1
|
Antonio-Villa NE, García-Tuomola A, Almeda-Valdes P, Vidrio-Velázquez M, Islas-Ortega L, Madrigal-Sanromán JR, Zaballa-Lasso C, Martínez-Ramos-Méndez A, De la Garza-Hernández NE, Bustamante-Martínez JF, González-Galvez G, Valadez-Capetillo M, Sanchez-Ruiz KL, Castillo-Galindo C, Yepez-Rodríguez AE, Polanco-Preza MA, Ceballos-Macías JJ, Valenzuela-Montoya JC, Escobedo-Ortiz AR, Ferreira-Hermosillo A, Rodríguez-Sanchez E, Romero-Zazueta A, Miracle-López S, Figueroa-Andrade MH, Faradji RN. Glycemic control, treatment and complications in patients with type 1 diabetes amongst healthcare settings in Mexico. Diabetes Res Clin Pract 2021; 180:109038. [PMID: 34487758 DOI: 10.1016/j.diabres.2021.109038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/11/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
AIMS Type 1 diabetes (T1D) is a growing chronic disease. Evidence of whether the healthcare setting affects management and glycemic control is scarce. We evaluate outcomes in patients with T1D in private and public healthcare settings in Mexico, registered in the National T1D Registry in Mexico (RENACED-DT1). METHODS Biochemical parameters, diabetes education, and treatment were analyzed considering the data registered in the last visit. Development of chronic complications was determined during follow-up. RESULTS We included 1,603 patients; 71.5% (n = 1,146) registered in the public system, and 28.5% (n = 457) in a private institution. Patients in the public setting had higher HbA1c (8.6%, IQR: 7.3%-10.5% vs 7.7%, IQR: 7.0%-8.8%; p < 0.001). Indicators of diabetes education, glucose monitoring, and use of insulin-pumps were lower in the public setting. Patients in the public setting were at higher risk of diabetic chronic kidney disease, retinopathy, and neuropathy. Diabetes knowledge was a mediator between type of healthcare setting and the likelihood of achieving glycemic control. CONCLUSIONS Patients registered in public healthcare settings have an adverse metabolic profile and higher risk of complications. Social factors need to be addressed in order to implement multidisciplinary measures focused on diabetes education for patients with T1D in Mexico.
Collapse
Affiliation(s)
- Neftali Eduardo Antonio-Villa
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Aili García-Tuomola
- Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición"Salvador Zubirán, Mexico City, Mexico; Endocrinology, Centro Medico ABC, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición"Salvador Zubirán, Mexico City, Mexico
| | | | - Laura Islas-Ortega
- Pediatric Endocrinology, Hospital del Niño DIF Hidalgo, Pachuca, Hidalgo, Mexico
| | | | | | | | | | - Jorge F Bustamante-Martínez
- Internal Medicine Department, Servicios de Salud de Nayarit, Hospital General de Tepic, Tepic, Nayarit, Mexico
| | - Guillermo González-Galvez
- Endocrinology, Instituto Jalisciense de Investigación en Diabetes y Obesidad S. C, Guadalajara, Jalisco, Mexico
| | | | - Karla L Sanchez-Ruiz
- Clínica de Diabetes, Secretaría de Salud del Estado de Durango, Durango, Durango, Mexico
| | | | | | - Miguel A Polanco-Preza
- Endocrinology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | | | - Julio C Valenzuela-Montoya
- Pediatric Endocrinology, Hospital De Gineco-Pediatría No. 31 IMSS, Mexicali, Baja California Norte, Mexico
| | - Ana R Escobedo-Ortiz
- Endocrinology, Hospital General Dr. Miguel Silva, Secretaria de Salud, Morelia, Michoacán, Mexico
| | - Aldo Ferreira-Hermosillo
- Endocrinology, Unidad de Investigación Médica en Enfermedades Endocrinas. Centro Médico Nacional Siglo XXI, IMSS, Mexico
| | | | | | - Sigfrido Miracle-López
- Endocrinology, Hospital Angeles Lomas, Huixquilucan, México; Associate Investigator, Centro de Investigación en Ciencias de la Salud (CICSA) Universidad, Anáhuac, Mexico
| | | | - Raquel N Faradji
- Endocrinology and Diabetes, Clinica EnDi, Mexico City, Mexico; Endocrinology, Centro Medico ABC, Mexico City, Mexico.
