal analyses constructed an unweighted care continuum: all diabetes; diagnosed; treated; and achieved glycaemic control. Unweighted multinomial regression models controlling for region were used to estimate the association between socio-demographic characteristics and changes in care continuum stage. Among 585 participants with diabetes at baseline, 71% were diagnosed, 51% were on treatment, and 32% had achieved glycaemic control. Among 210 participants with diabetes in the longitudinal population, 50 (24%) participants' diabetes management worsened, while 40 (19%) participants improved. Specifically, the proportion of those treated decreased (60% in 2014-2017 to 51% in 2018-2020), while the proportion of participants achieving glycaemic control did not change. Although treatment rates have declined substantially among people with diabetes in Venezuela, management changed less than expected during the crisis.
Collapse
Affiliation(s)
- Dina Goodman-Palmer
- Department of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Juan P. González-Rivas
- Department of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- International Clinical Research Center (ICRC), St. Ann’s University Hospital, Brno, Czech Republic
- Foundation for Clinic, Public Health and Epidemiology Research of Venezuela (FISPEVEN, INC), Caracas, Venezuela
| | - Lindsay M. Jaacks
- Department of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Global Academy of Agriculture and Food Systems, The University of Edinburgh, Midlothian, United Kingdom
| | - Maritza Duran
- Foundation for Clinic, Public Health and Epidemiology Research of Venezuela (FISPEVEN, INC), Caracas, Venezuela
- Venezuelan Society of Internal Medicine, Caracas, Venezuela
| | - María Inés Marulanda
- Foundation for Clinic, Public Health and Epidemiology Research of Venezuela (FISPEVEN, INC), Caracas, Venezuela
- Venezuelan Society of Internal Medicine, Caracas, Venezuela
- Research Department, Endocrine Associates of Florida, Orlando, Florida, United States of America
| | - Eunice Ugel
- Department of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Foundation for Clinic, Public Health and Epidemiology Research of Venezuela (FISPEVEN, INC), Caracas, Venezuela
- Public Health Research Unit, Department of Social and Preventive Medicine, School of Medicine, Universidad Centro-Occidental “Lisandro Alvarado”, Barquisimeto, Venezuela
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Goodarz Danaei
- Department of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ramfis Nieto-Martinez
- Department of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Foundation for Clinic, Public Health and Epidemiology Research of Venezuela (FISPEVEN, INC), Caracas, Venezuela
- Precision Care Clinic Corp, Saint Cloud, Florida, United States of America
| |
Collapse
|
2
|
Gomez EJ. Institutions, crisis and type 2 diabetes policy in Venezuela. BMJ Glob Health 2022; 7:bmjgh-2021-007174. [PMID: 35798441 PMCID: PMC9263942 DOI: 10.1136/bmjgh-2021-007174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/19/2022] [Indexed: 11/04/2022] Open
Abstract
In a context of economic, political and humanitarian crisis, ensuring effective type 2 diabetes self-care management services in Venezuela has been an ongoing public health challenge. Repeated shortfalls in access to medicine, healthcare workers and food scarcity have hampered the ability of patients with diabetes to effectively manage their condition and receive the healthcare support that they deserve. With respect to methodology, the author relied on qualitative research methods, with a focus on in-depth document analysis. Primary and secondary document data sources were used through a systematic key word search in online search engines and library databases. While one may attribute these challenges in Venezuela to ongoing economic, political and humanitarian crisis, this article combines this perspective with health systems and institutional challenges that appear to have perpetuated and in fact worsened Venezuela's diabetic situation. Specifically, a weakened healthcare system, fragmentation in diabetic primary care services and corruption in a context of ongoing humanitarian crisis have contributed to these ongoing challenges. Within humanitarian and political crisis conditions, future research on type 2 diabetic treatment and self-care management may benefit from combining perspectives in political science institutional theory and public health systems analysis to explain why governments in these settings continue to fall short of providing effective and equitable diabetic care.
