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López-Gómez SA, González-López BS, Scougall-Vilchis RJ, Márquez-Corona MDL, Minaya-Sánchez M, Navarrete-Hernández JDJ, de la Rosa-Santillana R, Acuña-González GR, Pontigo-Loyola AP, Villalobos-Rodelo JJ, Medina-Solís CE, Maupomé G. Factors Associated with Self-Report of Type 2 Diabetes Mellitus in Adults Seeking Dental Care in a Developing Country. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:218. [PMID: 36612540 PMCID: PMC9819279 DOI: 10.3390/ijerph20010218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/07/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
The aims of the present study were to identify the prevalence and risk indicators of type 2 diabetes mellitus (T2DM) in urban-based Mexican adults seeking care in a university-based triage/intake dental clinic, and to develop a predictive model. A cross-sectional study was conducted on 3354 medical/dental records of adults who sought care at the triage/intake dental clinics of a public university. The dependent variable was self-report of a previous diagnosis of T2DM made by a physician. Several socio-demographic and socioeconomic covariates were included, as well as others related to oral and general health. A multivariate binary logistic regression model was generated. We subsequently calculated well-known statistical measures employed to evaluate discrimination (classification) using an (adjusted) multivariate logistic regression model (goodness-of-fit test). The average age of patients was 42.5 ± 16.1 years old and the majority were female (64.1%). The prevalence of T2DM was 10.7% (95%CI = 9.7−11.8). In the final multivariate model, the variables associated (p < 0.05) with the presence of T2DM were older age (40 to 59 years old, OR = 2.00; 60 to 95 years old, OR = 2.78), having any type of health insurance (OR = 2.33), having high blood pressure (OR = 1.70), being obese (OR = 1.41), and having a functional dentition (OR = 0.68). Although the global fit of the model and the calibration tests were adequate, the sensitivity (0.0%) and positive predictive (0.0%) values were not. The specificity (100%) and negative predictive (89.3%) values, as well as the correctly classified (89.3%) value, were adequate. The area under the ROC curve, close to 0.70, was modest. In conclusion, a prevalence of T2DM of 10.7% in this sample of Mexican adults seeking dental care was similar to national figures. Clinical (blood pressure, BMI and functional dentition), demographic (age), and socioeconomic (health insurance) variables were found to be associated with T2DM. The dental setting could be appropriate for implementing preventive actions focused on identifying and helping to reduce the burden of T2DM in the population.
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Affiliation(s)
- Sandra Aremy López-Gómez
- School of Behavioral Sciences, Autonomous University of the State of Mexico, Toluca 50130, Mexico
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico
| | - Blanca Silvia González-López
- Advanced Studies and Research Center in Dentistry “Dr. Keisaburo Miyata”, Faculty of Dentistry, Autonomous University of the State of Mexico, Toluca 50130, Mexico
| | - Rogelio José Scougall-Vilchis
- Advanced Studies and Research Center in Dentistry “Dr. Keisaburo Miyata”, Faculty of Dentistry, Autonomous University of the State of Mexico, Toluca 50130, Mexico
| | | | | | | | - Rubén de la Rosa-Santillana
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico
| | | | | | | | - Carlo Eduardo Medina-Solís
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico
- Advanced Studies and Research Center in Dentistry “Dr. Keisaburo Miyata”, Faculty of Dentistry, Autonomous University of the State of Mexico, Toluca 50130, Mexico
| | - Gerardo Maupomé
- Richard M. Fairbanks School of Public Health, Indiana University/Purdue University, Indianapolis, IN 46202, USA
