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Pérez AG, Gutiérrez TV, Velázquez-Olmedo LB. Self-Reported Diabetes in Older Adults: A Comparison of Prevalence and Related Factors in the Mexican Health and Aging Study (2015, 2018, and 2021). J Diabetes Res 2024; 2024:2527791. [PMID: 39161705 PMCID: PMC11333132 DOI: 10.1155/2024/2527791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 07/16/2024] [Accepted: 07/29/2024] [Indexed: 08/21/2024] Open
Abstract
Aim: To estimate the prevalence and factors associated with diabetes among older adults and compare the prevalence rate of a three-round national survey of the Mexican Health and Aging Study (MHAS). Methods: A cross-sectional study was conducted with data obtained from MHAS 2015 (n = 8167), 2018 (n = 7854), and 2021 (n = 8060), which comprised a nationally representative sample of older adults in Mexico. The measures included sociodemographic characteristics and health. A binary logistic regression model was used to identify the association between independent variables and self-reported diabetes. Results: The prevalence of diabetes was 26.3%, 27.7%, and 28.1% in 2015, 2018, and 2021, respectively. This prevalence decreased with age and was higher for female, urban older adults, those with multimorbidity, a lower level of education, and without social security coverage for the three years. Age was associated with a lower possibility of presenting diabetes ([OR = 0.79[0.71-0.89]] and [OR = 0.41[0.33-0.52]] in groups aged 75-84 years and ≥85 years, respectively). Females continue to be more likely to present diabetes than males (OR = 1.39 [95% CI 1.25-1.55]). Older adults living in rural areas are 20% less likely to present diabetes than those living in urban areas (OR = 0.80 [95% CI 0.69-0.93]). Uninsured older adults (OR = 1.35 [95% CI 1.20-1.53]), those who wear glasses (OR = 1.23 [95% CI 1.16-1.30]), those with multimorbidity (OR = 1.13 [95% CI 1.01-1.27]), and those who currently drink alcohol (OR = 1.12 [95% CI 1.00-1.25]) were significantly more likely to have diabetes. Conclusion: An elevated prevalence of diabetes was found in older adults in Mexico, while not having access to social security was associated with a higher possibility of presenting diabetes and living in a rural area was associated with a lower possibility of presenting diabetes. Detection, prevention, and control programs should be implemented to reduce the incidence and severity of the disease in older adults and, thus, prevent its associated complications.
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Affiliation(s)
- Alvaro García Pérez
- Faculty of Higher Studies (FES)IztacalaNational Autonomous University of Mexico (UNAM), Mexico City, Mexico
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Saturno-Hernández P, Moreno-Zegbe E, Poblano-Verastegui O, Torres-Arreola LDP, Bautista-Morales AC, Maya-Hernández C, Uscanga-Castillo JD, Flores-Hernández S, Gómez-Cortez PM, Vieyra-Romero WI. Hospital care direct costs due to ambulatory care sensitive conditions related to diabetes mellitus in the Mexican public healthcare system. BMC Health Serv Res 2024; 24:507. [PMID: 38659025 PMCID: PMC11041024 DOI: 10.1186/s12913-024-10937-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Hospitalizations for ambulatory care sensitive conditions (ACSC) incur substantial costs on the health system that could be partially avoided with adequate outpatient care. Complications of chronic diseases, such as diabetes mellitus (DM), are considered ACSC. Previous studies have shown that hospitalizations due to diabetes have a significant financial burden. In Mexico, DM is a major health concern and a leading cause of death, but there is limited evidence available. This study aimed to estimate the direct costs of hospitalizations by DM-related ACSC in the Mexican public health system. METHODS We selected three hospitals from each of Mexico's main public institutions: the Mexican Social Security Institute (IMSS), the Ministry of Health (MoH), and the Institute of Social Security and Services for State Workers (ISSSTE). We employed a bottom-up microcosting approach from the healthcare provider perspective to estimate the total direct costs of hospitalizations for DM-related ACSC. Input data regarding length of stay (LoS), consultations, medications, colloid/crystalloid solutions, procedures, and laboratory/medical imaging studies were obtained from clinical records of a random sample of 532 hospitalizations out of a total of 1,803 DM-related ACSC (ICD-10 codes) discharges during 2016. RESULTS The average cost per DM-related ACSC hospitalization varies among institutions, ranging from $1,427 in the MoH to $1,677 in the IMSS and $1,754 in the ISSSTE. The three institutions' largest expenses are LoS and procedures. Peripheral circulatory and renal complications were the major drivers of hospitalization costs for patients with DM-related ACSC. Direct costs due to hospitalizations for DM-related ACSC in these three institutions represent 1% of the gross domestic product (GDP) dedicated to health and social services and 2% of total hospital care expenses. CONCLUSIONS The direct costs of hospitalizations for DM-related ACSC vary considerably across institutions. Disparities in such costs for the same ACSC among different institutions suggest potential disparities in care quality across primary and hospital settings (processes and resource utilization), which should be further investigated to ensure optimal supply utilization. Prioritizing preventive measures for peripheral circulatory and renal complications in DM patients could be highly beneficial.
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Butt MD, Ong SC, Rafiq A, Kalam MN, Sajjad A, Abdullah M, Malik T, Yaseen F, Babar ZUD. A systematic review of the economic burden of diabetes mellitus: contrasting perspectives from high and low middle-income countries. J Pharm Policy Pract 2024; 17:2322107. [PMID: 38650677 PMCID: PMC11034455 DOI: 10.1080/20523211.2024.2322107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Introduction Diabetes increases preventative sickness and costs healthcare and productivity. Type 2 diabetes and macrovascular disease consequences cause most diabetes-related costs. Type 2 diabetes greatly costs healthcare institutions, reducing economic productivity and efficiency. This cost of illness (COI) analysis examines the direct and indirect costs of treating and managing type 1 and type 2 diabetes mellitus. Methodology According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Cochrane, PubMed, Embase, CINAHL, Scopus, Medline Plus, and CENTRAL were searched for relevant articles on type 1 and type 2 diabetes illness costs. The inquiry returned 873 2011-2023 academic articles. The study included 42 papers after an abstract evaluation of 547 papers. Results Most articles originated in Asia and Europe, primarily on type 2 diabetes. The annual cost per patient ranged from USD87 to USD9,581. Prevalence-based cost estimates ranged from less than USD470 to more than USD3475, whereas annual pharmaceutical prices ranged from USD40 to more than USD450, with insulin exhibiting the greatest disparity. Care for complications was generally costly, although costs varied significantly by country and problem type. Discussion This study revealed substantial heterogeneity in diabetes treatment costs; some could be reduced by improving data collection, analysis, and reporting procedures. Diabetes is an expensive disease to treat in low- and middle-income countries, and attaining Universal Health Coverage should be a priority for the global health community.
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Affiliation(s)
- Muhammad Daoud Butt
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, USM, Penang, Malaysia
- Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Siew Chin Ong
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, USM, Penang, Malaysia
| | - Azra Rafiq
- Department of Biological Sciences, Middle East Technical University, Ankara, Turkey
- Department of Pharmacy, Riphah International University, Lahore, Pakistan
| | - Muhammad Nasir Kalam
- Department of Pharmacy, The Sahara University, Narowal, Pakistan
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Ahsan Sajjad
- Ibn Sina Community Clinic, South Wilcrest Drive, Houston, Texas, USA
| | - Muhammad Abdullah
- Department of Pharmacy, Punjab University College of Pharmacy, Lahore, Pakistan
| | - Tooba Malik
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
| | - Fatima Yaseen
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
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Abou Taha A, Dinesen S, Vergmann AS, Grauslund J. Present and future screening programs for diabetic retinopathy: a narrative review. Int J Retina Vitreous 2024; 10:14. [PMID: 38310265 PMCID: PMC10838429 DOI: 10.1186/s40942-024-00534-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/19/2024] [Indexed: 02/05/2024] Open
Abstract
Diabetes is a prevalent global concern, with an estimated 12% of the global adult population affected by 2045. Diabetic retinopathy (DR), a sight-threatening complication, has spurred diverse screening approaches worldwide due to advances in DR knowledge, rapid technological developments in retinal imaging and variations in healthcare resources.Many high income countries have fully implemented or are on the verge of completing a national Diabetic Eye Screening Programme (DESP). Although there have been some improvements in DR screening in Africa, Asia, and American countries further progress is needed. In low-income countries, only one out of 29, partially implemented a DESP, while 21 out of 50 lower-middle-income countries have started the DR policy cycle. Among upper-middle-income countries, a third of 59 nations have advanced in DR agenda-setting, with five having a comprehensive national DESP and 11 in the early stages of implementation.Many nations use 2-4 fields fundus images, proven effective with 80-98% sensitivity and 86-100% specificity compared to the traditional seven-field evaluation for DR. A cell phone based screening with a hand held retinal camera presents a potential low-cost alternative as imaging device. While this method in low-resource settings may not entirely match the sensitivity and specificity of seven-field stereoscopic photography, positive outcomes are observed.Individualized DR screening intervals are the standard in many high-resource nations. In countries that lacks a national DESP and resources, screening are more sporadic, i.e. screening intervals are not evidence-based and often less frequently, which can lead to late recognition of treatment required DR.The rising global prevalence of DR poses an economic challenge to nationwide screening programs AI-algorithms have showed high sensitivity and specificity for detection of DR and could provide a promising solution for the future screening burden.In summary, this narrative review enlightens on the epidemiology of DR and the necessity for effective DR screening programs. Worldwide evolution in existing approaches for DR screening has showed promising results but has also revealed limitations. Technological advancements, such as handheld imaging devices, tele ophthalmology and artificial intelligence enhance cost-effectiveness, but also the accessibility of DR screening in countries with low resources or where distance to or a shortage of ophthalmologists exists.
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Affiliation(s)
- Andreas Abou Taha
- Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.
| | - Sebastian Dinesen
- Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Anna Stage Vergmann
- Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Gómez-Morales GB, Rosas-Torres BS, Hernández-Jiménez WJ, Mattenberger-Cantú E, Vargas-Villarreal J, Almanza-Reyes H, González-Salazar F. Prevalence of obesity, diabetes and hypertension in immigrant populations in northeastern Mexico. Front Public Health 2024; 11:1220753. [PMID: 38274544 PMCID: PMC10809798 DOI: 10.3389/fpubh.2023.1220753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/30/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Hispanic immigrants are a fast-growing population in the United States of America (USA) that disproportionately suffer from chronic diseases. Despite the increasing prevalence of obesity in Latin-American countries, only a few studies have examined the onset of chronic diseases in Mexican and Central American migrants in Mexico. Objective The objective of this study is to determine the prevalence of obesity, diabetes, and hypertension in Central American immigrants who are in the process of traveling through northeastern Mexico to the United States. Methods An observational, descriptive, cross-sectional study was conducted among migrants, mostly Central Americans. Migrants who agreed to participate in the study were interviewed face-to-face by researchers to obtain their sociodemographic data. To obtain the prevalence, many health indicators related to obesity, diabetes, and hypertension, including weight, height, fasting glucose, and blood pressure, were measured. Results In total, 520 migrants were interviewed; sociodemographic data indicated that most participants were men (76%), from Honduras (72.6%), single (61.2%), and have elementary level of education (48.6%). The somatometric evaluation revealed that 28.9% were diagnosed as overweight, 10.7% with obesity, and 3.3% with malnutrition. Of less prevalence, 8.8% were detected with hypertension and 4.6% had fasting hyperglycemia. The mean participant age was 29.11 ± 10.00 years. For each participant, the average weight was 66.72 ± 13.09 kg; the average height was 1.64 ± 0.08 m; the average body mass index (BMI) was 24.59 ± 4.32; the mean systolic and diastolic pressures were 116.26 ± 15.13 and 74 ± 9.65, respectively; and the average glycemia was 100.97 ± 21.99. El Salvador showed the highest proportion of people with diabetes (14.7%). Women who participated in this study had a higher proportion of obesity (23.4%, p = 0.02) and overweight (36.2%) than men (8.4 and 29.2%, respectively). People from Mexico, Nicaragua, and Honduras reported a high prevalence of overweight participants (63.6, 47.4, and 30.7%, respectively), while people from El Salvador and Nicaragua had a high prevalence of obese participants (23.5 and 21.1%, respectively). Conclusion We found significant differences in the rates of obesity, diabetes, and hypertension between groups of Central American migrants and their place of origin, age, educational level, and gender. Our findings highlight the importance of exploring differences within groups of Central American migrants traveling through northeastern Mexico to the United States, which may explain several health indicators.
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Affiliation(s)
| | | | | | | | | | - Horacio Almanza-Reyes
- Faculty of Medicine and Psychology of the Autonomous, University of Baja California, Tijuana, Mexico
| | - Francisco González-Salazar
- Northeast Biomedical Research Center, Institute of Mexican Social Security, Monterrey, Mexico
- Basic Science Department, University of Monterrey, Garza García, Mexico
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Castillo-Hernandez KG, Espinosa A, Molina-Segui F, Ayuso-Peraza G, Mena-Macossay L, Mendez-Dominguez N, Bastarrachea RA, Laviada-Molina H. Lessons learned from a peer-supported diabetes education program in two dissimilar Mayan communities. Front Endocrinol (Lausanne) 2024; 14:1280539. [PMID: 38239980 PMCID: PMC10794663 DOI: 10.3389/fendo.2023.1280539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/16/2023] [Indexed: 01/22/2024] Open
Abstract
Background A steady rise in type 2 diabetes (T2D) in Mexico over the last 30 years has led to 11.5 million Mexicans being affected by this condition. There is an urgent need to develop interventions to prevent complications of T2D. Diabetes self-management education is the cornerstone of promoting self-care. Among all educational strategies, peer support has shown to be an effective method to encourage ongoing self-management. However, customization of interventions for distinct communities is imperative, as failure to do so can hinder the intervention's effectiveness. Methods We implemented a two-year prospective randomized controlled community-based trial in Conkal, a Mayan community from Yucatan, Mexico. The intervention consisted of receiving either a culturally sensitive peer support on top of a diabetes self-management education group (PLG); or a diabetes self-management education group only (EOG; control group). The primary outcome was changes in glycated hemoglobin, while secondary outcomes encompassed changes in systolic and diastolic blood pressure, body mass index, and diabetes self-care practices. Data collection was performed at baseline and every four months during the study period. Discussion Our experiences have highlighted the significance of peer-leader support in cultivating diabetes self-care skills, particularly within smaller, underserved communities characterized by strong social and cultural ties. However, when applied in larger or suburban settings, selecting peer leaders should be meticulous, considering sectorization within specific neighborhoods to foster a sense of belonging and familiarity among natural community clusters. In larger settlemnts, factors such as transportation challenges, time limitations, caregiving obligations, limited venue access, and changes in session locations can drive program discontinuation. Additionally, individuals with lower educational attainment are more susceptible to abandonment. Notably, those with lower education, uncontrolled diabetes, and extended diabetes duration exhibit a greater potential for improving glycemic control than their counterparts. Clinical registration https://www.isrctn.com/ISRCTN96897082.