Collapse
Affiliation(s)
- Eduardo J Gomez
- College of Health, Department Community and Population Health, Lehigh University, Bethlehem, Pennsylvania, USA
| |
Collapse
|
3
|
Zhou H, Zhang H, Ye R, Yan C, Lin J, Huang Y, Jiang X, Yuan S, Chen L, Jiang R, Zheng K, Cheng Z, Zhang Z, Dong M, Jin W. Pantothenate protects against obesity via brown adipose tissue activation. Am J Physiol Endocrinol Metab 2022; 323:E69-E79. [PMID: 35575231 DOI: 10.1152/ajpendo.00293.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Brown adipose tissue (BAT) is the primary site of adaptive thermogenesis, which is involved in energy expenditure and has received much attention in the field of obesity treatment. By screening a small-molecule compound library of drugs approved by the Food and Drug Administration, pantothenic acid was identified as being able to significantly upregulate the expression of uncoupling protein 1 (UCP1), a key thermogenic protein found in BAT. Pantothenate (PA) treatment decreased adiposity, reversed hepatic steatosis, and improved glucose homeostasis by increasing energy expenditure in C57BL/6J mice fed a high-fat diet. PA also significantly increased BAT activity and induced beige adipocytes formation. Mechanistically, the beneficial effects were mediated by UCP1 because PA treatment was unable to ameliorate obesity in UCP1 knockout mice. In conclusion, we identified PA as an effective BAT activator that can prevent obesity and may represent a promising strategy for the clinical treatment of obesity and related metabolic diseases.NEW & NOTEWORTHY PA treatment effectively and safely protected against obesity via the BAT-UCP1 axis. PA has therapeutic potential for treating obesity and type II diabetes.
Collapse
Affiliation(s)
- Huiqiao Zhou
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- University of the Chinese Academy of Sciences, Beijing, China
| | - Hanlin Zhang
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- University of the Chinese Academy of Sciences, Beijing, China
| | - Rongcai Ye
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- University of the Chinese Academy of Sciences, Beijing, China
| | - Chunlong Yan
- College of Agriculture, Yanbian University, Yanji, China
| | - Jun Lin
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- University of the Chinese Academy of Sciences, Beijing, China
| | - Yuanyuan Huang
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
| | - Xiaoxiao Jiang
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- University of the Chinese Academy of Sciences, Beijing, China
| | - Shouli Yuan
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- University of the Chinese Academy of Sciences, Beijing, China
| | - Li Chen
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- University of the Chinese Academy of Sciences, Beijing, China
| | - Rui Jiang
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- University of the Chinese Academy of Sciences, Beijing, China
| | - Kexin Zheng
- Institutes of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ziyu Cheng
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- University of the Chinese Academy of Sciences, Beijing, China
| | - Zhi Zhang
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- University of the Chinese Academy of Sciences, Beijing, China
| | - Meng Dong
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
| | - Wanzhu Jin
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- University of the Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
4
|
Multiclass classification of metabolic conditions using fasting plasma levels of glucose and insulin. HEALTH AND TECHNOLOGY 2021. [DOI: 10.1007/s12553-021-00550-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
5
|
Nieto-Martínez R, González-Rivas JP, Ugel E, Duran M, Dávila E, Constantino R, García A, Mechanick JI, Marulanda MI. Cardiometabolic risk factors in Venezuela. The EVESCAM study: a national cross-sectional survey in adults. Prim Care Diabetes 2021; 15:106-114. [PMID: 32768283 DOI: 10.1016/j.pcd.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 07/04/2020] [Accepted: 07/16/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND No previous study in Venezuela and few in the Region of the Americas have reported national cardiometabolic health data. OBJECTIVES To determine the prevalence and distribution of cardiometabolic risk factors (CMRF) in adults of Venezuela. METHODS A population-based, cross-sectional, and randomized cluster sampling national study was designed to recruit 4454 adults with 20 years or older from the eight regions of the country from July 2014 to January 2017. Sociodemographic, clinical, physical activity, nutritional, and psychological questionnaires; anthropometrics, blood pressure, and biochemical measurements were obtained. The results were weighted by gender, age, and regions. RESULTS Data from 3414 participants (77% of recruited), 52.2% female, mean age of 41.2 ± 15.8 years, were analyzed. CMRF adjusted-prevalence were: diabetes (12.3%), prediabetes (34.9%), hypertension (34.1%), obesity (24.6%), overweight (34.4%), abdominal obesity (47.6%), underweight (4.4%), hypercholesterolemia (19.8%), hypertriglyceridemia (22.7%), low HDL-cholesterol (63.2%), high LDL-c (20.5%), daily consumption of fruits (20.9%) and vegetables (30.0%), insufficient physical activity (35.2%), anxiety (14.6%) and depression (3.2%) symptoms, current smoker (11.7%), and high (≥ 20%) 10-year fatal cardiovascular risk (14.0%). CMRF prevalence varied according to gender, age and region of residence. CONCLUSIONS Cardiometabolic risk factors are highly prevalent in Venezuelan adults. This situation can be affected by the severe socio-economic crisis in the country. The joint action of different stakeholders to implement public health strategies for the prevention and treatment of these risk factors in Venezuela is urgently needed.