| |
Collapse
|
2
|
Faradji-Hazán RN, Valenzuela-Lara M, Díaz-Barriga Menchaca AP, Almeda-Valdes P, Antonio-Villa NE, Vidrio-Velázquez M, Islas-Ortega L, Martínez-Ramos-Méndez A, de la Garza-Hernández NE, Bustamante-Martínez JF, Sánchez-Ruiz KL, Yepez-Rodríguez AE, González-Gálvez G, Niño-Vargas RS, Sainz de la Maza-Viadero ME, Magis-Rodríguez C. Type 1 Diabetes Care in Mexico: An Analysis of the RENACED-DT1 National Registry. Rev Invest Clin 2021; 73:222-230. [PMID: 33944861 DOI: 10.24875/ric.20000498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Information regarding diagnosis, treatment, and follow-up of patients with type 1 diabetes (PWT1D) in Mexico is limited. We developed an on-line platform Registro Nacional de Pacientes con Diabetes Tipo 1 (RENACED-DT1). OBJECTIVE The objective of the study was to describe the characteristics and healthcare of PWT1D registered in RENACED-DT1. METHODS Analyses of 965 PWT1D from July 2014 to January 2018 in different endocrinology clinics around Mexico. RESULTS Sixty-one percent were female with median age of 21 years, age at diagnosis 11 years, and disease duration at inclusion 8.2 years. Treatment regimen was basal-bolus in 61% and insulin-pumps in 21% (mainly in the private sector); 33.3% with self-monitoring of blood-glucose (SMBG) ≥4 times/day. Mean HbA1c at last follow-up was 8.7 ± 2.1% (72±23 mmol/mol), 18% had HbA1c < 7% (53 mmol/mol), and 35% > 9% (75 mmol/mol). SMBG ≥ 4 times/day was associated with HbA1c < 7%. Time since diagnosis > 10 years, female sex, BMI ≥ 30 kg/m2, SMBG < 4 times/day, and any hypoglycemia were associated with microvascular complications (p < 0.05). CONCLUSIONS Percentage of patients achieving HbA1c < 7% is low; increased blood glucose monitoring is associated with better glycemic control. The achievement of optimal glycemic control must be increased to reduce the incidence of chronic complications and improve quality of life in PWT1D.
Collapse
Affiliation(s)
- Raquel N Faradji-Hazán
- Clínica EnDi, Mexico City; School of Medicine, Instituto Tecnológico de Monterrey, Mexico City, Mexico
| | | | | | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMyNSZ), Mexico City, Mexico
| | - Neftali E Antonio-Villa
- Department of Endocrinology and Metabolism, Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMyNSZ), Mexico City; MD/PhD Programa de Estudios Combinados en Medicina (PECEM) Program, Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City; Mexico
| | - Maricela Vidrio-Velázquez
- Department of Endocrinology, Hospital General Regional # 110, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jal., Mexico
| | - Laura Islas-Ortega
- Pediatric Endocrinology Service, Hospital del Niño DIF Hidalgo, Pachuca, Hgo., Mexico
| | | | | | | | | | | | | | - Ricardo S Niño-Vargas
- Centro para la Prevención y Atención Integral del VIH/SIDA de la Ciudad de México, Mexico City, Mexico
| | | | | |
Collapse
|
3
|
Faradji RN, Valenzuela-Lara M, Vidrio-Velázquez M, Yepez-Rodríguez AE, González-Galvez G, Sainz de la Maza-Viadero ME. RENACED-DT1: A National Type 1 Diabetes Registry Initiative in Mexico. Salud Publica Mex 2020; 62:232-234. [PMID: 32520478 DOI: 10.21149/11185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Raquel N Faradji
- Clinica EnDi. Mexico City, Mexico.,Centro Médico ABC. Mexico City, Mexico
| | | | | | | | | | | | | |
Collapse
|
4
|
Cardona-Muñoz EG, López-Alvarado A, Conde-Carmona I, Sánchez-Mejorada G, Pascoe-González S, Banda-Elizondo RG, García-Castillo A, González-Gálvez G, Velasco-Sánchez RG, Vidrio-Velázquez M, Leiva-Pons JL, Villeda-Espinosa E, Guerra-López A, Esturau-Santalo RM. Safety and efficacy of fimasartan in Mexican patients with grade 1-2 essential hypertension. Arch Cardiol Mex 2017; 87:316-325. [PMID: 28209359 DOI: 10.1016/j.acmx.2017.