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Affiliation(s)
- Karen G. Castillo-Hernandez
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Mérida, Merida, Mexico
| | - Alan Espinosa
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Fernanda Molina-Segui
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Mérida, Merida, Mexico
| | - Giselle Ayuso-Peraza
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Mérida, Merida, Mexico
| | - Leticia Mena-Macossay
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Mérida, Merida, Mexico
| | | | - Raúl A. Bastarrachea
- Samsun Diabetes Research Institute, Santa Barbara, California, CA, United States
| | - Hugo Laviada-Molina
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Mérida, Merida, Mexico
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Tsotra F, Malhotra A, Peristeris P, Athanasiou I, Müller M, Bader G. Health and Productivity Benefits with Early Intensified Treatment in Patients with Type 2 Diabetes: Results from Korea. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241240106. [PMID: 38708904 DOI: 10.1177/00469580241240106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
The available evidence suggests positive health outcomes associated with early treatment intensification in Type 2 diabetes mellitus (T2DM). Our study estimated the productivity effects arising from improved health correlated with early intensified treatment in T2DM in Korea. Using a recently published methodology and model, we investigated the association between early intensified treatment and the probability of experiencing fewer diabetes-related complication events. Treatment strategies leading to better health outcomes are expected to be associated with social value through increased participation in paid and unpaid work activities. Therefore, we translated the lower incidence of complications into monetary terms related to productivity for the Korean population. We quantified productivity by considering (a) absenteeism, (b) presenteeism, (c) permanent loss of labor force, and (d) activity restriction. Deterministic and probabilistic sensitivity analyses in the base case parameter were performed. Approximately, 1.7 thousand (standard deviation [SD] ±580 events) micro- and macrovascular complication events could potentially be avoided by early treatment intensification. This led to a societal gain attributed to increased productivity of 23 million USD (SD ± $8.2 million). This article demonstrates the likelihood of achieving better health and productivity through early intensified treatment in diabetes.
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Rojas-Martínez R, Escamilla-Nuñez C, Aguilar-Salinas CA, Castro-Porras L, Romero-Martínez M, Lazcano-Ponce E. Trends in the mortality of diabetes in Mexico from 1998 to 2022: a joinpoint regression and age-period-cohort effect analysis. Public Health 2024; 226:128-137. [PMID: 38056400 DOI: 10.1016/j.puhe.2023.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/04/2023] [Accepted: 10/22/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE The purpose was to analyze age-standardized trends in diabetes mortality rates (DMR) from 1998 to 2022, stratified by sex and Mexican state, and the effects attributable to age, period, and cohort by sex. STUDY DESIGN Joinpoint regression and age-period-cohort effect analysis. METHODS Based on the tenth revision of the International Classification of Diseases, E11, E12, E13, and E14 codes of the death certificate, a daily record of mortality was extracted from the death certificate attributable to diabetes as the main cause. From 1998 to 2022, sexes and ages (≥20 years) were used to calculate the crude mortality rates and standardized at the national and Mexican state levels. Additionally, the age-period-cohort model was used to examine age, period, and cohort effects. RESULTS From 1998 to 2005, the age-adjusted DMR increased by 3.6% (95% confidence interval [CI]: 2.7, 4.5) for the total population, as shown by the joinpoint regression analysis at a national level; from 2017 to 2020, it increased by 7.4% (95% CI: 0.6, 14.8). The DMR with the highest increase during the study period came mainly from states in the country's southeastern region, 2.3% to 3.7% per year. The net age and period effects showed that mortality increased with advancing age and with going time, respectively; and the net cohort effect revealed that mortality increased in more recent birth cohorts, mainly in men Rate Ratio (RR) = 2.37 (95% CI: 2.29, 2.46) vs RR = 1.13 (95% CI: 1.09, 1.17). CONCLUSION The DMR increased among older age groups. The period effect showed that mortality increased over time. Furthermore, the cohort effect showed that mortality increased in more recent birth cohorts, especially among men.
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Affiliation(s)
- R Rojas-Martínez
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - C Escamilla-Nuñez
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - C A Aguilar-Salinas
- Direction of Investigation, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - L Castro-Porras
- Policies, Population and Health Research Center, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - M Romero-Martínez
- Center for Evaluation and Survey Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - E Lazcano-Ponce
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Yan J, Shi Y, Zhang J, Chen S, Huo X, Shen Y, Zhang N. Impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in China. BMC Public Health 2023; 23:2224. [PMID: 37950184 PMCID: PMC10638726 DOI: 10.1186/s12889-023-17161-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Medical costs have been rising rapidly in recent years, and China is controlling medical costs from the perspective of health insurance payments. OBJECTIVES To explore the impact of the capitation prepayment method on medical expenses and health service utilization of coronary heart disease (CHD) patients, which provides a scientific basis for further improvement of the payment approach. METHODS The diagnosis records of visits for CHD in the database from 2014 to 2016 (April to December each year) were selected, and two townships were randomly selected as the pilot and control groups. Propensity score matching (PSM) and difference-in-difference (DID) model were used to assess changes in outpatient and inpatient expenses and health service utilization among CHD patients after the implementation of the capitation prepayment policy. RESULTS There were eventually 3,900 outpatients and 664 inpatients enrolled in this study after PSM. The DID model showed that in the first year of implementing the reform, total outpatient expenses decreased by CNY 13.953, drug expenses decreased by CNY 11.289, as well as Medicare payments decreased by CNY 8.707 in the pilot group compared to the control group. In the second year of implementing the reform, compared with the control group, the pilot group had a reduction of CNY 3.123 in other expenses, and a reduction of CNY 6.841 in Medicare payments. There was no significant change in inpatient expenses in the pilot group compared to the control group, but there was an increase of 0.829 visits to rural medical institutions, and an increase of 0.750 visits within the county for inpatients. CONCLUSIONS The capitation prepayment method has been effective in controlling the outpatient expenses of CHD patients, as well as improving the medical service capacity of medical institutions within the Medical Community, and increasing the rate of inside county visits for inpatients.
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Affiliation(s)
- Jincao Yan
- School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Yunke Shi
- School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Jiani Zhang
- School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Siwei Chen
- School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Xinran Huo
- School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Yue Shen
- School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Ning Zhang
- School of Public Health, Capital Medical University, Beijing, 100069, China.
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Bozkurt AK, VAN Rijn MJ, Bouskela E, Gastaldi G, Glauser F, Haller H, Rosas-Saucedo J, Zingg D, Calabrese A, Rabe E, Mansilha A. Enhancing identification and treatment of patients with concomitant chronic venous insufficiency and diabetes mellitus. A modified Delphi study from the CODAC (ChrOnic venous disease and Diabetes Advisory Council) group. INT ANGIOL 2023; 42:427-435. [PMID: 37962898 DOI: 10.23736/s0392-9590.23.05061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Chronic venous insufficiency (CVI) and diabetes mellitus (DM) pose significant burdens to patients and healthcare systems. While the two diseases share a number of commonalities in risk factors and pathophysiology, they are often assessed and managed separately. This can lead to a worsening of comorbidities and limitations in a patient's quality of life. This project aims to develop recommendations to enhance the identification and treatment of patients with concomitant CVI and DM. METHODS Using a modified Delphi method, a panel of experts developed 38 Likert Scale and two multiple choice questions across six key themes. These were used to form an online survey which was disseminated through a convenience sampling approach to CVI and DM healthcare professionals across Europe, Central America, South America, and the Middle East. The threshold for consensus was set at ≥75%. RESULTS A total of 238 responses were received. 27/38 statements attained >90% agreement, nine of 38 attained between 75-90%, and two failed to meet the threshold (<75%). The awareness around the impact of the two diseases was high, but a gap was highlighted in the identification of patients with concomitant CVI and DM. CONCLUSIONS The high level of agreement shows that healthcare professionals are aware of the gaps in identification and treatment of patients with concomitant CVI and DM, and of the need to approach this as a combined therapy area. An algorithm is proposed to help the identification of at-risk patients and to provide recommendations on the management of patients with concomitant disease.
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Affiliation(s)
- Ahmet K Bozkurt
- Department of Cardiovascular Surgery, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Marie J VAN Rijn
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands -
| | - Eliete Bouskela
- Biomedical Center, Laboratory for Clinical and Experimental Research on Vascular Biology (BioVasc), State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Giacomo Gastaldi
- Division of Endocrinology, Diabetology, Nutrition, and Patient Education, University Hospital of Geneva, Geneva, Switzerland
| | - Frederic Glauser
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Hermann Haller
- Hannover Medical School, Department of Nephrology and Hypertension, Hanover, Germany
| | | | | | | | - Eberhard Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | - Armando Mansilha
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Angiology and Vascular Surgery, Hospital de S. João, Porto, Portugal
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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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Castro-Porras LV, Rojas-Martínez R, Romero-Martínez M, Aguilar-Salinas CA, Escamilla-Nuñez C. The Trend in the Prevalence of Diabetes Mellitus in the Mexican Indigenous Population From 2000 to 2018. AJPM FOCUS 2023; 2:100087. [PMID: 37790638 PMCID: PMC10546564 DOI: 10.1016/j.focus.2023.100087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Diabetes is a worldwide public health problem. In Mexico, diabetes was the third leading cause of death in the total population in 2020. The indigenous people in Mexico are approximately 6%. This study aims to estimate the trends in diabetes prevalence from 2000 to 2018 in the group of Mexican indigenous language speakers and to analyze the main sociodemographic (e.g., age, educational and socioeconomic level, and the urbanicity of the area of residence) and clinical (e.g., age of diabetes onset, years with diabetes, and BMI) characteristics of this group. Methods This cross-sectional study included participants aged ≥20 years from 4 National Health Surveys, 2000-2018. We presented the analyses for indigenous and nonindigenous strata. Logistic models adjusted were used to estimate the trend of diabetes in the study period. Results We found a significant increase in the prevalence of diabetes in the indigenous group. This trend in the ORs was maintained when adjusting for age, sex, waist circumference, and area of residence. For the study period, the prevalence change in diagnosed diabetes in the indigenous group was greater than that in the nonindigenous group (OR=6.4, 95% CI=4.1, 8.8 and OR=3.3, 95% CI=2.5, 4.1, respectively). We also found a significant prevalence change in undiagnosed diabetes for the indigenous group (OR=7.7, 95% CI=1.3, 14.6). Conclusions In contrast to the results in nonindigenous populations, our main result reveals an increasing probability of being diabetic in the indigenous population from 2006 to 2018. It is necessary to clarify the origin of the accelerated change in diabetes prevalence among the indigenous population in Mexico.
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Affiliation(s)
- Lilia V. Castro-Porras
- Policies, Population and Health Research Center, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rosalba Rojas-Martínez
- Reproductive Health Department, Center for Population Health, Instituto Nacional de Salud Publica, Mexico City, Mexico
| | - Martín Romero-Martínez
- Center for Evaluation and Survey Research, Instituto Nacional de Salud Publica, Mexico City, Mexico
| | - Carlos A. Aguilar-Salinas
- Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran, Mexico City, Mexico
- Tec Salud, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Consuelo Escamilla-Nuñez
- Environmental Health Department, Center for Population Health, Instituto Nacional de Salud Publica, Mexico City, Mexico
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13
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Huang AA, Huang SY. Hospitalized COVID-19 patients with diabetes have an increased risk for pneumonia, intensive care unit requirement, intubation, and death: A cross-sectional cohort study in Mexico in 2020. Health Sci Rep 2023; 6:e1222. [PMID: 37081996 PMCID: PMC10112272 DOI: 10.1002/hsr2.1222] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023] Open
Abstract
Background Diabetes mellitus is a chronic health condition that has been linked with an increased risk of severe illness and mortality from COVID-19. In Mexico, the impact of diabetes on COVID-19 outcomes in hospitalized patients has not been fully quantified. Understanding the increased risk posed by diabetes in this patient population can help healthcare providers better allocate resources and improve patient outcomes. Objective The objective of this study was to quantify the extent outcomes (pneumonia, intensive care unit [ICU] stay, intubation, and death) are worsened in diabetic patients with COVID-19. Methods Between April 14, 2020 and December 20, 2020 (last accessed), data from the open-source COVID-19 database maintained by the Mexican Federal Government were examined. Utilizing hospitalized COVID-19 patients with complete outcome data, a retrospective cohort study (N = 402,388) was carried out. In relation to COVID-19, both univariate and multivariate logistic regression were used to investigate the effect of diabetes on specific outcomes. Results The analysis included 402,388 adults (age >18) with confirmed hospitalized COVID-19 cases with mean age 46.16 (standard deviation = 15.55), 214,161 (53%) male. The outcomes delineated included pneumonia (N = 88,064; 22%), ICU requirement (N = 23,670; 6%), intubation (N = 23,670; 6%), and death (N = 55,356; 14%). After controlling for confounding variables diabetes continued to be an independent risk factor for both pneumonia (odds ratio [OR]: 1.8, confidence interval [CI]: 1.76-1.84, p < 0.01), ICU requirement (OR: 1.09, CI: 1.04-1.14, p < 0.01), intubation (OR: 1.07, CI: 1.04-1.11, p < 0.01), and death (OR: 1.88, CI: 1.84-1.93, p < 0.01) in COVID-19 patients. Conclusions According to the study, all outcomes (pneumonia, ICU requirement, intubation, and death) were greater among hospitalized individuals with diabetes and COVID-19. Additional study is required to acquire a better understanding of how diabetes affects COVID-19 outcomes and to develop practical mitigation techniques for the risk of severe sickness and complications in this particular patient population.