Collapse
Affiliation(s)
- Ramfis Nieto-Martínez
- LifeDoc Health, Memphis, TN, USA; Department of Global Health and Population. Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Physiology, School of Medicine, University Centro-Occidental "Lisandro Alvarado" and Cardio-metabolic Unit 7, Barquisimeto, Venezuela; Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela.
| | - Juan P González-Rivas
- International Clinical Research Center (ICRC), St Anne's University Hospital (FNUSA) Brno, Czech Republic; Department of Global Health and Population. Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela.
| | - Eunice Ugel
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela; Public Health Research Unit, Department of Social and Preventive Medicine, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado", Barquisimeto, Venezuela
| | - Maritza Duran
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - Eric Dávila
- Department of Internal Medicine, School of Medicine "Dr. Luis Razetti", Universidad Central de Venezuela (UCV), Caracas, Venezuela
| | - Ramez Constantino
- Department of Internal Medicine, School of Medicine, Universidad de Carabobo, Valencia, Venezuela
| | - Alberto García
- Department of Physiology. School of Medicine "Dr. Luis Razetti", Universidad Central de Venezuela (UCV), Caracas, Venezuela
| | - Jeffrey I Mechanick
- The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - María Inés Marulanda
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| |
Collapse
|
6
|
González-Rivas JP, Mechanick JI, Iglesias-Fortes R, De-Oliveira-Gomes D, Silva J, Valencia J, Figueroa E, Duran M, Ugel E, Infante-García MM, Marulanda MI, Nieto-Martínez R. Optimal waist circumference cutoff values to predict cardiometabolic alterations in a Venezuela national representative sample. The EVESCAM study. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2020; 91:272-280. [PMID: 33362194 PMCID: PMC8351653 DOI: 10.24875/acm.20000165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/20/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Waist circumference (WC) value reflects abdominal adiposity, but the amount abdominal fat that is associated to cardiometabolic risk factors varies among ethnicities. Determination of metabolic abnormalities has not undergone a WC adaptation process in Venezuela. AIMS The aim of the study was (1) to determine the optimal WC cutoff value associated with ≥2 cardiometabolic alterations and (2) incorporating this new WC cutoff, to determine the prevalence of abdominal obesity and cardiometabolic risk factors related in Venezuela. METHODS The study was national population-based, cross-sectional, and randomized sample, from 2014 to 2017. To assess performance of WC for identifying cardiometabolic alterations, receiver operating characteristics curves, area under the curve (AUC), sensitivity, specificity, and positive likelihood ratios were calculated. RESULTS Three thousand three hundred eighty-seven adults were evaluated with mean age of 41.2 ± 15.8 years. Using the best tradeoff between sensitivity and specificity, WC cutoffs of 90 cm in men (sensitivity = 72.4% and specificity = 66.1%) and 86 cm in women (sensitivity = 76.2% and specificity = 61.4%) were optimal for aggregation of ≥2 cardiometabolic alterations. AUC was 0.75 in men and 0.73 in women using these new cutoffs. Prevalence of abdominal obesity and metabolic syndrome was 59.6% (95 CI; 57.5-61.7) and 47.6% (95 CI; 45.2-50.0), respectively. Cardiometabolic risk factors were associated with being men, higher age, adiposity, and living in northern or western regions. CONCLUSION The optimal WC values associated with cardiometabolic alterations were 90 cm in men and 86 cm in women. More than half of the Venezuelan population had abdominal obesity incorporating this new WC cutoff.
