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Fierro I, Gallardo-Mora O, Alba-Leonel A, Carvajal A, Molina-Guarneros JA. Prescription of oral antidiabetics in Mexico. A cross-sectional study. PLoS One 2023; 18:e0288699. [PMID: 37498817 PMCID: PMC10373993 DOI: 10.1371/journal.pone.0288699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
In 2016 diabetes was declared an epidemic and a health emergency in Mexico. As the rationale of the treatment is to achieve target glycemia levels, the appropriateness of the medications used is important. The aim of this study is to learn the pattern of antidiabetic drug prescription and factors associated with inappropriate prescription in Mexico. A retrospective cross-sectional drug utilization study has been conducted. A randomly selected sample was carefully examined. Out of 3600 clinical records of patients diagnosed with type 2 diabetes mellitus (T2DM), 196 records were revised. As far as control is concerned, 36.7% had their glycemia values in the recommended range. A combination of different antidiabetics was the most common pattern observed (60.7%); the most frequent was that of the association of metformin with whatever oral antidiabetics. Prescriptions were considered as inappropriate in 149 cases (76.0%); younger age and lack of nutritional assessment was significantly related to inappropriate prescription. A trend to use more drugs for treating T2DM has been consistently observed. Despite using so many drugs, most of the patients are not controlled. Avoiding inappropriate prescription by following current guidelines may contribute to a better control and, in turn, decrease morbidity and mortality for this cause.
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Affiliation(s)
- Inmaculada Fierro
- Departamento de Ciencias de la Salud, Universidad Europea Miguel de Cervantes, Valladolid, Spain
| | - Osiel Gallardo-Mora
- Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México (UNAM), Mexico, Mexico
| | - Adela Alba-Leonel
- Escuela Nacional de Enfermería y Obstetricia, Universidad Nacional Autónoma de México (UNAM), Mexico, Mexico
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Al-Remawi M, Jaber N, Elsayed A, Alsafadi D, Salah KA. Stabilization of insulin using low molecular weight chitosan carbonate nanocarrier. Carbohydr Polym 2022; 291:119579. [DOI: 10.1016/j.carbpol.2022.119579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/09/2022] [Accepted: 05/04/2022] [Indexed: 11/02/2022]
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Gračner T. Bittersweet: How prices of sugar-rich foods contribute to the diet-related disease epidemic in Mexico. JOURNAL OF HEALTH ECONOMICS 2021; 80:102506. [PMID: 34537582 DOI: 10.1016/j.jhealeco.2021.102506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 04/30/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
I provide new evidence on how price changes of nutritionally similar foods, such as those rich in sugar or fats, change obesity and diet-related diseases in the context of Mexico between 1996-2010. I merge a bar-code level price dataset with product-specific nutritional composition to two datasets with health outcomes: state-level administrative and nationally representative individual-level panel data. Exploiting within-city variation in prices using fixed effects models, I show that decreased prices of sugar-rich foods increase obesity, type 2 diabetes, and hypertension prevalence; yet the prices of foods rich in other nutrients do not. Health responses to price changes are the largest for those abdominally obese or at the highest risk for chronic disease. The association between prices of sugary foods and chronic disease is meaningful: I estimate that in Mexico, price reductions of sugary foods explain roughly 15 percent of the rise in obesity and diabetes during the 15-year study period.
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Affiliation(s)
- Tadeja Gračner
- RAND Corporation, 1776 Main St, Santa Monica, CA 90401, United States.
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Powell J, Fuentes-Rivera E, Darney B. Comparison of immediate postpartum contraception among women with a high versus low risk pregnancy in Mexico: a retrospective cohort study. BMJ Open 2021; 11:e048048. [PMID: 34341048 PMCID: PMC8330582 DOI: 10.1136/bmjopen-2020-048048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE We tested whether women who reported high-risk pregnancies or deliveries were more likely to receive immediate postpartum contraception prior to discharge compared with normal-risk women in Mexico. METHODS This is a retrospective study using the National Health and Nutrition Survey. We classified women as high-risk based on reported complications in pregnancy and delivery. We used multivariable logistic regression to test the association of high-risk status and receipt of postpartum contraception (any modern method and Tier one methods) prior to discharge. RESULTS Our sample included 5030 deliveries (population N=3 923 657). Overall, 19.1% of the sample were high risk. Over 60% of women in the high-risk and normal-risk group received immediate postpartum contraception, but a greater proportion of high-risk women received a method (67% vs 61% normal risk; p<0.001). However, in multivariable models, there were no significant differences in receipt of any modern method or tier 1 method by risk group. CONCLUSION Women with high-risk pregnancies were not more likely to receive postpartum contraception than the normal-risk group, once accounting for sociodemographic and clinical factors. Prenatal and postpartum contraception counselling should address the health effects of high-risk pregnancies and interpregnancy intervals to improve maternal health outcomes.
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Affiliation(s)
- Jacqueline Powell
- Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Evelyn Fuentes-Rivera
- Center for Health Systems Research, Instituto Nacional de Salud Publica (INSP), Mexico City, Mexico
| | - Blair Darney
- Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
- Center for Population Health Research, Instituto Nacional de Salud Publica (INSP), Mexico City, Mexico
- School of Public Health, Oregon Health & Science University - Portland State University, Portland, OR, USA
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Torres-Ibarra L, Rivera-Paredez B, Hernández-López R, Canto-Osorio F, Sánchez-Romero LM, López-Olmedo N, González-Morales R, Ramírez P, Salmerón J, Barrientos-Gutiérrez T. Regular consumption of soft drinks is associated with type 2 diabetes incidence in Mexican adults: findings from a prospective cohort study. Nutr J 2020; 19:126. [PMID: 33218344 PMCID: PMC7678283 DOI: 10.1186/s12937-020-00642-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/05/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although high consumption of soft drinks has been associated with excess of type 2 diabetes risk, the strength of this association in the Mexican population, where a type 2 diabetes genetic susceptibility has been well established, has been scarcely studied. This study aimed to estimate the risk of type 2 diabetes due to soft drinks consumption in a cohort of Mexicans. METHODS We used data on 1445 participants from the Health Workers Cohort Study, a prospective cohort conducted in Cuernavaca, Mexico. Soft drinks consumption was assessed with a semi-quantitative 116-item food frequency questionnaire. Incident type 2 diabetes was defined as self-report of physician-diagnosed type 2 diabetes, fasting glucose > 126 mg/dl, or hypoglycemic medication at any examination. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models. RESULTS With a total of 9526.2 person-years of follow-up, 109 incident cases of type 2 diabetes were observed. Type 2 diabetes incidence rate was 7.6, 11.0, and 17.1 per 1000 person-years across levels of soft drinks consumption of < 1, 1-4, and ≥ 5 servings/week, respectively (p < 0.001 for trend). The intake of ≥5 soft drinks/week was significantly associated with an increased risk of type 2 diabetes (HR 1.9 95% CI:1.0-3.5) compared with consumption of < 1/week (p-trend = 0.040). The HR was attenuated by further adjustment for body mass index (HR 1.5 95%CI:0.8-2.8) and abdominal obesity (HR 1.6 95%CI:0.8-3.0). CONCLUSIONS The consumption of soft drinks was associated with a higher risk of type 2 diabetes in a cohort of Mexican adults. Our results further support recommendations to limit soft drinks intake to address the growing diabetes epidemic in Mexico.
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Affiliation(s)
- Leticia Torres-Ibarra
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Berenice Rivera-Paredez
- Research Center on Policies, Population and Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rubí Hernández-López
- Research Center on Policies, Population and Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Francisco Canto-Osorio
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Luz María Sánchez-Romero
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Nancy López-Olmedo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Romina González-Morales
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Paula Ramírez
- Epidemiological Research and Health Services Unit, Mexican Institute of Social Security, Cuernavaca, Morelos, Mexico
| | - Jorge Salmerón
- Research Center on Policies, Population and Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Paniagua R, Ramos A, Fabian R, Lagunas J, Amato D. Chronic Kidney Disease and Dialysis in Mexico. Perit Dial Int 2020. [DOI: 10.1177/089686080702700406] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The increasing rates in incidence and prevalence of chronic kidney disease (CKD) are important challenges for health systems around the world, and are even more significant for undeveloped countries. In Mexico the prevalence of CKD seems to be similar to that in highly developed nations, with diabetes as the leading cause of CKD; however, human and economic resources seem to be insufficient for treatment needs. This is reflected in the unacceptably high mortality rates and in noncompliance with established standards and guidelines. Several measures need to be taken to improve this picture, such as more efficient programs for the prevention of obesity, diabetes, and hypertension. Organizing a national registry of patients with CKD is now a pressing need, as is a continuous search for additional funding and budgets to increase the number of qualified nephrologists and specialized nurses and to continue the much-needed research on CKD.