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Affiliation(s)
- Alexander A. Huang
- Department of Statistics and Data ScienceCornell UniversityIthacaNew YorkUSA
- Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Samuel Y. Huang
- Department of Statistics and Data ScienceCornell UniversityIthacaNew YorkUSA
- Virginia Commonwealth University School of MedicineRichmondUSA
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14
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Rojas Alvarez A, Vazquez CE, Lopez-Ortega M, Angel JL. A comparison of rural-urban differences in out-of-pocket expenses among older Mexicans with diabetes. Front Public Health 2022; 10:1025159. [PMID: 36339153 PMCID: PMC9634568 DOI: 10.3389/fpubh.2022.1025159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/28/2022] [Indexed: 01/28/2023] Open
Abstract
Objective To compare total out-of-pocket expenses for physician visits and medications among older adults living with diabetes in Mexico from urban, semi-urban, and rural areas. Methods The sample included 2,398 Mexicans aged 65 years and older with self-reported diabetes from the 2018 Mexican Health and Aging Study. Out-of-pocket expenses for physician visits and medications were regressed on locality, controlling for several factors. Results The profile of those with higher out-of-pocket medication expenditures included rural localities, higher education, unmarried, depressive symptoms, participation in Seguro Popular, and lacking insurance. In the multivariate analysis, rural older adults with diabetes paid a higher amount in medication expenditures compared with other localities. Conclusion Differences in locality are closely tied to the effective implementation of Seguro Popular. Although this program has improved access to care, participants have higher out-of-pocket expenditures for medications than those on employer-based plans across all localities. Among all groups, the uninsured bare the highest burden of expenditures, highlighting a continued need to address health inequities for the most underserved populations.
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Affiliation(s)
- Alfonso Rojas Alvarez
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, TX, United States,*Correspondence: Alfonso Rojas Alvarez
| | - Christian E. Vazquez
- School of Social Work, University of Texas at Arlington, Arlington, TX, United States,Christian E. Vazquez
| | | | - Jacqueline L. Angel
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, TX, United States
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15
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Tsotra F, Kappel M, Peristeris P, Bader G, Levi E, Lister N, Malhotra A, Ostwald DA. The societal impact of early intensified treatment in patients with type 2 diabetes mellitus. J Comp Eff Res 2022; 11:1185-1199. [PMID: 36170017 DOI: 10.2217/cer-2022-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The current study estimates the societal impact of early intensified treatment compared with initial monotherapy with subsequent treatment intensification in newly diagnosed adults with type 2 diabetes mellitus in Mexico. Methods: An individual patient-level simulation and a static cohort model were employed to simulate the treatment pathway and the probability of experiencing complications of diabetes. The avoided number of events was translated into avoided productivity losses, which were monetized using wages. Results: Patients on early intensified treatment experienced approximately 13,000 fewer complication events over 10 years. This was translated into a societal impact of $54 million (USD). Conclusion: Early treatment intensification is likely to be of particular benefit to health outcomes and productivity losses.
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Affiliation(s)
| | | | | | | | | | - Nicola Lister
- Novartis Global Health & Sustainability, Johannesburg, South Africa
| | | | - Dennis A Ostwald
- WifOR Institute, Darmstadt, Germany.,SIBE, Graduate School of the Faculty for Leadership & Management, Steinbeis University, Berlin, Germany
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16
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López Sánchez GF, López-Bueno R, Villaseñor-Mora C, Pardhan S. Comparison of Diabetes Mellitus Risk Factors in Mexico in 2003 and 2014. Front Nutr 2022; 9:894904. [PMID: 35845804 PMCID: PMC9280272 DOI: 10.3389/fnut.2022.894904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The prevalence of diabetes mellitus in Mexico is very high. This study aimed to compare the risk factors of diabetes mellitus in Mexican adults in 2003 and in 2014. Methods This study had a repeated cross-sectional design. Data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) from Mexico (Wave 0, 2003, and Wave 2, 2014) were compared. Self-reported diabetes mellitus (outcome) was evaluated with the yes/no question: "Have you ever been diagnosed with diabetes mellitus (high blood sugar)?" Bivariate analyses and multivariable logistic regression analyses adjusted for potential risk factors were conducted. Results In 11 years (2003-2014), the prevalence of self-reported diabetes mellitus in Mexican adults increased by 2.6 times in those younger than 50 years (2003: 2.1%; 2014: 5.5%) and by 1.9 times in those ≥50 years (2003: 12.7%; 2014: 24.2%). In 2003, the risk factors associated with diabetes mellitus were female sex (OR 1.344, 95% CI 1.176-1.536), age ≥50 years (OR 6.734, 95% CI 5.843-7.760), being overweight (OR 1.359, 95% CI 1.175-1.571), obesity (OR 1.871, 95% CI 1.583-2.211), and lower physical activity of <600 MET-minutes/week (OR 1.349, 95% CI 1.117-1.630). In 2014, the exposure characteristics significantly associated with diabetes mellitus were female sex (OR 1.244, 95% CI 1.025-1.511), older age ≥50 years (OR 4.608, 95% CI 3.260-6.515), being overweight (OR 1.649, 95% CI 1.305-2.083), obesity (OR 1.778, 95% CI 1.398-2.261), and in those who had not attended/completed primary school (OR 1.360, 95% CI 1.042-1.773). Conclusion The prevalence of diabetes mellitus in Mexico significantly increased from 2003 to 2014. Female sex, age older than 50 years, and being overweight or obese were significant risk factors in both 2003 and 2014. Not having completed primary school was a new significant risk factor in 2014. Public health policies and strategies should prioritize decreasing the high levels of overweight and obesity, and improve health literacy in Mexico.
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Affiliation(s)
- Guillermo F. López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Rubén López-Bueno
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | | | - Shahina Pardhan
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, United Kingdom
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17
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Sagaceta-Mejía J, Tolentino-Mayo L, Cruz-Casarrubias C, Nieto C, Barquera S. Understanding of front of package nutrition labels: Guideline daily amount and warning labels in Mexicans with non-communicable diseases. PLoS One 2022; 17:e0269892. [PMID: 35749373 PMCID: PMC9231753 DOI: 10.1371/journal.pone.0269892] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/29/2022] [Indexed: 11/19/2022] Open
Abstract
One strategy for the prevention and treatment of non-communicable diseases (NCDs) is the implementation of the front-of-pack labeling (FoPL) in foods and beverages. In 2020, Mexico adopted the warning label system (WL) as a new public health policy, whose aim is to help consumers make healthier food choices. Previously, the Guideline Daily Amount (GDA) was the labelling used it. This paper aims to compare the understanding of two FoPL, the GDA and the WL, through the identification of unhealthy products in Mexicans with NCDs. We analyzed data from 14,880 Mexican adults older than 20 years old with NCDs (overweight-obesity (OW/O), self-reported diabetes mellitus 2 (DM2), or/and hypertension (HT), or/and dyslipidemia (Dys)). Participants were randomly assigned to one of two groups: the GDA labeling or WL. Each group had to respond to a survey and had to classify food products images as healthy or unhealthy according to the labelling system to which they were assigned. The correct classification was determined according to the criteria of Chile’s labeling nutrient profile stage 3. To evaluate the correct classification in each one of the groups we evaluated the differences in proportions. Logistic regression models were used to assess the likelihood to correctly classify the product according to participants’ number of diseases and WL information, taking GDA label as a reference. Participants who used the information contained in the GDA label misclassified food product labels in greater proportion (70%), mostly participants with three or more NCDs (participants with OW/O+ HT+ Dys, represent 42.3% of this group); compared with those who used WL (50%). The odds of correct classification of food products using WL image were two times greater compared to GDA image in participants with NCDs; being greater in participants with three or more NCDs. The study results highlight the usefulness of WL as it helps Mexicans with NCDs to classify unhealthy food products more adequately compared with GDA.
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Affiliation(s)
- Janine Sagaceta-Mejía
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Lizbeth Tolentino-Mayo
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
- * E-mail:
| | - Carlos Cruz-Casarrubias
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Claudia Nieto
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Simón Barquera
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
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18
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Aceves B, Denman CA, Ingram M, Torres JF, Nuño T, Garcia DO, Madhivanan P, Rosales CB. Testing Scalability of a Diabetes Self-Management Intervention in Northern Mexico: An Ecological Approach. Front Public Health 2021; 9:617468. [PMID: 34490173 PMCID: PMC8416481 DOI: 10.3389/fpubh.2021.617468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/24/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Type 2 diabetes mellitus (T2DM) has become a major issue in Mexico, reporting almost 100,000 attributable deaths in 2016. Low-income Mexican citizens who face various issues associated with T2DM, including the lack of access to self-management services, are particularly affected by the condition. Health centers have been designated to serve T2DM patients by providing resources on chronic disease prevention. Meta Salud Diabetes (MSD) is a self-management intervention developed to address cardiovascular complications and other health issues within the T2DM population, which have been proven effective and useful for health centers. The intervention was designed for T2DM support groups—grupos de ayuda mutua (GAMs) located within health centers. Methods: From February to June 2019, a binational research team conducted a test scale-up study in Northwest Sonora under the Ministry of Health utilizing the Institute for Healthcare Improvement Framework for scaling up health interventions. Investigators worked in collaboration and trained 19 stakeholders from a regional health system identified from various ecological levels on MSD and implementation process. Results: All five GAMs within the regional health system received and completed the intervention. In total, 72 participants were enrolled with behavioral and biological [HbA1c, blood pressure, body mass index (BMI)] measures taken at baseline. Post-intervention measurements were taken from 72% of participants who completed the intervention. Statistical analysis demonstrated improved behavioral and biological measures when comparing baseline to post-intervention, specifically statistically significant improvements in HbA1c and sugar-sweetened beverage consumption. Implementation fidelity (IF) measures indicated extensive adherence to the intervention curriculum, and moderators specifically demonstrated influences on implementation. Stakeholders from various ecological levels provided support to those facilitating the MSD intervention by allotting time and resources to properly prepare for sessions. An implementation coordinator from the regional health office assisted MSD facilitators by resolving barriers to implementation and worked toward federal accreditation for GAMs to receive additional funding. Conclusion: Results provide evidence for using regional health systems as a scalable unit when implementing chronic disease self-management interventions state- and nationwide. This study will help inform future efforts to scale up the health intervention in various states throughout Mexico. Clinical Trial Registration:www.ClinicalTrials.gov; https://www.clinicaltrials.gov/ct2/show/NCT02804698?term=NCT02804698&draw=2&rank=1, identifier: NCT02804698.
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Affiliation(s)
- Benjamin Aceves
- Public Health Practice and Translational Research, University of Arizona, Tucson, AZ, United States
| | | | - Maia Ingram
- Public Health Practice and Translational Research, University of Arizona, Tucson, AZ, United States
| | | | - Tomas Nuño
- Public Health Practice and Translational Research, University of Arizona, Tucson, AZ, United States
| | - David O Garcia
- Public Health Practice and Translational Research, University of Arizona, Tucson, AZ, United States
| | - Purnima Madhivanan
- Public Health Practice and Translational Research, University of Arizona, Tucson, AZ, United States
| | - Cecilia B Rosales
- Public Health Practice and Translational Research, University of Arizona, Tucson, AZ, United States
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19
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Noriega A, Meizner D, Camacho D, Enciso J, Quiroz-Mercado H, Morales-Canton V, Almaatouq A, Pentland A. Screening Diabetic Retinopathy Using an Automated Retinal Image Analysis System in Independent and Assistive Use Cases in Mexico: Randomized Controlled Trial. JMIR Form Res 2021; 5:e25290. [PMID: 34435963 PMCID: PMC8430849 DOI: 10.2196/25290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/12/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The automated screening of patients at risk of developing diabetic retinopathy represents an opportunity to improve their midterm outcome and lower the public expenditure associated with direct and indirect costs of common sight-threatening complications of diabetes. OBJECTIVE This study aimed to develop and evaluate the performance of an automated deep learning-based system to classify retinal fundus images as referable and nonreferable diabetic retinopathy cases, from international and Mexican patients. In particular, we aimed to evaluate the performance of the automated retina image analysis (ARIA) system under an independent scheme (ie, only ARIA screening) and 2 assistive schemes (ie, hybrid ARIA plus ophthalmologist screening), using a web-based platform for remote image analysis to determine and compare the sensibility and specificity of the 3 schemes. METHODS A randomized controlled experiment was performed where 17 ophthalmologists were asked to classify a series of retinal fundus images under 3 different conditions. The conditions were to (1) screen the fundus image by themselves (solo); (2) screen the fundus image after exposure to the retina image classification of the ARIA system (ARIA answer); and (3) screen the fundus image after exposure to the classification of the ARIA system, as well as its level of confidence and an attention map highlighting the most important areas of interest in the image according to the ARIA system (ARIA explanation). The ophthalmologists' classification in each condition and the result from the ARIA system were compared against a gold standard generated by consulting and aggregating the opinion of 3 retina specialists for each fundus image. RESULTS The ARIA system was able to classify referable vs nonreferable cases with an area under the receiver operating characteristic curve of 98%, a sensitivity of 95.1%, and a specificity of 91.5% for international patient cases. There was an area under the receiver operating characteristic curve of 98.3%, a sensitivity of 95.2%, and a specificity of 90% for Mexican patient cases. The ARIA system performance was more successful than the average performance of the 17 ophthalmologists enrolled in the study. Additionally, the results suggest that the ARIA system can be useful as an assistive tool, as sensitivity was significantly higher in the experimental condition where ophthalmologists were exposed to the ARIA system's answer prior to their own classification (93.3%), compared with the sensitivity of the condition where participants assessed the images independently (87.3%; P=.05). CONCLUSIONS These results demonstrate that both independent and assistive use cases of the ARIA system present, for Latin American countries such as Mexico, a substantial opportunity toward expanding the monitoring capacity for the early detection of diabetes-related blindness.
