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Sammut-Powell C, Sisk R, Silva-Tinoco R, de la Pena G, Almeda-Valdes P, Juarez Comboni SC, Goncalves S, Cameron R. External validation of a minimal-resource model to predict reduced estimated glomerular filtration rate in people with type 2 diabetes without diagnosis of chronic kidney disease in Mexico: a comparison between country-level and regional performance. Front Endocrinol (Lausanne) 2024; 15:1253492. [PMID: 38586458 PMCID: PMC10998449 DOI: 10.3389/fendo.2024.1253492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/19/2024] [Indexed: 04/09/2024] Open
Abstract
Background Patients with type 2 diabetes are at an increased risk of chronic kidney disease (CKD) hence it is recommended that they receive annual CKD screening. The huge burden of diabetes in Mexico and limited screening resource mean that CKD screening is underperformed. Consequently, patients often have a late diagnosis of CKD. A regional minimal-resource model to support risk-tailored CKD screening in patients with type 2 diabetes has been developed and globally validated. However, population heath and care services between countries within a region are expected to differ. The aim of this study was to evaluate the performance of the model within Mexico and compare this with the performance demonstrated within the Americas in the global validation. Methods We performed a retrospective observational study with data from primary care (Clinic Specialized in Diabetes Management in Mexico City), tertiary care (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán) and the Mexican national survey of health and nutrition (ENSANUT-MC 2016). We applied the minimal-resource model across the datasets and evaluated model performance metrics, with the primary interest in the sensitivity and increase in the positive predictive value (PPV) compared to a screen-everyone approach. Results The model was evaluated on 2510 patients from Mexico (primary care: 1358, tertiary care: 735, ENSANUT-MC: 417). Across the Mexico data, the sensitivity was 0.730 (95% CI: 0.689 - 0.779) and the relative increase in PPV was 61.0% (95% CI: 52.1% - 70.8%). These were not statistically different to the regional performance metrics for the Americas (sensitivity: p=0.964; relative improvement: p=0.132), however considerable variability was observed across the data sources. Conclusion The minimal-resource model performs consistently in a representative Mexican population sample compared with the Americas regional performance. In primary care settings where screening is underperformed and access to laboratory testing is limited, the model can act as a risk-tailored CKD screening solution, directing screening resources to patients who are at highest risk.
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Affiliation(s)
| | - Rose Sisk
- Gendius Ltd, Alderley Edge, United Kingdom
| | - Ruben Silva-Tinoco
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Public Health Services of the Mexico City Government, Mexico, City, Mexico
| | - Gustavo de la Pena
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico
- Metabolic Diseases Research, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Alcántara-Garcés MT, Rodríguez-Ramírez AM, García-Ulloa AC, García-Alanis M, Martínez-Reyes GN, Del Moral Vidal LP, Arizmendi-Rodríguez RE, Hernández-Jiménez S, Almeda-Valdes P. Coping and risk perception during the COVID-19 pandemic in type 2 diabetes: Does it influence metabolic control? PLOS Glob Public Health 2024; 4:e0002793. [PMID: 38349901 PMCID: PMC10863872 DOI: 10.1371/journal.pgph.0002793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/19/2023] [Indexed: 02/15/2024]
Abstract
Diabetes and poor glycemic control are significant predictors of severity and death in the COVID-19 disease. The perception of this risk in individuals with type 2 diabetes (T2D) could modify coping styles, leading to behaviors associated with better self-care and metabolic control. Theoretically, active coping is associated with better glycemic control in patients with T2D. Nonetheless, information during extreme risk like the COVID-19 pandemic is still limited. Our objective was to evaluate the association between coping styles and risk perception in the COVID-19 pandemic and the change in metabolic parameters. This is a prospective study that included individuals with T2D treated in a tertiary care center during the COVID-19 outbreak who returned to follow-up one year later. We assessed coping styles and risk perception with the Extreme Risk Coping Scale and the risk perception questionnaire. Clinical characteristics and metabolic parameters were registered in both visits. Groups were compared using Kruskal Wallis tests, and changes in metabolic parameters were assessed with Wilcoxon rank sum tests. Our sample included 177 participants at baseline, and 118 concluded the study. Passive coping was more frequent in women. Low-risk perception was associated with higher age, lower psychiatric comorbidities, and lower frequency of psychiatric treatment compared with other risk perception groups. Patients with active coping plus high-risk perception did not have a change in metabolic parameters at follow-up, whereas patients with other coping styles and lower risk perception had an increase in total cholesterol, LDL-cholesterol, and triglycerides. There were no differences by coping group or by risk perception in glycemic control.
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Affiliation(s)
- María Teresa Alcántara-Garcés
- Centro de Atención Integral del Paciente con Diabetes (CAIPaDi) Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alejandra Monserrat Rodríguez-Ramírez
- Centro de Atención Integral del Paciente con Diabetes (CAIPaDi) Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ana Cristina García-Ulloa
- Centro de Atención Integral del Paciente con Diabetes (CAIPaDi) Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mario García-Alanis
- Neurology and Psychiatry Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Gabriela Nazareth Martínez-Reyes
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Lupita Paola Del Moral Vidal
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rodrigo Eduardo Arizmendi-Rodríguez
- Centro de Atención Integral del Paciente con Diabetes (CAIPaDi) Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sergio Hernández-Jiménez
- Centro de Atención Integral del Paciente con Diabetes (CAIPaDi) Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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3
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Pérez Buenfil LA, Fortier J, Almeda-Valdes P, Güereca Olguín DC, Mena-Hernández L, Corona-Hernández MDLÁ, Lima-Galindo AA, Barbosa B, Sánchez-Gomez JE, Hernández A, Domínguez-Cherit J, Valdés-Rodríguez R. Multifactorial causes of chronic itch in diabetes: More than just neuropathy. Australas J Dermatol 2023; 64:354-358. [PMID: 37264566 DOI: 10.1111/ajd.14092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/09/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Chronic pruritus is common in patients with diabetes though its pathophysiology is unknown and difficult to pinpoint given the multi-system manifestations of diabetes. Herein, we aim to evaluate the severity of chronic itch in patients with diabetes and its association with glycaemic control, microvascular complications and quality of life. METHODS We conducted a retrospective study of 105 adults with diabetes evaluated by a dermatologist at a tertiary care centre in Mexico City. Degree of chronic pruritus and its impact on quality of life as well as laboratory, clinical and demographic data were collected. Patients without chronic pruritus (n = 62) were compared to those with chronic pruritus (n = 43). The latter cohort was further stratified by itch severity, and characteristics of their itch were quantified. RESULTS Neuropathy and loss of protective sensation were more common in patients with chronic pruritus, compared to those without chronic pruritus (p = 0.007 and p = 0.001, respectively). Anxiety and depression were more common in individuals with chronic pruritus (p = 0.009), and these group reported higher effect of pruritus on their quality of life (p < 0.0001). The most common sites of itch were the head, back and arms. Among patients with chronic itch, increasing itch severity was associated with decreasing eGFR (p = 0.080). CONCLUSIONS The underlying cause of chronic itch in patients with diabetes is likely multifactorial and owing to microvascular complications such as neuropathy and nephropathy. Better understanding of the causes of itch in these patients can allow for more targeted treatment, leading to improved quality of life.
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Affiliation(s)
- Luis Angel Pérez Buenfil
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Julia Fortier
- University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Paloma Almeda-Valdes
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Diana Cecilia Güereca Olguín
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Lourdes Mena-Hernández
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Anabell Andrea Lima-Galindo
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Bibiana Barbosa
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Josué Ernesto Sánchez-Gomez
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Amparo Hernández
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Judith Domínguez-Cherit
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Cuenca D, Ventura-Gallegos JL, Almeda-Valdes P, Tusié-Luna MT, Reza-Albarran A, Ventura-Ayala L, Ordoñez-Sánchez ML, Segura-Kato Y, Gomez-Perez FJ, Conte MDP, Gonzalez LR, Zentella-Dehesa A. A novel nonsense mutation in the insulin receptor gene in a patient with HAIR-AN syndrome and endometrial cancer. Mol Genet Metab Rep 2023; 35:100965. [PMID: 36941956 PMCID: PMC10024124 DOI: 10.1016/j.ymgmr.2023.100965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/11/2022] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 03/14/2023] Open
Abstract
Severe insulin resistance can be caused by rare genetic defects in the insulin receptor known as insulin receptoropathies. These genetic defects cause a wide spectrum of clinical manifestations ranging from mild syndromes to lethal disorders. Among those is the HAIR-AN an extreme subtype of polycystic ovary syndrome (PCOS). We present a case of a 29-year-old woman with amenorrhea, severe insulin resistance, hirsutism, and acanthosis nigricans who also developed endometrial cancer. She was found to carry a novel heterozygous nonsense mutation insulin receptor gene (INSR). The mutation was inherited from the mother. Levels of insulin receptor and AKT were measured using Western-Blot from peripheral blood mononuclear cells and were both decreased. Thus, we conclude that the identified mutation in the insulin receptor gene and lead to decreased activity of the downstream signaling of the insulin pathway.
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Affiliation(s)
- Dalia Cuenca
- Department of Endocrinology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Belisario Dominguez, Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Jose Luis Ventura-Gallegos
- Unit of Biochememistry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Belisario Dominguez, Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Department of Endocrinology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Belisario Dominguez, Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - María Teresa Tusié-Luna
- Unit of Molecular Biology and Genomic Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Belisario Dominguez, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Alfredo Reza-Albarran
- Department of Endocrinology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Belisario Dominguez, Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Laura Ventura-Ayala
- Unit of Biochememistry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Belisario Dominguez, Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Ma. Luisa Ordoñez-Sánchez
- Unit of Molecular Biology and Genomic Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Belisario Dominguez, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Yayoi Segura-Kato
- Unit of Molecular Biology and Genomic Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Belisario Dominguez, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Francisco Javier Gomez-Perez
- Department of Endocrinology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Belisario Dominguez, Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Michelle De Puy Conte
- Department of Endocrinology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Belisario Dominguez, Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Lizbet Ruilova Gonzalez
- Department of Endocrinology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Belisario Dominguez, Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Alejandro Zentella-Dehesa
- Unit of Biochememistry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Belisario Dominguez, Sección XVI, Tlalpan, 14080 Mexico City, Mexico
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Romo-Romo A, Castillo-Martínez L, Aguilar-Salinas CA, Brito-Córdova GX, Martagón AJ, Gómez-Pérez FJ, Almeda-Valdes P. Associated factors to the consumption of non-nutritive sweeteners in the Mexican adult population. Salud Publica Mex 2023; 65:200-207. [PMID: 38060884 DOI: 10.21149/14145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/26/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To identify the associated factors to the consumption of non-nutritive sweeteners (NNS) in the Mexican adult population since its consumption has increased exponentially worldwide. MATERIALS AND METHODS An online survey was applied to 5 038 Mexican adults to evaluate the frequency of NNS consumption and classify the population in tertiles. The sociodemographic, lifestyle and health status characteristics of the participants were compared by gradient of NNS consumption, and a multiple linear regression analysis was performed to determine the associated factors to the NNS consumption. RESULTS The variables that showed a positive association (p≤0.01) with the consumption of NNS were economic income, BMI, smoking, physical activity, diet quality, the presence of chronic diseases (diabetes, hypertension, or dyslipidemias), and the consumption of fruit. The age and the consumption of confectionery and sugar-sweetened beverages were negatively associated (p<0.01) with the consumption of NNS. CONCLUSION The results of this study help to characterize the target population that is a consumer of NNS since it is recommended not encourage the preference for sweet taste and to promote a decrease in the consumption of both caloric and NNS, preferring the natural flavor of food.
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Affiliation(s)
- Alonso Romo-Romo
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, Mexico..
| | - Lilia Castillo-Martínez
- Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, Mexico..
| | - Carlos A Aguilar-Salinas
- División de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, Mexico. Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, Mexico..
| | - Griselda X Brito-Córdova
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, Mexico..
| | - Alexandro J Martagón
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, Mexico..
| | - Francisco J Gómez-Pérez
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, Mexico..
| | - Paloma Almeda-Valdes
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, Mexico. Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, Mexico..