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Affiliation(s)
- Ramón Paniagua
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
| | | | - Rosaura Fabian
- UMAE Hospital General Gaudencio González Garza, Instituto Mexicano del Seguro Social, México City, México
| | - Jesús Lagunas
- UMAE Hospital General Gaudencio González Garza, Instituto Mexicano del Seguro Social, México City, México
| | - Dante Amato
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
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Rojas-Martínez R, Basto-Abreu A, Aguilar-Salinas CA, Zárate-Rojas E, Villalpando S, Barrientos-Gutiérrez T. [Prevalence of previously diagnosed diabetes mellitus in Mexico.]. SALUD PUBLICA DE MEXICO 2019; 60:224-232. [PMID: 29746739 DOI: 10.21149/8566] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/24/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To compare the prevalence of previously diagnosed diabetes in 2016 with previous national surveys and to describe treatment and its complications. MATERIALS AND METHODS Mexico's national surveys Ensa 2000, Ensanut 2006, 2012 and 2016 were used. For 2016, logistic regression models and measures of central tendency and dispersion were obtained. RESULTS The prevalence of previously diagnosed diabetes in 2016 was 9.4%. The increase of 2.2% relative to 2012 was not significant and only observed in patients older than 60 years. While preventive measures have increased, the access to medical treatment and lifestyle has not changed. The treatment has been modified, with an increase in insulin and decrease in hypoglycaemic agents. CONCLUSIONS Population aging, lack of screening actions and the increase in diabetes complications will lead to an increase on the burden of disease. Policy measures targeting primary and secondary prevention of diabetes are crucial.
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Affiliation(s)
- Rosalba Rojas-Martínez
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, México
| | - Ana Basto-Abreu
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, México
| | | | | | - Salvador Villalpando
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública. México
| | - Tonatiuh Barrientos-Gutiérrez
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, México
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Costa-Urrutia P, Abud C, Franco-Trecu V, Colistro V, Rodríguez-Arellano ME, Granados J, Seelaender M. Genetic susceptibility to pre diabetes mellitus and related association with obesity and physical fitness components in Mexican-Mestizos. Prim Care Diabetes 2018; 12:416-424. [PMID: 30041843 DOI: 10.1016/j.pcd.2018.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 05/19/2018] [Accepted: 07/01/2018] [Indexed: 12/16/2022]
Abstract
Pre diabetes mellitus (pre-DM) is considered an early-reversible condition that can progress to Type 2 diabetes mellitus (T2DM) which is the main cause of death for adult Mexican population. Gene variants influencing fasting glucose levels may constitute helpful tool for prevention purposes in pre-DM condition. Physically active Mexican-Mestizo adults (n=565) were genotyped for 6 single nucleotide polymorphisms (SNPs) (ADIPOQ rs2241766, ACSL1 rs9997745, LIPC rs1800588, PPARA rs1800206, PPARG rs1801282 and PPARGC1A rs8192678) related to lipid and carbohydrate metabolism. Fasting glucose was measured and values classified as pre-DM (≥100mg/dL) or normal fasting glucose. Logistic models were used to test associations between pre-DM condition and SNPs, and interaction with Body Mass Index (BMI) and physical fitness components. The A allele of ASCL1 rs9997745 conferred increased risk (OR=3.39, p=0.001) of pre-DM which is modulated by BMI. The A allele of the PPARGC1A rs8192678 showed significant SNP*BMI (OR=1.10, p=0.008) interaction effect for pre-DM risk, meaning that obese subjects showed higher pre-DM risk but normal weight subjects showed lower risk. The effect increased with age and was attenuated by higher cardiorespiratory values. We found that both ACSL1 rs9997745 and PPARGC1A rs8192678 are associated with pre-DM, and that BMI significantly modified their association.
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Affiliation(s)
- Paula Costa-Urrutia
- Department of Cell and Developmental Biology Institute of Biomedical Sciences, Faculty of Medicine, University of São Paulo, Av. Prof. Lineu Prestes, 2415, São Paulo, Brazil; Sport City, SA de CV, Grupo Marti, Blvd Adolfo López Mateos 1181, San Pedro de los Pinos, ZC: 01180 Álvaro Obregón, Mexico City, Mexico.
| | - Carolina Abud
- Sport City, SA de CV, Grupo Marti, Blvd Adolfo López Mateos 1181, San Pedro de los Pinos, ZC: 01180 Álvaro Obregón, Mexico City, Mexico
| | - Valentina Franco-Trecu
- Departamento de Ecología y Evolución, Facultad de Ciencias, Universidad de la República, Iguá 4225, ZC: 11400 Montevideo, Uruguay
| | - Valentina Colistro
- Departamento de Genética, Facultad de Medicina, Universidad de la República, Av. Gral. Flores 2125, ZC: 11800 Montevideo, Uruguay
| | - Martha Eunice Rodríguez-Arellano
- Laboratorio de Medicina Genómica del Hospital Regional Lic, Adolfo López Mateos, ISSSTE, Av. Universidad 1321, Florida, ZC: 01030 Álvaro Obregón, Mexico City, Mexico
| | - Julio Granados
- División de Inmunogenética, Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, ZC: 14080, Mexico City, Mexico
| | - Marilia Seelaender
- Department of Cell and Developmental Biology Institute of Biomedical Sciences, Faculty of Medicine, University of São Paulo, Av. Prof. Lineu Prestes, 2415, São Paulo, Brazil
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Bustamante AV, Vilar-Compte M, Ochoa Lagunas A. Social support and chronic disease management among older adults of Mexican heritage: A U.S.-Mexico perspective. Soc Sci Med 2018; 216:107-113. [PMID: 30292581 DOI: 10.1016/j.socscimed.2018.09.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/02/2018] [Accepted: 09/14/2018] [Indexed: 01/16/2023]
Abstract
This study explores the association between social support and chronic disease self-management among older adults of Mexican heritage who live in the U.S. and Mexico. We hypothesize that social support increases the ability to manage hypertension and Type 2 (T2) diabetes, regardless of place of residence. We also investigate if differences in country of residence and health system factors influence the ability to manage chronic conditions. Older adults 65 years or older from Los Angeles (LA) and Mexico City (CDMX), with diagnosed hypertension or T2 diabetes (self-reported), attending government agencies, participated in the study. The statistical analyses investigate differences between older adults in LA and CDMX; identify the association between social support and chronic disease self-management; and examine the role of T2 diabetes treatment, testing and complications on self-management. Our study findings show that social support was a statistically significant predictor of improved T2 diabetes self-management (37%-51%, p < 0.05). The association between social support and hypertension self-management was only significant (90% confidence level) for adherence to weight management and increased alcohol consumption. Our study did not identify statistically significant differences in social support between LA and CDMX. However, almost 40% of sampled older adults were at risk of social isolation, signaling a vulnerable population that needs to be targeted by health and social systems in the U.S. and Mexico. Our study also shows that social support is a strong predictor of improved T2 diabetes management in the U.S. and Mexico. While older adults in the U.S. and Mexico reported similar access to care and health insurance coverage, higher adherence to low salt diets in LA and reduced coverage of glucose testing in CDMX could signal areas of opportunity for policymakers. Health care providers in both countries need to identify ways of improving adherence to physical activity and weight management.
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Affiliation(s)
- Arturo Vargas Bustamante
- Department of Health Policy & Management, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South Room 31-299C, Box 951772, Los Angeles, CA, 90095, USA.
| | - Mireya Vilar-Compte
- Department of Health Studies, Universidad Iberoamricana, Prolongación Paseo de Reforma 880, Lomas de Santa Fe, CP 01219, CDMX, Mexico.
| | - Adriana Ochoa Lagunas
- University of Sussex in Brighton, Guillermo Prieto 25 Bis, Lomas Quebradas Magdalena Contreras, CP 10000, CDMX, Mexico.
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Barquera S, Schillinger D, Aguilar-Salinas CA, Schenker M, Rodríguez LA, Hernández-Alcaraz C, Sepúlveda-Amor J. Collaborative research and actions on both sides of the US-Mexico border to counteract type 2 diabetes in people of Mexican origin. Global Health 2018; 14:84. [PMID: 30134925 PMCID: PMC6104005 DOI: 10.1186/s12992-018-0390-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/29/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Type 2 Diabetes (T2D) is now a massive epidemic in both California and Mexico, with serious consequences for social and economic well-being. A large proportion of these populations share common ethnic backgrounds. Yet diverse environmental and social conditions across regions create unique opportunities to explore the ways that T2D risk, incidence, management and outcomes manifest. MAIN TEXT An action-oriented research consortium headed up by the University of California and Universidad Nacional Autónoma de Mexico was constituted to set priorities for bi-national translational research, in an attempt to implement and evaluate clinical, public health and policy actions to decrease the burden of T2D for people of Mexican origin. In this paper, we describe the epidemiology of T2D in Mexico and California, review current efforts to combat the epidemic, highlight gaps in knowledge and identify urgent areas of opportunity for collaboration. The group has developed a common research agenda and funding has been obtained to evaluate biological samples from the 2016 Mexican Health Survey, collaborate in a telemedicine-based retinopathy project, implement interventions in food banks, promote a communications campaign, and design a large-scale diabetes prevention effectiveness trial. CONCLUSIONS T2D has caused a state of emergency in Mexico and is a major health problem among Mexican populations on both sides of the border. Understanding the commonalities and differences between California and Mexico for those of Mexican origin with respect to T2D, when combined with a sharing of knowledge and advances, can produce a bi-national translational research agenda to inform relevant policy and practice. Amidst economic and political uncertainty and limited healthcare budgets, this collaboration can contribute to the development of scientific evidence to inform policies and interventions. This may provide a promising collaborative model that could be expanded to other health conditions and regions of the world.