Collapse
Affiliation(s)
- Juan P. González-Rivas
- International Clinical Research Center, St Anne’s University Hospital Brno, Brno, Czech Republic
- Department of Global Health and Population. Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela
| | - Jeffrey I. Mechanick
- Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rocio Iglesias-Fortes
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela
| | - Diana De-Oliveira-Gomes
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela
| | - Jesús Silva
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela
| | - José Valencia
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela
| | - Estherbany Figueroa
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela
| | - Maritza Duran
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela
| | - Eunice Ugel
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela
- Department of Social and Preventive Medicine, Public Health Research Unit, School of Medicine, Universidad Centro-Occidental “Lisandro Alvarado”, Barquisimeto, Venezuela
| | - María M. Infante-García
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela
| | - María Inés Marulanda
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela
| | - Ramfis Nieto-Martínez
- Department of Global Health and Population. Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela
- LifeDoc Diabetes and Obesity Clinic, Memphis, TN, US
- Department of Physiology, School of Medicine, University Centro-Occidental “Lisandro Alvarado” and Cardio-metabolic Unit 7, Barquisimeto, Venezuela
| |
Collapse
|
7
|
Goodman D, González-Rivas JP, Jaacks LM, Duran M, Marulanda MI, Ugel E, Mattei J, Chavarro JE, Nieto-Martinez R. Dietary intake and cardiometabolic risk factors among Venezuelan adults: a nationally representative analysis. BMC Nutr 2020; 6:61. [PMID: 33088579 PMCID: PMC7566137 DOI: 10.1186/s40795-020-00362-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/15/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Increasing trends in global obesity have been attributed to a nutrition transition where healthy foods are replaced by ultra-processed foods. It remains unknown if this nutrition transition has occurred in Venezuela, a country undergoing a socio-political crisis with widespread food shortages. METHODS We described dietary intake of Venezuelans from a nationally representative study conducted between 2014 and 2017. We conducted a cross-sectional analysis of dietary, sociodemographic, and clinical data from Venezuelans ≥20 years of age (n = 3420). Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Standardized clinical and anthropometric measurements estimated obesity, type 2 diabetes, and hypertension. A Dietary Diversity Score (DDS) was calculated using an amended Minimum Dietary Diversity for Women score where the range was 0 to 8 food groups, with 8 being the most diverse. Analyses accounted for complex survey design by estimating weighted frequencies of dietary intake and DDS across sociodemographic and cardiometabolic risk-based subgroups. RESULTS The prevalence of obesity was 24.6% (95% CI: 21.6-27.7), type 2 diabetes was 13.3% (11.2-15.7), and hypertension was 30.8% (27.7-34.0). Western foods were consumed infrequently. Most frequently consumed foods included coffee, arepas (a salted corn flour cake), and cheese. Mean DDS was 2.3 food groups (Range: 0-8, Standard Error: 0.07) and this score did not vary among subgroups. Men, younger individuals, and those with higher socioeconomic status were more likely to consume red meat and soft drinks once or more weekly. Women and those with higher socioeconomic status were more likely to consume vegetables and cheese once or more daily. Participants with obesity, type 2 diabetes, and hypertension had lower daily intake of red meat and arepas compared to participants without these risk factors. CONCLUSIONS Despite high prevalence of cardiometabolic risk factors, adults in Venezuela have not gone through a nutrition transition similar to that observed elsewhere in Latin America. Dietary diversity is low and widely consumed food groups that are considered unhealthy are part of the traditional diet. Future studies are needed in Venezuela using more comprehensive measurements of dietary intake to understand the effect of the socio-political crisis on dietary patterns and cardiometabolic risk factors.
Collapse
Affiliation(s)
- Dina Goodman
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA USA
| | - Juan P. González-Rivas
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA USA
- International Clinical Research Center (ICRC), St. Ann’s University Hospital, Brno, Czech Republic
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - Lindsay M. Jaacks
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA USA
| | - Maritza Duran
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - María Inés Marulanda
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
- Endocrine Associates of Florida, Research Department, Orlando, Florida USA
| | - Eunice Ugel
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
- Public Health Research Unit, Department of Social and Preventive Medicine, School of Medicine, Universidad Centro-Occidental “Lisandro Alvarado”, Barquisimeto, Venezuela
| | - Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
| | - Ramfis Nieto-Martinez
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA USA
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
- LifeDoc Health, Memphis, TN USA
| |
Collapse
|
8
|
Avilés-Santa ML, Monroig-Rivera A, Soto-Soto A, Lindberg NM. Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent. Curr Diab Rep 2020; 20:62. [PMID: 33037442 PMCID: PMC7546937 DOI: 10.1007/s11892-020-01341-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. RECENT FINDINGS The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.
Collapse
Affiliation(s)
- M Larissa Avilés-Santa
- Division of Extramural Scientific Programs, Clinical and Health Services Research at the National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
| | | | | | | |
Collapse
|
9
|
González-Rivas J, Mechanick J, Duran M, Ugel E, Marulanda M, Nieto-Martínez R. Re-Classifying Hypertension in the Venezuelan EVESCAM Database Using 2017 AHA/ACC Criteria: High Prevalence, Poor Control, and Urgent Call for Action. Ann Glob Health 2019; 85:74. [PMID: 31148436 PMCID: PMC6634473 DOI: 10.5334/aogh.2346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In 2017 the American Heart Association (AHA)/American College of Cardiology (ACC) changed the criteria to define hypertension (HTN). OBJECTIVE To re-analyze Venezuelan data to update HTN prevalence rates and estimate the number of adults with uncontrolled blood pressure (BP) using AHA/ACC criteria. METHODS The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3,420 adults from July 2014 to January 2017, with a response rate of 77.3%. The mean of two BP measurements was obtained using a standard oscillometric device protocol. HTN was defined using both 2017 AHA/ACC guideline (BP ≥ 130/80 mmHg) and JNC7 (BP ≥ 140/90 mmHg) criteria. FINDINGS The crude prevalence of HTN using 2017 AHA/ACC guideline criteria was 60.4%, 13% higher than with the JNC7 criteria. The age-standardized prevalence was 55.4% in men and 49.0% in women (p < 0.001), 17.5% and 12.7% higher, respectively, compared with the JNC7 criteria. In subjects without self-reported HTN, the age-standardized prevalence of HTN was 43.4% in men and 32.3% in women, of whom, 22.9% and 19.2% were between 130-139/80-89 mmHg, respectively. In those with self-reported HTN, the prevalence of uncontrolled BP (≥130/80 mmHg) on antihypertensive medication was 66.8% in men and 65.8% in women. The total estimated number of subjects with HTN in Venezuela increased to 11 million, and only about 1.8 million are controlled. CONCLUSION Using the new 2017 AHA/ACC guideline, the prevalence of HTN in Venezuela is approximately half of the adult population and associated with relatively poor BP control.