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Ibarra-Salce R, Pozos-Varela FJ, Martinez-Zavala N, Lam-Chung CE, Mena-Ureta TS, Janka-Zires M, Faradji RN, Madrigal-Sanroman JR, de la Garza-Hernandez NE, Almeda-Valdes P. Correlation Between Hemoglobin Glycation Index Measured by Continuous Glucose Monitoring With Complications in Type 1 Diabetes. Endocr Pract 2023; 29:162-167. [PMID: 36627022 DOI: 10.1016/j.eprac.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVE HbA1C is the "gold standard" parameter to evaluate glycemic control in diabetes; however, its correlation with mean glucose is not always perfect. The objective of this study was to correlate continuous glucose monitoring (CGM)-derived hemoglobin glycation index (HGI) with microvascular complications. METHODS We conducted a cross-sectional study including permanent users of CGM with type 1 diabetes mellitus or latent autoimmune diabetes of the adult. HGI was estimated, and presence of microvascular complications was compared in subgroups with high or low HGI. A logistic regression analysis to assess the contribution of high HGI to chronic kidney disease (CKD) was performed. RESULTS In total, 52 participants who were aged 39.7 ± 14.7 years, with 73.1% women and 15.5 years (IQR, 7.5-29 years) since diagnosis, were included; 32.7% recorded diabetic retinopathy, 25% CKD, and 19.2% neuropathy. The median HbA1C was 7.6% (60 mmol/mol) and glucose management indicator (GMI) 7.0% (53 mmol/mol). The average HGI was 0.55% ± 0.66%. The measured HbA1C was higher in the group with high HGI (8.1% [65 mmol/mol] vs 6.9% [52 mmol/mol]; P < .001), whereas GMI (7.0% [53 mmol/mol] vs 7.0% [53 mmol/mol]; P = .495) and mean glucose were similar in both groups (153 mg/dL vs 153 mg/dL; P = .564). In the high HGI group, higher occurrence of CKD (P = .016) and neuropathy were observed (P = .025). High HGI was associated with increased risk of CKD (odds ratio [OR]: 5.05; 95% CI: 1.02-24.8; P = .04) after adjusting for time since diagnosis (OR: 1.09; 95% CI: 1.02-1.16; P = .008). CONCLUSION High HGI measured by CGM may be a useful marker for increased risk of microvascular diabetic complications.
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Affiliation(s)
- Raul Ibarra-Salce
- Diabetes and Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Francisco Javier Pozos-Varela
- Diabetes and Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Nestor Martinez-Zavala
- Diabetes and Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Cesar Ernesto Lam-Chung
- Diabetes and Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Tania Sofia Mena-Ureta
- Diabetes and Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Marcela Janka-Zires
- Diabetes and Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | | | | | | | - Paloma Almeda-Valdes
- Diabetes and Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico; Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico.
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López-Prieto RS, Reza-Albarrán AA, Clark P, Gómez Díaz RA, Aguilera-Rubalcava MS, Güereca-Olguín DC, Jalife-Velázquez GQ, Soto-Mota A, Viveros-Ruiz TL, Juárez-Martínez L, Gómez-Pérez FJ, Almeda-Valdes P. ALBUMINURIA, DISEASE DURATION AND GLYCATED HEMOGLOBIN ARE RELATED WITH BONE MINERAL DENSITY IN TYPE 1 DIABETES: A CROSS-SECTIONAL STUDY. Endocr Pract 2023; 29:362-367. [PMID: 36828282 DOI: 10.1016/j.eprac.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/18/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE Studies have found a significant decrease in bone mineral density (BMD) in individuals with type 1 diabetes (T1D) compared to healthy controls. Factors associated with this phenomenon have yet to be defined; therefore, this study aimed to explore the association of glycated hemoglobin (HbA1c), disease duration, albuminuria, and glomerular filtration rate (GFR) with BMD in adults with T1D. METHODS Cross-sectional study carried out in tertiary care. BMD analysis was performed by dual X-ray absorptiometry (DXA). Linear models were constructed considering variables associated with BMD. Approval from the Ethics Committees and informed consent were obtained. RESULTS We included 128 participants, 59% women, 16% with menopause. The median age was 33 (26-42) years. The average age of diabetes diagnosis was 15.3 ± 6.3 years, and the median disease duration was 19.5 (12-27) years. In the adjusted analysis, higher albuminuria (p<0.01) and disease duration (p<0.05) were associated with a lower BMD in the femoral neck and total hip, independently of age, sex, and body mass index (BMI). Higher HbA1c (p<0.01) was associated with a lower spine BMD after adjustment for age, sex, and BMI. CONCLUSION Studied factors specific to T1D, including albuminuria, disease duration, and HbA1c have an association with BMD regardless of BMI, age, and sex.
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Affiliation(s)
- Rossy S López-Prieto
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - Alfredo A Reza-Albarrán
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - Patricia Clark
- Clinical Epidemiology Unit, Hospital Infantil Federico Gómez, Mexico City, México
| | - Rita A Gómez Díaz
- Clinical Epidemiology Unit, UMAE, Hospital de Especialidades Centro Medico Siglo XXI, IMSS, Mexico City, México
| | - Miguel S Aguilera-Rubalcava
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - Diana C Güereca-Olguín
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - Grecia Q Jalife-Velázquez
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - Adrián Soto-Mota
- Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - Tannia L Viveros-Ruiz
- Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - Liliana Juárez-Martínez
- Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - Francisco J Gómez-Pérez
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - Paloma Almeda-Valdes
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México; Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México.
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8
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Moreno-Loaeza L, Escamilla-Núñez MC, Sevilla-González MDR, García-De La Torre GS, Castro-Porras LV, Denova-Gutiérrez E, Vargas-Vázquez A, Gomez Velasco DV, Rojas-Martinez R, Almeda-Valdes P. Diagnostic performance of questionnaires to identify individuals with impaired fasting glucose in Mexican adult population. Diabetes Res Clin Pract 2023; 195:110186. [PMID: 36471515 DOI: 10.1016/j.diabres.2022.110186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/11/2022] [Revised: 09/22/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate the diagnostic performance of five questionnaires to identify impaired fasting glucose (IFG) in Mexican adult population. METHODS The study included 23,311 subjects from five cohorts, three composed of individuals who sought medical advice in their first level clinics or participated in research studies and two representative surveys of the Mexican population. The reference standard was IFG which was defined as a fasting glucose ≥ 100 mg/dL. Diagnostic performance was evaluated with specificity, sensitivity, positive and negative predictive values, area under the curve, and the proportion of correctly classified individuals. RESULTS The prevalence of IFG ranged from 14.4 to 48.1 % across the cohorts. Diagnostic performance of the questionnaires varied in each cohort depending on IFG prevalence. The questionnaires designed by Rojas, American Diabetes Association and International Diabetes Federation had the best performance considering the correct classification (>66.0 %) of subjects in all cohorts. However, Rojas' questionnaire had the best balance between sensitivity and specificity across the cohorts. CONCLUSION In the Mexican population, considering different scenarios, the Rojas' questionnaire had the best diagnostic performance. The implementation of questionnaires for the identification of prediabetes and undiagnosed diabetes requires further study in specific populations.
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Affiliation(s)
- Lizbeth Moreno-Loaeza
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Lilia V Castro-Porras
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Edgar Denova-Gutiérrez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública (INSP), Mexico City, Mexico
| | - Arsenio Vargas-Vázquez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Donají V Gomez Velasco
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rosalba Rojas-Martinez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Nutrición Salvador Zubirán, Mexico City, Mexico; Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, Mexico.
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9
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Garcia-Ulloa AC, Díaz-Pineda M, Ramírez-García A, Antonio-Villa NE, Almeda-Valdes P, Kaufer-Horwitz M, Torres-Mejía G, Aguilar-Salinas CA, Hernández-Jiménez SC. The beneficial effect of a comprehensive diabetes care model on high-risk relatives accompanying patients with type 2 diabetes. Prim Care Diabetes 2022; 16:791-796. [PMID: 36182627 DOI: 10.1016/j.pcd.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/24/2022] [Revised: 08/25/2022] [Accepted: 09/19/2022] [Indexed: 11/18/2022]
Abstract
AIMS Assess the effect of a diabetes program on lifestyle, metabolic, and mental health parameters in relatives of patients with T2D, and correlate changes between relatives and patients. METHODS Relatives were included in a structured program for patients with T2D. They received individualized interventions or were asked to follow lifestyle modifications indicated to their patient with diabetes. Outcomes were change in BMI, fat loss, patients achieving LDL-c and triglycerides goals, exercise, and mental health indicators at three and twelve months. RESULTS We included 200 relatives. Obesity was present in 42 %, hypertension in 8.5 %, hypercholesterolemia in 29.5 %, and hypertriglyceridemia in 46 % of relatives. Relatives lost - 3.7 kg and - 3.0 kg of body fat at three months and one-year evaluations. At least 60 % achieved normal triglycerides and LDL-c, and 40 % exercised at least 150 min/week. Anxiety symptoms dropped from 37 % to 22 % (p = 0.001), and depressive symptoms from 22 % to 12.9 % (p = 0.01) at three months. Correlations were found between the changes in relatives and patients in weight at three months (r = 0.22, p = 0.001), one year (r = 0.3, p < 0.001), and the number of goals achieved at one year. CONCLUSION Relatives of patients with diabetes attending a multidisciplinary program for T2D benefit in metabolic, lifestyle, and mental health indicators.
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Affiliation(s)
- Ana C Garcia-Ulloa
- Center of Comprehensive Care of the Patient with Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico; Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Michelle Díaz-Pineda
- Center of Comprehensive Care of the Patient with Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Alberto Ramírez-García
- Center of Comprehensive Care of the Patient with Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Neftali Eduardo Antonio-Villa
- Faculty of Medicine, Universidad Nacional Autónoma de México, Circuito Escolar 411 A, Copilco Universidad, Coyoacán, 04360 Mexico CIty, Mexico
| | - Paloma Almeda-Valdes
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Martha Kaufer-Horwitz
- Obesity and Eating Disorders Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Gabriela Torres-Mejía
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Carlos A Aguilar-Salinas
- Direction of Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico.
| | - Sergio C Hernández-Jiménez
- Center of Comprehensive Care of the Patient with Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico; Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
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10
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García-Ulloa AC, Almeda-Valdes P, Cuatecontzi-Xochitiotzi TE, Ramírez-García JA, Díaz-Pineda M, Garnica-Carrillo F, González-Duarte A, Narayan KMV, Aguilar-Salinas CA, Hernández-Jiménez S. Detection of sudomotor alterations evaluated by Sudoscan in patients with recently diagnosed type 2 diabetes. BMJ Open Diabetes Res Care 2022; 10:10/6/e003005. [PMID: 36521878 PMCID: PMC9756300 DOI: 10.1136/bmjdrc-2022-003005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Diabetic peripheral neuropathy (DPN) causes morbidity and affects the quality of life. Before diabetes diagnosis, neuropathic damage may be present. Sudoscan provides accurate measurement of the sudomotor function. This study aimed to assess the abnormalities detected by Sudoscan, offered estimates of DPN prevalence, and investigated the relationship between metabolic and clinical parameters. Additionally, we evaluated the diagnostic accuracy of the Sudoscan compared with monofilament and tuning fork tests for detecting DPN. RESEARCH DESIGN AND METHODS Cross-sectional descriptive study including patients with type 2 diabetes for <5 years since diagnosis. We investigated the presence of DPN using a 128 Hz tuning fork test, the 10 g monofilament, and the sudomotor dysfunction in feet using Sudoscan. We compared patients with and without alterations in the Sudoscan. A logistic regression model analyzed variables independently associated with sudomotor dysfunction. RESULTS From 2013 to 2020, 2243 patients were included, 55.1% women, age 51.8 years, and 17.1% with normal weight. Monofilament tests and/or tuning fork examination were abnormal in 29% (95% CI 0.23% to 0.27%) and 619 patients (27.6%, 0.25% to 0.29%) had sudomotor alterations. In logistic regression analysis, age (β=1.01, 0.005-1.02), diastolic blood pressure (β=0.98, 0.96-0.99), heart rate (β=1.01, 1.00-1.02), glucose (β=1.00, 1.00-1.03), albuminuria (β=1.001, 1.000-1.001), beta-blockers=1.98, 1.21-3.24) and fibrate use=0.61, 0.43-0.87) were associated with sudomotor dysfunction. The AUC (area under the curve) for Sudoscan was 0.495 (0.469-0.522), with sensitivity and specificity of 24% and 71%, respectively. CONCLUSION The Sudoscan identified an important proportion of patients with dysfunction, allowing prompt intervention to decrease the risk for complications. TRIAL REGISTRATION NUMBER NCT02836808.