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Affiliation(s)
- Simón Barquera
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Dean Schillinger
- UCSF Division of General Internal Medicine at San Francisco General Hospital, 1545 Divisadero St., First and Second Floors, San Francisco, CA 94115 USA
- UCSF Center for Vulnerable Populations, School of Medicine, Department of Medicine, 1001 Potrero Ave, San Francisco, CA 94110 USA
| | - Carlos A. Aguilar-Salinas
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan C.P, 14080 Ciudad de Mexico, Mexico
| | - Marc Schenker
- UC Davis School of Medicine, Department of Public Health Sciences, University of California Davis Medical Sciences 1-C, One Shields Avenue, Davis, CA 95616 USA
| | - Luis A. Rodríguez
- UCSF School of Medicine, Department of Epidemiology & Biostatistics, 550 16th St, San Francisco, CA 94158 USA
| | - Cesar Hernández-Alcaraz
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Jaime Sepúlveda-Amor
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
- UCSF School of Medicine, Department of Epidemiology & Biostatistics, 550 16th St, San Francisco, CA 94158 USA
- UCSF Institute for Global Health Sciences, Mission Hall, Box 1224, 550 16th Street, Third Floor, San Francisco, CA 94158 USA
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11
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[Why don't doctors use early insulinization therapy in patients with diabetes mellitus type 2?: A qualitative approach in a Mexican city]. Salud Colect 2018; 13:693-712. [PMID: 29340447 DOI: 10.18294/sc.2017.1341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 05/30/2017] [Indexed: 11/24/2022] Open
Abstract
Early insulinization therapy is regarded as an efficient aid to improve long term control and quality of life in patients with diabetes mellitus type 2 (DM2). Nevertheless, both patients and medical staff confront barriers in using this therapeutic tool. This study employs a qualitative approach to explore the barriers to early insulinization among medical staff from the public sector in the city of Xalapa, Veracruz, México. Between 2015 and 2016, in-depth interviews were conducted with general and specialist physicians offering primary health care to patients with DM2. The transcribed interviews were analyzed to extract and organize categories and subcategories of barriers among medical staff. These barriers were then grouped into three categories and exemplified with interview excerpts: barriers coming from the medical staff itself, barriers emerging from the doctor-patient interaction, and institutional barriers. Uses for the classification obtained are discussed, as are some of the solutions proposed by study participants.
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12
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Gonzalez-Gonzalez C, Tysinger B, Goldman DP, Wong R. Projecting diabetes prevalence among Mexicans aged 50 years and older: the Future Elderly Model-Mexico (FEM-Mexico). BMJ Open 2017; 7:e017330. [PMID: 29074514 PMCID: PMC5665264 DOI: 10.1136/bmjopen-2017-017330] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/22/2017] [Accepted: 08/29/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Diabetes has been growing as a major health problem and a significant burden on the population and on health systems of developing countries like Mexico that are also ageing fast. The goal of the study was to estimate the future prevalence of diabetes among Mexico's older adults to assess the current and future health and economic burden of diabetes. DESIGN A simulation study using longitudinal data from three waves (2001, 2003 and 2012) of the Mexican Health and Aging Study and adapting the Future Elderly Model to simulate four scenarios of hypothetical interventions that would reduce diabetes incidence and to project the future diabetes prevalence rates among populations 50 years and older. PARTICIPANTS Data from 14 662 participants with information on self-reported diabetes, demographic characteristics, health and mortality. OUTCOME MEASURES We obtained, for each scenario of diabetes incidence reduction, the following summary measures for the population aged 50 and older from 2012 to 2050: prevalence of diabetes, total population with diabetes, number of medical visits. RESULTS In 2012, there were approximately 20.7 million persons aged 50 and older in Mexico; 19.3% had been diagnosed with diabetes and the 2001-2003 diabetes incidence was 4.3%. The no-intervention scenario shows that the prevalence of diabetes is projected to increase from 19.3% in 2012 to 34.0% in 2050. Under the 30% incidence reduction scenario, the prevalence of diabetes will be 28.6% in 2050. Comparing the no-intervention scenario with the 30% and 60% diabetes incidence reduction scenarios, we estimate a total of 816 320 and 1.6 million annual averted cases of diabetes, respectively, for the year 2020. DISCUSSION Our study underscores the importance of diabetes as a disease by itself and also the potential healthcare demands and social burden of this disease and the need for policy interventions to reduce diabetes prevalence.
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Affiliation(s)
| | - Bryan Tysinger
- Roybal Center for Health Policy Simulation, University of Southern California, Los Angeles, California, USA
| | - Dana P Goldman
- Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Rebeca Wong
- Department of Preventive Medicine and Community Health, Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
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13
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Multimorbidity Patterns in Older Adults: An Approach to the Complex Interrelationships Among Chronic Diseases. Arch Med Res 2017; 48:121-127. [PMID: 28577866 DOI: 10.1016/j.arcmed.2017.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 02/02/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIMS There is a growing need for evidence based answers to multimorbidity, especially in primary care settings. The aim was estimate the prevalence and patterns of multimorbidity in a Mexican population of public health institution users ≥60 years old. METHODS Observational and multicenter study was carried out in four family medicine units in Mexico City; included older men and women who attended at least one consultation with their family doctor during 2013. The most common diseases were grouped into 11 domains. The observed and expected rates, as well as the prevalence ratios, were calculated for the pairs of the more common domains. Logistic regression models were developed to estimate the magnitude of the association. Cluster and principal components analyses were performed to identify multimorbidity patterns. RESULTS Half of all of the patients who were ≥60 years old and treated by a family doctor had multimorbidity. The most common disease domains were hypertensive and endocrine diseases. The highest prevalence of multimorbidity concerned the renal domain. The domain pairs with the strongest associations were endocrine + renal and hypertension + cardiac. The cluster and principal components analyses revealed five consistent patterns of multimorbidity. CONCLUSIONS The domains grouped into five patterns could establish the framework for developing treatment guides, deepen the knowledge of multimorbidity, develop strategies to prevent it, decrease its burden, and align health services to the care needs that doctors face in daily practice.
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Andrade FCD, López-Ortega M. Educational Differences in Health Among Middle-Aged and Older Adults in Brazil and Mexico. J Aging Health 2017; 29:923-950. [PMID: 28553819 DOI: 10.1177/0898264317705781] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study examines educational differences in health conditions among middle-aged and older adults in Brazil and Mexico. METHOD Cross-sectional data from the 2013 Brazilian National Health Survey and the 2012 Mexican National Health and Nutrition Survey were used in the analyses. We used multivariate Poisson regressions to examine the relationship between educational level and prevalence of common health conditions (obesity, abdominal obesity, diabetes, hypertension, heart disease, and hearing and visual impairments). RESULTS Socioeconomic and sex inequalities persist in both countries. In general, low levels of education were associated with higher risk for having health conditions. However, men of lower education had a smaller risk of abdominal obesity and hypertension. DISCUSSION Brazil and Mexico have expanded public health actions aimed at improving health behaviors, diagnosis, and access to treatment of chronic conditions. However, important social disparities remain. Improving lifestyle behaviors, such as physical activity and dietary habits, could benefit both countries.
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Rivera-Hernandez M. Religiosity, Social Support and Care Associated with Health in Older Mexicans with Diabetes. JOURNAL OF RELIGION AND HEALTH 2016; 55:1394-1410. [PMID: 26316196 PMCID: PMC4837086 DOI: 10.1007/s10943-015-0105-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The main purpose of this study was to examine the relationships between religiosity, social support, diabetes care and control and self-rated health of people living in Mexico who have been diagnosed with diabetes. Structural equation modeling was used to examine these associations using the Mexican Health and Aging Study, a national representative survey of older Mexicans. Findings indicate that emotional support from one's spouse/partner directly affects diabetes care and control and health. Although there is no direct relationship between religiosity and health, religiosity was positively associated with diabetes care and control, but not significantly related to health.
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Affiliation(s)
- Maricruz Rivera-Hernandez
- Center for Gerontology and Healthcare Research, Brown University, 121 South Main Street, Box G-S121 (6), Providence, RI, 02912, USA.