Collapse
Affiliation(s)
| | | | | | - Eunice Ugel
- School of Medicine, University Centro-Occidental “Lisandro Alvarado”, Barquisimeto, VE
| | | | - Ramfis Nieto-Martínez
- South Florida Veterans Affairs Foundation for Research & Education and Geriatric Research, Education, and Clinical Center (GRECC), Miami VA Healthcare System, Miami, Florida, US
| |
Collapse
|
10
|
Hernández-Hernández R, Octavio-Seijas JA, Morr I, López-Rivera J, Gúzman-Franolic ML, Costantini-Olmos AP, Silva E, Méndez-Amaya NC, Duín A, Vásquez D, Ruíz-Lugo JF, Marval J, Duín JCC, Ponte-Negretti CI, Beaney T, Kobeissi E, Poulter NR. Results of the May Measurement Month 2017: blood pressure campaign in Venezuela-Americas. Eur Heart J Suppl 2019; 21:D124-D126. [PMID: 31043899 PMCID: PMC6479505 DOI: 10.1093/eurheartj/suz075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cardiovascular diseases, mainly coronary heart disease and stroke, are the first cause of death in Venezuela; and hypertension is the main risk factor. May Measurement Month (MMM) is a global initiative aimed at raising awareness of elevated blood pressure (BP) and to act as a temporary solution to the lack of regular screening programmes. Some representative studies indicate prevalence of hypertension in Venezuela between 24 and 39%, and control rate around 20%. Sixty-four sites were included to participate in MMM, mainly in pharmacies. Physical measurements included height, weight, and abdominal circumference. Blood pressure was measured in the sitting position three times after resting for 5 min, 1 min apart, using validated oscillometric devices. 21 644 individuals were screened. After multiple imputation, 10 584 individuals [48.9% (50.7% male; 47.7% female)] had hypertension. Of individuals not receiving antihypertensive medication, 1538 (12.2%) were hypertensive. Of individuals receiving antihypertensive medication, 2974 (32.9%) had uncontrolled BP. About 16% had obesity calculated by body mass index; 43.8% of women and 20.7% of men had abdominal obesity. This was the largest BP screening carried out in Venezuela, in which 48.9% of the individuals had elevated BP, untreated hypertension was 12.2%, and one-third of subjects taking treatment were not controlled. About 16% had obesity by body mass index, and abdominal obesity is more common in women. These results suggest that repeated screening like MMM17 can identify hypertension in important numbers and can also evaluate programmes of hypertension treatment and control in Venezuela.