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Affiliation(s)
- Alejandro Noriega
- MIT Media Laboratory, Massachusetts Institute of Technology, Cambridge, MA, United States.,Prosperia Salud, Mexico City, Mexico
| | - Daniela Meizner
- Retina Department, Asociación para Evitar la Ceguera en México, Mexico City, Mexico
| | - Dalia Camacho
- Prosperia Salud, Mexico City, Mexico.,Engineering Academic Division, Instituto Tecnológico Autónomo de México, Mexico City, Mexico
| | - Jennifer Enciso
- Prosperia Salud, Mexico City, Mexico.,Posgrado de Ciencias Bioquímicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Hugo Quiroz-Mercado
- Retina Department, Asociación para Evitar la Ceguera en México, Mexico City, Mexico
| | | | - Abdullah Almaatouq
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Alex Pentland
- MIT Media Laboratory, Massachusetts Institute of Technology, Cambridge, MA, United States
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20
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Seiglie JA, Franco RR, Wirtz VJ, Meigs JB, Mendoza MA, Miranda JJ, Gómez-Dantés H, Lozano R, Wexler DJ, Serván-Mori E. Regional and state-level patterns of type 2 diabetes prevalence in Mexico over the last three decades. Diabetes Res Clin Pract 2021; 177:108927. [PMID: 34186106 PMCID: PMC10835737 DOI: 10.1016/j.diabres.2021.108927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/01/2021] [Accepted: 06/17/2021] [Indexed: 01/03/2023]
Abstract
AIMS We aimed to characterize and illustrate the regional and state-level change in type 2 diabetes (T2D) prevalence in Mexico between 1990 and 2017. METHODS We conducted an ecological and secondary analysis using data from the Global Burden of Disease study on T2D prevalence of the adult Mexican population. We estimated the absolute increase and annual growth rate of T2D prevalence between 1990 and 2017, stratified by age group and region. RESULTS Nationally, between 1990 and 2017, the prevalence of T2D in Mexico increased from 9.5% to 14.3%. The highest increase in T2D prevalence was observed in the East and Southcentral regions, with the lowest absolute change in T2D prevalence observed in Northern states. The highest average annual growth rate in T2D prevalence was observed in Southern Mexico, in the three Southern states with the lowest human development index, and among individuals ages 15-49 years across all regions, compared to those 50 years and older. CONCLUSIONS The prevalence of T2D in Mexico has increased substantially over the past three decades, with a clear shift in T2D prevalence from Northern to Southern states and a faster increase occurring in Southern Mexico among younger adults and in areas with lower economic resources.
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Affiliation(s)
- Jacqueline A Seiglie
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Roxana Rodriguez Franco
- Center for Demographic Urban, and Environmental Studies, El Colegio de Mexico, Mexico City, Mexico
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - James B Meigs
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Miguel Angel Mendoza
- School of Economics, National Autonomous University of Mexico, Mexico City, Mexico
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; The George Institute for Global Health, Sydney, Australia
| | - Héctor Gómez-Dantés
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico.
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21
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Duan KI, Rodriguez Garza F, Flores H, Palazuelos D, Maza J, Martinez-Juarez LA, Elliott PF, Moreno Lázaro E, Enriquez Rios N, Nigenda G, Palazuelos L, McBain RK. Economic evaluation of a novel community-based diabetes care model in rural Mexico: a cost and cost-effectiveness study. BMJ Open 2021; 11:e046826. [PMID: 33827847 PMCID: PMC8031699 DOI: 10.1136/bmjopen-2020-046826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Diabetes is the leading cause of disability-adjusted life years in Mexico, and cost-effective care models are needed to address the epidemic. We sought to evaluate the cost and cost-effectiveness of a novel community-based model of diabetes care in rural Mexico, compared with usual care. DESIGN We performed time-driven activity-based costing to estimate annualised costs associated with typical diabetes care in Chiapas, Mexico, as well as a novel diabetes care model known as Compañeros En Salud Programa de Enfermedades Crónicas (CESPEC). We conducted Markov chain analysis to estimate the cost-effectiveness of CESPEC compared with usual care from a societal perspective. We used patient outcomes from CESPEC in 2016, as well as secondary data from existing literature. SETTING Rural primary care clinics in Chiapas, Mexico. PARTICIPANTS Adults with diabetes. INTERVENTIONS CESPEC is a novel, comprehensive, diabetes care model that integrates community health workers, provider education, supply chain management and active case finding. OUTCOME MEASURE The primary outcome was the incremental cost-effectiveness of CESPEC compared with care as usual, per quality-adjusted life year (QALY) gained, expressed in 2016 US dollars. RESULTS The economic cost of the CESPEC diabetes model was US$144 per patient per year, compared with US$125 for diabetes care as usual. However, CESPEC care was associated with 0.13 additional years of health-adjusted life expectancy compared with usual care and 0.02 additional years in the first 5 years of treatment. This translated to an incremental cost-effectiveness ratio (ICER) of US$2981 per QALY gained over a patient's lifetime and an ICER of US$10 444 over the first 5 years. Findings were robust to multiple sensitivity analyses. CONCLUSIONS CESPEC is a cost-effective, community-based model of diabetes care for patients in rural Mexico. Given the high prevalence and significant morbidity associated with diabetes in Mexico and other countries in Central America, this model should be considered for broader scale up and evaluation.
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Affiliation(s)
- Kevin I Duan
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | | | - Hugo Flores
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Compañeros en Salud/Partners In Health Mexico, Ángel Albino Corzo, Chiapas, Mexico
| | - Daniel Palazuelos
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Compañeros en Salud/Partners In Health Mexico, Ángel Albino Corzo, Chiapas, Mexico
- Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Jimena Maza
- Compañeros en Salud/Partners In Health Mexico, Ángel Albino Corzo, Chiapas, Mexico
| | | | | | | | | | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Lindsay Palazuelos
- Compañeros en Salud/Partners In Health Mexico, Ángel Albino Corzo, Chiapas, Mexico
- Partners In Health, Boston, Massachusetts, USA
| | - Ryan K McBain
- Partners In Health, Boston, Massachusetts, USA
- RAND Corp Boston Office, Boston, Massachusetts, USA
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César Ernesto LC, Néstor MZ, Raúl IS, Francisco Javier PV, Tania S MU, Francisco BH, Alejandro CM, Marcela JZ, Almeda-Valdes P. Comparison of Clinical Tests for Peripheral Diabetic Neuropathy in a Type 1 Diabetes Cohort. Endocr Pract 2021; 27:567-570. [PMID: 33798738 DOI: 10.1016/j.eprac.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the performance and agreement of 5 modalities for testing sensory neuropathy against a neurothesiometer among Hispanic patients with type 1 diabetes (T1D) in an outpatient setting. METHODS A cross-sectional study was conducted at a tertiary reference center in Mexico City. Sensitivity, specificity, predictive values, and likelihood ratios were calculated using a VibraTip device, 128 Hz tuning fork, and the Semmes-Weinstein 5.07/10 g monofilament test, Ipswich touch test (IpTT), and pinprick test (PPT). The VPT obtained using a neurothesiometer was used as the standard. Agreement between tests was calculated using kappa coefficients. RESULTS Our study included 78 patients (156 examinations), of whom 56.4% were females. The mean age was 38.2 ± 13.0 years, and the mean body mass index was 24.6 ± 4.8 kg/m2. The best sensitivity was found for IpTT and VibraTip (89.7% and 79.3%, respectively), while the PPT and IpTT had the highest positive predictive values (94.4% and 92.9%, respectively). The highest kappa coefficients were obtained for the IpTT vs neurothesiometer (kappa coefficient [κ] = 0.893, P < .001), followed by VibraTip vs neurothesiometer (κ = 0.782, P < .001). The VibraTip vs IpTT also had a substantial agreement (κ= 0.713, P < .001). CONCLUSION Our findings demonstrated that the IpTT had the best diagnostic performance and agreement compared with the standard in this cohort of Hispanic patients with T1D. The IpTT is a useful, simple test for diabetic neuropathy screening. These findings support its inclusion in future guidelines for diabetic foot examination.
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Affiliation(s)
- Lam-Chung César Ernesto
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán
| | - Martínez Zavala Néstor
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán
| | - Ibarra-Salce Raúl
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán
| | | | - Mena Ureta Tania S
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán
| | - Berumen Hermosillo Francisco
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán
| | - Campos Muñoz Alejandro
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán
| | - Janka Zires Marcela
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán.
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Martins RB, Ordaz-Briseño SA, Flores-Hernández S, Bós ÂJG, Baptista-Rosas RC, Mercado-Sesma AR. Comparison of prevalence of diabetes complications in Brazilian and Mexican adults: a cross-sectional study. BMC Endocr Disord 2021; 21:48. [PMID: 33726717 PMCID: PMC7962221 DOI: 10.1186/s12902-021-00711-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Type 2 diabetes is more frequent in Latin American people than in non-Hispanic whites due to a combination of genetic and lifestyle risk factors. Brazil and Mexico are the most populous countries in Latin America. The present study aimed to compare the results of the National Health Survey "PNS" in Brazil and the National Survey Health and Nutrition "ENSANUT" in Mexico regarding the prevalence, complications and healthcare issues of diabetes in both countries. METHODS A cross-sectional study was conducted with data from the National Health Survey (PNS) of 2013 in Brazil and the National Survey of Health and Nutrition (ENSANUT) of 2018 in Mexico. The prevalence of diabetes, complications and risk factors related to developing diabetes were considered. RESULTS The respondents included 3636 individuals in Brazil and 4555 individuals in Mexico. There were significant differences in age and time living with diabetes between the two countries. Mexican people had twice as likely as Brazilian people to have a complication (p < 0.0001). The principal risk factor (OR 2.47; p ≤ 0.0001) for developing any diabetic complication was living with diabetes for more than 15 years. Visual impairment was the most frequent complication in both countries, but it was more prevalent in Mexico (p ≤ 0.001). CONCLUSIONS Diabetes complications are important health problems in Brazil and Mexico. Visual impairment was the principal complication in both countries. Several factors, such as access to and type of health system, living in a rural area, treatment, BMI and performing preventive actions, affected the risk of developing a complication. However, living with diabetes for more than 15 years was the principal risk factor. National health surveys have added significant information on the impact of diabetes in these Latin American populations. This comparison of data could provide valuable information to guide national policies and program decisions in both countries.
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Affiliation(s)
- Renata Breda Martins
- Biomedical Gerontology at Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Ângelo José Gonçalves Bós
- Biomedical Gerontology at Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Raúl C Baptista-Rosas
- Departamento de Salud Enfermedad como proceso individual, Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, Mexico
- Multidisciplinary Health Research Center, Centro Universitario de Tonalá/Universidad de Guadalajara (México), 45425, Tonalá, Jalisco, Mexico
| | - Arieh Roldán Mercado-Sesma
- Departamento de Salud Enfermedad como proceso individual, Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, Mexico.
- Multidisciplinary Health Research Center, Centro Universitario de Tonalá/Universidad de Guadalajara (México), 45425, Tonalá, Jalisco, Mexico.
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Sosa-Rubí SG, Seiglie JA, Chivardi C, Manne-Goehler J, Meigs JB, Wexler DJ, Wirtz VJ, Gómez-Dantés O, Serván-Mori E. Incremental Risk of Developing Severe COVID-19 Among Mexican Patients With Diabetes Attributed to Social and Health Care Access Disadvantages. Diabetes Care 2021; 44:373-380. [PMID: 33208487 PMCID: PMC7818336 DOI: 10.2337/dc20-2192] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/26/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is an important risk factor for severe coronavirus disease 2019 (COVID-19), but little is known about the marginal effect of additional risk factors for severe COVID-19 among individuals with diabetes. We tested the hypothesis that sociodemographic, access to health care, and presentation to care characteristics among individuals with diabetes in Mexico confer an additional risk of hospitalization with COVID-19. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study using public data from the General Directorate of Epidemiology of the Mexican Ministry of Health. We included individuals with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 between 1 March and 31 July 2020. The primary outcome was the predicted probability of hospitalization, inclusive of 8.5% of patients who required intensive care unit admission. RESULTS Among 373,963 adults with COVID-19, 16.1% (95% CI 16.0-16.3) self-reported diabetes. The predicted probability of hospitalization was 38.4% (37.6-39.2) for patients with diabetes only and 42.9% (42.2-43.7) for patients with diabetes and one or more comorbidities (obesity, hypertension, cardiovascular disease, and chronic kidney disease). High municipality-level of social deprivation and low state-level health care resources were associated with a 9.5% (6.3-12.7) and 17.5% (14.5-20.4) increased probability of hospitalization among patients with diabetes, respectively. In age-, sex-, and comorbidity-adjusted models, living in a context of high social vulnerability and low health care resources was associated with the highest predicted probability of hospitalization. CONCLUSIONS Social vulnerability contributes considerably to the probability of hospitalization among individuals with COVID-19 and diabetes with associated comorbidities. These findings can inform mitigation strategies for populations at the highest risk of severe COVID-19.