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Arrellano-Valdez F, Urrutia-Osorio M, Arroyo C, Soto-Vega E. A comprehensive review of urologic complications in patients with diabetes. SPRINGERPLUS 2014; 3:549. [PMID: 25332855 PMCID: PMC4183758 DOI: 10.1186/2193-1801-3-549] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 09/10/2014] [Indexed: 12/15/2022]
Abstract
Diabetes Mellitus (DM) is a chronic disease characterized by hyperglycemia, as a result of abnormal insulin production, insulin function, or both. DM is associated with systemic complications, such as infections, neuropathy and angiopathy, which involve the genitourinary tract. The three most significant urologic complications include: bladder cystopathy, sexual dysfunction and urinary tract infections. Almost half of the patients with DM have bladder dysfunction or cystopathy, which can be manifested in women as hypersensitivity (in 39-61% of the diabetic women) or neurogenic bladder. In males it can be experienced as lower urinary tract symptoms (in 25% of diabetic males with a nearly twofold increased risk when seen by age groups). Additionally, an increased prostate volume affects their micturition as well as their urinary tract. Involving sexual dysfunction in women, it includes reduced libido, decreased arousal, clitoral erectile dysfunction and painful or non-sensitive intercourse; and in diabetic males it varies from low libido, ejaculatory abnormalities and erectile dysfunction. Globally, sexual disorders have a prevalence of 18-42%. Erectile dysfunction is ranked as the third most important complication of DM. Urinary tract infections are observed frequently in diabetic patients, and vary from emphysematous infections, Fournier gangrene, staghorn infected lithiasis to repetitive bacterial cystitis. The most frequent finding in diabetic women has been lower urinary tract infections. Because of the high incidence of obesity worldwide and its association with diabetes, it is very important to keep in mind the urologic complication associated with DM in patients, in order to better diagnose and treat this population.
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Affiliation(s)
- Fernando Arrellano-Valdez
- />Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, 21 sur 1103, Barrio de Santiago, Puebla, Puebla C.P 72410 México
| | - Marta Urrutia-Osorio
- />Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, 21 sur 1103, Barrio de Santiago, Puebla, Puebla C.P 72410 México
| | - Carlos Arroyo
- />Hospital Ángeles de Puebla, Puebla, México
- />Hospital Universitario de Puebla, Benemérita Universidad Autónoma de Puebla, Avenida 25 Poniente 1301, Los Volcanes, 72410 Heroica Puebla De Zaragoza, PUE Mexico
| | - Elena Soto-Vega
- />Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, 21 sur 1103, Barrio de Santiago, Puebla, Puebla C.P 72410 México
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17
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Denman CA, Rosales C, Cornejo E, Bell ML, Munguía D, Zepeda T, Carvajal S, Guernsey de Zapien J. Evaluation of the community-based chronic disease prevention program Meta Salud in Northern Mexico, 2011-2012. Prev Chronic Dis 2014; 11:E154. [PMID: 25211502 PMCID: PMC4164035 DOI: 10.5888/pcd11.140218] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Meta Salud is a community health worker-facilitated intervention in Hermosillo, Sonora, Mexico, and was adapted from Pasos Adelante, a similar evidence-based intervention developed for a Latino population in the United States-Mexico border region. The objective of this study was to examine outcomes for Meta Salud and compare them with outcomes for Pasos Adelante. METHODS This pretest-posttest study took place during 13 weeks among low-income residents of an urban area. The program provided information on topics such as heart health, physical activity, nutrition, diabetes, healthy weight, community health, and emotional well-being; included individual and group activities aimed at motivating behavior change; and encouraged participants to engage in brisk physical activity. RESULTS We found significant decreases from baseline to conclusion in body mass index, waist circumference, hip circumference, weight, triglycerides, and low-density lipoprotein (LDL) cholesterol. From baseline to 3-month follow-up, we found significant decreases in body mass index, waist circumference, weight, LDL cholesterol, and glucose, and an increase in high-density lipoprotein cholesterol. Outcomes for Meta Salud were similar to those found for Pasos Adelante. CONCLUSION The physiological improvements found among participants in Meta Salud and comparable changes among participants in Pasos Adelante suggest a scalable and effective behavioral intervention for regions of the United States and Mexico that share a common boundary or have similar cultural and linguistic characteristics.
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Affiliation(s)
- Catalina A Denman
- El Colegio de Sonora, Av Obregón #54, Colonia Centro, Hermosillo, Sonora, México 83000. E-mail:
| | - Cecilia Rosales
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Elsa Cornejo
- El Colegio de Sonora, Hermosillo, Sonora, Mexico
| | - Melanie L Bell
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | | | - Tanyha Zepeda
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Scott Carvajal
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
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Amerindian-specific regions under positive selection harbour new lipid variants in Latinos. Nat Commun 2014; 5:3983. [PMID: 24886709 PMCID: PMC4062071 DOI: 10.1038/ncomms4983] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/29/2014] [Indexed: 12/13/2022] Open
Abstract
Dyslipidemia and obesity are especially prevalent in populations with Amerindian
backgrounds, such as Mexican–Americans, which predispose these populations to
cardiovascular disease. Here we design an approach, known as the cross-population allele
screen (CPAS), which we conduct prior to a genome-wide association study (GWAS) in 19,273
Europeans and Mexicans, in order to identify Amerindian risk genes in Mexicans. Utilizing
CPAS to restrict the GWAS input variants to only those differing in frequency between the
two populations, we identify novel Amerindian lipid genes, receptor-related orphan receptor alpha (RORA) and salt-inducible kinase
3 (SIK3), and three
loci previously unassociated with dyslipidemia or obesity. We also detect lipoprotein lipase (LPL) and apolipoprotein
A5 (APOA5)
harbouring specific Amerindian signatures of risk variants and haplotypes. Notably, we
observe that SIK3 and one novel
lipid locus underwent positive selection in Mexicans. Furthermore, after a high-fat meal,
the SIK3 risk variant carriers
display high triglyceride levels. These findings suggest that Amerindian-specific genetic
architecture leads to a higher incidence of dyslipidemia and obesity in modern Mexicans. Dyslipidemia and obesity have a high prevalence in populations with
Amerindian backgrounds, such as Mexican–Americans. Here, the authors design an approach
to identify Amerindian risk genes in Mexicans and identify five genomic loci, which include
RORA and SIK3 that may contribute to the risk of dyslipidemia and obesity in
Amerindian populations.
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Pérez-Fuentes R, Baez-Duarte BG, Zamora-Ginez I, Ruiz-Vivanco G, Pulido-Pérez P, Nieva-Vázquez A, Gonzalez-Mejia ME, Torres-Rasgado E. Early decrease of insulin sensitivity in offspring of individuals with type 2 diabetes. The Mexican Diabetes Prevention Study. Arch Med Res 2014; 45:217-22. [PMID: 24606816 DOI: 10.1016/j.arcmed.2014.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 01/23/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Defects in insulin sensitivity (IS) and insulin secretion have been recognized as risk factors for type 2 diabetes (T2D) and its complications. We undertook this study to establish the relationship between healthy type 2 diabetic offspring (OFD) from a Mexican population with IS. METHODS A total of 602 Mexican subjects, 359 first-degree offspring of T2D (OFD+) and 243 first-degree non-offspring of T2D (OFD-) were classified as young adults (age range, 18-44 years) and middle-aged adults (age range, 45-65 years). Groups were clinically and biochemically characterized. Quantitative insulin sensitivity check index (QUICKI) was used to estimate IS and the homeostasis model assessment B (HOMA-B) was used to estimate B cell function. RESULTS IS decreased significantly (p <0.05) in OFD+ middle-aged (QUICKI 0.330 ± 0.03) compared with OFD- (0. 370 ± 0.03). Middle-aged adults (OFD+) had the highest prevalence of increased fasting insulin levels (FIL) (13.6%) and decreased IS (22.9%) compared with OFD- groups (3.2%). A binary regression analysis showed the association of OFD+ with increased FIL (odds ratio [OR], 3.71; 95% confidence interval [95% CI], 1.68-8.2; p = 0.001), and QUICKI (OR, 10.87; 95% CI, 2.36-44.69; p <0.01) adjusted by gender, age, and obesity. CONCLUSIONS Our results suggest that decreased IS itself could be recognized as one of the earliest detectable abnormalities in middle-aged adults. Moreover, prevalence increases with age and is associated with type 2 diabetic offspring, regardless of obesity.
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Affiliation(s)
- Ricardo Pérez-Fuentes
- Laboratorio de Investigación en Fisiopatología de Enfermedades Crónicas, Centro de Investigación Biomédica de Oriente (CIBIOR), Instituto Mexicano del Seguro Social (IMSS), Atlixco, Puebla, Mexico; Facultad de Medicina, Benemérita Universidad Autónoma de Puebla (BUAP), Puebla, Mexico.