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Affiliation(s)
- Ana Cristina García-Ulloa
- Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Departamento Endocrinologia y Metabolismo, Tlalpan, Mexico
| | - Paloma Almeda-Valdes
- Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Teresa Enedina Cuatecontzi-Xochitiotzi
- Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Departamento Endocrinologia y Metabolismo, Tlalpan, Mexico
| | - Jorge Alberto Ramírez-García
- Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Departamento Endocrinologia y Metabolismo, Tlalpan, Mexico
| | - Michelle Díaz-Pineda
- Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Departamento Endocrinologia y Metabolismo, Tlalpan, Mexico
| | - Fernanda Garnica-Carrillo
- Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Departamento Endocrinologia y Metabolismo, Tlalpan, Mexico
| | - Alejandra González-Duarte
- Departamento de Neurología, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Departamento Endocrinologia y Metabolismo, Tlalpan, Mexico
| | | | | | - Sergio Hernández-Jiménez
- Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Departamento Endocrinologia y Metabolismo, Tlalpan, Mexico
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11
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Barajas-Martínez A, Mehta R, Ibarra-Coronado E, Fossion R, Martínez Garcés VJ, Arellano MR, González Alvarez IA, Bautista YVM, Bello-Chavolla OY, Pedraza NR, Encinas BR, Carrión CIP, Ávila MIJ, Valladares-García JC, Vanegas-Cedillo PE, Juárez DH, Vargas-Vázquez A, Antonio-Villa NE, Almeda-Valdes P, Resendis-Antonio O, Hiriart M, Frank A, Aguilar-Salinas CA, Rivera AL. Physiological Network Is Disrupted in Severe COVID-19. Front Physiol 2022; 13:848172. [PMID: 35360235 PMCID: PMC8961032 DOI: 10.3389/fphys.2022.848172] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
The human body is a complex system maintained in homeostasis thanks to the interactions between multiple physiological regulation systems. When faced with physical or biological perturbations, this system must react by keeping a balance between adaptability and robustness. The SARS-COV-2 virus infection poses an immune system challenge that tests the organism's homeostatic response. Notably, the elderly and men are particularly vulnerable to severe disease, poor outcomes, and death. Mexico seems to have more infected young men than anywhere else. The goal of this study is to determine the differences in the relationships that link physiological variables that characterize the elderly and men, and those that characterize fatal outcomes in young men. To accomplish this, we examined a database of patients with moderate to severe COVID-19 (471 men and 277 women) registered at the "Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán" in March 2020. The sample was stratified by outcome, age, and sex. Physiological networks were built using 67 physiological variables (vital signs, anthropometric, hematic, biochemical, and tomographic variables) recorded upon hospital admission. Individual variables and system behavior were examined by descriptive statistics, differences between groups, principal component analysis, and network analysis. We show how topological network properties, particularly clustering coefficient, become disrupted in disease. Finally, anthropometric, metabolic, inflammatory, and pulmonary cluster interaction characterize the deceased young male group.
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Affiliation(s)
- Antonio Barajas-Martínez
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Programa de Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Roopa Mehta
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | | | - Ruben Fossion
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Vania J. Martínez Garcés
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Plan of Combined Studies in Medicine (PECEM-MD/PhD), Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Monserrat Ramírez Arellano
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Plan of Combined Studies in Medicine (PECEM-MD/PhD), Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | | | | | | | - Natalia Ramírez Pedraza
- Departamento de Radiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Bethsabel Rodríguez Encinas
- Departamento de Radiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Carolina Isabel Pérez Carrión
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - María Isabel Jasso Ávila
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Jorge Carlos Valladares-García
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Pablo Esteban Vanegas-Cedillo
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Diana Hernández Juárez
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Arsenio Vargas-Vázquez
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Plan of Combined Studies in Medicine (PECEM-MD/PhD), Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Neftali Eduardo Antonio-Villa
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Plan of Combined Studies in Medicine (PECEM-MD/PhD), Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Paloma Almeda-Valdes
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Osbaldo Resendis-Antonio
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Instituto Nacional de Medicina Genómica & Coordinación de la Investigación Científica-Red de Apoyo a la Investigación, UNAM, Ciudad de México, Mexico
| | - Marcia Hiriart
- Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Alejandro Frank
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- El Colegio Nacional, Mexico City, Mexico
| | - Carlos A. Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Ana Leonor Rivera
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
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12
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Perez-Zepeda MU, Almeda-Valdes P, Fernandez-Villa JM, Gomez-Arteaga RC, Borda MG, Cesari M. Thyroid stimulating hormone levels and geriatric syndromes: secondary nested case-control study of the Mexican Health and Aging Study. Eur Geriatr Med 2021; 13:139-145. [PMID: 34601711 DOI: 10.1007/s41999-021-00564-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the incidence of geriatric syndromes (GS) in community dwelling older adults with subclinical hypothyroidism. METHODS This is an analysis from the Mexican Health and Aging Study, of a subsample of 2089 subjects with TSH determination. From this last subsample, we included 1628 individuals with TSH levels in the subclinical range (4.5-10 µU/ml). RESULTS The multivariate analysis showed that when comparing data obtained from the 2012 wave with the 2015 wave results, there was a significant incidence of some GS such as falls (OR 1.79, CI 1.16-2.77, p = 0.0116), fatigue (OR 2.17, CI 1.40-3.38, p = 0.0348) and depression (OR 1.70, CI 1.06-2.71, p = 0.0246) among the subclinical hypothyroidism group. CONCLUSION This study showed a greater incidence of GS in subjects 50 years and older with sub-clinical hypothyroidism, when compared to those with normal thyroid function.
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Affiliation(s)
- Mario U Perez-Zepeda
- Research Department, INGER Instituto Nacional de Geriatria, Mexico City, Mexico.,Health Sciences Research Center (CICSA), FCS, Universidad Anahuac Mexico Campus Norte, Mexico City, Edo. de Mexico, Mexico
| | - Paloma Almeda-Valdes
- Research Center of Metabolic Diseases, Instituto Nacional de Ciencias Medicas Y Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | | | - Miguel G Borda
- Semillero de Neurociencias y Envejecimiento, Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogota, Colombia.,Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
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13
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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.
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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.
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14
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Lam-Chung CE, Rodríguez LL, Kato YS, Jiménez González IJ, Mena-Hernández L, Rivera-Juárez R, Almeda-Valdes P, Vázquez JA. Occurrence of Klinefelter Syndrome Mosaic 45,X/46,XY/47,XXY/48,XXYY/48,XXXY and Primary Hyperparathyroidism. AACE Clin Case Rep 2021; 7:293-298. [PMID: 34522767 PMCID: PMC8426603 DOI: 10.1016/j.aace.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 10/24/2022] Open
Abstract
Objective The presence of primary hyperparathyroidism (PHPT) and Klinefelter syndrome (KS) is rare, and its association with KS mosaicism is even rarer. We report an unusual combination of these entities with a mild phenotype of KS. Methods The patient was a 44-year-old male with a history of PHPT who had recurrent urolithiasis despite being treated with a successful parathyroidectomy. On examination, he had axillary hair growth, bilateral gynecomastia, a large port-wine stain at the right hemithorax and upper right limb, and genitalia and pubic hair corresponding to Tanner IV classification with small, normal consistency testicles. Results Laboratory findings were unremarkable except for a slightly elevated luteinizing hormone, which was normal on repeat testing. Because of the picture of unexplained gynecomastia, laboratory findings, and low-volume testis, a diagnosis of KS was considered. Chromosomal analysis revealed a rare 45,X/46,XY/47,XXY/48,XXYY/48,XXXY KS mosaic. Conclusions KS phenotypes are largely variable, and their association with PHPT remains to be elucidated.
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Affiliation(s)
- César Ernesto Lam-Chung
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Larissa López Rodríguez
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Yayoi Segura Kato
- Unit of Molecular Biology and Genomic Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Iván Josué Jiménez González
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Lourdes Mena-Hernández
- Department of Dermatology. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Renata Rivera-Juárez
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Jazmín Arteaga Vázquez
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
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Lam-Chung CE, Martínez Zavala N, Ibarra-Salce R, Pozos Varela FJ, Mena Ureta TS, Berumen Hermosillo F, Campos Muñoz A, Janka Zires M, Almeda-Valdes P. Association of estimated glucose disposal rate and chronic diabetic complications in patients with type 1 diabetes. Endocrinol Diabetes Metab 2021; 4:e00288. [PMID: 34505411 PMCID: PMC8502215 DOI: 10.1002/edm2.288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 11/09/2022]
Abstract
Introduction The role of insulin resistance in diabetic chronic complications among individuals with type 1 diabetes (T1D) has not been clearly defined. The aim of this study was to examine the performance of insulin resistance, evaluated using the estimated glucose disposal rate (eGDR) for the identification of metabolic syndrome (MS) and diabetic chronic complications. Methods Cross‐sectional study in a tertiary care centre. We included patients of 18 years and older, with at least 6 months of T1D duration. Anthropometric, clinical and biochemical data were collected. Results Seventy patients, 41 (58.6%) women, with a median age of 36.6 years (range 18–65). Mean age of onset and duration of diabetes was 13.5 ± 6.5 and 23.6 ± 12.2 years, respectively. Twenty‐one (30%) patients met the metabolic syndrome (MS) criteria. Patients with MS had lower eGDR compared to patients without (5.17 [3.10–8.65] vs. 8.86 [6.82–9.85] mg/kg/min, respectively, p = .003). Median eGDR in patients with nephropathy, retinopathy and neuropathy compared with those without was 6.75 (4.60–8.20) versus 9.53 (8.57–10.3); p < .001, 6.45 (4.60–7.09) versus 9.50 (8.60–10.14); p < .001, 5.56 (4.51–6.81) versus 9.49 [8.19–10.26] mg/kg/min; p < .001, respectively. The eGDR showed an area under the curve of 0.909, 0.879, 0.897 and 0.836 for the discrimination of MS, retinopathy, neuropathy and nephropathy, respectively. Conclusions Patients with T1D diabetic complications have higher insulin resistance. The eGDR discriminates patients with chronic diabetic complications and MS. While more ethnic‐specific studies are required, this study suggests the possibility to incorporate eGDR into routine diabetes care.
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Affiliation(s)
- César Ernesto Lam-Chung
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Néstor Martínez Zavala
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Raúl Ibarra-Salce
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Francisco Javier Pozos Varela
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Tania S Mena Ureta
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Francisco Berumen Hermosillo
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alejandro Campos Muñoz
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Marcela Janka Zires
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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16
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César Ernesto LC, Álvaro EO, Yayoi SK, Juanita SS, María Teresa TL, Almeda-Valdes P. Differentiating Among Type 1, Type 2 Diabetes, and MODY: Raising Awareness About the Clinical Implementation of Genetic Testing in Latin America. AACE Clin Case Rep 2021; 7:138-140. [PMID: 34095472 PMCID: PMC8053617 DOI: 10.1016/j.aace.2020.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To describe a case of maturity-onset diabetes of the young (MODY) to highlight the importance of a correct diabetes diagnosis. Methods We describe a Mexican family misdiagnosed with T1D and T2D. Results A 36-year-old woman with diabetes and adverse outcomes during 2 pregnancies had been diagnosed with T2D 10 years ago. Genetic testing was performed due to clinical and family history, which showed a pathogenic heterozygous variant c.544G>T (p.Val182Leu) in the GCK gene. This mutation was also confirmed in most of the family members who had been diagnosed with diabetes. Conclusion This case highlights the need for a correct diabetes classification. Reassessment of diabetes etiology is justified, especially in individuals with unclear clinical presentation or when family history is suggestive.
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Affiliation(s)
- Lam-Chung César Ernesto
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Elizondo Ochoa Álvaro
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Segura Kato Yayoi
- Molecular Biology and Genomic Medicine Unit; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Silva-Serrano Juanita
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Tusié Luna María Teresa
- Molecular Biology and Genomic Medicine Unit; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
- Address correspondence and reprint requests to Dr. Paloma Almeda-Valdes, Department of Endocrinology and Metabolism,Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan 14080, México City, México.
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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.