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Affiliation(s)
- Sandra G Sosa-Rubí
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Jacqueline A Seiglie
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Carlos Chivardi
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - James B Meigs
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of General Medicine, Massachusetts General Hospital, Boston, MA
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Octavio Gómez-Dantés
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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25
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Antonio-Villa NE, Palma-Moreno BG, Rodríguez-Dávila FM, Gómez-Pérez FJ, Aguilar-Salinas CA, Hernández-Jiménez S, García-Ulloa AC, Almeda-Valdes P. Use of an electronic integral monitoring system for patients with diabetes to identify factors associated with an adequate glycemic goal and to measure quality of care. Prim Care Diabetes 2021; 15:162-168. [PMID: 32830095 DOI: 10.1016/j.pcd.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/28/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
AIMS To evaluate the use of the electronic integral monitoring system (SMID) to identify factors associated to glycemic control and its impact in the quality of care in patients with type 2 diabetes (T2D). METHODS T2D patients registered in SMID were analyzed. Biochemical, clinical and lifestyle variables were recorded. Factors associated to HbA1c ≤7% were explored. Quality of care of the clinic was measured according to the National Committee for Quality Assurance Criteria (NCQA) that requires a score of 75 to achieve a good quality of care. RESULTS 511 patients were included. Prescription of basal insulin, SGLT-2 inhibitors and barriers to follow nutritional plan were associated with decreased probability of having adequate glycemic control. Patients in the maintenance stage of motivation had higher probability of having HbA1c ≤7%. According to NCQA evaluation 60 points were achieved. Glucose goals were not met; 35.9% had HbA1c ≥9% and 17% HbA1c <7%. While foot evaluation, smoking approach, blood pressure and lipids goals were accomplished; eye and renal evaluations were borderline. CONCLUSION Glycemic control in patients with long standing T2D and multiple comorbidities is challenging, which directly impacts in the quality of care. Professionals should focus in reinforcing non-pharmacological interventions to optimize glycemic targets.
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Affiliation(s)
- Neftali Eduardo Antonio-Villa
- Program (PECEM), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico; Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - B Geovani Palma-Moreno
- Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Fátima M Rodríguez-Dávila
- Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Francisco J Gómez-Pérez
- Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; División de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico
| | - Sergio Hernández-Jiménez
- Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Ana Cristina García-Ulloa
- Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Paloma Almeda-Valdes
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico.
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26
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Bello-Chavolla OY, Vargas-Vázquez A, Antonio-Villa NE, Del Razo-Olvera FM, Elías-López D, A Aguilar-Salinas C. A High Incidence of Metabolic Syndrome Traits in Mexicans Points at Obesity-Related Metabolic Dysfunction. Diabetes Metab Syndr Obes 2021; 14:1073-1082. [PMID: 33727840 PMCID: PMC7955682 DOI: 10.2147/dmso.s266568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 12/11/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Metabolic Syndrome (MS) is a construct relating to a series of metabolic dysfunctions attributable to insulin resistance and obesity. Here, we estimate the incidence of MS according to their individual components using a Mexican open-population cohort. METHODS We evaluated data of 6144 Mexicans amongst whom 3340 did not have MS either by IDF or ATP-III definitions using data from an open-population cohort. We estimated the incidence of MS and each of its traits after a median follow-up of 2.24 (IQR 2.05-2.58) years and evaluated risk factors for MS incidence and each of its traits. We also explored individuals without any MS trait to evaluate trait and MS incidence after follow-up. RESULTS We observed a high incidence of MS-IDF (115.11 cases per 1000 person-years, 95% CI 107.76-122.47), followed by MS-ATP-III (75.77 cases per 1000 person-years, 95% CI). The MS traits with the highest incidence were low HDL-C and abdominal obesity, which was consistent for subjects without MS and those without any MS trait. When assessing predictors of MS incidence, obesity, insulin resistance, and increased apolipoprotein B levels predicted MS incidence. Weight loss >5% of body weight and physical activity were the main protective factors. Obesity was a main determinant for incident MS traits in our population, with weight loss being also a protective factor for most MS traits. CONCLUSION We observed a high incidence of MS in apparently healthy Mexican adults. Low HDL-C and abdominal obesity were the most frequent incident MS traits, with obesity being the main determinant of its incidence.
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Affiliation(s)
- Omar Yaxmehen Bello-Chavolla
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Division of Research, Instituto Nacional de Geriatría, Mexico City, Mexico
| | - Arsenio Vargas-Vázquez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, UNAM, Mexico City, Mexico
| | - Neftali Eduardo Antonio-Villa
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, UNAM, Mexico City, Mexico
| | - Fabiola Mabel Del Razo-Olvera
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Daniel Elías-López
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Division of Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
- Correspondence: Carlos A Aguilar-Salinas Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, Distrito Federal, CP 14080, MéxicoTel +525554870900, 5703 Email
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Montesi L. 'If I don't take care of myself, who will?' Self-caring subjects in Oaxaca's mutual-aid groups. Anthropol Med 2020; 27:380-394. [PMID: 32419477 DOI: 10.1080/13648470.2020.1715010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Based on seven months of ethnographic fieldwork in two urban health centres in Oaxaca City, Mexico, this paper analyses the ways in which underprivileged middle-aged and older female patients experience and transform grupos de ayuda mutua (GAMs), or mutual-aid groups, a public health programme aimed at improving chronic patients' adherence to their biomedical treatments. GAMs work as 'technologies of the self' within the context of the Mexican neoliberal regime and patients are urged to be self-responsible. GAM members regard such urging favourably and act according to their broader understandings of life, which they see as a lucha (struggle) that requires cuidarse (a polysemic verb alluding to self-care for self-preservation) and hard work in a structurally unequal place characterised by precarity and social unrest. This seemingly rugged individualism is converted into microlevel collaboration through culturally distinctive Oaxacan practices of mutual help. By exploring the playful ways these women participate in GAMs, this paper shows how biomedical settings can be repurposed as spaces of socialisation and wellbeing for older women living in vulnerable conditions.
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Affiliation(s)
- Laura Montesi
- Cátedras CONACyT, CIESAS Pacífico Sur, Oaxaca, Mexico
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Abstract
In this commentary, I assess the adverse syndemic interactions between COVID-19 and diabetes mellitus. This syndemic is of major concern for a country like Mexico which has seen a steady rise in the percentage of its population suffering these diseases. Mexico now has one of the highest rates of diabetes in the world and a rapidly growing COVID-19 caseload.
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Affiliation(s)
- Merrill Singer
- Center for Health, Intervention and Prevention, Department of Anthropology, University of Connecticut , Storrs, Connecticut, USA
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Tello J, Garcillán PP, Ezcurra E. How dietary transition changed land use in Mexico. AMBIO 2020; 49:1676-1684. [PMID: 31994027 PMCID: PMC7413932 DOI: 10.1007/s13280-020-01317-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/28/2019] [Accepted: 01/03/2020] [Indexed: 06/10/2023]
Abstract
The nutrition transition towards western diets in developing countries occurs at multiple levels, impacting health and society and also the environment. In Mexico, the shift in food consumption and production patterns, particularly in relation to animal source foods (ASF), has changed land use. We studied the consumption and production of ASF and change in agricultural land use in Mexico during the second half of the twentieth century and until 2013; using domestic and international data sources, our findings show an increasing proportion of farmed area devoted to the production of feed crops domestically, and also an increasing demand of farmed feed beyond national borders. We discuss how the intensification of livestock production is associated to major environmental threats and suggest that opportunities are available for sustainable and healthy food options.
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Affiliation(s)
- José Tello
- Centro de Investigaciones Biológicas del Noroeste (CIBNOR), Av. Instituto Politécnico Nacional 195, Playa Palo de Santa Rita Sur, 23205 La Paz, BCS Mexico
| | - Pedro P. Garcillán
- Centro de Investigaciones Biológicas del Noroeste (CIBNOR), Av. Instituto Politécnico Nacional 195, Playa Palo de Santa Rita Sur, 23205 La Paz, BCS Mexico
| | - Exequiel Ezcurra
- Department of Botany and Plant Sciences, University of California Riverside, 900 University Ave, Riverside, CA 92521 USA
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Prevalence and Risk Factors for Self-Report Diabetes Mellitus: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186497. [PMID: 32906612 PMCID: PMC7558180 DOI: 10.3390/ijerph17186497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022]
Abstract
The aim of this study was to estimate the prevalence and risk factors for self-reported diabetes mellitus (DM) in the adult population of the Central-West region of Brazil. In 2013, a cross-sectional study using the data from the National Health Survey and comprising 7519 individuals aged ≥18 years from the Central-West region was conducted. Participants were interviewed at their homes about sociodemographic data and risk factors for DM. To verify the risk factors with DM, the Poisson regression model was used. The analyses were performed for the total sample and stratified according to sex. The prevalence of DM was 6.5% (95% confidence interval [95% CI], 5.7–7.3). The diagnosis of self-reported DM was 4.3% in men and 7.5% in women. In the global sample, it was found that age between 40–59 years and ≥60 years, previous smoking (former smoker), self-reported hypertension, self-reported dyslipidemia, overweight, and obesity were independently associated with self-reported DM. In men, risk factors were: Age ≥ 60 years, self-reported hypertension, self-reported dyslipidemia, and obesity. In women, risk factors were: Age 30–39 years, 40–59 years, and ≥60 years, previous smoking (former smoker), self-reported hypertension, self-reported dyslipidemia, overweight, and obesity. Conclusion: The prevalence of DM was 6.5%. DM was associated with advanced age; previous smoking (former smoker), hypertension, dyslipidemia, overweight, and obesity. Some differences in risk factors between men and women were noted.
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Castillo-Hernandez KG, Laviada-Molina H, Hernandez-Escalante VM, Molina-Segui F, Mena-Macossay L, Caballero AE. Peer Support Added to Diabetes Education Improves Metabolic Control and Quality of Life in Mayan Adults Living With Type 2 Diabetes: A Randomized Controlled Trial. Can J Diabetes 2020; 45:206-213. [PMID: 33129754 DOI: 10.1016/j.jcjd.2020.08.107] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 06/29/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Yucatán, located in the southern region of Mexico, is the state with the country's highest prevalence of uncontrolled diabetes. Because of its particular cultural and socioeconomic characteristics, the residents of Yucatán face unique health-care challenges. The objective of our study was to evaluate the effect of peer support added to a diabetes education program on glycemic control and diabetes-related quality of life when compared with a conventional diabetes education program in patients with type 2 diabetes in a Mayan community in Mexico. METHODS In March 2015, a total of 58 participants with a previous diagnosis of type 2 diabetes who were recruited from community health centres in Komchén were randomly assigned in equal numbers to 1 of 2 groups: 1) a peer support and diabetes self-management education group (PSEG) or 2) a conventional diabetes self-management education-only group. The primary outcomes of interest were glycated hemoglobin (A1C) values and diabetes-related quality of life. The majority of subjects were bilingual (Mayan and Spanish speakers), female and middle aged, and had a low level of formal education and high baseline A1C (mean, 8.7%). RESULTS Whereas both groups showed significant improvements from baseline to study end in absolute levels of A1C, the PSEG group had a more pronounced clinical improvement, but no statistical improvement, in A1C compared with the conventional diabetes self-management education-only group. PSEG participants exhibited statistically significant improvement in diabetes-related quality of life at 8 months. CONCLUSIONS Our study demonstrates the benefits of peer-support education above and beyond the impact of diabetes self-management education on diabetes-related quality of life in an underserved Mayan community in Mexico.
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Affiliation(s)
- Karen G Castillo-Hernandez
- Marist University of Mérida, Mérida, Mexico; Faculty of Medicine, Autonomous University of Yucatán, Mérida, Mexico
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Whittemore R, Vilar-Compte M, De La Cerda S, Delvy R, Jeon S, Burrola-Méndez S, Pardo-Carrillo M, Lozano-Marrufo A, Pérez-Escamilla R. ¡Sí, Yo Puedo Vivir Sano con Diabetes! A Self-Management Randomized Controlled Pilot Trial for Low-Income Adults with Type 2 Diabetes in Mexico City. Curr Dev Nutr 2020; 4:nzaa074. [PMID: 32368713 PMCID: PMC7186776 DOI: 10.1093/cdn/nzaa074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/28/2020] [Accepted: 04/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is a worldwide epidemic and a leading cause of death in Mexico, with a prevalence of 15.9%, and >70% of diagnosed adults have poor glycemic control [glycated hemoglobin (HbA1c) >7.5%]. We developed a diabetes self-management education program contextualized to the study population, including dietary preferences, health literacy, and health system. OBJECTIVES We aimed to evaluate the efficacy of a self-management + text message program (¡Sí, Yo Puedo Vivir Sano con Diabetes!) on primary (HbA1c), and secondary behavioral (self-management), clinical, and psychosocial outcomes in adults with T2D in Mexico City. METHODS Participants were recruited at public primary healthcare centers (Seguro Popular), and randomly allocated to treatment (n = 26) or wait-list control groups (n = 21) with data collected at 3 and 6 mo. The program included 7 weekly sessions and 6 mo of daily text/picture messages. Descriptive statistics and a generalized linear mixed model with intent-to-treat analysis were calculated. RESULTS Participants were 55.5 ± 8.8 y of age (mean ± SD), 68% female, 88.6% overweight/obese, and 57% lived in food-insecure households. Mean ± SD T2D duration was 11.9 ± 7.8 y and HbA1c was 9.2% ± 1.5%. There was 89% attendance at sessions and 6.4% attrition across both groups at 6 mo. Group-by-time effects were seen in self-monitoring of blood glucose (P < 0.01) and diabetes self-efficacy (P < 0.04); and a trend for lower HbA1c was seen in the intervention group at 6 mo (P = 0.11). Significant improvements in dietary behavior (P < 0.01) were demonstrated in the intervention group over time, but this did not reach statistical significance compared with the control group. CONCLUSIONS The program was associated with clinically significant improvements in T2D self-management, self-efficacy, and HbA1c over time. Thus, T2D self-management skills, including diet, were improved in a vulnerable metropolitan population.This trial was registered at clinicaltrials.gov as NCT03159299.