| | - Blanca G Baez-Duarte
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla (BUAP), Puebla, Mexico
| | - Irma Zamora-Ginez
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla (BUAP), Puebla, Mexico
| | | | - Patricia Pulido-Pérez
- Laboratorio de Investigación en Fisiopatología de Enfermedades Crónicas, Centro de Investigación Biomédica de Oriente (CIBIOR), Instituto Mexicano del Seguro Social (IMSS), Atlixco, Puebla, Mexico
| | - Adriana Nieva-Vázquez
- Laboratorio de Investigación en Fisiopatología de Enfermedades Crónicas, Centro de Investigación Biomédica de Oriente (CIBIOR), Instituto Mexicano del Seguro Social (IMSS), Atlixco, Puebla, Mexico
| | - M Elba Gonzalez-Mejia
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla (BUAP), Puebla, Mexico
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Kimoto R, Ronquillo D, Caamaño MC, Martinez G, Schubert L, Rosado JL, Garcia O, Long KZ. Food, eating and body image in the lives of low socioeconomic status rural Mexican women living in Queretaro State, Mexico. Health Place 2014; 25:34-42. [DOI: 10.1016/j.healthplace.2013.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 08/25/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
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Gelhorn HL, Stringer SM, Brooks A, Thompson C, Monz BU, Boye KS, Hach T, Lund SS, Palencia R. Preferences for medication attributes among patients with type 2 diabetes mellitus in the UK. Diabetes Obes Metab 2013; 15:802-9. [PMID: 23464623 DOI: 10.1111/dom.12091] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 01/20/2013] [Accepted: 03/03/2013] [Indexed: 11/30/2022]
Abstract
AIM To examine preferences for oral medication attributes among participants with early and advanced type 2 diabetes mellitus (T2DM) in the UK using a discrete choice experiment (DCE). METHODS A web-based DCE was administered where participants indicated which medication they preferred from two different hypothetical oral anti-diabetic (OAD) medication profiles, each composed of differing levels of seven attributes (efficacy, hypoglycaemic events, weight change, gastrointestinal/nausea side effects, urinary tract infection and genital infection, blood pressure and cardiovascular risk) for 20 sets of pair-wise comparisons. A random effects multinomial logit regression model was used to estimate the preference weight (PW) for each of the attribute levels, and the relative importance (RI) of each attribute was calculated. Analyses were conducted for the overall sample and for medication and gender subgroups. RESULTS The final sample included 100 participants with a mean age of 62.9 (SD 11.1) years and comparable numbers of participants of each gender (51% male, 49% female). The majority of the participants were White-British (92%). The total PW and corresponding RI were highest for four of the seven attributes: hypoglycaemic events (PW = 1.98; RI = 24.7%), weight change (PW = 1.65; RI = 20.6%), gastrointestinal/nausea side effects (PW = 1.49; RI = 18.6%) and efficacy (PW = 1.44; RI = 18.0%). The RI values differed for some attributes across gender and number of current T2DM medication subgroups. CONCLUSION The results suggest that hypoglycaemia, weight change, gastrointestinal side effects and efficacy are of primary importance to patients in their OAD preferences in T2DM. These four attributes comprised over 80% of the RI.
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Affiliation(s)
- H L Gelhorn
- United BioSource Corporation, Bethesda, MD, USA.
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Lopez R, Agullo P, Lakshmanaswamy R. Links between obesity, diabetes and ethnic disparities in breast cancer among Hispanic populations. Obes Rev 2013; 14:679-91. [PMID: 23611507 DOI: 10.1111/obr.12030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 01/25/2013] [Accepted: 02/18/2013] [Indexed: 12/27/2022]
Abstract
Breast cancer is the most prevalent malignancy in women worldwide and is a growing concern due to rising incidence and ongoing ethnic disparities in both incidence and mortality. A number of factors likely contribute to these trends including rising rates of obesity and diabetes across the globe and differences in genetic predisposition. Here, we emphasize Hispanic populations and summarize what is currently known about obesity, diabetes and individual genetic predisposition as they relate to ethnic disparities in breast cancer incidence and mortality. In addition, we discuss potential contributions to breast cancer aetiology from molecular mechanisms associated with obesity and diabetes including dyslipidemia, hyperglycaemia, hyperinsulinaemia, endocrine dysfunction and inflammation. We propose that unique differences in diet and lifestyle coupled with individual genetic predisposition and endocrine/immune dysfunction explain most of the ethnic disparities seen in breast cancer incidence and mortality.
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Affiliation(s)
- R Lopez
- Center of Excellence in Cancer Research, Center of Excellence in Diabetes Research, Department of Biomedical Sciences MSB1, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
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Talavera JO, Martinez G, Cervantes JL, Marin JA, Rodriguez-Briones I, Gonzalez JG, Ocampo R, Sanchez-Mijangos H, Bernal-Rosales LP, Polanco A. A double-blind, double-dummy, randomized, placebo-controlled trial to evaluate the effect of statin therapy on triglyceride levels in Mexican hypertriglyceridemic patients. Curr Med Res Opin 2013; 29:379-86. [PMID: 23323877 DOI: 10.1185/03007995.2013.766590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The most prevalent dyslipidemias in Mexico are low high-density lipoprotein (HDL) and high triglyceride (TG) levels. Hypertriglyceridemia (HTG) has been considered an independent risk factor for cardiovascular disease (CVD). The aim of this study was to evaluate the efficacy of rosuvastatin (RSV) in reducing TG levels in Mexican patients. METHODS A randomized, double-blind, double-dummy, parallel-group, placebo-controlled, multicenter, phase IV study was conducted. Patients were of both genders, ≥ 18 years old, with basal TG levels between 200 and 800 mg/dl, LDL levels ≤ 190 mg/dl. Patients were randomized to receive rosuvastatin 10 mg (Group 1), 20 mg (Group 2) or placebo (Group 3) once daily for 8 weeks. Primary efficacy was TG level; secondary efficacy was non-HDL; HDL, low-density lipoprotein (LDL), total cholesterol (TC), Apo (apolipoprotein) A1, and ApoB. Safety data were evaluated up to 30 days after the last dose of medication. The Mann-Whitney U-test was performed to contrast each RSV groups against placebo; p < 0.05 was considered significant. Trial registry number is NCT00473655. RESULTS A total of 334 patients were randomized: Group 1 = 111, Group 2 = 112, and Group 3 = 111. Basal TG median value levels were 278 mg/dl, 266 mg/dl, 279 mg/dl with median reduction (MdR) at 8 weeks of 26.6%, 32.19% and 7.58%, respectively, (Group 1 vs. Group 3 p = 0.002, and Group 2 vs. Group 3 p < 0.0001). Basal non-HDL values were 179 mg/dl, 180 mg/dl and 179 mg/dl with a MdR of 27%, 32% and 8%, respectively (Group 1 vs. Group 3 p < 0.0001, and Group 2 vs. Group 3 p < 0.0001); basal LDL vales were 130 mg/dl, 130 mg/dl and 127 mg/dl with MdR 35%, 44% and -4% (Group 1 vs. Group 3 p < 0.0001, Group 2 vs. Group 3 p < 0.0001); basal ApoB values were 114 mg/dl, 115 mg/dl and 110.5 mg/dl with MdR 25%, 33% and -0.5% (Group 1 vs. Group 3 p < 0.0001, Group 2 vs. Group 3 p < 0.001). CONCLUSION Rosuvastatin 10 and 20 mg/day significantly reduced triglycerides and improved atherogenic lipid profile in HTG Mexican patients. The main limitation was the short follow-up time period.
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Affiliation(s)
- Juan-Osvaldo Talavera
- Clinical Research Training Center, National Medical Center, XXI Century, Social Security Mexican Institute, F.D., Mexico
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Barquera S, Campos-Nonato I, Aguilar-Salinas C, Lopez-Ridaura R, Arredondo A, Rivera-Dommarco J. Diabetes in Mexico: cost and management of diabetes and its complications and challenges for health policy. Global Health 2013; 9:3. [PMID: 23374611 PMCID: PMC3599194 DOI: 10.1186/1744-8603-9-3] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 01/25/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mexico has been experiencing some of the most rapid shifts ever recorded in dietary and physical activity patterns leading to obesity. Diabetes mellitus has played a crucial role causing nearly 14% of all deaths. We wanted to make a comprehensive study of the role of diabetes in terms of burden of disease, prevalence, cost of diabetes, cost of complications and health policy. METHOD We review the quantitative data that provides evidence of the extent to which the Mexican health economy is affected by the disease and its complications. We then discuss the current situation of diabetes in Mexico with experts in the field. RESULTS There was a significant increase in the prevalence of diabetes from 1994 to 2006 with rising direct costs (2006: outpatient USD$ 717,764,787, inpatient USD$ 223,581,099) and indirect costs (2005: USD$ 177,220,390), and rising costs of complications (2010: Retinopathy USD$ 10,323,421; Cardiovascular disease USD$ 12,843,134; Nephropathy USD$ 81,814,501; Neuropathy USD$ 2,760,271; Peripheral vascular disease USD$ 2,042,601). The health policy focused on screening and the creation of self-support groups across the country. CONCLUSIONS The increasing diabetes mortality and lack of control among diagnosed patients make quality of treatment a major concern in Mexico. The growing prevalence of childhood and adult obesity and the metabolic syndrome suggest that the situation could be even worse in the coming years. The government has reacted strongly with national actions to address the growing burden posed by diabetes. However our research suggests that the prevalence and mortality of diabetes will continue to rise in the future.