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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
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Pozos-Varela FJ, Mena-Ureta TS, Lam-Chung CE, Ibarra-Salce R, Martínez-Zavala N, Janka-Zires M, Almeda-Valdes P. Reconsidering the Basal Proportion of Insulin Dose: Glycemic and Microvascular Outcomes in Type 1 Diabetes Mellitus. J Endocr Soc 2021. [PMCID: PMC8089725 DOI: 10.1210/jendso/bvab048.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Optimal glycemic control is required to lower the risk of complications in type 1 diabetes mellitus (T1DM). This can be achieved with multiple daily insulin injections (MDI) or with continuous subcutaneous insulin infusion (CSII). Most diabetes guidelines recommend a proportion of basal insulin (basal proportion of total insulin dose; %B/T) around 50% of the total daily dose (TDD), although there is scarce evidence that suggests that a lower %B/T is associated with lower HbA1c levels. Our objective was to evaluate the association of the %B/T with glycemic and microvascular outcomes. We included 132 T1DM adults of the Diabetes Clinic in a tertiary care center, 117 (88.6%) using MDI and 15 (11.4%) using CSII. Data from the medical records and insulin pumps software during outpatient visits were retrospectively collected. Individuals with end-stage renal disease, solid-organ transplant, pregnancy, and glucocorticoid use were excluded. A positive correlation between %B/T and HbA1c levels was found, r=0.26 (p=0.002). Three groups were analyzed according to the %B/T: ≤40%, 41–59% and ≥60%, observing differences in HbA1c concentrations: 7.1% (6.7–8.0%), 7.8% (7.2–9.1%) and 8.7% (7.6–10.2%), respectively (p=0.003). Regarding microvascular complications, the cases of nephropathy were 0 (0%), 23 (30.7%) and 18 (40%) across those groups (p=0.029) even though there was no difference in T1DM duration across groups. There were also no differences in body mass index, TDD, TDD/weight (units/kg/day), nor in the rates of retinopathy or neuropathy. Multiple regression analysis identified %B/T as an independent predictor of the HbA1c concentration. A difference in the rates of hypoglycemic episodes per month was found among individuals with a %B/T ≤50%: 2 (1–5) versus 6 (2.5–12) episodes per month in those having a higher %BT (p=0.002). There are limitations in our study, including the retrospective nature of the analysis, no data about meal content and a low usage of CGM (thus relying on variable self-monitoring of blood glucose). Therefore, we cannot asseverate that lowering the %B/T would improve glycemic and microvascular outcomes. Nevertheless, our findings indicate that the %B/T correlates with HbA1c levels and are consistent with those previously described. It also suggests a relationship with hypoglycemia and to the best of our knowledge, it is the first time that an association between %B/T and nephropathy has been noted.
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Affiliation(s)
| | - Tania Sofía Mena-Ureta
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Raúl Ibarra-Salce
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Néstor Martínez-Zavala
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Marcela Janka-Zires
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Fernandez-Chirino L, Antonio-Villa NE, Bello-Chavolla OY, Almeda-Valdes P. Elevated Serum Uric Acid Is a Facilitating Mechanism for Insulin Resistance Mediated Accumulation of Visceral Adipose Tissue. J Endocr Soc 2021. [PMCID: PMC8089282 DOI: 10.1210/jendso/bvab048.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Serum uric acid (SUA) is related to cardiometabolic conditions such as insulin resistance (IR) and visceral adipose tissue (VAT) accumulation, which have a thoroughly explored bidirectional relationship. Here, we aimed to clarify the nature of the role uric acid plays inside this relationship, alongside the underlying causality mechanism. Methods: We conducted a population-based cross-sectional study comprising 8,504 subjects from a joint cohort composed from both NHANES 2003–2004 and 2011–2012 cycles and ENSANUT Medio Camino 2016. We performed mixed effects linear regression models using HOMA2-IR, adipoIR, and METS-VF as indicators of both peripheral and adipose tissue IR and VAT accumulation, indicating the subject’s cohort of origin as a random effect. Furthermore, we performed multiple mediation analyses to assess a potential causal mechanism and ROC curves to establish cut-off points for identification of IR and visceral obesity using SUA. Finally, with an additional dataset comprised of 226 subjects with both euglycemic hyperinsulinemic clamp (EHC) and dual X-ray absorptiometry (DXA) measurements for IR and VAT accumulation, we performed a network of confirmatory mediation analyses including adiponectin measurements. Results: We found that SUA has a mediating role inside the bidirectional relationship between IR and visceral obesity, and it is part of an underlying causality mechanism which includes adiponectin. The proportion of the mechanism mediated by SUA is greater when stated that IR (in either peripheral or adipose tissue) leads to VAT accumulation (14.90%[13.20%-17.00%] and 15.54%[13.61%-18.00%]) instead of the opposite direction (4.88%[3.06%-7.00%] and 8.13%[5.91%-10.00%]). This result was strengthened by a mediation analysis network using the gold-standard measurements where we observed that the joint effect of SUA and adiponectin mediated 16.32% [8.84%-26.00%] for the effect of IR and VAT accumulation and 12.52% [3.23%-23.00%] in the opposite direction. Cut-off points for SUA to predict peripheral IR were 6.1 mg/dL and 4.8 mg/dL, for males and females respectively. For visceral obesity, cut-offs were 6.4 mg/dL and 4.8 mg/dL for males and females. SUA had a high negative predictive value for all assessments. Conclusions: Elevated SUA acts as mediator inside the bidirectional relationship between IR and VAT accumulation. Its role appears to be larger when considering adipose tissue IR as the promoter for VAT accumulation.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Almeda-Valdes P, Antonio-Villa NE, Rodríguez-Dávila FM, Palma-Moreno BG, Gómez-Pérez FJ, Aguilar-Salinas CA, García-Ulloa AC, Hernández-Jiménez S. Comparison of Two Electronic Systems for Obtaining Diabetes Care Indicators in Clinical Practice. Clin Diabetes 2021; 39:167-172. [PMID: 33981130 PMCID: PMC8061551 DOI: 10.2337/cd20-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We compared the completeness of data captured by physicians in a diabetes outpatient clinic using a general electronic health record system versus one that was specifically geared to diabetes. Use of a diabetes-oriented data system was found to allow for greater capture of crucial variables required for diabetes care than a general electronic record and was well accepted by health care providers.
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Affiliation(s)
- Paloma Almeda-Valdes
- Research Unit of Metabolic Diseases, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
- Endocrinology and Metabolism Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Neftali Eduardo Antonio-Villa
- Research Unit of Metabolic Diseases, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
- MD/PhD (PECEM) Program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Fátima M. Rodríguez-Dávila
- Endocrinology and Metabolism Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - B. Geovani Palma-Moreno
- Endocrinology and Metabolism Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Francisco J. Gómez-Pérez
- Endocrinology and Metabolism Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Carlos A. Aguilar-Salinas
- Direction of Nutrition, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
- Monterrey Institute of Technology and Higher Education, School of Medicine and Health Sciences, Mexico City, Mexico
| | - Ana Cristina García-Ulloa
- Endocrinology and Metabolism Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
- Center of Comprehensive Care for the Patient With Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Sergio Hernández-Jiménez
- Endocrinology and Metabolism Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
- Center of Comprehensive Care for the Patient With Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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22
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García-Ulloa AC, Almeda-Valdes P, Aguilar-Salinas CA, Hernández-Jiménez S. Development and Validation of a Software Linked to an Internet Portal That Facilitates the Medical Treatment and Empowerment of Patients with Type 2 Diabetes, Interaction with Medical Personnel, and the Generation of a Real-Time Registry. J Diabetes Sci Technol 2021; 15:525-527. [PMID: 32814459 PMCID: PMC8256083 DOI: 10.1177/1932296820949941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ana Cristina García-Ulloa
- Centro de Atención Integral del Paciente
con Diabetes. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,
México City, Mexico
- Departamento de Endocrinología y
Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,
México City, Mexico
| | - Paloma Almeda-Valdes
- Departamento de Endocrinología y
Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,
México City, Mexico
- Unidad de Investigación de Enfermedades
Metabólicas. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,
México City, Mexico
| | - Carlos A. Aguilar-Salinas
- Unidad de Investigación de Enfermedades
Metabólicas. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,
México City, Mexico
- Dirección de Nutrición, Instituto
Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
- Tecnologico de Monterrey, Escuela de
Medicina y Ciencias de la Salud, Monterrey, N.L., Mexico
| | - Sergio Hernández-Jiménez
- Centro de Atención Integral del Paciente
con Diabetes. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,
México City, Mexico
- Departamento de Endocrinología y
Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,
México City, Mexico
- Sergio Hernández-Jiménez, MD, Centro de
Atención Integral del Paciente con Diabetes, Vasco de Quiroga No. 15. Colonia
Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico.
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23
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Risdon S, Battault S, Romo-Romo A, Roustit M, Briand L, Meyer G, Almeda-Valdes P, Walther G. Sucralose and Cardiometabolic Health: Current Understanding from Receptors to Clinical Investigations. Adv Nutr 2021; 12:1500-1513. [PMID: 33578411 PMCID: PMC8321845 DOI: 10.1093/advances/nmaa185] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/27/2020] [Revised: 10/26/2020] [Accepted: 12/31/2020] [Indexed: 12/15/2022] Open
Abstract
The excess consumption of added sugar is consistently found to be associated with weight gain, and a higher risk of type 2 diabetes mellitus, coronary heart disease, and stroke. In an effort to reduce the risk of cardiometabolic disease, sugar is frequently replaced by low- and null-calorie sweeteners (LCSs). Alarmingly, though, emerging evidence indicates that the consumption of LCSs is associated with an increase in cardiovascular mortality risk that is amplified in those who are overweight or obese. Sucralose, a null-caloric high-intensity sweetener, is the most commonly used LCS worldwide, which is regularly consumed by healthy individuals and patients with metabolic disease. To explore a potential causal role for sucralose in increased cardiovascular risk, this present review summarizes the preclinical and clinical data from current research detailing the effects of sucralose on systems controlling food intake, glucose homeostasis, and gut microbiota.
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Affiliation(s)
| | | | - Alonso Romo-Romo
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Matthieu Roustit
- Université Grenoble Alpes, Inserm U1042, Grenoble, France,Grenoble Alpes University Hospital, Clinical Pharmacology, Inserm CIC1406, Grenoble, France
| | - Loic Briand
- AgroSup Dijon, INRAE, Université de Bourgogne Franche-Comté, CNRS, Centre des Sciences du Goût et de l'Alimentation, Dijon, France
| | | | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
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24
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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] [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: 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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25
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Barajas-Martínez A, Ibarra-Coronado E, Sierra-Vargas MP, Cruz-Bautista I, Almeda-Valdes P, Aguilar-Salinas CA, Fossion R, Stephens CR, Vargas-Domínguez C, Atzatzi-Aguilar OG, Debray-García Y, García-Torrentera R, Bobadilla K, Naranjo Meneses MA, Mena Orozco DA, Lam-Chung CE, Martínez Garcés V, Lecona OA, Marín-García AO, Frank A, Rivera AL. Physiological Network From Anthropometric and Blood Test Biomarkers. Front Physiol 2021; 11:612598. [PMID: 33510648 PMCID: PMC7835885 DOI: 10.3389/fphys.2020.612598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022] Open
Abstract
Currently, research in physiology focuses on molecular mechanisms underlying the functioning of living organisms. Reductionist strategies are used to decompose systems into their components and to measure changes of physiological variables between experimental conditions. However, how these isolated physiological variables translate into the emergence -and collapse- of biological functions of the organism as a whole is often a less tractable question. To generate a useful representation of physiology as a system, known and unknown interactions between heterogeneous physiological components must be taken into account. In this work we use a Complex Inference Networks approach to build physiological networks from biomarkers. We employ two unrelated databases to generate Spearman correlation matrices of 81 and 54 physiological variables, respectively, including endocrine, mechanic, biochemical, anthropometric, physiological, and cellular variables. From these correlation matrices we generated physiological networks by selecting a p-value threshold indicating statistically significant links. We compared the networks from both samples to show which features are robust and representative for physiology in health. We found that although network topology is sensitive to the p-value threshold, an optimal value may be defined by combining criteria of stability of topological features and network connectedness. Unsupervised community detection algorithms allowed to obtain functional clusters that correlate well with current medical knowledge. Finally, we describe the topology of the physiological networks, which lie between random and ordered structural features, and may reflect system robustness and adaptability. Modularity of physiological networks allows to explore functional clusters that are consistent even when considering different physiological variables. Altogether Complex Inference Networks from biomarkers provide an efficient implementation of a systems biology approach that is visually understandable and robust. We hypothesize that physiological networks allow to translate concepts such as homeostasis into quantifiable properties of biological systems useful for determination and quantification of health and disease.