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Affiliation(s)
| | - Mireya Vilar-Compte
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
| | - Selene De La Cerda
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
| | | | | | - Soraya Burrola-Méndez
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
| | - Mariana Pardo-Carrillo
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
| | - Annel Lozano-Marrufo
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
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León-Flores P, Nájera N, Pérez E, Pardo B, Jimenez F, Diaz-Chiguer D, Villarreal F, Hidalgo I, Ceballos G, Meaney E. Effects of Cacao By-Products and a Modest Weight Loss Intervention on the Concentration of Serum Triglycerides in Overweight Subjects: Proof of Concept. J Med Food 2020; 23:745-749. [PMID: 32286894 DOI: 10.1089/jmf.2019.0201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Therapeutic approaches to decrease serum triglyceride (TG) concentrations are not successful mainly due to poor adherence or adverse effects of therapies. In consequence, the search for new low-cost and safer therapeutic alternatives is mandatory. Dark chocolate and cacao have shown promising results improving lipid profiles. Recently, using cacao by-products to reduce elevated cardiometabolic risk markers in an animal model of obesity induced by a high-fat diet and fructose, we showed that TGs, low-density lipoprotein cholesterol, and the TG/high-density lipoprotein (HDL) ratio decreased, suggesting that cacao by-products improved the metabolic function of obese animals. Based on these results, as a proof of concept, a blinded placebo-controlled study was implemented to explore the effects of cacao by-products on anthropometric and biochemical variables in a group of overweight subjects participating in a program composed of reduced-calorie-diet counseling plus a simple aerobic exercise plan. The results showed that counseling induced weight and abdominal circumference reductions in both groups. TGs did not change in the control group; however, TG decreased significantly by 54.9 mg/dL (27.9%) in the experimental group. The TG/HDL cholesterol ratio changed markedly (1.5) in the experimental group. The results reported suggest the use of cacao by-products as an alternative for the treatment of hypertriglyceridemia.
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Affiliation(s)
- Perla León-Flores
- Integral Caardiometabolic Research Laboratory, Research and Posgraduate Studies Section, School of Medicine, National Polytechnique Institute, Mexico City, Mexico
| | - Nayelli Nájera
- Integral Caardiometabolic Research Laboratory, Research and Posgraduate Studies Section, School of Medicine, National Polytechnique Institute, Mexico City, Mexico
| | - Elizabeth Pérez
- Unit of Metabolism and Nutritional Support, Hospital Juarez, Mexico City, Mexico
| | - Blanca Pardo
- Unit of Metabolism and Nutritional Support, Hospital Juarez, Mexico City, Mexico
| | | | | | | | - Isabel Hidalgo
- Integral Caardiometabolic Research Laboratory, Research and Posgraduate Studies Section, School of Medicine, National Polytechnique Institute, Mexico City, Mexico
| | - Guillermo Ceballos
- Integral Caardiometabolic Research Laboratory, Research and Posgraduate Studies Section, School of Medicine, National Polytechnique Institute, Mexico City, Mexico
| | - Eduardo Meaney
- Integral Caardiometabolic Research Laboratory, Research and Posgraduate Studies Section, School of Medicine, National Polytechnique Institute, Mexico City, Mexico
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Risk of developing pre-diabetes or diabetes over time in a cohort of Mexican health workers. PLoS One 2020; 15:e0229403. [PMID: 32210432 PMCID: PMC7094846 DOI: 10.1371/journal.pone.0229403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/05/2020] [Indexed: 11/19/2022] Open
Abstract
Aim To determine the association between known risk factors (e.g., obesity, metabolic syndrome and its components) and the development of pre-diabetes or diabetes over time in a cohort of Mexican health workers. Methods Participants in the Mexican Health Worker Cohort Study with complete information at two waves of data collection, 2004–2006 (W1) and 2011–2013 (W2), were included in the analysis (n = 1,174). Multivariable binary and multinomial logistic regression were used to examine the cross-sectional associations between specific risk factors and diabetes status (diabetes, pre-diabetes, or neither) at W1 and the longitudinal associations between changes in risk factors and progression of diabetes status from W1 to W2, respectively. Results Mean time between waves was 7.0 years (SD 1.1). Prevalence of pre-diabetes and diabetes was 16% and 10% at W1 and increased to 30% and 16% at W2, respectively. The cross-sectional prevalence of pre-diabetes and diabetes was significantly higher among men, participants over the age of 45 years, and individuals who were overweight or obese or had metabolic syndrome (MS), three or more components of the MS, elevated alanine aminotransferase (ALT) levels, or elevated uric acid. In longitudinal analyses, remaining obese or gaining weight between waves was associated with an increased risk of developing pre-diabetes. A greater risk of developing pre-diabetes or diabetes was also observed among individuals who either maintained or acquired MS, elevated ALT, or elevated uric acid (only for diabetes) from W1 to W2. Conclusions Weight gain and acquiring or maintaining MS, elevated ALT levels, or elevated uric acid were associated with a significant risk of developing pre-diabetes or diabetes. Our findings, especially in the context of the obesity epidemic in Mexico, point towards an urgent need for initiatives to help reduce excess weight in order to avert future cases of pre-diabetes and diabetes.
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Whittemore R, Vilar-Compte M, Burrola-Méndez S, Lozano-Marrufo A, Delvy R, Pardo-Carrillo M, De La Cerda S, Pena-Purcell N, Pérez-Escamilla R. Development of a diabetes self-management + mHealth program: tailoring the intervention for a pilot study in a low-income setting in Mexico. Pilot Feasibility Stud 2020; 6:25. [PMID: 32082611 PMCID: PMC7023698 DOI: 10.1186/s40814-020-0558-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 01/27/2020] [Indexed: 11/12/2022] Open
Abstract
Background Type 2 diabetes (T2D) is a public health pandemic disproportionately affecting low- and middle-income countries. The purpose of this formative research was to adapt evidence-based diabetes self-management education programs to the context of Seguro Popular clinics in Mexico. A theory-based mHealth (pictorial text messaging) component was developed. Method Our formative research and development of the program protocol consisted of six phases: (1) interviews and focus groups with stakeholders on the challenges to T2D management, curriculum content needs, and the use of mHealth as a supplement to a DSME program; (2) review of the theoretical underpinning, curriculum, and interactive strategies of four evidence-based DSME programs and modification to meet the needs of adults with T2D and systems of care in Mexico City; (3) development of theory-based illustrated text messages; (4) evaluation of text messaging acceptability and access in adults with T2D via focus groups; (5) development of program manual; and (6) development of a training program for health care providers. Results The ¡Sí, Yo Puedo Vivir Sano Con Diabetes! included 7 group-based weekly lessons; simple, interactive content; weekly empowerment messages; video novellas; group activities; and goal setting. Adaptations to the cultural context of Mexico included content/activities on diabetes etiology (addressing cultural misconceptions), nutrition (indigenous foods and plate method), self-blood glucose monitoring, and diabetes-related stress/coping. We used the Health Action Process Approach to guide the text message development, which posits that adoption, initiation, and maintenance of health behaviors require the development of intentions, plans, coping, and self-efficacy. Our final text message bank consisted of 181 messages. There were approximately 20–30 messages for each process of behavior change (e.g., action planning, maintenance self-efficacy) and 30 messages for each content topic (e.g., eating healthy, physical activity). There were 96 messages that were illustrated. Training materials were also developed. Discussion We used a systematic approach, collaboration with stakeholders, and a well-established behavior change theory to develop an evidence-based intervention to an international context and system of care. Collectively, this process has the potential to enhance the feasibility, acceptability, and efficacy of the program.
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Affiliation(s)
- Robin Whittemore
- 1Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06516 USA
| | - Mireya Vilar-Compte
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Soraya Burrola-Méndez
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Annel Lozano-Marrufo
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Roberta Delvy
- 1Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06516 USA
| | - Mariana Pardo-Carrillo
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Selene De La Cerda
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Ninfa Pena-Purcell
- 3Texas A & M University, 2251 TAMU Mailstop, College Station, Texas 77845 USA
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Diener C, Reyes-Escogido MDL, Jimenez-Ceja LM, Matus M, Gomez-Navarro CM, Chu ND, Zhong V, Tejero ME, Alm E, Resendis-Antonio O, Guardado-Mendoza R. Progressive Shifts in the Gut Microbiome Reflect Prediabetes and Diabetes Development in a Treatment-Naive Mexican Cohort. Front Endocrinol (Lausanne) 2020; 11:602326. [PMID: 33488518 PMCID: PMC7821428 DOI: 10.3389/fendo.2020.602326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/20/2020] [Indexed: 12/26/2022] Open
Abstract
Type 2 diabetes (T2D) is a global epidemic that affects more than 8% of the world's population and is a leading cause of death in Mexico. Diet and lifestyle are known to contribute to the onset of T2D. However, the role of the gut microbiome in T2D progression remains uncertain. Associations between microbiome composition and diabetes are confounded by medication use, diet, and obesity. Here we present data on a treatment-naive cohort of 405 Mexican individuals across varying stages of T2D severity. Associations between gut bacteria and more than 200 clinical variables revealed a defined set of bacterial genera that were consistent biomarkers of T2D prevalence and risk. Specifically, gradual increases in blood glucose levels, beta cell dysfunction, and the accumulation of measured T2D risk factors were correlated with the relative abundances of four bacterial genera. In a cohort of 25 individuals, T2D treatment-predominantly metformin-reliably returned the microbiome to the normoglycemic community state. Deep clinical characterization allowed us to broadly control for confounding variables, indicating that these microbiome patterns were independent of common T2D comorbidities, like obesity or cardiovascular disease. Our work provides the first solid evidence for a direct link between the gut microbiome and T2D in a critically high-risk population. In particular, we show that increased T2D risk is reflected in gradual changes in the gut microbiome. Whether or not these T2D-associated changes in the gut contribute to the etiology of T2D or its comorbidities remains to be seen.
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Affiliation(s)
- Christian Diener
- Computational Genomics, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
- Gibbons Lab, Institute for Systems Biology, Seattle, WA, United States
| | | | - Lilia M. Jimenez-Ceja
- Metabolic Research Laboratory, Department of Medicine and Nutrition, University of Guanajuato, León, Mexico
| | - Mariana Matus
- Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Claudia M. Gomez-Navarro
- Metabolic Research Laboratory, Department of Medicine and Nutrition, University of Guanajuato, León, Mexico
| | - Nathaniel D. Chu
- Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Vivian Zhong
- Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - M. Elizabeth Tejero
- Computational Genomics, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Eric Alm
- Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Osbaldo Resendis-Antonio
- Computational Genomics, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
- Human Systems Biology Laboratory, Coordinación de la Investigación Científica—Red de Apoyo a la Investigación, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- *Correspondence: Osbaldo Resendis-Antonio, ; Rodolfo Guardado-Mendoza,
| | - Rodolfo Guardado-Mendoza
- Metabolic Research Laboratory, Department of Medicine and Nutrition, University of Guanajuato, León, Mexico
- Research Department, Hospital Regional de Alta Especialidad del Bajío, León, Mexico
- *Correspondence: Osbaldo Resendis-Antonio, ; Rodolfo Guardado-Mendoza,
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Ingram M, Denman CA, Cornejo-Vucovich E, Castro-Vasquez MDC, Aceves B, Ocejo AG, de Zapien JG, Rosales C. The Meta Salud Diabetes Implementation Study: Qualitative Methods to Assess Integration of a Health Promotion Intervention Into Primary Care to Reduce CVD Risk Among an Underserved Population With Diabetes in Sonora, Mexico. Front Public Health 2019; 7:347. [PMID: 31803710 PMCID: PMC6874016 DOI: 10.3389/fpubh.2019.00347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 11/01/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Within health promotion research, there is a need to assess strategies for integration and scale up in primary care settings. Hybrid interventions that combine clinical effectiveness trials with implementation studies can elicit important contextual information on facilitators and barriers to integration within a health care system. This article describes lessons learned in developing and implementing a qualitative study of a cluster-randomized controlled trial (RCT) to reduce cardiovascular disease (CVD) among people with diabetes in Sonora, Mexico, 2015–2019. Methods:The research team worked cooperatively with health center personnel from 12 Centers that implemented the intervention. The study used observations, stakeholder meetings, case studies, staff interviews and decision maker interviews to explore issues such as staff capacity, authority, workflow, space, and conflicting priorities, as well as patients' response to the program within the clinical context and their immediate social environments. Applying a multi-layered contextual framework, two members of the research team coded an initial sample of the data to establish inclusion criteria for each contextual factor. The full team finalized definitions and identified sub nodes for the final codebook. Results: Characteristics of management, staffing, and the local environment were identified as essential to integration and eventual adoption and scale up across the health system. Issues included absence of standardized training and capacity building in chronic disease and health promotion, inadequate medical supplies, a need for program monitoring and feedback, and lack of interdisciplinary support for center staff. Lack of institutional support stemming from a curative vs. preventive approach to care was a barrier for health promotion efforts. Evolving analysis, interpretation, and discussion resulted in modifications of flexible aspects of the intervention to realities of the health center environment. Conclusion: This study illustrates that a robust and comprehensive qualitative study of contextual factors across a social ecological spectrum is critical to elucidating factors that will promote future adoption and scale up of health promotion programs in primary care. Application of conceptual frameworks and health behavior theory facilitates identification of facilitators and barriers across contexts. Trial registration:www.ClinicalTrials.gov, identifier: NCT02804698 Registered on June 17, 2016.