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Affiliation(s)
- Simon Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
| | - Ismael Campos-Nonato
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
| | - Carlos Aguilar-Salinas
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F, Mexico
| | - Ruy Lopez-Ridaura
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
| | - Armando Arredondo
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
| | - Juan Rivera-Dommarco
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
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Perichart-Perera O, Balas-Nakash M, Rodríguez-Cano A, Legorreta-Legorreta J, Parra-Covarrubias A, Vadillo-Ortega F. Low Glycemic Index Carbohydrates versus All Types of Carbohydrates for Treating Diabetes in Pregnancy: A Randomized Clinical Trial to Evaluate the Effect of Glycemic Control. Int J Endocrinol 2012; 2012:296017. [PMID: 23251152 PMCID: PMC3517846 DOI: 10.1155/2012/296017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 10/16/2012] [Accepted: 10/17/2012] [Indexed: 11/25/2022] Open
Abstract
Background. Due to the higher prevalence of obesity and diabetes mellitus (DM), more pregnant women complicated with diabetes are in need of clinical care. Purpose. Compare the effect of including only low glycemic index (GI) carbohydrates (CHO) against all types of CHO on maternal glycemic control and on the maternal and newborn's nutritional status of women with type 2 DM and gestational diabetes mellitus (GDM). Methods. Women (n = 107, ≤29 weeks of gestation) were randomly assigned to one of two nutrition intervention groups: moderate energy and CHO restriction (Group 1: all types of CHO, Group 2: low GI foods). Results. No baseline differences in clinical data were observed. Capillary glucose concentrations throughout pregnancy were similar between groups. Fewer women in Group 2 exceeded weight gain recommendations. Higher risk of prematurity was observed in women in Group 2. No differences in glycemic control were observed between women with type 2 DM and those with GDM. Conclusions. Inclusion of low GI CHO as part of a comprehensive nutrition intervention is equally effective in improving glycemic control as compared to all types of CHO. This strategy had a positive effect in preventing excessive maternal weight gain but increased the risk of prematurity.
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Affiliation(s)
- Otilia Perichart-Perera
- Nutrition Research Department, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes, 11000 Mexico City, Mexico
| | - Margie Balas-Nakash
- Nutrition Research Department, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes, 11000 Mexico City, Mexico
| | - Ameyalli Rodríguez-Cano
- Nutrition Research Department, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes, 11000 Mexico City, Mexico
| | - Jennifer Legorreta-Legorreta
- Nutrition Research Department, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes, 11000 Mexico City, Mexico
| | - Adalberto Parra-Covarrubias
- Endocrinology Department, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes, 11000 Mexico City, Mexico
| | - Felipe Vadillo-Ortega
- Unidad de Vinculación, Facultad de Medicina, UNAM, Instituto Nacional de Medicina Genomica, 04510 Mexico City, Mexico
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Peralta-Leal V, Leal-Ugarte E, Meza-Espinoza JP, Dávalos-Rodríguez IP, Bocanegra-Alonso A, Acosta-González RI, Gonzales E, Nair S, Durán-González J. Association of a serotonin transporter gene (SLC6A4) 5-HTTLPR polymorphism with body mass index categories but not type 2 diabetes mellitus in Mexicans. Genet Mol Biol 2012; 35:589-93. [PMID: 23055796 PMCID: PMC3459407 DOI: 10.1590/s1415-47572012005000048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 03/22/2012] [Indexed: 11/22/2022] Open
Abstract
The serotonergic system has been hypothesized to contribute to the biological susceptibility to type 2 diabetes mellitus (T2DM) and body-mass index (BMI) categories. We investigate a possible association of 5-HTTLPR polymorphism (L and S alleles) in the promoter region of the serotonin transporter gene (SLC6A4) with the development of T2DM and/or higher BMI by analyzing a sample of 138 individuals diagnosed with T2DM and 172 unrelated controls from the Mexican general population. In the total sample genotypes were distributed according to Hardy-Weinberg equilibrium, and S allele frequency was 0.58. There was no statistical association between 5-HTTLPR polymorphism and the development of T2DM in this Mexican population sample (p = 0.12). Nevertheless, logistic regression analysis of the L allele and increased BMI disclosed an association, after adjusting for age, sex and T2DM (p = 0.02, OR 1.74, 95% CI: 1.079–2.808).
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Affiliation(s)
- Valeria Peralta-Leal
- Facultad de Medicina e Ingeniería en Sistemas Computacionales, Departamento de Genética Aplicada a la Medicina, Universidad Autónoma de Tamaulipas, H. Matamoros Tamaulipas, México
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de León-Castañeda CD, Altagracia-Martínez M, Kravzov-Jinich J, Cárdenas-Elizalde MDR, Moreno-Bonett C, Martínez-Núñez JM. Cost-effectiveness study of oral hypoglycemic agents in the treatment of outpatients with type 2 diabetes attending a public primary care clinic in Mexico City. CLINICOECONOMICS AND OUTCOMES RESEARCH 2012; 4:57-65. [PMID: 22427724 PMCID: PMC3304331 DOI: 10.2147/ceor.s27826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Worldwide, diabetes mellitus presents a high burden for individuals and society. In Latin America, many people with diabetes have limited access to health care, which means that indirect costs may exceed direct health care cost. Diabetes is Mexico's leading cause of death. PURPOSE To evaluate the cost-effectiveness ratios of the most used oral hypoglycemic agents (OHA) in the treatment of outpatients with type 2 diabetes attending a public primary care clinic in Mexico City. DESIGN A cross-sectional and analytic study was conducted in Mexico City. METHODOLOGY Twenty-seven adult outpatients with type 2 diabetes who were treated either with metformin or glibenclamide were included. Acarbose was used as an alternative strategy. The study was carried out from the perspective of Mexican society. Direct medical and nonmedical costs as well as indirect costs were evaluated using a structured questionnaire. Efficacies of all drug treatments were evaluated retrospectively. A systematic search was conducted to select published randomized clinical trials based on predetermined inclusion criteria, and treatment success was defined as glycosylated hemoglobin factor ≤ 7%. Efficacy data of each drug and/or combination were analyzed using meta-analysis. The Monte Carlo Markov model was used. Quality-adjusted life-years (QALY) were used as the unit of effectiveness; incremental and sensitive analyses were performed and a 5% discount rate was calculated. A hypothetical cohort of 10,000 patients was modeled. RESULTS The odds ratios of the success of each drug treatment were obtained from the meta-analyses, and were the following: 5.82 (glibenclamide), 3.86 (metformin), 3.5 (acarbose), and 6.76 (metformin-glibenclamide). The cost-effectiveness ratios found were US$272.63/QALY (glibenclamide), US$296.48/QALY (metformin), and US$409.86/QALY (acarbose). Sensitivity analysis did not show changes for the most cost-effective therapy when the effectiveness probabilities or treatment costs were modified. CONCLUSION Glibenclamide is the most cost-effective treatment for the present study outpatient population diagnosed with type 2 diabetes in the early stages.
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Affiliation(s)
- Christian Díaz de León-Castañeda
- Department of Biological Systems and Health Care, Biological and Health Sciences Division, Universidad Autónoma Metropolitana-Xochimilco, Mexico DF, Mexico
| | - Marina Altagracia-Martínez
- Department of Biological Systems and Health Care, Biological and Health Sciences Division, Universidad Autónoma Metropolitana-Xochimilco, Mexico DF, Mexico
| | - Jaime Kravzov-Jinich
- Department of Biological Systems and Health Care, Biological and Health Sciences Division, Universidad Autónoma Metropolitana-Xochimilco, Mexico DF, Mexico
| | - Ma del Rosario Cárdenas-Elizalde
- Department of Biological Systems and Health Care, Biological and Health Sciences Division, Universidad Autónoma Metropolitana-Xochimilco, Mexico DF, Mexico
| | - Consuelo Moreno-Bonett
- Department of Biological Systems and Health Care, Biological and Health Sciences Division, Universidad Autónoma Metropolitana-Xochimilco, Mexico DF, Mexico
| | - Juan Manuel Martínez-Núñez
- Department of Biological Systems and Health Care, Biological and Health Sciences Division, Universidad Autónoma Metropolitana-Xochimilco, Mexico DF, Mexico
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Pérez-Hernández IH, Avendaño-Flores YS, Mejía-Zepeda R. Analysis of the membrane fluidity of erythrocyte ghosts in diabetic, spontaneously hypertensive rats. Acta Diabetol 2010; 47 Suppl 1:47-55. [PMID: 19404568 DOI: 10.1007/s00592-009-0120-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 04/06/2009] [Indexed: 10/20/2022]
Abstract
Diabetes and hypertension are closely related diseases associated with changes in membrane fluidity. Here, we measured the membrane fluidity of erythrocyte ghosts from spontaneously hypertensive rats (SHR), with or without streptozotocin (STZ)-induced diabetes, at the ages of 1, 3 and 6 months, by introducing the use of the intramolecular excimer forming dipyrenylpropane (DPyP) in this model. Type 2 diabetes mellitus (T2DM) was induced in 48-h-old, newborn male SHR by intraperitoneal injection of STZ. We found lower excimer to monomer (I (e)/I (m)) DPyP ratios in diabetic SHR than in control SHR at 3 and 6 months old, indicating a decrease in membrane fluidity. Simultaneously, the composition of fatty acids was determined and it was found that the unsaturated to saturated fatty acids ratio (U/S) was compatible with changes in membrane fluidity. These results suggest that the change in fatty acid composition of erythrocyte ghosts contributes significantly to the decreased membrane fluidity detected with DPyP in diabetic SHR.