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Affiliation(s)
- Antonio Barajas-Martínez
- Posgrado en Ciencias Biomédicas, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.,Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Elizabeth Ibarra-Coronado
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Martha Patricia Sierra-Vargas
- Subdirección de Investigación Clínica, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, Mexico.,Facultad Mexicana de Medicina, Universidad La Salle, Ciudad de México, Mexico
| | - Ivette Cruz-Bautista
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Paloma Almeda-Valdes
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Carlos A Aguilar-Salinas
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.,Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico.,Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Ruben Fossion
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Christopher R Stephens
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Claudia Vargas-Domínguez
- Departamento de Investigación en Inmunología y Medicina Ambiental, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, Mexico
| | - Octavio Gamaliel Atzatzi-Aguilar
- Departamento de Investigación en Inmunología y Medicina Ambiental, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, Mexico.,Cátedras CONACYT, Ciudad de México, Mexico
| | - Yazmín Debray-García
- Departamento de Investigación en Inmunología y Medicina Ambiental, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, Mexico
| | - Rogelio García-Torrentera
- Unidad de Urgencias Respiratorias, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, Mexico
| | - Karen Bobadilla
- Departamento de Investigación en Inmunología y Medicina Ambiental, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, Mexico
| | - María Augusta Naranjo Meneses
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Dulce Abril Mena Orozco
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - César Ernesto Lam-Chung
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Vania Martínez Garcés
- Programa de Estudios Combinados en Medicina, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Octavio A Lecona
- Posgrado en Ciencias Biomédicas, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.,Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Arlex O Marín-García
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Alejandro Frank
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.,El Colegio Nacional, Ciudad de México, Mexico
| | - Ana Leonor Rivera
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
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Sevilla-Gonzalez MDR, Moreno Loaeza L, Lazaro-Carrera LS, Bourguet Ramirez B, Vázquez Rodríguez A, Peralta-Pedrero ML, Almeda-Valdes P. Spanish Version of the System Usability Scale for the Assessment of Electronic Tools: Development and Validation. JMIR Hum Factors 2020; 7:e21161. [PMID: 33325828 PMCID: PMC7773510 DOI: 10.2196/21161] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 06/07/2020] [Revised: 09/13/2020] [Accepted: 10/19/2020] [Indexed: 01/03/2023] Open
Abstract
Background The System Usability Scale (SUS) is a common metric used to assess the usability of a system, and it was initially developed in English. The implementation of electronic systems for clinical counseling (eHealth and mobile health) is increasing worldwide. Therefore, tools are needed to evaluate these applications in the languages and regional contexts in which the electronic tools are developed. Objective This study aims to translate, culturally adapt, and validate the original English version of the SUS into a Spanish version. Methods The translation process included forward and backward translation. Forward translations were made by 2 native Spanish speakers who spoke English as their second language, and a backward translation was made by a native English speaker. The Spanish SUS questionnaire was validated by 10 experts in mobile app development. The face validity of the questionnaire was tested with 10 mobile phone users, and the reliability testing was conducted among 88 electronic application users. Results The content validity index of the new Spanish SUS was good, as indicated by a rating of 0.92 for the relevance of the items. The questionnaire was easy to understand, based on a face validity index of 0.94. The Cronbach α was .812 (95% CI 0.748-0.866; P<.001). Conclusions The new Spanish SUS questionnaire is a valid and reliable tool to assess the usability of electronic tools among Spanish-speaking users.
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Affiliation(s)
- Magdalena Del Rocio Sevilla-Gonzalez
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States.,Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Nutrición Salvador Zubirán and Instituto Tecnológico y de Estudios Superiores de Monterrey Tec Salud, Ciudad de México, Mexico
| | - Lizbeth Moreno Loaeza
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Nutrición Salvador Zubirán and Instituto Tecnológico y de Estudios Superiores de Monterrey Tec Salud, Ciudad de México, Mexico
| | - Laura Sofia Lazaro-Carrera
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Nutrición Salvador Zubirán and Instituto Tecnológico y de Estudios Superiores de Monterrey Tec Salud, Ciudad de México, Mexico
| | - Brigette Bourguet Ramirez
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Nutrición Salvador Zubirán and Instituto Tecnológico y de Estudios Superiores de Monterrey Tec Salud, Ciudad de México, Mexico
| | | | | | - Paloma Almeda-Valdes
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Nutrición Salvador Zubirán and Instituto Tecnológico y de Estudios Superiores de Monterrey Tec Salud, Ciudad de México, Mexico.,Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
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27
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Romo-Romo A, Aguilar-Salinas CA, López-Carrasco MG, Guillén-Pineda LE, Brito-Córdova GX, Gómez-Díaz RA, Gómez-Pérez FJ, Almeda-Valdes P. Sucralose Consumption over 2 Weeks in Healthy Subjects Does Not Modify Fasting Plasma Concentrations of Appetite-Regulating Hormones: A Randomized Clinical Trial. J Acad Nutr Diet 2020; 120:1295-1304. [PMID: 32711853 DOI: 10.1016/j.jand.2020.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/23/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The effect of nonnutritive sweeteners on appetite is controversial. Some studies have found changes in certain appetite control hormones with sucralose intake that may be through interaction with sweet taste receptors located in the intestine. OBJECTIVE The aim of this study was to evaluate whether sucralose consumption could produce changes in fasting plasma concentrations of appetite-regulating hormones, including glucagon-like peptide 1, ghrelin, peptide tyrosine tyrosine, and leptin, and secondarily in insulin resistance. DESIGN A 2-week parallel randomized clinical trial with an additional visit conducted 1 week after dosing termination. PARTICIPANTS/SETTING Sixty healthy, normal-weight individuals, without habitual consumption of nonnutritive sweeteners were recruited from July 2015 to March 2017 in Mexico City. INTERVENTION Daily sucralose consumption at 15% of the acceptable daily intake by using commercial sachets added to food. The control group followed the same protocol without an intervention. MAIN OUTCOMES MEASURED Fasting concentrations of appetite regulating hormones before and after the intervention. Fasting glucose and insulin concentrations were measured to assess insulin resistance as a secondary outcome. STATISTICAL ANALYSIS PERFORMED Basal and final concentrations were compared using Wilcoxon matched-pairs test and Mann-Whitney U test for analysis between groups. Repeated measures analysis of variance was used to evaluate changes in the homeostasis model assessment of insulin resistance. RESULTS Sucralose was not associated with changes in any of the hormones measured. One week postintervention, an incremental change (P=0.04) in the homeostasis model assessment of insulin resistance was found in the intervention group. CONCLUSIONS Sucralose intake is not associated with changes in fasting concentrations of glucagon-like peptide 1, ghrelin, peptide tyrosine tyrosine, or leptin. An increase in the homeostasis model assessment of insulin resistance observed only at 1 week postdosing is of unknown clinical significance, if any.
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28
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Bello-Chavolla OY, Bahena-López JP, Vargas-Vázquez A, Antonio-Villa NE, Márquez-Salinas A, Fermín-Martínez CA, Rojas R, Mehta R, Cruz-Bautista I, Hernández-Jiménez S, García-Ulloa AC, Almeda-Valdes P, Aguilar-Salinas CA. Clinical characterization of data-driven diabetes subgroups in Mexicans using a reproducible machine learning approach. BMJ Open Diabetes Res Care 2020; 8:8/1/e001550. [PMID: 32699108 PMCID: PMC7380860 DOI: 10.1136/bmjdrc-2020-001550] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/05/2020] [Accepted: 06/14/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Previous reports in European populations demonstrated the existence of five data-driven adult-onset diabetes subgroups. Here, we use self-normalizing neural networks (SNNN) to improve reproducibility of these data-driven diabetes subgroups in Mexican cohorts to extend its application to more diverse settings. RESEARCH DESIGN AND METHODS We trained SNNN and compared it with k-means clustering to classify diabetes subgroups in a multiethnic and representative population-based National Health and Nutrition Examination Survey (NHANES) datasets with all available measures (training sample: NHANES-III, n=1132; validation sample: NHANES 1999-2006, n=626). SNNN models were then applied to four Mexican cohorts (SIGMA-UIEM, n=1521; Metabolic Syndrome cohort, n=6144; ENSANUT 2016, n=614 and CAIPaDi, n=1608) to characterize diabetes subgroups in Mexicans according to treatment response, risk for chronic complications and risk factors for the incidence of each subgroup. RESULTS SNNN yielded four reproducible clinical profiles (obesity related, insulin deficient, insulin resistant, age related) in NHANES and Mexican cohorts even without C-peptide measurements. We observed in a population-based survey a high prevalence of the insulin-deficient form (41.25%, 95% CI 41.02% to 41.48%), followed by obesity-related (33.60%, 95% CI 33.40% to 33.79%), age-related (14.72%, 95% CI 14.63% to 14.82%) and severe insulin-resistant groups. A significant association was found between the SLC16A11 diabetes risk variant and the obesity-related subgroup (OR 1.42, 95% CI 1.10 to 1.83, p=0.008). Among incident cases, we observed a greater incidence of mild obesity-related diabetes (n=149, 45.0%). In a diabetes outpatient clinic cohort, we observed increased 1-year risk (HR 1.59, 95% CI 1.01 to 2.51) and 2-year risk (HR 1.94, 95% CI 1.13 to 3.31) for incident retinopathy in the insulin-deficient group and decreased 2-year diabetic retinopathy risk for the obesity-related subgroup (HR 0.49, 95% CI 0.27 to 0.89). CONCLUSIONS Diabetes subgroup phenotypes are reproducible using SNNN; our algorithm is available as web-based tool. Application of these models allowed for better characterization of diabetes subgroups and risk factors in Mexicans that could have clinical applications.
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Affiliation(s)
- Omar Yaxmehen Bello-Chavolla
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Tlalpan, 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 Zubiran, Tlalpan, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Coyoacan, Mexico
| | - Neftali Eduardo Antonio-Villa
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Tlalpan, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Coyoacan, Mexico
| | - Alejandro Márquez-Salinas
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Coyoacan, Mexico
| | - Carlos A Fermín-Martínez
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Coyoacan, Mexico
| | - Rosalba Rojas
- Instituto Nacional de Salud Publica, Cuernavaca, Mexico
| | - Roopa Mehta
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Tlalpan, Mexico
| | - Ivette Cruz-Bautista
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Tlalpan, Mexico
| | - Sergio Hernández-Jiménez
- Center of Comprehensive Care for the Patient with Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ana Cristina García-Ulloa
- Center of Comprehensive Care for the Patient with Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Tlalpan, Mexico
| | - Carlos Alberto Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Tlalpan, Mexico
- Department of Endocrinology and Metabolism, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Tlalpan, Mexico
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Nuevo Leon, Mexico
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Sevilla M, Gomez-Velasco D, Cruz-Bautista I, Lazaro-Carrera L, Almeda-Valdes P, Tusie-Luna T, Manning A, Aguilar-Salinas C. The SLC16A11 Risk Haplotype for Type 2 Diabetes (T2D) Is Associated to Differentiated Responses in Weight Loss, and Glucose Metabolism After Treatments to Prevent T2D. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa058_033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
A haplotype in SLC16A11 is associated with decreased insulin action, and risk for type 2 diabetes (T2D) in Mexicans. We aim to determine the impact of the risk haplotype on SLC16A11 on early therapeutic responses in treatments to prevent T2D.
Methods
We recruited subjects with at least one prediabetes criteria according to the American Diabetes Association, and body mass index 25–45 kg/m2. Subjects were randomized in two groups: lifestyle intervention (LSI): hypocaloric diet, 25 kcal/kg of ideal weight, 45% of the total intake of carbohydrates, 30% lipids and 15% protein sources + physical activity (>150 min medium intensity per week), or LSI + metformin (750 mg prolonged release twice a day). Interventions were prescribed by standardized dietitians. The goal was to achieve >3% weight loss. We evaluated the early treatment response in a follow-up period of 12 weeks with intermediate visits each 3 weeks to reinforce knowledge and treatment goals. Evaluations (baseline and post-treatment) included an oral glucose tolerance test (OGTT), and dual-energy X-ray absorptiometry. Adherence to treatment was measured trough electronic recordings. Participants were genotyped for the risk allele rs13342232. Researchers remained blinded to the genotype results. The effects of the risk haplotype were evaluated with linear and logistic regressions adjusted by age, sex, and baseline body fat %.