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Affiliation(s)
- Maia Ingram
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health University of Arizona, Tucson, AZ, United States
| | - Catalina A Denman
- Center for Health and Society Studies, El Colegio de Sonora, Hermosillo, Mexico
| | | | | | - Benjamin Aceves
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health University of Arizona, Tucson, AZ, United States
| | - Abraham Garcia Ocejo
- Department of Epidemiology, Mel and Enid Zuckerman College of Public Health University of Arizona, Tucson, AZ, United States
| | - Jill Guernsey de Zapien
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health University of Arizona, Tucson, AZ, United States
| | - Cecilia Rosales
- Division of Public Health Practice and Translational Research, Mel and Enid Zuckerman College of Public Health University of Arizona, Tucson, AZ, United States
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Armenta-Guirado B, Martínez-Contreras T, Candia-Plata MC, Esparza-Romero J, Martínez-Mir R, Haby MM, Valencia ME, Díaz-Zavala RG. Effectiveness of the Diabetes Prevention Program for Obesity Treatment in Real World Clinical Practice in a Middle-Income Country in Latin America. Nutrients 2019; 11:nu11102324. [PMID: 31581478 PMCID: PMC6835923 DOI: 10.3390/nu11102324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/15/2019] [Indexed: 12/12/2022] Open
Abstract
The Diabetes Prevention Program (DPP) is effective for the prevention of type 2 diabetes by weight loss with diet and physical activity. However, there is little evidence as to whether this program could be translated into real-world clinical practice in Latin American countries. The objective of this work was to evaluate the effectiveness of the DPP for the management of overweightness and obesity at 6 and 12 months in clinical practice in Mexico. This was a non-controlled intervention study implemented in five public clinics in northern Mexico. Two hundred and thirty-seven adults aged 45.7 ± 9.9 years with a Body Mass Index (BMI) of 34.4 ± 5.4 kg/m2 received group sessions with an adaptation of the DPP, in addition to nutrition counseling. One hundred and thirty-three (56%) participants concluded the 6 month phase. They showed a significant weight loss, ranging from 2.76 ± 4.76 to 7.92 ± 6.85 kg (p ≤ 0.01) in the clinics. The intention-to-treat analysis showed a more conservative weight loss. Participant retention at the end of 12 months was low (40%). The implementation of the DPP in different public clinics in Mexico was effective in the management of obesity in the short term, but better strategies are required to improve participant retention in the long term.
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Affiliation(s)
- Brianda Armenta-Guirado
- Department of Health Sciences, University of Sonora, Blvd. Bordo Nuevo S/N, Blvd. Antiguo Ejido Providencia, Cajeme, Sonora 85010, Mexico.
| | - Teresita Martínez-Contreras
- Department of Chemical and Biological Sciences, University of Sonora, Blvd. Luis Encinas y Rosales S/N. Hermosillo, Sonora 83000, Mexico.
| | - Maria C Candia-Plata
- Department of Medicine and Health Sciences, University of Sonora, Blvd. Luis Encinas y Rosales S/N. Hermosillo, Sonora 83000, Mexico.
| | - Julián Esparza-Romero
- Diabetes Research Units, Department of Public Nutrition and Health, Research Center for Food and Development CIAD, A.C., Camino Gustavo Enrique Astiazarán Rosas No. 46 Col. La Victoria. Hermosillo, Sonora 83000, Mexico.
| | - Raúl Martínez-Mir
- Department of Psychology and Communication, University of Sonora, Blvd. Luis Encinas y Rosales S/N. Hermosillo, Sonora 83000, Mexico.
| | - Michelle M Haby
- Department of Chemical and Biological Sciences, University of Sonora, Blvd. Luis Encinas y Rosales S/N. Hermosillo, Sonora 83000, Mexico.
| | - Mauro E Valencia
- Department of Chemical and Biological Sciences, University of Sonora, Blvd. Luis Encinas y Rosales S/N. Hermosillo, Sonora 83000, Mexico.
| | - Rolando G Díaz-Zavala
- Department of Chemical and Biological Sciences, University of Sonora, Blvd. Luis Encinas y Rosales S/N. Hermosillo, Sonora 83000, Mexico.
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Rodríguez-Hernández AP, Márquez-Corona MDL, Pontigo-Loyola AP, Medina-Solís CE, Ximenez-Fyvie LA. Subgingival Microbiota of Mexicans with Type 2 Diabetes with Different Periodontal and Metabolic Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3184. [PMID: 31480468 PMCID: PMC6751498 DOI: 10.3390/ijerph16173184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/23/2019] [Accepted: 08/29/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Type-2-Diabetes (T2D) and Periodontitis are major inflammatory diseases. However, not much is known about the specific subgingival microbiota in Mexicans with diabetes and metabolic dysbiosis. The aim of this study was to describe the subgingival microbiota of Mexicans with T2D and the different periodontal and metabolic conditions, through "Checkerboard" DNA-DNA hybridization. METHODS Subjects were divided into two groups-periodontal-health (PH) (PH_non-T2D; n = 59, PH_T2D; n = 14) and generalized-periodontitis (GP) (GP_non-T2D; n = 67, GP_T2D; n = 38). Obesity (BMI ≥ 30 kg/m2) and serum levels of glycated-hemoglobin (HbA1c), total-lipids, triglycerides, total-cholesterol, high-density-lipids, and low-density-lipids were measured for the T2D individuals. Subgingival microbial identification was processed for 40 species through DNA-probes. RESULTS Subjects with T2D harbored significantly higher mean total levels (PH: p < 0.001, and GP_NS), a lower proportion of "red" complex (GP: p < 0.01), a higher proportion of "yellow" (GP; p < 0.001), and "orange" (GP; p < 0.01) complex than the non-T2D. GP_T2D individuals exhibited a greater proportion of putative-species-Campylobacter gracilis and S. constellatus (p < 0.001), and Parvimonas micra and Prevotella nigrescens (p < 0.01), than GP_non-T2D. T2D individuals with HbA1c > 8% had presented significantly higher mean pocket-depth and higher levels of G. morbillorum (p < 0.05) and those with obesity or dyslipidemia harbored higher levels, prevalence, or proportion of Streptococcus sp., Actinomyces sp., and Capnocytophaga sp. CONCLUSIONS T2D individuals harbored a particular microbial profile different to non-T2D microbiota. Metabolic control was related to dysbiosis of microbiota-HbA1c>8% related to periodontitis and obesity or dyslipidemia with the predominance of saccharolytic bacteria, irrespective of their periodontal condition.
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Affiliation(s)
| | - María de Lourdes Márquez-Corona
- The Academic Area of Dentistry in the Health Sciences Institute, the Autonomous University of the State of Hidalgo, Pachuca 42039, Mexico
| | - América Patricia Pontigo-Loyola
- The Academic Area of Dentistry in the Health Sciences Institute, the Autonomous University of the State of Hidalgo, Pachuca 42039, Mexico
| | - Carlo Eduardo Medina-Solís
- The Academic Area of Dentistry in the Health Sciences Institute, the Autonomous University of the State of Hidalgo, Pachuca 42039, Mexico.
| | - Laurie-Ann Ximenez-Fyvie
- Laboratory of Molecular Genetics, School of Dentistry, National Autonomous University of Mexico (UNAM), Mexico City 04360, Mexico.
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Whittemore R, Vilar-Compte M, De La Cerda S, Marron D, Conover R, Delvy R, Lozano-Marrufo A, Pérez-Escamilla R. Challenges to diabetes self-management for adults with type 2 diabetes in low-resource settings in Mexico City: a qualitative descriptive study. Int J Equity Health 2019; 18:133. [PMID: 31443659 PMCID: PMC6708131 DOI: 10.1186/s12939-019-1035-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023] Open
Abstract
Background The prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. The purpose of this study was to identify the challenges for T2D self-management as perceived by both adults with T2D and health care providers in primary health clinics from Seguro Popular in Mexico City. Methods This was a qualitative descriptive study conducted in three Seguro Popular primary care clinics in Mexico City using convenience sampling. Semi-structured interviews were conducted with participants and data were analyzed using a content analysis approach. Results The sample included 20 adults with T2D [52.5 years old (SD = 9.9), diagnosed with T2D for 12.3 years (SD = 6.3), mean A1C of 9.8% (SD = 2.4), 80% female, 90% with financial insecurity] and 19 providers [primarily female (78.9%), mean age of 41.6 years old (SD = 11.4), 12.3 mean years in practice (SD = 8.50)]. Personal challenges included cultural beliefs, lack of resources, challenges to lifestyle modification, lack of family support/competing demands, and mental health issues. System level challenges included lack of resources, perceived quality of care, and patient engagement barriers. Conclusions Evidence-based diabetes self-management programs need to become more accessible, taking into consideration the social determinants of health and building upon current initiatives to improve early diagnosis and treatment of T2D. Cultural beliefs, personal control, and low health literacy influence diabetes self-management in adults with T2D with limited resources. Mental health and financial challenges of adults with T2D will require multidisciplinary team-based care. Future research on best practices to implement and scale-up evidence-based patient-centered T2D prevention and DSME programs for the poor and underserved is warranted in Mexico and world-wide.
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Affiliation(s)
- Robin Whittemore
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT, 06516, USA.
| | - Mireya Vilar-Compte
- Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Álvaro Obregón, Mexico City, Mexico
| | - Selene De La Cerda
- Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Álvaro Obregón, Mexico City, Mexico
| | - Denise Marron
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT, 06516, USA
| | - Rosabelle Conover
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT, 06516, USA
| | - Roberta Delvy
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT, 06516, USA
| | - Annel Lozano-Marrufo
- Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Álvaro Obregón, Mexico City, Mexico
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Seuring T, Serneels P, Suhrcke M. The impact of diabetes on labour market outcomes in Mexico: A panel data and biomarker analysis. Soc Sci Med 2019; 233:252-261. [PMID: 31252158 DOI: 10.1016/j.socscimed.2019.05.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 05/21/2019] [Accepted: 05/29/2019] [Indexed: 12/15/2022]
Abstract
Recent evidence for Mexico suggests important differences in health status between people with diagnosed and undiagnosed diabetes. However, there is at best scarce evidence on the economic consequences of diabetes, especially in contexts where the condition often remains undiagnosed, as is typically the case in low- and middle income countries. Using Mexican longitudinal and biomarker data we estimated the relationship between diabetes, as well as its time since diagnosis, and employment probabilities, wages and working hours. We further explored how these relationships differ for those with diagnosed and undiagnosed diabetes. For the longitudinal analyses, nationally representative data from 11995 men and 13858 women 15-64 years old were taken from three waves (2002, 2005, 2009) of the Mexican Family Life Survey. We estimated a fixed effects model to account for unmeasured time-invariant confounders of diabetes. We found a reduction in the probability of being employed of 7.7 and 6.3 percentage points for men and women, respectively, but no significant relationship with hours worked or wages. Employment probabilities fell gradually with each year since diagnosis for men but not for women. Using cross-sectional biomarker data, our results indicate that 68% of those exhibiting glycated hemoglobin (HbA1c) levels above the clinical diabetes threshold did not self-report a diagnosis, hence were undiagnosed. Nevertheless, regression analysis revealed that there was no association of diabetes with labour outcomes for undiagnosed women or men. This suggests that results based on self-reported diabetes cannot be extended to the (rather large) part of the population with undiagnosed diabetes, likely because of a selection of people in worse health and with a longer diabetes duration into the diagnosed population. Earlier diagnosis and improved treatment of diabetes therefore may prevent adverse health effects and related economic hardship.
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Affiliation(s)
- Till Seuring
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Research Group for Evidence-Based Public Health, Achterstr. 30, 28359, Bremen, Germany; Health Sciences Bremen, Institute for Public Health and Nursing University of Bremen, Bremen, Germany; University of East Anglia, Norwich Research Park, Norwich, Norfolk, UK.
| | - Pieter Serneels
- University of East Anglia, Norwich Research Park, Norwich, Norfolk, UK
| | - Marc Suhrcke
- University of York, Heslington, York, UK; Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette/Belval, Luxembourg
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Chen-Ku CH, Gonzalez-Galvez G, Vásquez M, Fuente G, Nakazone MA, Silva Giordano AI, de Sa Pereira MH. VASCULAR COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES: PREVALENCE AND COMORBIDITIES IN 6 COUNTRIES OF LATIN AMERICA (A COHORT OF THE DISCOVER STUDY PROGRAM). Endocr Pract 2019; 25:994-1002. [PMID: 31170372 DOI: 10.4158/ep-2018-0473] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To provide real world observational data about glucose control, the burden of diabetes, comorbidities, and cardiovascular risk factors among patients initiating second-line therapy in Latin America (LA). Methods: This report is a cross-sectional analysis of the LA cohort of the DISCOVER study, describing the regional prevalence of microvascular and macrovascular complications in Mexico, Costa Rica, Panama, Colombia, Argentina, and Brazil. Results: One thousand six hundred and sixteen patients were included in 69 investigational sites. Hemoglobin A1c was >7% (42 mmol/mol) in 81.3% of subjects. Macrovascular complications were reported by 13.8% of the subjects. Microvascular conditions were reported in 15.2% of the subjects. The prevalence of hypertension and of hyperlipidemia was 55.5% and 45.9%, respectively. Blood pressure, total cholesterol, and low-density lipoprotein were out of target levels in 38.5%, 51.2%, and 81.7% of the patients, respectively. Overweight or obesity was reported in 83.8% of the cases. Conclusion: Our study shows that patients with type 2 diabetes in LA are not reaching their glucose, lipids, blood pressure, and weight targets. The prevalence of microvascular (15.2%), macrovascular (13.8%), and uncontrolled comorbidities in patients at an early stage of the disease (initiating a second-line therapy) highlights the need for more aggressive risk factor screening as well as treatment in LA. Abbreviations: CV = cardiovascular; CVD = cardiovascular disease; DM = diabetes mellitus; HbA1c = hemoglobin A1c; LA = Latin America/Latin American; LDL = low density cholesterol; T2DM = type 2 diabetes mellitus.