Collapse
Affiliation(s)
- Rafael Hernández-Hernández
- Hypertension and Cardiovascular Risk Factors Clinic, Clinical Pharmacology Unit, Dean of Health Sciences, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, Venezuela
| | - José Andrés Octavio-Seijas
- Department of Experimental Cardiology, Tropical Medicine Institute, Universidad Central de Venezuela, Caracas, Venezuela
| | - Igor Morr
- Department of Experimental Cardiology, Tropical Medicine Institute, Universidad Central de Venezuela, Caracas, Venezuela
| | - Jesús López-Rivera
- Hypertension Unit, Department of Medicine, General Hospital San Cristóbal, Táchira State, Venezuela
| | | | | | - Egle Silva
- Instituto de Investigaciones de Enfermedades Cardiovasculares de LUZ, Universidad del Zulia, Maracaibo, Venezuela
| | | | - Amanda Duín
- Hypertension and Cardiovascular Risk Factors Clinic, Clinical Pharmacology Unit, Dean of Health Sciences, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, Venezuela
| | - Dámaso Vásquez
- Venezuelan Society of Cardiology and Venezuelan Society of Hypertension, Caracas, Venezuela
| | - José Félix Ruíz-Lugo
- Venezuelan Society of Cardiology and Venezuelan Society of Hypertension, Caracas, Venezuela
| | - José Marval
- Venezuelan Society of Cardiology and Venezuelan Society of Hypertension, Caracas, Venezuela
| | - Juan Carlos Camacho Duín
- Hypertension and Cardiovascular Risk Factors Clinic, Clinical Pharmacology Unit, Dean of Health Sciences, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, Venezuela
| | | | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Elsa Kobeissi
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| |
Collapse
|
11
|
Altuve M, Severeyn E. Joint analysis of fasting and postprandial plasma glucose and insulin concentrations in Venezuelan women. Diabetes Metab Syndr 2019; 13:2242-2248. [PMID: 31235164 DOI: 10.1016/j.dsx.2019.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/24/2019] [Indexed: 01/21/2023]
Abstract
AIMS Plasma glucose and insulin concentrations in fasting and postprandial reflect the metabolism of glucose by the human body and are useful in the diagnosis of metabolic diseases, such as diabetes and insulin resistance. In this work, these concentrations are jointly analyzed in Venezuelan women and 28 classes that better specify each metabolic condition are generated. MATERIALS AND METHODS Each class comprises a combination of fasting and postprandial ranges of glucose and insulin concentrations defined in the literature as normal, impaired and diabetic. A hypothesis test was used to find statistically significant differences between the classes, and confidence intervals for age and glucose and insulin concentrations were defined for each class. RESULTS AND CONCLUSION The process of deterioration of glucose metabolism advances with the age of the subject, more than half of the prediabetics have impaired glucose levels in fasting but normal in postprandial and normal insulin levels in fasting and postprandial, and one third of diabetics have diabetic glucose levels in fasting and postprandial and normal insulin levels in fasting and postprandial. This categorization of subjects would allow the application of a more specific treatment and the possibility of predicting the progress of the metabolic disorder.
Collapse
Affiliation(s)
- Miguel Altuve
- Faculty of Electrical and Electronic Engineering, Pontifical Bolivarian University, Bucaramanga, Colombia.
| | - Erika Severeyn
- Department of Thermodynamics and Transfer Phenomena, Simon Bolivar University, Caracas, Venezuela.
| |
Collapse
|
12
|
Muñoz-González MC, Lima-Martínez MM, Nava A, Trerotola G, Paoli M, Cabrera-Rego JO, Gonzalez B, Arciniegas A, Paez J. FINDRISC Modified for Latin America as a Screening Tool for Persons with Impaired Glucose Metabolism in Ciudad Bolívar, Venezuela. Med Princ Pract 2019; 28:324-332. [PMID: 30852570 PMCID: PMC6639652 DOI: 10.1159/000499468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/10/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The Finnish Diabetes Risk Score (FINDRISC) includes anthropometric, metabolic, and lifestyle factors that predict type 2 diabetes mellitus. The objective of this study was to evaluate the FINDRISC modified for Latin America (LA-FINDRISC) as a screening tool for persons with impaired glucose metabolism in Ciudad Bolívar, Venezuela. METHODS Subjects aged between 18 and 70 years of both sexes without known diabetes were invited to participate. After informed consent, they were screened with the LA-FINDRISC questionnaire and then given an oral glucose tolerance test, using the American Diabetes Association criteria for diagnosis. To obtain the cutoff point of LA-FINDRISC for predicting impaired glucose regulation, a receiver operating characteristic curve was constructed. RESULTS A total of 200 subjects were evaluated, 64.5% female, with a mean age of 35.20 ± 13.84 years. Of these, 158 (79%) did not present with carbohydrate metabolism disorder, while 42 (21%) did. Age (p = 0.0001), body mass index (p = 0.011), and waist circumference (p = 0.031) were significantly higher in subjects with impaired glucose regulation when compared to those without it. There were a significantly greater number of sedentary (p = 0.039) and hypertensive subjects (p = 0.0001), as well as those with a history of glucose >100 mg/dL (p = 0.0001), in the impaired glucose metabolism group. A cutoff LA-FINDRISC of 14 points predicted a high risk of impaired glucose regulation with a sensitivity of 45.2% and a specificity of 89.9%. CONCLUSION A LA-FINDRISC >14 points had low sensitivity but high specificity for predicting carbohydrate metabolism disorders in this group of patients from Ciudad Bolívar.