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/28/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To evaluate efficacy and safety of 60mg and 120mg Fimasartan (FMS) alone or combined with 12.5mg hydrochlorothiazide (HCTZ) in a Mexican population. METHODS A six month, treat-to-target, open study was conducted on subjects with grade 1-2 hypertension. The subjects were initially treated with 60mg FMS once daily. In week 8, those with Diastolic Blood Pressure (DBP) <90mmHg continued on the same FMS dose during the rest of the study, while those with DBP ≥90mmHg were randomised to either 120mg FMS or 60mg FMS + 12.5mg HCTZ once daily. In week 12, randomised subjects with DBP ≥90mmHg received 120mg FMS+12.5mg HCTZ, while those achieving target continued with their assigned treatment until the end of the study. RESULTS FMS 60mg (n=272) decreased both DBP and Systolic Blood Pressure (SBP) by 11.3±8.9 (p<.0001) and 16.0±14.1 (p<.0001)mmHg, respectively, with 75.4% of subjects reaching the treatment target. Subjects assigned to FMS 120mg, FMS 60mg+HCTZ 12.5mg, or FMS 120mg+HCTZ 12.5mg once daily, showed significant reductions in DBP and SBP with their assigned treatment. At the end of the study, 237/272 subjects (87.1%) achieved a DBP<90mmHg and an SBP<140mmHg. The most frequently reported adverse reactions included headache (3.7%), dry mouth (1.1%), transient liver enzyme increase (1.1%), and dizziness (0.7%). CONCLUSION Fimasartan is safe and effective in Mexican subjects with grade 1-2 essential hypertension.
Collapse
Affiliation(s)
- Ernesto G Cardona-Muñoz
- Investigación Clínica Especializada, Sociedad Civil, Guadalajara, Jalisco, Mexico; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | | | | | - Sara Pascoe-González
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | | | | | | | | | - José L Leiva-Pons
- Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, San Luis Potosí, Mexico
| | | | | | | |
Collapse
|
5
|
Ortega-González C, Aguilera-Pérez JR, Arce-Sánchez L, Barquera-Cervera S, Díaz-Polanco A, Fernández-Sánchez M, Ferreira-Hermosillo A, Martínez-Cruz N, Medina-García C, Molina-Ayala MA, Muñoz-Manrique CG, Pantoja-Millán JP, Perichart-Perera O, Pimentel-Nieto D, Reyes-Rodríguez EA, Romero-Zazueta A, Ruiz-Padilla CL, Vergara-López A, Vidrio-Velázquez M, Villagordoa-Mesa J, Zúñiga-González SA. [Consensus of diagnosis and treatment of obesity in women in reproductive age and climacterium]. Ginecol Obstet Mex 2015; 83:363-391. [PMID: 26285488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The development of obesity is complex and multifactorial, with genetic, biological, environmental and lifestyle of each individual etiology. The different changes in metabolism of women, amongst other factors, lead to disorganization in the distribution of lipids, which gathered in large quantities within the viscera, increases cardiovascular mortality and it is a major determinant factor of the metabolic syndrome. OBJECTIVE To homologate and to apply concepts of evidence-based clinical practice in diagnosis and treatment of obesity in women in reproductive age and climacterium. METHOD The experts' consensus was done by specialized physicians properly endocrinologists, gynecologists, surgeons, psychologists, nutrition specialists, physical activity and public health, according to their expertise and clinical judgment. The recommendations were based in diagnostic criteria aside from the level of evidence of previously established treatment guidelines, controlled clinical trials and standardized guides for women in reproductive age and climacterium with obesity. RESULTS The establishment of a nutritional intervention amongst other aspects of lifestyle is the first-line in the treatment of obesity. Current pharmacological treatments offer modest results in efficiency and security in weight reduction so these must go along with real changes in lifestyle in order to obtain better results in the short and long term. CONCLUSION The high prevalence of overweight and obesity in our country, especially in women in reproductive age, compels us to pose and work in prevention strategies as well as diverse therapeutic plans favoring safe weight loss and results in the long term.
Collapse
|