Results
We evaluated 61 subjects, 30 carriers, and 31 non-carriers. Most of participants (57%) achieved ≥3% weight loss. The LSI + metformin treatment increased in carriers, 2 times OR 3 IC95% (1.07 – 8.6) (P = 0.04) the probability to reach the ≥3% weight loss goal compared with LSI and non-carriers. In the same treatment, carriers had a greater decrease in the total and incremental area under the curve of insulin in the OGTT IC95% (−1.75 −0.11) (P = 0.02) compared with non-carriers and LSI. Carriers also had higher decrease in postprandial glucose compared with non-carriers regardless of treatment −12.63 + 30.38 vs 0.71 30.24 (P = 0.02).
Conclusions
After 12 weeks of treatment, carriers with prediabetes showed a higher probability achieve weight loss and to improve insulin secretion with metformin. Regardless of the treatment, carriers were prone to improve postprandial glucose.
Funding Sources
Miguel Aleman Medical Research Award.
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Almeda-Valdes P, Herrera-Mercadillo RJ, Aguilar-Salinas CA, Uribe M, Méndez-Sánchez N. The Role of Diet in Patients with Metabolic Syndrome. Curr Med Chem 2019; 26:3613-3619. [PMID: 28521684 DOI: 10.2174/0929867324666170518095316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/16/2016] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 01/22/2023]
Abstract
Metabolic syndrome is a frequent metabolic disorder characterized by obesity and insulin resistance seems to be the main pathophysiological alteration. The goal of treating metabolic syndrome is to reduce the risk of coronary heart disease and the development of type 2 diabetes. The lifestyle modification therapy combines specific recommendations on diet alone or combined with other strategies. In this review, we address the following topics: 1) the importance of the high prevalence of metabolic syndrome and obesity, and 2) the role of lifestyle modification focusing on dietary fat intake in the management of MS.
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Affiliation(s)
- Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Roberto J Herrera-Mercadillo
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Misael Uribe
- Liver Research Unit, Medica Sur Clinic & Foundation. Mexico City, Mexico
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Bello-Chavolla OY, Antonio-Villa NE, Vargas-Vázquez A, Viveros-Ruiz TL, Almeda-Valdes P, Gomez-Velasco D, Mehta R, Elias-López D, Cruz-Bautista I, Roldán-Valadez E, Martagón AJ, Aguilar-Salinas CA. Metabolic Score for Visceral Fat (METS-VF), a novel estimator of intra-abdominal fat content and cardio-metabolic health. Clin Nutr 2019; 39:1613-1621. [PMID: 31400997 DOI: 10.1016/j.clnu.2019.07.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 02/09/2019] [Revised: 05/28/2019] [Accepted: 07/11/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS Intra-abdominal and visceral fat (VAT) are risk factors for the development of cardio-metabolic comorbidities; however its clinical assessment is limited by technology and required expertise for its assessment. We aimed to develop a novel score (METS-VF) to estimate VAT by combining the non-insulin-based METS-IR index, waist-height ratio (WHtr), age and sex. METHODS We developed METS-VF in a sample of 366 individuals with Dual X-ray absorptiometry (DXA). METS-VF was modeled using non-linear regression and validated in two replication cohorts with DXA (n = 184, with n = 118 who also had MRI) and bio-electrical impedance (n = 991). We also assessed METS-VF to predict incident type 2 diabetes (T2D) and arterial hypertension independent of body-mass index (BMI) in our Metabolic Syndrome Cohort (n = 6144). RESULTS We defined METS-VF as: 4.466 + 0.011*(Ln(METS-IR))3 + 3.239*(Ln(WHtr))3 + 0.319*(Sex) + 0.594*(Ln(Age)). METS-VF showed better performance compared to other VAT surrogates using either DXA (AUC 0.896 95% CI 0.847-0.945) or MRI (AUC 0.842 95% CI 0.771-0.913) as gold standards. We identified a METS-VF cut-off point >7.18 in healthy patients which has 100% sensitivity (95% CI 76.8-100) and 87.2% specificity (95% CI 79.1-93.0) to identify increased VAT (>100 cm2). METS-VF also had adequate performance in subjects with metabolically-healthy obesity. Finally, in our metabolic syndrome cohort, subjects in the upper quintiles of METS-VF (>7.2) had 3.8 and 2.0-fold higher risk of incident T2D and hypertension, respectively (p < 0.001). This effect was independent of BMI for both outcomes. CONCLUSION METS-VF is a novel surrogate to estimate VAT, which has better performance compared to other surrogate VAT indexes and is predictive of incident T2D and hypertension. METS-VF could be a useful tool to assess cardio-metabolic risk in primary care practice and research settings.
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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; MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico
| | - Neftali Eduardo Antonio-Villa
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico
| | - Arsenio Vargas-Vázquez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico
| | - Tannia Leticia Viveros-Ruiz
- Unidad de Investigación de Enfermedades Metabólicas, 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; Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Donaji Gomez-Velasco
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Roopa Mehta
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Daniel Elias-López
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Ivette Cruz-Bautista
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Ernesto Roldán-Valadez
- Directorate of Research, Hospital General de Mexico "Dr Eduardo Liceaga", Mexico; I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Radiology, Russia
| | - Alexandro J Martagón
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico.
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Bello-Chavolla O, Vargas-Vazquez A, Almeda-Valdes P, Antonio-Villa N, Aguilar Salinas C. MON-164 The Non-insulin-based METS-IR Index Combined With Liver Transaminases Improves Prediction Of Fatty Liver And Fibrosis. J Endocr Soc 2019. [PMCID: PMC6551077 DOI: 10.1210/js.2019-mon-164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND: Liver fat content (LFC) evaluation requires histologic examination of liver biopsy specimens, which is invasive and costly. Non-invasive alternatives to assess LFC, which include spectroscopy-MRI (MRI-S) and transient elastography (TE), are limited by cost and complexity. Laboratory-based surrogates to estimate LFC have been developed and include the AST/ALT ratio, Fatty Liver Index (FLI) and NAFLD score. Previous studies have shown that the non-insulin-based METS-IR index is associated with LFC. OBJECTIVE: To evaluate diagnostic performance of METS-IR combined with liver transaminase assessment to estimate LFC. METHODS: We assessed subjects with and without T2D who had a laboratory and MRI-S evaluation. Using linear regression, we developed an estimate of LFC using METS-IR and liver function tests; prediction was improved including sex and T2D using non-linear regression and bootstrap cross-validation (n=2,000). We contrasted the FLI and NAFLD scores with METS-IR to estimate LFC using partial correlation and to detect NAFLD (LFC>5.5% by MRI-S) using areas AUROC. This assessment was validated in a cohort of 197 subjects who underwent TE and a cohort of 57 subjects in whom liver biopsy specimens were collected during bariatric surgery to assess predictive performance for both liver steatosis and fibrosis. RESULTS: In the discovery cohort, we included 56 healthy subjects and 58 with T2D. We modeled the Metabolic Score for Liver Fat Content (METS-LFC) and LFC (r2=0.548) as: METS-LFC=(METS-IR*ALT)/(2*AST), Estimated LFC (%)=-3.524+[0.340*METS-LFC]+1.529(T2D)-1.620(Sex). NAFLD was present in 33 subjects (28.9%) of the discovery cohort. The correlation between estimated and observed LFC was higher for METS-LFC (ρ=0.735 95%CI 0.608-0.828) compared to other estimates as was the AUROC (AUC=0.869 95%CI 0.797-0.941). The validation cohort was composed by lean and obese individuals who had METS-LFC and TE; we observed increasing estimated LFC using METS-LFC with TE-derived liver steatosis categories (p<0.001). METS-IR had the better predictive performance for TE-diagnosed steatosis (AUC 0.860 95%CI 0.807-0.912), whilst FLI, METS-IR and METS-LFC had similarly predictive performance for liver fibrosis. Finally, we validated this index in liver biopsy specimens from subjects with average BMI of 45.54±7.47 kg/m2, 33 patients had steatosis and NASH histologic evidence and 10 had biopsy-proven NASH. Compared to biopsy specimens METS-LFC (AUC=0.759, p=0.004) was superior to FLI (AUC=0.615, p=0.201) and the NAFLD score (AUC=0.746, p=0.006) to detect liver steatosis. CONCLUSION: Combined estimation of METS-IR and liver transaminases improves prediction of liver fat content by MRI, TE and biopsy-proven liver steatosis.
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Affiliation(s)
| | | | | | - Neftali Antonio-Villa
- Unidad de Investigacin de Enfermedades Metabolica, Unidad de Investigación de Enfermedades Metabólicas, MEXICO CITY, , Mexico
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Tenorio-Rojo A, Almeda-Valdes P, Reza-Albarran A, Gomez-Perez F. SAT-535 Association Between Adiponectin and Bone Mineral Density in Mexican Postmenopausal Women with Normal Glucose Tolerance and Type 2 Diabetes Mellitus. J Endocr Soc 2019. [PMCID: PMC6552245 DOI: 10.1210/js.2019-sat-535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Adiponectin’s effect on bone health is not well dilucidated and literature reports are controversial. Human studies on the relationship between adiponectin and bone mineral density, have obtained variable results. Prevalence of osteoporosis and type 2 diabetes mellitus (T2DM) has significantly increased in our population, making it useful to identify a diagnostic and prognostic marker that can predict skeletal outcomes in these patients. Objective: To stablish the association between adiponectin levels and bone mineral density (BMD) in Mexican postmenopausal women with normal glucose tolerance (NGT) and T2DM. Material and methods: Cross-sectional study. We reviewed all bone densitometries since January 2014, identifying all postmenopausal women. We excluded patients with impaired fasting glucose, impaired glucose tolerance and concurrent diseases or therapies that could impact BMD. Glucose, HbA1c, adiponectin, body composition, and anthropometric parameters were measured in all participants. Considering an association of 0.30, allowing an α-error of 0.05 and β-error of 0.20 we estimated a sample size of 170 women. Results: 69 women have been recruited until October 2018 (NGT n= 35; T2DM n= 34). Mean age was 64.2 ± 9.6 years with time since menopause onset of 15.5 ± 8.3 years. Mean BMI was 26.5 ± 4.3 kg/m2, mean body fat 39.4 ± 5.8% and median waist circumference 85 [78.3-93] cm. In women with T2DM median time from diagnosis was 12 years and median HbA1c of 7% (6.2-8.0%). There were no significant differences in adiponectin concentration between groups (NGT: 11.7 [8.4-20.4] μg/mL; T2DM: 9.7 [5.7-17.3] μg/mL, p= 0.192). In all participants we observed a positive correlation between body weight and BMD in the femoral neck (ρ= 0.435, p< 0.0001), total hip (ρ= 0.405, p= 0.001) and lumbar spine (ρ= 0.387, p= 0.001). A negative association between adiponectin and BMD was demonstrated only in the femoral neck (ρ = -0.349, p = 0.004). Analyzing by subgroups women with NTG preserve this association (ρ = - 0.348, p = 0.044), while women with T2DM only show a tendency (ρ = -0.320, p = 0.075). When adjusting by body weight, the association was lost (NGT ρ = -0.252, p = 0.157; T2DM ρ = -0.075, p = 0.689). Conclusion: There is no association between adiponectin levels and BMD in Mexican postmenopausal women with NGT and T2DM. The negative association observed before the adjustment was mediated by body weight. To clarify these findings is necessary to complete the study’s sample size.