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Barajas-Nava LA, Garduño-Espinosa J, Mireles Dorantes JM, Medina-Campos R, García-Peña MC. Models of comprehensive care for older persons with chronic diseases: a systematic review with a focus on effectiveness. BMJ Open 2022; 12:e059606. [PMID: 36170225 PMCID: PMC9362834 DOI: 10.1136/bmjopen-2021-059606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Ageing entails a variety of physiological changes that increase the risk of chronic non-communicable diseases. The prevalence of these diseases leads to an increase in the use of health services. The care models implemented by health systems should provide comprehensive long-term healthcare. We conducted this systematic review to determine whether any model of care for older persons have proven to be effective. METHODS A systematic review of literature was carried out to identify randomised clinical trials that have assessed how effective a care model for older patients with chronic diseases. A searches electronic databases such as MEDLINE, Turning Research Into Practice Database, Cochrane Library and Cochrane Central Register of controlled Trials was conducted from January 1966 to January 2021. Two independent reviewers assessed the eligibility of the studies. Interventions were identified and classified according to the taxonomies developed by the Cochrane Effective Practice and Organisation of Care and Cochrane Consumers and Communication groups. RESULTS Of the 4952 bibliographic references that were screened, 577 were potentially eligible and the final sample included 25 studies that evaluated healthcare models in older people with chronic diseases. In the 25 care models, the most frequently implemented interventions were educational, and those based on the provision of healthcare. Only 22% of the outcomes of interventions were identified as being effective, whereas 21% were identified as being partially effective; thus, more than 50% of the outcomes were identified as being ineffective. CONCLUSIONS It was not possible to determine a care model as effective. The interventions implemented in the models are variable. The most effective outcomes were focused on improving the patient-healthcare professional relationship in the early stages of the intervention. The interventions addressed in the studies were similar to public health interventions as their main objectives focused on promoting health. Most studies were of low methodological quality.
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Affiliation(s)
- Leticia A Barajas-Nava
- Evidence-Based Medicine Research Unit, Hospital Infantil de México Federico Gómez (HIMFG), National Health Institute, México City, México
| | - Juan Garduño-Espinosa
- Head of the Research Office, Hospital Infantil de México Federico Gómez (HIMFG), National Health Institute, México City, México
| | | | - Raúl Medina-Campos
- Deputy Research Director, Instituto Nacional de Geriatría, México City, México
| | - M Carmen García-Peña
- Head of the Research Office, Instituto Nacional de Geriatría, México City, México
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Rojas-Martínez R, Basto-Abreu A, Aguilar-Salinas CA, Zárate-Rojas E, Villalpando S, Barrientos-Gutiérrez T. [Prevalence of previously diagnosed diabetes mellitus in Mexico.]. SALUD PUBLICA DE MEXICO 2019; 60:224-232. [PMID: 29746739 DOI: 10.21149/8566] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/24/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To compare the prevalence of previously diagnosed diabetes in 2016 with previous national surveys and to describe treatment and its complications. MATERIALS AND METHODS Mexico's national surveys Ensa 2000, Ensanut 2006, 2012 and 2016 were used. For 2016, logistic regression models and measures of central tendency and dispersion were obtained. RESULTS The prevalence of previously diagnosed diabetes in 2016 was 9.4%. The increase of 2.2% relative to 2012 was not significant and only observed in patients older than 60 years. While preventive measures have increased, the access to medical treatment and lifestyle has not changed. The treatment has been modified, with an increase in insulin and decrease in hypoglycaemic agents. CONCLUSIONS Population aging, lack of screening actions and the increase in diabetes complications will lead to an increase on the burden of disease. Policy measures targeting primary and secondary prevention of diabetes are crucial.