Collapse
Affiliation(s)
| | - Marcos M Lima-Martínez
- Department of Physiological Sciences, Universidad de Oriente, Ciudad Bolívar, Venezuela,
- Endocrinology, Diabetes, Metabolism and Nutrition Unit, Ciudad Bolívar, Venezuela,
| | - Aura Nava
- Department of Physiological Sciences, Universidad de Oriente, Ciudad Bolívar, Venezuela
| | - Gisuardo Trerotola
- Department of Physiological Sciences, Universidad de Oriente, Ciudad Bolívar, Venezuela
| | - Mariela Paoli
- Endocrinology Unit, Andes University Hospital Autonomous Institute, Mérida, Venezuela
| | - Julio O Cabrera-Rego
- Intensive Coronary Care Unit, Hospital "Comandante Manuel Fajardo,", Havana, Cuba
| | | | | | | |
Collapse
|
13
|
Epicardial adipose tissue thickness and type 2 diabetes risk according to the FINDRISC modified for Latin America. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2018; 31:15-22. [PMID: 30166212 DOI: 10.1016/j.arteri.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/15/2018] [Accepted: 06/16/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Finnish Diabetes Risk Score (FINDRISC) is a tool to predict 10-year risk of type 2 diabetes mellitus (T2DM), and visceral adiposity is associated with higher cardio-metabolic risk. The objective of the study was to assess the relationship of epicardial adipose tissue (EAT) thickness with T2DM risk according to the FINDRISC tool. METHODS The study was conducted in Ciudad Bolívar, Venezuela, and included 55 subjects of whom 37 (67.3%) were women and 18 (32.7%) men with ages between 18 and 75 years. A record was made of weight, height, body mass index (BMI), waist circumference (WC), fasting glucose, baseline insulin, plasma lipids, Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), and EAT thickness. The FINDRISC tool, with WC cut-off points modified for Latin America (LA-FINDRISC) was used. RESULTS BMI, WC, plasma insulin concentration, HOMA-IR index, and EAT thickness were higher (P<0.0001) in the high-risk group compared to subjects in the low-moderate risk group according to the LA-FINDRISC. LA-FINDRISC was positively correlated with BMI (r=0.513; P=0.0001), WC (r=0.524; P=0.0001), fasting blood glucose (r=0.396; P=0.003); baseline plasma insulin (r=0.483; P=0.0001); HOMA-IR index (r=0.545; P=.0.0001); and EAT thickness (r=0.702; P=0.0001). The multivariate regression analysis showed that fasting blood glucose (P=0.023) and EAT thickness (P=0.007) remained independently associated with high T2DM risk. CONCLUSIONS LA-FINDRISC was associated with EAT thickness and insulin resistance markers. Both were independently and directly associated with high risk for diabetes in the LA-FINDRISC category.
Collapse
|
14
|
Nieto-Martínez R, Mechanick JI, Brajkovich I, Ugel E, Risques A, Florez H, González-Rivas JP. Prevalence of diabetes in three regions of Venezuela. The VEMSOLS study results. Prim Care Diabetes 2018; 12:126-132. [PMID: 29249672 DOI: 10.1016/j.pcd.2017.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 11/23/2017] [Accepted: 11/30/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The prevalence of diabetes in multiple regions of Venezuela is unknown. To determine the prevalence of diabetes in five populations from three regions of Venezuela. METHODS During 2006-2010, 1334 subjects ≥20years were selected by multistage stratified random sampling from all households from 3 regions of Venezuela. Anthropometric measurements and biochemical analysis were obtained. Statistical methods were calculated using SPSS 20 software. FINDINGS Mean (SE) age was 44.8 years (0.39) and 68.5% were females. The prevalence of diabetes was 8.3% (95% CI, 6.9%-10.0%), higher in men than women (11.2% and 7.0% respectively; p=0.01). The prevalence adjusted by age and gender was 8.0% (95% CI, 6.9%-9.9%). This figure increased with age, with the lowest prevalence in the 20-29year old group (1.8% [95% CI, 0.6%-4.8%]) and the highest in the oldest group (26.8% [95% CI, 16.2%-40.5%]). Subjects with overweight or obesity had no increased risk of diabetes compared with those with normal weight. However, in women, the presence of abdominal obesity was associated with an increase of the risk of diabetes by 77% (OR 1.77 [95% CI, 1.1%-2.9%]). The prevalence of prediabetes was 14.6% (95% CI, 12.8%-16.7%), and only 48.2% were aware of their diabetes condition. CONCLUSION In this study, 8.3% of the subjects had diabetes and 14.6% prediabetes. Less than half of the subjects with diabetes were aware of their condition. These results point to a major public health problem, requiring the implementation of diabetes prevention programs.