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Affiliation(s)
- Andrea Tenorio-Rojo
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, , Mexico
| | - Paloma Almeda-Valdes
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, , Mexico
| | - Alfredo Reza-Albarran
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, , Mexico
| | - Francisco Gomez-Perez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, , Mexico
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Almeda-Valdes P, Gómez Velasco DV, Arellano Campos O, Bello-Chavolla OY, Del Rocío Sevilla-González M, Viveros Ruiz T, Martagón Rosado AJ, Bautista CJ, Muñoz Hernandez L, Cruz-Bautista I, Moreno-Macias H, Huerta-Chagoya A, Rodríguez-Álvarez KG, Walford GA, Jacobs SBR, Guillen Pineda LE, Ordoñez-Sánchez ML, Roldan-Valadez E, Azpiroz J, Furuzawa-Carballeda J, Clark P, Herrera-Hernández MF, Zambrano E, Florez JC, Tusié Luna MT, Aguilar-Salinas CA. The SLC16A11 risk haplotype is associated with decreased insulin action, higher transaminases and large-size adipocytes. Eur J Endocrinol 2019; 180:99-107. [PMID: 30475225 DOI: 10.1530/eje-18-0677] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/19/2018] [Indexed: 02/05/2023]
Abstract
Objective A haplotype at chromosome 17p13 that reduces expression and function of the solute carrier transporter SLC16A11 is associated with increased risk for type 2 diabetes in Mexicans. We aim to investigate the detailed metabolic profile of SLC16A11 risk haplotype carriers to identify potential physiological mechanisms explaining the increased type 2 diabetes risk. Design Cross-sectional study. Methods We evaluated carriers (n = 72) and non-carriers (n = 75) of the SLC16A11 risk haplotype, with or without type 2 diabetes. An independent sample of 1069 subjects was used to replicate biochemical findings. The evaluation included euglycemic-hyperinsulinemic clamp, frequently sampled intravenous glucose tolerance test (FSIVGTT), dual-energy X-ray absorptiometry (DXA), MRI and spectroscopy and subcutaneous abdominal adipose tissue biopsies. Results Fat-free mass (FFM)-adjusted M value was lower in carriers of the SLC16A11 risk haplotype after adjusting for age and type 2 diabetes status (β = -0.164, P = 0.04). Subjects with type 2 diabetes and the risk haplotype demonstrated an increase of 8.76 U/L in alanine aminotransferase (ALT) (P = 0.02) and of 7.34 U/L in gamma-glutamyltransferase (GGT) (P = 0.05) compared with non-carriers and after adjusting for gender, age and ancestry. Among women with the risk haplotype and normal BMI, the adipocyte size was higher (P < 0.001). Conclusions Individuals carrying the SLC16A11 risk haplotype exhibited decreased insulin action. Higher serum ALT and GGT levels were found in carriers with type 2 diabetes, and larger adipocytes in subcutaneous fat in the size distribution in carrier women with normal weight.
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Affiliation(s)
- Paloma Almeda-Valdes
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Donaji V Gómez Velasco
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Olimpia Arellano Campos
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Omar Yaxmehen Bello-Chavolla
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Magdalena Del Rocío Sevilla-González
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Tannia Viveros Ruiz
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Alexandro J Martagón Rosado
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Claudia J Bautista
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Liliana Muñoz Hernandez
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Ivette Cruz-Bautista
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Hortensia Moreno-Macias
- Unidad de Biología Molecular y Medicina Genómica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán/Instituto de Investigaciones Biomédicas UNAM, Mexico City, Mexico
- División de Ciencias Sociales y Humanidades, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Alicia Huerta-Chagoya
- Unidad de Biología Molecular y Medicina Genómica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán/Instituto de Investigaciones Biomédicas UNAM, Mexico City, Mexico
| | - Karen Guadalupe Rodríguez-Álvarez
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
| | - Geoffrey A Walford
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Suzanne B R Jacobs
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Luz E Guillen Pineda
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ma Luisa Ordoñez-Sánchez
- Unidad de Biología Molecular y Medicina Genómica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán/Instituto de Investigaciones Biomédicas UNAM, Mexico City, Mexico
| | - Ernesto Roldan-Valadez
- Directorate of Research, Hospital General de Mexico "Dr Eduardo Liceaga", Dr Balmis 148, Col. Doctores, Del. Cuauhtemoc, 06726 Mexico City, Mexico
- Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya str., 8, b. 2, 119992 Moscow, Russia
| | - Joaquín Azpiroz
- Centro Nacional de Investigación en Imagenología e Instrumentación Médica, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Jannette Furuzawa-Carballeda
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Patricia Clark
- Unidad de Epidemiología Clínica, Hospital Infantil de México Federico Gómez-Facultad de Medicina Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Miguel F Herrera-Hernández
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Elena Zambrano
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jose C Florez
- Center for Genomic Medicine and Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - María Teresa Tusié Luna
- Unidad de Biología Molecular y Medicina Genómica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán/Instituto de Investigaciones Biomédicas UNAM, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L. México
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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De Los Santos-Aguilar RG, Chávez-Villa M, Contreras AG, García-Herrera JS, Gamboa-Domínguez A, Vargas-Sánchez J, Almeda-Valdes P, Reza-Albarrán AA, Iñiguez-Ariza NM. Successful Multimodal Treatment of an IGF2-Producing Solitary Fibrous Tumor With Acromegaloid Changes and Hypoglycemia. J Endocr Soc 2019; 3:537-543. [PMID: 30788455 PMCID: PMC6371079 DOI: 10.1210/js.2018-00281] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022] Open
Abstract
Doege–Potter syndrome with acromegaloid facial changes is extremely rare. Uncooked cornstarch along with glucocorticoids have been used as supportive care in patients with non–islet cell tumor hypoglycemia (NICTH). Preoperative embolization of hepatic solitary fibrous tumors (SFT) with NICTH has yielded unsatisfactory results. Herein we present the case of a 61-year-old man with a 3-month history of severe frequent hypoglycemic episodes and acromegaloid facial changes. During a spontaneous hypoglycemia (26 mg/dL), laboratory values showed a hypoinsulinemic pattern with low levels of GH, IGFPB3, and an IGF2/IGF1 ratio of 8.5:1. Cross-sectional imaging revealed a large (16 × 13 × 11 cm) hepatic tumor, and cytology was consistent with SFT. A preoperative right portal embolization was performed in an effort to induce normal remnant liver hypertrophy to allow for safe tumor resection. After the procedure, uncooked starch treatment followed by prednisone was started, achieving complete remission of hypoglycemic episodes in the preoperative setting. He subsequently underwent partial hepatectomy. The histologic diagnosis was compatible with a potentially malignant SFT. The patient had an excellent outcome with complete remission of hypoglycemia, improvement of facial acromegaloid changes, and no further evidence of disease. To our knowledge, this is the first case of a patient with Doege–Potter syndrome with acromegaloid facial changes induced by a potentially malignant liver SFT, treated successfully with a multimodal approach consisting of uncooked cornstarch, low-dose prednisone, preoperative embolization, and complete surgical resection. The use of cornstarch and low-dose glucocorticoids may be an adequate treatment in advance of undergoing surgery.
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Affiliation(s)
- Ramón G De Los Santos-Aguilar
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mariana Chávez-Villa
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alan G Contreras
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan S García-Herrera
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Armando Gamboa-Domínguez
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Joel Vargas-Sánchez
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Research Unit for Metabolic Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo A Reza-Albarrán
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Nicole M Iñiguez-Ariza
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Gómez-Velasco DV, Almeda-Valdes P, Martagón AJ, Galán-Ramírez GA, Aguilar-Salinas CA. Empowerment of patients with type 2 diabetes: current perspectives. Diabetes Metab Syndr Obes 2019; 12:1311-1321. [PMID: 31496769 PMCID: PMC6689555 DOI: 10.2147/dmso.s174910] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 06/25/2019] [Indexed: 01/18/2023] Open
Abstract
Patient empowerment is a continuous process in which knowledge, motivation, and capacity to take control of their disease are built within a person. This concept is not always well understood and applied. This review describes the strategies to induce empowerment in patients with diabetes. In addition, the most common scales used to evaluate empowerment in diabetes is described. Furthermore, the effectiveness of the empowerment-based interventions for improving metabolic control and diabetes knowledge are described. Finally, we discuss opportunities for empowerment implementation in clinical practice and current needs on research that can be translated into public policies.
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Affiliation(s)
- Donají V Gómez-Velasco
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 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
| | - Alexandro J Martagón
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Gabriela A Galán-Ramírez
- 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
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
- Correspondence: Carlos A Aguilar-SalinasUnidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15 Colonia Belisario Domínguez Sección XVI. Delegación Tlalpan, Mexico City14080, MexicoTel +52 555 487 0900 ext 6319 Email
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Almeda-Valdes P, Palacio Ríofrio J, Zamudio Coronado K, Rivera de la Parra D, Bermeo Cabrera J, Gómez-Pérez F, Aguilar-Salinas C, Mehta R. Factors Associated with Insulin Nonadherence in Type 1 Diabetes Mellitus Patients in Mexico. Dubai Diabetes Endocrinol J 2019. [DOI: 10.1159/000502903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
<b><i>Background:</i></b> Lack of adherence to insulin therapy is common among patients with type 1 diabetes. Factors associated with insulin omission in adult persons with type 1 diabetes in Latin America have not been studied in detail. <b><i>Objectives:</i></b> To investigate factors associated with insulin nonadherence including the presence of psychological disorders (disordered eating behaviors and depression) in adult patients with type 1 diabetes. <b><i>Methods:</i></b> Cross-sectional study including 104 consecutive adults (≥18 years old) attending a tertiary care center in Mexico City. Adherence to insulin therapy was measured with a specific item in a questionnaire. Sociodemographic data and factors related to insulin omission, including validated questionnaires to evaluate disordered eating behavior and depression, were collected and compared between the nonadherent and adherent groups with parametric or nonparametric statistical tests, as appropriate. <b><i>Results:</i></b> We classified 51 (49.1%) patients as nonadherent and 53 (50.9%) as adherent. Adherent subjects reported that they planned their activities around insulin application more often than the nonadherent subjects did (43.4 vs. 23.5%, <i>p</i> = 0.032). In a logistic regression model, fear of hypoglycemia (OR = 11.39) and economic reasons (OR = 6.02) were independently associated with insulin adherence. Presence of disordered eating behavior was identified in 14.4% of subjects, the majority belonging to the nonadherent group. <b><i>Conclusions:</i></b> Only 50% of the patients with type 1 diabetes were adherent. The principal factors associated with nonadherence were economic reasons and fear of hypoglycemia.
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Romo-Romo A, Aguilar-Salinas CA, Brito-Córdova GX, Gómez-Díaz RA, Almeda-Valdes P. Sucralose decreases insulin sensitivity in healthy subjects: a randomized controlled trial. Am J Clin Nutr 2018; 108:485-491. [PMID: 30535090 DOI: 10.1093/ajcn/nqy152] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/14/2018] [Indexed: 01/16/2023] Open
Abstract
Background Recently, the absence of metabolic effects from nonnutritive sweeteners has been questioned. Objective The aim of this study was to evaluate the effects of sucralose consumption on glucose metabolism variables. Design We performed a randomized controlled trial involving healthy subjects without comorbidities and with a low habitual consumption of nonnutritive sweeteners (n = 33/group). Methods The intervention consisted of sucralose consumption as 15% of Acceptable Daily Intake every day for 14 d using commercial sachets. The control group followed the same procedures without any intervention. The glucose metabolism variables (insulin sensitivity, acute insulin response to glucose, disposition index, and glucose effectiveness) were evaluated by using a 3-h modified intravenous-glucose-tolerance test before and after the intervention period. Results Individuals assigned to sucralose consumption showed a significant decrease in insulin sensitivity with a median (IQR) percentage change of -17.7% (-29.3% to -1.0%) in comparison to -2.8% (-30.7% to 40.6%) in the control group (P= 0.04). An increased acute insulin response to glucose from 577 mU · L-1· min (350-1040 mU · L-1· min) to 671 mU · L-1· min (376-1010 mU · L-1· min) (P = 0.04) was observed in the sucralose group for participants with adequate adherence. Conclusions Sucralose may have effects on glucose metabolism, and our study complements findings previously reported in other trials. Further studies are needed to confirm the decrease in insulin sensitivity and to explore the mechanisms for these metabolic alterations. This trial was registered at www.clinicaltrials.gov as NCT02589002.