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Affiliation(s)
- Rosalba Rojas-Martínez
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, México
| | - Ana Basto-Abreu
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, México
| | | | | | - Salvador Villalpando
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública. México
| | - Tonatiuh Barrientos-Gutiérrez
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, México
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Villarreal-Pérez JZ, Villarreal-Martínez JZ, Lavalle-González FJ, Torres-Sepúlveda MDR, Ruiz-Herrera C, Cerda-Flores RM, Castillo-García ER, Rodríguez-Sánchez IP, Martínez de Villarreal LE. Plasma and urine metabolic profiles are reflective of altered beta-oxidation in non-diabetic obese subjects and patients with type 2 diabetes mellitus. Diabetol Metab Syndr 2014; 6:129. [PMID: 25937838 PMCID: PMC4416397 DOI: 10.1186/1758-5996-6-129] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 11/19/2014] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The two primary pathophysiological characteristics of patients with type 2 diabetes mellitus (T2DM) are insulin resistance (IR) and beta cell dysfunction. It has been proposed that the development of IR is secondary to the accumulation of triacylglycerols and fatty acids in the muscle and liver, which is in turn thought to be secondary to an enzymatic defect in mitochondrial beta-oxidation. The purpose of the present study was to analyze the molecules of intermediary metabolism to determine if an alteration in mitochondrial function exists in T2DM patients and, if so, to determine whether this alteration is caused by excess nutrients or an enzymatic defect. DESIGN AND METHODS Seventy-seven subjects were recruited and divided into four groups (21 T2DM patients, 17 non-diabetic overweight/obese subjects, 20 offspring of T2DM patients, and 19 healthy subjects). Anthropometric parameters were determined by air plethysmography, and biochemical and metabolic parameters were measured, including 31 acylcarnitines (ACs) and 13 amino acids quantified by MS/MS and 67 organic acids measured by GC/MS. RESULTS Patients with T2DM showed elevation of short-chain ACs (C2, C4), a glycogenic amino acid (valine), a glycogenic and ketogenic amino acid (tyrosine), and a ketogenic amino acid (leucine) as well as altered excretion of dicarboxylic acids. T2DM offspring with abnormal glucose tolerance test GTT showed increased levels of C16. Subjects in the obese group who were dysglycemic also showed altered urinary excretion of dicarboxylic acids and lower levels of a long-chain AC (C14:2). CONCLUSIONS These results suggest that mitochondrial beta-oxidation is altered in T2DM patients and that the alteration is most likely caused by nutrient overload through a different pathway from that observed in obese subjects.
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Affiliation(s)
- Jesús Zacarías Villarreal-Pérez
- />Universidad Autónoma de Nuevo León, Hospital Universitario, “Dr. José Eleuterio González”, Servicio de Endocrinología, Monterrey, Nuevo León, 64460 México
| | - Jesús Zacarías Villarreal-Martínez
- />Departamento de Medicina Interna, Universidad Autónoma de Nuevo León, Hospital Universitario, “Dr. José Eleuterio González”, Monterrey, Nuevo León 64460 México
| | - Fernando Javier Lavalle-González
- />Universidad Autónoma de Nuevo León, Hospital Universitario, “Dr. José Eleuterio González”, Servicio de Endocrinología, Monterrey, Nuevo León, 64460 México
| | - María del Rosario Torres-Sepúlveda
- />Departamento de Genética, Universidad Autónoma de Nuevo León, Hospital Universitario, “Dr. José Eleuterio González”, Av. Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo León 64460 México
| | - Consuelo Ruiz-Herrera
- />Departamento de Genética, Universidad Autónoma de Nuevo León, Hospital Universitario, “Dr. José Eleuterio González”, Av. Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo León 64460 México
| | - Ricardo Martín Cerda-Flores
- />Universidad Autónoma de Nuevo León, Facultad de Enfermería, Avenida Gonzalitos, 1500 Norte, Col. Mitras Centro, Monterrey, NL México
| | - Erik Rubén Castillo-García
- />Departamento de Genética, Universidad Autónoma de Nuevo León, Hospital Universitario, “Dr. José Eleuterio González”, Av. Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo León 64460 México
| | - Irám Pablo Rodríguez-Sánchez
- />Departamento de Genética, Universidad Autónoma de Nuevo León, Hospital Universitario, “Dr. José Eleuterio González”, Av. Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo León 64460 México
| | - Laura Elia Martínez de Villarreal
- />Departamento de Genética, Universidad Autónoma de Nuevo León, Hospital Universitario, “Dr. José Eleuterio González”, Av. Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo León 64460 México
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