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McEwen MM, Pasvogel A, Elizondo-Pereo R, Meester I, Vargas-Villarreal J, González-Salazar F. Diabetes Self-Management Behaviors, Health Care Access, and Health Perception in Mexico-US Border States. DIABETES EDUCATOR 2019; 45:164-173. [PMID: 30741101 DOI: 10.1177/0145721719828952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study was to describe diabetes self-management behaviors, diabetes health care access, and health perception for Mexican adults and Hispanics residing in the Mexico-US border region. Methods This study used data from the Behavior Risk Factor Surveillance System (BRFSS) survey diabetes items (n = 26) to assess characteristics of Hispanics in 4 Arizona border counties (n = 216) and cross-sectional data from a modified BRFSS in a convenience sample of adults residing in Monterrey, Mexico (n = 351). Data were analyzed for descriptive statistics with SPSS. Results The Mexico cohort was younger than the Arizona cohort (59.36 [11.5] vs 65.54 [11.1], respectively) and the mean length of time with type 2 diabetes was similar. Less than 10% (9.7%) of the Arizona cohort reported never monitoring blood glucose compared to 22.5% of the Mexico cohort. The mean (SD) number of times in the past 12 months the Mexico cohort saw their health care provider was 9.09 (6.8) vs 4.49 (8.3) for the Arizona cohort. Despite provider access, there were differences in self-management behaviors between the cohorts. Conclusions Due to environmental and policy factors in the Mexico-US border region, there continues to be a gap in evidence-based practice and uptake of self-management behaviors for adults with diabetes. Resources such as the BRFSS and shared practice guidelines would bridge this gap.
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Affiliation(s)
- Marylyn M McEwen
- College of Nursing & Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Alice Pasvogel
- College of Nursing, University of Arizona, Tucson, Arizona
| | | | - Irene Meester
- Basic Sciences Department, University of Monterrey, Monterrey, NL, Mexico
| | - Javier Vargas-Villarreal
- Laboratory of Cellular Physiology, Northeast Center of Research, Mexican Institute of Social Security, Monterrey, NL, Mexico
| | - Francisco González-Salazar
- Basic Sciences Department, University of Monterrey, Monterrey, NL, Mexico
- Laboratory of Cellular Physiology, Northeast Center of Research, Mexican Institute of Social Security, Monterrey, NL, Mexico
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Doubova SV, Infante C, Villagrana-Gutiérrez GL, Martínez-Vega IP, Pérez-Cuevas R. Adequate health literacy is associated with better health outcomes in people with type 2 diabetes in Mexico. PSYCHOL HEALTH MED 2019; 24:853-865. [PMID: 30706719 DOI: 10.1080/13548506.2019.1574356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study evaluates the health literacy of people with type 2 diabetes and its association with health outcomes. We conducted a cross-sectional survey in two family medicine clinics of the Mexican Institute of Social Security that included 778 diabetic patients >19 years of age. The Spanish version of the European Health Literacy questionnaire served to measure health literacy. Multiple logistic regressions were performed to determine the association between the independent variable (health literacy) and dependent variables (good self-rated health, glycemic control, and diabetes-related hospitalizations) after controlling for conceptually relevant patient's characteristics. Only 17.6% of patients had adequate health literacy; while, the remaining percentage showed inadequate (23%), or problematic (59.4%) health literacy. After adjusting for the patients' characteristics, those with adequate health literacy had 4.66 (95%CI: 2.26-9.61) times the odds of good self-rated health compared to those with inadequate literacy. Patients with adequate health literacy had 0.65 (95%CI: 0.49-0.86) times the odds of hospitalization due to diabetes compared to those with inadequate literacy. Compared to inadequate health literacy, problematic literacy was associated with increased odds of glycemic control. In conclusion, healthcare providers should actively address the health literacy needs of patients to increase good self-rated health, glucose control and reduce hospitalizations.
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Affiliation(s)
- Svetlana V Doubova
- a Epidemiology and Health Services Research Unit , CMN Siglo XXI, Mexican Institute of Social Security , Mexico City , Mexico
| | - Claudia Infante
- b Instituto de Investigaciones Sociales , Universidad Nacional Autónoma de México. Circuito Mario de la Cueva s/n. Ciudad de la Investigación en Humanidades, Ciudad Universitaria , Mexico City , Mexico
| | | | - Ingrid Patricia Martínez-Vega
- a Epidemiology and Health Services Research Unit , CMN Siglo XXI, Mexican Institute of Social Security , Mexico City , Mexico
| | - Ricardo Pérez-Cuevas
- d National Institute of Public Health , Health Systems Research Center , Cuernavaca City , Mexico
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Aponte J. Demographics, A1C Testing, and Medication Use of Mexican Americans and Mexicans With Diabetes. DIABETES EDUCATOR 2019; 45:155-163. [PMID: 30658554 DOI: 10.1177/0145721718825354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study is to investigate diabetes rates among Mexicans 20 years and older living in the United States and Mexico in 2012 and 2016. Methods The national sample was the National Health and Nutrition Examination Survey (NHANES) 2011-2012, NHANES 2015-2016, Mexican National Health and Nutrition Survey 2012 (ie, Encuesta Nacional de Salud y Nutrición 2012 [ENSANUT 2012]), and ENSANUT de Medio Camino 2016 (ENSANUT-MC 2016). Sex, age, A1C testing, and medication use (insulin, oral hypoglycemic agents, and both) were examined among participants. Results Most participants in study were female (50.7%, 53.9%, and 57.2%) and were younger (61 years, 57 years, and 60 years). A1C testing was conducted more in the United States (69.6% and 82.6%) than in Mexico (9.5% and 15.1%). More Mexicans (73.1% and 67.8% vs 54.9% and 54.9%) were using oral hypoglycemic agents, while more Mexican Americans used insulin (12.6% and 11.6% vs 6.3% and 11.1%) and used both insulin and oral hypoglycemic agents (17.1% and 15.8% vs 6.6% and 8.7%). Conclusions By examining and highlighting the diabetes mellitus practices and standardization of A1C testing, providers will be able to better understand and address the rising rates of diabetes in the United States and Mexico while driving practice and policy changes.
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Affiliation(s)
- Judith Aponte
- Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York, New York
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Rivera-Hernández M, Rahman M, Galárraga O. Preventive healthcare-seeking behavior among poor older adults in Mexico: the impact of Seguro Popular, 2000-2012. SALUD PUBLICA DE MEXICO 2019; 61:46-53. [PMID: 30753772 PMCID: PMC6561080 DOI: 10.21149/9185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/25/2018] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Determine the effect of Seguro Popular (SP) on preventive care utilization among low-income SP beneficiaries and uninsured elders in Mexico. MATERIALS AND METHODS Fixed-effects instrumental-variable (FE-IV) pseudo-panel estimation from three rounds of the Mexican National Health and Nutrition Survey (2000, 2006 and 2012). RESULTS Our findings suggest that SP has no significant effect on the use of preventive services, including screening for diabetes, hypertension, breast cancer and cervical cancer, by adults aged 50 to 75 years. CONCLUSIONS Despite the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in healthcare access and utilization still exist in Mexico. The Mexican government must keep working on extending health insurance coverage to vulnerable adults. Additional efforts to increase health care coverage and to support preventive care are needed to reduce persistent disparities in healthcare utilization.
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Affiliation(s)
| | - Momotazur Rahman
- Department of Health Services, Policy and Practice, Brown University. Providence, Rhode Island, USA
| | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University. Providence, Rhode Island, USA
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Talavera JO, Rivas-Ruiz R, Pérez-Rodríguez M, Roy-Garcia IA, Palacios-Cruz L. De vuelta a la clínica: sin justificación no existe pregunta de investigación que valga. GAC MED MEX 2019; 155:168-175. [PMID: 31056591 PMCID: PMC7446752 DOI: 10.24875/gmm.19004942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/16/2019] [Indexed: 12/12/2022] Open
Abstract
A clinical research question requires the concurrence of clinical experience and knowledge on methodology and statistics in that who formulates it. Initially, a research question should have a structure that clearly establishes what is that which is being sought (consequence or outcome), in whom (baseline status), and by action of what (maneuver). Subsequently, its reasoning must explore four aspects: feasibility and reasonableness of the questioning, lack of a prior answer, relevance of the answer to be obtained, and applicability. Once these aspects are satisfactorily covered, the question can be regarded as being "clinically relevant", which is different from being statistically significant, which refers to the probability of the result being driven by chance, which does not reflect the relevance of the question or the outcome. One should never forget that every maneuver entails adverse events that, when serious, discredit good results. It is imperative to have the possible answer estimated from within the structure of the question. The function of clinical research is to corroborate or reject a hypothesis, rather than to empirically test to find out what the outcome is.
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Affiliation(s)
- Juan O Talavera
- Dirección de Enseñanza e Investigación, Centro Médico ABC. Ciudad de México, México
| | - Rodolfo Rivas-Ruiz
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Centro de Adiestramiento en Investigación Clínica. Ciudad de México, México
| | - Marcela Pérez-Rodríguez
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Centro de Adiestramiento en Investigación Clínica. Ciudad de México, México
| | - Ivonne Analí Roy-Garcia
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Centro de Adiestramiento en Investigación Clínica. Ciudad de México, México
| | - Lino Palacios-Cruz
- Secretaría de Salud, Instituto Nacional de Psiquiatría "Dr. Ramón de la Fuente", Subdirección de Investigaciones Clínicas, Departamento Epidemiología Clínica. Ciudad de México, México
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Dávila-Cervantes CA, Agudelo-Botero M. Sex disparities in the epidemic of type 2 diabetes in Mexico: national and state level results based on the Global Burden of Disease Study, 1990-2017. Diabetes Metab Syndr Obes 2019; 12:1023-1033. [PMID: 31360070 PMCID: PMC6625746 DOI: 10.2147/dmso.s205198] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/02/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To analyze the type 2 diabetes (T2D) health burden in Mexico by sex at the national and state levels from 1990 to 2017. METHODS This was a secondary analysis based on data from the Global Burden of Disease Study, 1990-2017. We used the indicators of mortality rates, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). RESULTS At the national level, there was an increase in the standardized mortality rates, YLLs, YLDs and DALYs, especially in the male group. At the state level, the health impacts of T2D varied within the population and did not exhibit any clearly defined geographic pattern. However, the most pronounced increases in the various indicators occurred in the poorer states of the country. CONCLUSION T2D continues to have a dominant impact on Mexican public health, with marked disparities between the states. Working to reduce these health inequalities is necessary, and resources must be focused on the priority groups, for example, men, young and middle-aged adults, and individuals living in the states with the highest index of marginalization.
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Affiliation(s)
| | - Marcela Agudelo-Botero
- Politics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
- Correspondence: Marcela Agudelo-BoteroPolitics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Circuito Centro Cultural 20, Insurgentes Cuicuilco, Coyoacán, Mexico City04510, MexicoTel +52 1 554 374 5473Email
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Political party ambitions and type-2 diabetes policy in Brazil and Mexico. HEALTH ECONOMICS POLICY AND LAW 2018; 15:261-276. [PMID: 30394254 DOI: 10.1017/s1744133118000415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the Americas, next to the United States, Brazil and Mexico have the highest prevalence of type-2 diabetes. In contrast to most studies, this article compares and analyzes the politics behind the implementation of type-2 diabetes self-care management programs (DSM), which is a new area of scholarly research. This article claims that Brazil outpaced Mexico with respect to the implementation of effective DSM programs, the product of positive policy spillover effects associated with the president and governing political party's popular anti-poverty programs, and the enduring legacy of centralized ministry of health financial and human resource assistance to primary care programs in a context of decentralization. Brazil also benefited from having a strong partnership with international health agencies. None of these factors was present in Mexico. Findings suggest that more research needs to go into understanding the complex political and inter-governmental contexts facilitating DSM program implementation, which is a neglected area of research.
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Doubova SV, Borja-Aburto VH, Guerra-Y-Guerra G, Salgado-de-Snyder VN, González-Block MÁ. Loss of job-related right to healthcare is associated with reduced quality and clinical outcomes of diabetic patients in Mexico. Int J Qual Health Care 2018; 30:283-290. [PMID: 29432612 DOI: 10.1093/intqhc/mzy012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/24/2018] [Indexed: 01/29/2023] Open
Abstract
Objectives The Mexican Institute of Social Security (IMSS) provides a package of health, economic and social benefits to workers employed in private firms within the formal labour market and to their economic dependants. Affiliates have a right to these benefits only while they remain contracted, thus posing a risk for the continuity of healthcare. This study evaluates the association between the time (in days) without the right to healthcare due to job loss in the formal labour market and the quality of healthcare and clinical outcomes among IMSS affiliates with Type 2 diabetes mellitus (T2DM). Design Retrospective cohort study 2013-2015. Setting Six IMSS family medicine clinics (FMC) in Mexico City. Participants T2DM patients (n = 27 217) affiliated with job-related health insurance and at least one consultation with a family doctor during 2013. Source of Information IMSS affiliation department database and electronic health records and clinical laboratory databases. Main Outcome Measure(s) Quality of the processes (eight indicators) and outcomes (three indicators) of healthcare. Results The results indicated that losing IMSS right to healthcare is frequent, occurring to one-third of T2DM patients during the follow-up period. The time without the right to healthcare in the observed period was of 120 days on average and was associated with a 43.2% loss of quality of care and a 19.2% reduction in clinical outcomes of T2DM. Conclusion Policies aimed at ensuring access and continuity of care, regardless of job status, are critical for improving the quality of processes and outcomes of healthcare for diabetic patients.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Mexico City 06720, Mexico
| | - Víctor Hugo Borja-Aburto
- Unidad de Salud Pública, Instituto Mexicano del Seguro Social, Hamburgo 18, Mexico City 06700, Mexico City, Mexico
| | - Germán Guerra-Y-Guerra
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Av. Universidad #655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mor., México
| | - V Nelly Salgado-de-Snyder
- Instituto Nacional de Salud Pública, Av. Universidad #655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mor., México
| | - Miguel Ángel González-Block
- Cátedra PwC de Investigación en Sistemas de Salud, Facultad de Ciencias de la Salud, Universidad Anáhuac, Av Universidad Anáhuac #46, Lomas Anahuac, 52786 Naucalpan de Juárez, Méx., Mexico
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