Collapse
Affiliation(s)
- Ramfis Nieto-Martínez
- Department of Physiology, School of Medicine, University Centro-Occidental "Lisandro Alvarado" (UCLA), Barquisimeto, Venezuela; Cardio-Metabolic Unit 7, Barquisimeto, Venezuela; Geriatric Research, Education, and Clinical Center (GRECC), Miami VA Healthcare System, Miami, FL, USA; South Florida Veterans Affairs Foundation for Research & Education, Miami, USA
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Imperia Brajkovich
- Department of Internal Medicine B, School of Medicine "Luis Razetti", University Hospital of Caracas, University Central de Venezuela, Caracas, Venezuela
| | - Eunice Ugel
- Department of Preventive Medicine, School of Medicine, University Centre-Occidental "Lisandro Alvarado", Barquisimeto, Venezuela
| | - Alejandro Risques
- Department of Social and Preventive Medicine, School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Hermes Florez
- University of Miami Miller School of Medicine and Miami Veterans Affairs Medical Center, Miami, FL, USA
| | | |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW Successful interventions are needed to diagnose and manage type 2 diabetes (T2DM) in Latin America, a region that is experiencing a significant rise in rates of T2DM. Complementing an earlier review exploring diabetes prevention efforts in Latin America, this scoping review examines the literature on (1) policies and governmental programs intended to improve diabetes diagnosis and treatment in Latin America and (2) interventions to improve diabetes management in Latin America. It concludes with a brief discussion of promising directions for future research. RECENT FINDINGS Governmental policies and programs for the diagnosis and treatment of diabetes in different Latin American countries have been implemented, but their efficacy to date has not been rigorously evaluated. There are some promising intervention approaches in Latin America to manage diabetes that have been evaluated. Some of these utilize multidisciplinary teams, a relatively resource-intensive approach difficult to replicate in low-resource settings. Other evaluated interventions in Latin America have successfully leveraged mobile health tools, trained peer volunteers, and community health workers (CHWs) to improve diabetes management and outcomes. There are some promising approaches and large-scale governmental efforts underway to curb the growing burden of type 2 diabetes in Latin America. While some of these interventions have been rigorously evaluated, further research is warranted to determine their effectiveness, cost, and scalability in this region.
Collapse
Affiliation(s)
- Elizabeth Kaselitz
- Department of Global REACH, University of Michigan Medical School, 1111 Catherine Street, Ann Arbor, MI, 48104, USA.
- VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, 48105, USA.
| | - Gurpreet K Rana
- Taubman Health Sciences Library, University of Michigan, 1135 East Catherine Street, Ann Arbor, MI, 48109, USA
| | - Michele Heisler
- VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, 48105, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Michigan Center for Diabetes Translational Research (MCDTR, University of Michigan, Ann Arbor VA, Ann Arbor, MI, USA
| |
Collapse
|
16
|
Nieto-Martínez R, González-Rivas JP, Florez H, Mechanick JI. Transcultural Endocrinology: Adapting Type-2 Diabetes Guidelines on a Global Scale. Endocrinol Metab Clin North Am 2016; 45:967-1009. [PMID: 27823615 DOI: 10.1016/j.ecl.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Type-2 diabetes (T2D) needs to be prevented and treated effectively to reduce its burden and consequences. White papers, such as evidence-based clinical practice guidelines (CPG) and their more portable versions, clinical practice algorithms and clinical checklists, may improve clinical decision-making and diabetes outcomes. However, CPG are underused and poorly validated. Protocols that translate and implement these CPG are needed. This review presents the global dimension of T2D, details the importance of white papers in the transculturalization process, compares relevant international CPG, analyzes cultural variables, and summarizes translation strategies that can improve care. Specific protocols and algorithmic tools are provided.
Collapse
Affiliation(s)
- Ramfis Nieto-Martínez
- Department of Physiology, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado" and Cardio-metabolic Unit 7, Av. Andrés Bello con Av. Libertador, Apartado 516, Barquisimeto, Venezuela; Department of Physiology, School of Medicine, University of Panamá, Vía Transísmica, Apartado 0824, Estafeta Universitaria, Panamá, República de Panamá.
| | - Juan P González-Rivas
- The Andes Clinic of Cardio-Metabolic Studies, Av. Miranda entre calles Bermúdez y Arismendi, Apartado 3112, Timotes, Venezuela
| | - Hermes Florez
- Miami Veterans Affairs Medical Center, University of Miami Miller School of Medicine, 1201 Northwest 16th Street, CLC 207, Miami, FL 33125, USA
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, 1192 Park Avenue, New York, NY 10128, USA
| |
Collapse
|