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Affiliation(s)
- Ismael H Pérez-Hernández
- Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Av de los Barrios No 1 Los Reyes Iztacala, CP 54090 Tlalnepantla, Estado de México, Mexico
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Gakidou E, Mallinger L, Abbott-Klafter J, Guerrero R, Villalpando S, Ridaura RL, Aekplakorn W, Naghavi M, Lim S, Lozano R, Murray CJL. Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys. Bull World Health Organ 2010; 89:172-83. [PMID: 21379413 DOI: 10.2471/blt.10.080820] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 10/20/2010] [Accepted: 11/02/2010] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the effectiveness of the health system response to the challenge of diabetes across different settings and explore the inequalities in diabetes care that are attributable to socioeconomic factors. METHODS We used nationally representative health examination surveys from Colombia, England, the Islamic Republic of Iran, Mexico, Scotland, Thailand and the United States of America to obtain data on diagnosis, treatment and control of hyperglycaemia, arterial hypertension and hypercholesterolaemia among individuals with diabetes. Using logistic regression, we explored the socioeconomic determinants of diagnosis and effective case management. FINDINGS A substantial proportion of individuals with diabetes remain undiagnosed and untreated, both in developed and developing countries. The figures range from 24% of the women in Scotland and the USA to 62% of the men in Thailand. The proportion of individuals with diabetes reaching treatment targets for blood glucose, arterial blood pressure and serum cholesterol was very low, ranging from 1% of male patients in Mexico to about 12% in the United States. Income and education were not found to be significantly related to the rates of diagnosis and treatment anywhere except in Thailand, but in the three countries with available data insurance status was a strong predictor of diagnosis and effective management, especially in the United States. CONCLUSION There are many missed opportunities to reduce the burden of diabetes through improved control of blood glucose levels and improved diagnosis and treatment of arterial hypertension and hypercholesterolaemia. While no large socioeconomic inequalities were noted in the management of individuals with diabetes, financial access to care was a strong predictor of diagnosis and management.
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Affiliation(s)
- Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, Seattle, WA 98121, USA.
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Affiliation(s)
- Iliana V. Kohler
- a Population Studies Center , University of Pennsylvania , 239 McNeil Building, 3718 Locust Walk, Philadelphia , PA , 19104–6298 E-mail:
| | - Beth J. Soldo
- b Population Studies Center , University of Pennsylvania
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Cruz M, Valladares-Salgado A, Garcia-Mena J, Ross K, Edwards M, Angeles-Martinez J, Ortega-Camarillo C, de la Peña JE, Burguete-Garcia AI, Wacher-Rodarte N, Ambriz R, Rivera R, D'artote AL, Peralta J, Parra EJ, Kumate J. Candidate gene association study conditioning on individual ancestry in patients with type 2 diabetes and metabolic syndrome from Mexico City. Diabetes Metab Res Rev 2010; 26:261-70. [PMID: 20503258 DOI: 10.1002/dmrr.1082] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) is influenced by diverse environmental and genetic risk factors. Metabolic syndrome (MS) increases the risk of cardiovascular disease and diabetes. We analysed 14 cases of polymorphisms located in 10 candidate loci, in a sample of patients with T2D and controls from Mexico City. METHODS We analysed the association of 14 polymorphisms located within 10 genes (TCF7L2, ENPP1, ADRB3, KCNJ11, LEPR, PPARgamma, FTO, CDKAL1, SIRT1 and HHEX) with T2D and MS. The analysis included 519 subjects with T2D defined according to the ADA criteria, 389 with MS defined according to the AHA/NHLBI criteria and 547 controls. Association was tested with the program ADMIXMAP including individual ancestry, age, sex, education and in some cases body mass index (BMI), in a logistic regression model. RESULTS The two markers located within the TCF7L2 gene showed strong associations with T2D (rs7903146, T allele, odd ratio (OR) = 1.76, p = 0.001 and rs12255372, T allele, OR = 1.78, p = 0.002), but did not show significant association with MS. The non-synonymous rs4994 polymorphism of the ADRB3 gene was associated with T2D (Trp allele, OR = 0.62, p = 0.001) and MS (Trp allele, OR = 0.74, p = 0.018). Nominally significant associations were also observed between T2D and the SIRT1 rs3758391 SNP and MS and the HHEX rs5015480 polymorphism. CONCLUSIONS Variants located within the gene TCF7L2 are strongly associated with T2D but not with MS, providing support to previous evidence indicating that polymorphisms at the TCF7L2 gene increase T2D risk. In contrast, the non-synonymous ADRB3 rs4994 polymorphism is associated with T2D and MS.
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Affiliation(s)
- M Cruz
- Unidad de Investigacion Medica en Bioquimica, Hospital de Especialidades, Instituto Mexicano del Seguro Social, CMN Siglo XXI, Mexico, DF, Mexico.
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Andrade FCD. Measuring the impact of diabetes on life expectancy and disability-free life expectancy among older adults in Mexico. J Gerontol B Psychol Sci Soc Sci 2009; 65B:381-9. [PMID: 20028950 DOI: 10.1093/geronb/gbp119] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED OBJECTIVES. The aim of the present study is to investigate differences in total life expectancy (TLE), disability-free life expectancy (DFLE), disabled life expectancy (DLE), and personal care assistance between individuals with and without diabetes in Mexico. METHODS The sample was drawn from the nationally representative Mexican Health and Aging Study. Disability was assessed through a basic Activities of Daily Living (ADL) measure, the Instrumental Activities of Daily Living (IADL) scale, and the Nagi physical performance measure. The Interpolation of Markov Chains method was used to estimate the impact of diabetes on TLE and DFLE. RESULTS Results indicate that diabetes reduces TLE at ages 50 and 80 by about 10 and 4 years, respectively. Diabetes is also associated with fewer years in good health. DFLE (based on ADL measures) at age 50 is 20.8 years (95% confidence interval [CI]: 19.2-22.3) for those with diabetes, compared with 29.9 years (95% CI: 28.8-30.9) for those without diabetes. Regardless of diabetes status, Mexican women live longer but face a higher disability burden than men. CONCLUSION Among older adults in Mexico, diabetes is associated with shorter TLE and DFLE. The negative effect of diabetes on the number of years lived, particularly in good health, creates significant economic, social, and individual costs for elderly Mexicans.
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Affiliation(s)
- Flávia C D Andrade
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, 123 Huff Hall, 1206 South Fourth Street, Champaign, IL 61820, USA.
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Prevalence of erectile dysfunction and its treatment in a Mexican population: distinguishing between erectile function change and dysfunction. JOURNAL OF MEN'S HEALTH 2009. [DOI: 10.1016/j.jomh.2008.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Salinas JJ. Tapping healthcare resource by older Mexicans with diabetes: how migration to the United States facilitates access. J Cross Cult Gerontol 2008; 23:301-12. [PMID: 18677556 DOI: 10.1007/s10823-008-9076-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study employs semi-structured interviews conducted in two small migrant towns in Michoacán, Mexico to determine how older Mexicans with diabetes access healthcare and treatment. Barriers in access to healthcare services are identified as well as how family members and migration are utilized to offset these limitations. Results indicate that former migrants who were economically successful in the USA have greater options in the type of services they are able to use. In addition, residents with diabetes who have family members living in the USA receive remittances in the form of money and medical supplies that aid in the treatment of their illness. Implications for policy are discussed.
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Affiliation(s)
- Jennifer J Salinas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, 77555-0460, USA.
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Hu D, Fu P, Xie J, Chen CS, Yu D, Whelton PK, He J, Gu D. Increasing prevalence and low awareness, treatment and control of diabetes mellitus among Chinese adults: the InterASIA study. Diabetes Res Clin Pract 2008; 81:250-7. [PMID: 18495287 DOI: 10.1016/j.diabres.2008.04.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Accepted: 04/09/2008] [Indexed: 11/30/2022]
Abstract
AIMS To estimate the prevalence rates of impaired fasting glucose (IFG) and diabetes mellitus (DM) and to evaluate the awareness, treatment, and control of DM in the Chinese adult population. METHODS The International Collaborative Study of Cardiovascular Disease in ASIA (InterASIA), a cross-sectional study, was conducted in 2000-2001. A nationally representative sample of 15,236 Chinese adults between 35 and 74 years old who had fasting plasma glucose measured were used for the present research. Awareness, treatment, and control of DM were defined by subjects self-reporting a DM diagnosis and the use of a prescription medication or nonpharmacological intervention for DM, and had a fasting plasma glucose <126mg/dl, respectively. RESULTS The prevalence rates of IFG and DM in Chinese adults aged 35-74 years were 7.33 and 5.49%, respectively, with the age-standardized prevalence also 7.33 and 5.49%, respectively. Among patients with DM, 23.66% were aware of their DM, 20.33% were taking prescribed medication or nonpharmacological interventions, and 8.28% had fasting plasma glucose <126mg/dl. Among diabetics who reported a prior diagnosis of DM, 85.22% were taking prescription medication or nonpharmacological interventions and 35% had fasting plasma glucose <126mg/dl. CONCLUSIONS The prevalence rate of DM among Chinese adults has been increasing in recent years. The rates of awareness, treatment and control of DM are relatively low. Improving the awareness, treatment, and control is urgently needed for the intervention of DM in the Chinese adult population.
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Affiliation(s)
- Dongsheng Hu
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
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Barquera S, Durazo-Arvizu RA, Luke A, Cao G, Cooper RS. Hypertension in Mexico and among Mexican Americans: prevalence and treatment patterns. J Hum Hypertens 2008; 22:617-26. [PMID: 18305546 DOI: 10.1038/jhh.2008.9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Increased social and economic integration across the US-Mexican borders has led to important new developments in public health. Lower levels of cardiovascular mortality have been observed among Mexican Americans (MAs) although few direct comparisons have been undertaken with Mexico. Using survey data in the respective countries we examined blood pressure (BP) levels, hypertension prevalence and patterns of awareness, treatment and control in Mexico and among MAs. A national representative sample of the adult population from Mexico collected in 2000 (N=49 294), and data on 8688 MA participants in the 1999-2004 National Health and Nutrition Examination survey from the United States were available for analysis. US-born MAs and those born in Mexico were analysed separately in the US data. Lack of direct standardization of methods between surveys necessitated statistical adjustment of BP values. Analyses were based on persons aged 25-64 in each country. Sex- and age-adjusted mean systolic/diastolic BPs were 122/80, 119/71 and 120/73 in Mexicans, immigrant MAs and US-born MAs, respectively. The prevalences of hypertension (BP > or = 140/90 or treatment) were 33, 17 and 22%. Hypertension control rates were 3.7, 32.1 and 37.9%, in the same groups. Awareness and treatment rates were 25 and 13% in Mexico and 54 and 46% among MAs in the United States, respectively. Hypertension appears to be more common in Mexico than among Mexican immigrants to the United States. Despite relatively low access to health insurance in the United States, hypertension control increased over the course of this migration.
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Affiliation(s)
- S Barquera
- Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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Garcia-Garcia G, Aviles-Gomez R, Luquin-Arellano VH, Padilla-Ochoa R, Lepe-Murillo L, Ibarra-Hernandez M, Briseño-Renteria G. Cardiovascular risk factors in the Mexican population. Ren Fail 2007; 28:677-87. [PMID: 17162426 DOI: 10.1080/08860220600936096] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Chronic degenerative disorders have become a major health problem in Mexico. Cardiovascular diseases represent the first cause of death in our country. Diabetes mellitus (DM) has emerged as the main health problem in Mexico. Its prevalence doubled from < 3% in the 1960s to 6% in the 1980s. Between 1993 and 2000, diabetes mellitus increased from 6.7% to 8.2%, a 22% growth over a seven-year period. In 1995, the cost of the treatment of DM represented 15.48% of the health budget and 0.79% of the GDP. The prevalence of hypertension (HTN) increased from 10% in 1933 to 20% in 1990 and from 23.8% to 30.7% between 1993 and 2000. The expenditures from HTN in 1999 corresponded to 13.9% of the health budget, and 0.71% of GDP. Dyslipidemias are very common. Close to 40% of the population has levels of HDL cholesterol < 35 mg/dL, 24.3% has fasting triglycerides > 200 mg/dL, and 10% has hypercholesterolemia. The prevalence of obesity increased from 21.4% in 1993, to 23.7% in the year 2000. Eight percent of the population has a glomerular filtration rate < 60 mL/min, and 9.1% has proteinuria. Twenty-four percent uses tobacco regularly, and 13% had the habit in the past. Smoking is more frequent among diabetics (34%).In conclusion, cardiovascular risks factors are highly common among the Mexican population and increasing at alarming rates. Preventive programs targeted to decrease their prevalence are urgently needed in Mexico and should become a national priority.
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Davila-Perez C, Amano A, Alpuche-Solis AG, Patiño-Marin N, Pontigo-Loyola AP, Hamada S, Loyola-Rodriguez JP. Distribution of Genotypes of Porphyromonas gingivalis in Type 2 Diabetic Patients with Periodontitis in Mexico. J Clin Periodontol 2007; 34:25-30. [PMID: 17116161 DOI: 10.1111/j.1600-051x.2006.01011.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine and compare the distribution of Porphyromonas gingivalis fimA genotypes in type 2 diabetes mellitus (T2DM) patients affected by periodontitis, using non-diabetic subjects with and without periodontitis as control groups. MATERIAL AND METHODS This study involved 75 subjects divided into three groups of 25 subjects each: Group 1 (non-T2DM without periodontitis), Group 2 (non-T2DM with periodontitis) and Group 3 (T2DM with periodontitis). The outcome variable was periodontitis, and explanatory variables were age, sex, T2DM and specific P. gingivalis fimA genotypes. RESULTS In non-T2DM subjects with healthy periodontal tissues, type I fimA was the most frequently detected individually (40%) or in combinations (40%). In non-T2DM subjects with periodontitis, the most frequently detected type was Ib individually (20%) or in combinations (36%). In T2DM patients with periodontitis, the most frequently detected types were types I (20%) and III (20%), but there was no statistical difference (p>0.05) with non-T2DM periodontitis subjects. CONCLUSIONS Type I genotype was more frequently detected in periodontally healthy sites from non-T2DM subjects than in periodontitis sites from either subjects with or without T2DM. However, in sites affected by periodontitis from T2DM subjects the predominating types were I and III, which are less virulent strains of P. gingivalis.
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Affiliation(s)
- Claudia Davila-Perez
- The Master's Degree in Dental Science with Specialization in Advanced General Dentistry Program at San Luis Potosi University, Mexico
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Navalón-García K, Mendoza-Alcantar L, Díaz-Vargas ME, Martínez-Godínez MA, Reyna-Garfias H, Aguilar-Salinas CA, Riba L, Canizales-Quinteros S, Villarreal-Molina T, González-Chávez A, Argueta-Villamar V, Tusié-Luna MT, Miliar-García A. HNF-1alpha G574S is a functional variant with decreased transactivation activity. Diabet Med 2006; 23:1295-300. [PMID: 17116178 DOI: 10.1111/j.1464-5491.2006.02008.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To assess the functional consequence of the hepatocyte nuclear factor 1alpha gene (HNF-1alpha) G574S variant previously proposed as a diabetes susceptibility allele, in a group of Mexican Type 2 diabetic patients with end-stage renal disease (ESRD). METHODS The transcriptional activity of the HNF-1alpha G574S recombinant protein on the human insulin promoter was assessed by transfection assays in RINm5f and HepG2 cell lines. RESULTS Two unrelated Mexican diabetic patients with no known African ancestry were found to carry the G574S variant. This substitution was not found among unrelated healthy control subjects. Whereas the G574S HNF-1alpha transcription activation of the human insulin promoter was 40% lower than that of the wild-type protein in RINm5f beta cells, no difference was found in a hepatic cell line (HepG2). CONCLUSIONS G574S affects the transactivation potential of HNF-1alpha on the insulin promoter in pancreatic beta-cells. Although it has been difficult to prove its role in the development of diabetes in case-control association studies, this variant exhibits functional effects consistent with it being a potential diabetes susceptibility allele.
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Affiliation(s)
- K Navalón-García
- Instituto Politécnico Nacional Escuela Superior de Medicins, Sección de Estudios de Postgrado e Investigación, Plan de San Luis y Díaz Mirón s/n, Miguel Hidalgo, Mexico
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Garcia de Alba Garcia JE, Dallo FJ, Salcedo Rocha AL, Colunga Rodriguez C, Perez N, Baer RD, Weller SC. The relative effect of self-management practices on glycaemic control in type 2 diabetic patients in Mexico. Chronic Illn 2006; 2:77-85. [PMID: 17175651 DOI: 10.1177/17423953060020020301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In this study, we examined the relative impact of self-management activities on glycaemic control in a population at high risk for developing complications. METHODS Patients diagnosed with diabetes mellitus of at least 1 year in duration at 30 years of age or older were sampled from the Instituto de Mexico Seguro Social (IMSS) Family Medicine Clinics in Guadalajara, Mexico (n=800). Demographic, clinical and health behaviour variables were used to predict good/poor glycaemic control, as measured by haemoglobin Alc (A1C). RESULTS Most (72.24%) patients had poor control (A1C > or = 7.0). Hyperglycaemia was significantly associated with factors not under patient control, such as having diabetes for a longer time [odds ratio (OR) = 2.40, 95% confidence interval (CI) 1.39, 4.14], having a first-degree relative with diabetes (OR= 1.52; 95% CI 1.06, 2.19), and being prescribed anti-diabetic medications, e.g. insulin (OR = 7.88, 95% CI 2.42, 25.63). After controlling for these variables, the only self-management variable that reduced the likelihood of hyperglycaemia was following a special diet (OR=0.49; 95% CI 0.32, 0.76). Furthermore, depression had an important effect on self-management, as those with lower levels of depressive symptoms were more likely to follow a diet and exercise. DISCUSSION While patients in this population have little control over many factors associated with glycaemic control, an important exception is diet. However, because of the adverse effect of depression on dieting, both depression management and dietary education are important for this population.
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Affiliation(s)
- Javier E Garcia de Alba Garcia
- Instituto Mexicano del Seguro Social, Unidad de Investigacio Social, Epidemiologica y en Servios de Salud, CMNO Belisario Dominguez 1000 Colonia Independencia, Guadalajara, Jalisco, Mexico
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