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Affiliation(s)
| | - Carlos A Aguilar-Salinas
- Departamento de Endocrinología y Metabolismo, and.,Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | | | - Rita A Gómez-Díaz
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Departamento de Endocrinología y Metabolismo, and.,Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Bello-Chavolla OY, Almeda-Valdes P, Gomez-Velasco D, Viveros-Ruiz T, Cruz-Bautista I, Romo-Romo A, Sánchez-Lázaro D, Meza-Oviedo D, Vargas-Vázquez A, Campos OA, Sevilla-González MDR, Martagón AJ, Hernández LM, Mehta R, Caballeros-Barragán CR, Aguilar-Salinas CA. METS-IR, a novel score to evaluate insulin sensitivity, is predictive of visceral adiposity and incident type 2 diabetes. Eur J Endocrinol 2018. [PMID: 29535168 DOI: 10.1530/eje-17-0883] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We developed a novel non-insulin-based fasting score to evaluate insulin sensitivity validated against the euglycemic-hyperinsulinemic clamp (EHC). We also evaluated its correlation with ectopic fact accumulation and its capacity to predict incident type 2 diabetes mellitus (T2D). DESIGN AND METHODS The discovery sample was composed by 125 subjects (57 without and 68 with T2D) that underwent an EHC. We defined METS-IR as Ln((2*G0)+TG0)*BMI)/(Ln(HDL-c)) (G0: fasting glucose, TG0: fasting triglycerides, BMI: body mass index, HDL-c: high-density lipoprotein cholesterol), and compared its diagnostic performance against the M-value adjusted by fat-free mass (MFFM) obtained by an EHC. METS-IR was validated in a sample with EHC data, a sample with modified frequently sampled intravenous glucose tolerance test (FSIVGTT) data and a large cohort against HOMA-IR. We evaluated the correlation of the score with intrahepatic and intrapancreatic fat measured using magnetic resonance spectroscopy. Subsequently, we evaluated its ability to predict incident T2D cases in a prospective validation cohort of 6144 subjects. RESULTS METS-IR demonstrated the better correlation with the MFFM (ρ = -0.622, P < 0.001) and diagnostic performance to detect impaired insulin sensitivity compared to both EHC (AUC: 0.84, 95% CI: 0.78-0.90) and the SI index obtained from the FSIVGTT (AUC: 0.67, 95% CI: 0.53-0.81). METS-IR significantly correlated with intravisceral, intrahepatic and intrapancreatic fat and fasting insulin levels (P < 0.001). After a two-year follow-up, subjects with METS-IR in the highest quartile (>50.39) had the highest adjusted risk to develop T2D (HR: 3.91, 95% CI: 2.25-6.81). Furthermore, subjects with incident T2D had higher baseline METS-IR compared to healthy controls (50.2 ± 10.2 vs 44.7 ± 9.2, P < 0.001). CONCLUSION METS-IR is a novel score to evaluate cardiometabolic risk in healthy and at-risk subjects and a promising tool for screening of insulin sensitivity.
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Affiliation(s)
- Omar Yaxmehen Bello-Chavolla
- Unidad de Investigación de Enfermedades MetabólicasInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
- MD/PhD (PECEM) ProgramFacultad de Medicina, Universidad Nacional Autónoma de México, Mexico, Mexico
| | - Paloma Almeda-Valdes
- Unidad de Investigación de Enfermedades MetabólicasInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
- Department of Endocrinology and MetabolismInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico
| | - Donaji Gomez-Velasco
- Unidad de Investigación de Enfermedades MetabólicasInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | - Tannia Viveros-Ruiz
- Unidad de Investigación de Enfermedades MetabólicasInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | - Ivette Cruz-Bautista
- Unidad de Investigación de Enfermedades MetabólicasInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | - Alonso Romo-Romo
- Unidad de Investigación de Enfermedades MetabólicasInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | - Daniel Sánchez-Lázaro
- Unidad de Investigación de Enfermedades MetabólicasInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | - Dushan Meza-Oviedo
- Unidad de Investigación de Enfermedades MetabólicasInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | - Arsenio Vargas-Vázquez
- Unidad de Investigación de Enfermedades MetabólicasInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
- MD/PhD (PECEM) ProgramFacultad de Medicina, Universidad Nacional Autónoma de México, Mexico, Mexico
| | - Olimpia Arellano Campos
- Unidad de Investigación de Enfermedades MetabólicasInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | | | - Alexandro J Martagón
- Unidad de Investigación de Enfermedades MetabólicasInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
- Instituto Tecnológico y de Estudios Superiores de Monterrey Tec SaludMonterrey, Mexico
| | - Liliana Muñoz Hernández
- Unidad de Investigación de Enfermedades MetabólicasInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | - Roopa Mehta
- Unidad de Investigación de Enfermedades MetabólicasInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | | | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades MetabólicasInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
- Department of Endocrinology and MetabolismInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico
- Instituto Tecnológico y de Estudios Superiores de Monterrey Tec SaludMonterrey, Mexico
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Yoshino J, Almeda-Valdes P, Moseley AC, Mittendorfer B, Klein S. Percutaneous muscle biopsy-induced tissue injury causes local endoplasmic reticulum stress. Physiol Rep 2018; 6:e13679. [PMID: 29687616 PMCID: PMC5913661 DOI: 10.14814/phy2.13679] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 01/12/2023] Open
Abstract
Endoplasmic reticulum (ER) stress is likely involved in the pathogenesis of metabolic dysfunction in people with obesity and diabetes. Although tissue biopsy is often used to evaluate the presence and severity of ER stress, it is not known whether acute tissue injury‐induced by percutaneous muscle biopsy causes ER stress and its potential downstream effects on markers of inflammation and metabolic function. In this study, we tested the hypothesis that percutaneous biopsy‐induced tissue injury causes ER stress and alters inflammatory and metabolic pathways in skeletal muscle. Vastus lateralis muscle tissue was obtained by percutaneous biopsy at 0600 h and 12 h later from either the contralateral leg (Group 1, n = 6) or at the same site as the initial biopsy (Group 2, n = 6) in women who were overweight. Muscle gene expression of selected markers of ER stress, inflammation, and regulators of glucose and lipid metabolism were determined. Compared with Group 1, muscle gene expression in the second biopsy sample obtained in Group 2 demonstrated marked increases in markers of ER stress (GRP78, XBP1, ATF6) and inflammation (IL6, TNF), and alterations in metabolic regulators (decreased expression of GLUT4 and PPARGC1A and increased expression of FASN). Our results suggest that acute tissue injury induced by percutaneous muscle biopsy causes an integrated local response that involves an induction of ER stress and alterations in markers of inflammation and regulators of glucose and lipid metabolism.
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Affiliation(s)
- Jun Yoshino
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Paloma Almeda-Valdes
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Anna C Moseley
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Bettina Mittendorfer
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Samuel Klein
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Yamaguchi S, Moseley AC, Almeda-Valdes P, Stromsdorfer KL, Franczyk MP, Okunade AL, Patterson BW, Klein S, Yoshino J. Diurnal Variation in PDK4 Expression Is Associated With Plasma Free Fatty Acid Availability in People. J Clin Endocrinol Metab 2018; 103:1068-1076. [PMID: 29294006 PMCID: PMC6283414 DOI: 10.1210/jc.2017-02230] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/20/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Many biological pathways involved in regulating substrate metabolism display rhythmic oscillation patterns. In rodents, clock genes regulate circadian rhythms of metabolic genes and substrate metabolism. However, the interrelationships among substrate metabolism, metabolic genes, and clock genes have not been fully explored in people. OBJECTIVE We tested the hypothesis that the diurnal expression pattern of pyruvate dehydrogenase kinase 4 (PDK4), a key metabolic enzyme involved in fuel switching between glucose and free fatty acids (FFAs), is associated with plasma FFA concentration and clock genes. DESIGN AND METHODS We analyzed peripheral blood mononuclear cells (PBMCs), subcutaneous adipose tissue, and plasma samples obtained serially during 24 hours from metabolically healthy women (n = 10) and evaluated the interrelationships among PDK4, plasma FFA, and clock genes. We also determined the potential mechanisms responsible for PDK4 transcriptional regulation by using primary human PBMCs and adipocytes. RESULTS We found that PDK4 diurnal expression patterns were similar in PBMCs and adipose tissue (ρ = 0.84, P < 0.001). The diurnal variation in PBMC PDK4 expression correlated more strongly with plasma FFA and insulin (ρ = 0.86 and 0.63, respectively, both P < 0.001) concentrations than clock genes. Data obtained from primary culture experiments demonstrated that FFAs directly induced PDK4 gene expression, at least in part through activation of peroxisome proliferator-activated receptor α. CONCLUSIONS Our results suggest that plasma FFA availability is an important regulator of diurnal expression patterns of PDK4, and we identify a novel interaction between plasma FFA and cellular diurnal rhythms in regulating substrate metabolism.
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Affiliation(s)
- Shintaro Yamaguchi
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Anna C Moseley
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Paloma Almeda-Valdes
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kelly L Stromsdorfer
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Michael P Franczyk
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Adewole L Okunade
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Bruce W Patterson
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Samuel Klein
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jun Yoshino
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- Correspondence and Reprint Requests: Jun Yoshino, MD, PhD, Center for Human Nutrition, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8031, St. Louis, Missouri 63110. E-mail:
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Bermeo-Cabrera J, Almeda-Valdes P, Riofrios-Palacios J, Aguilar-Salinas CA, Mehta R. Insulin Adherence in Type 2 Diabetes in Mexico: Behaviors and Barriers. J Diabetes Res 2018; 2018:3190849. [PMID: 30116737 PMCID: PMC6079463 DOI: 10.1155/2018/3190849] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/16/2018] [Accepted: 06/28/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To investigate factors associated with insulin adherence in subjects with type 2 diabetes mellitus (T2D) attending a tertiary care centre in Mexico City. MATERIAL AND METHODS Cross-sectional study, including 200 patients. Adherence to insulin therapy was measured with a medication adherence questionnaire. Sociodemographic data and factors related to insulin omission were collected and compared between the nonadherent and adherent groups. RESULTS We categorized 117 (58.5%) patients as nonadherent and 83 (41.5%) as adherent. Among the adherent, only 22 patients (11%) had excellent adherence to insulin therapy. The following factors were associated with nonadherence: lack of planning of daily activities (46.1%), fear of hypoglycemia (41%), economic factors (15.4%), and number of insulin applications (2.31 versus 1.76 applications per day). CONCLUSIONS In this study, patients with type 2 diabetes attending a tertiary care referral centre showed inadequate adherence to insulin therapy. The principal factors associated with insulin omission were low socioeconomic status, fear of hypoglycemia, and a greater number of insulin applications per day.
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Affiliation(s)
- Janneth Bermeo-Cabrera
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Josefa Riofrios-Palacios
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A. Aguilar-Salinas
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Roopa Mehta
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Almeda-Valdes P, Aguilar-Salinas CA, Uribe M, Canizales-Quinteros S, Méndez-Sánchez N. Impact of anthropometric cut-off values in determining the prevalence of metabolic alterations. Eur J Clin Invest 2016; 46:940-946. [PMID: 27600089 DOI: 10.1111/eci.12672] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of obesity has increased worldwide in parallel with associated metabolic disturbances such as diabetes and non-alcoholic fatty liver disease. OBJECTIVE The objective of this article is to underscore discrepancies in the standard anthropometric cut-off values and the presence of metabolic disturbances including diabetes and non-alcoholic fatty liver disease caused by biological and ethnic variations. MATERIALS AND METHODS We performed a literature review regarding the diagnosis and prevalence of obesity, diabetes, metabolic syndrome and non-alcoholic fatty liver disease and about the different available indicators to define obesity. RESULTS There is an ongoing epidemic of these chronic diseases, partially attributed to the increased prevalence of obesity. The available markers to indicate adiposity are imperfect, and the selection of accurate cut-off points is still not clear. CONCLUSION Methods to quantify adiposity that are useful in clinical practice should be developed to better classify individuals and to reflect metabolic risk more appropriately.
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Affiliation(s)
- Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Misael Uribe
- Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Samuel Canizales-Quinteros
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, Universidad Nacional Autónoma de México, Instituto Nacional de Medicina Genómica (INMEGEN), Tlalpan, Mexico
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Romo-Romo A, Aguilar-Salinas CA, Brito-Córdova GX, Gómez Díaz RA, Vilchis Valentín D, Almeda-Valdes P. Effects of the Non-Nutritive Sweeteners on Glucose Metabolism and Appetite Regulating Hormones: Systematic Review of Observational Prospective Studies and Clinical Trials. PLoS One 2016; 11:e0161264. [PMID: 27537496 PMCID: PMC4990242 DOI: 10.1371/journal.pone.0161264] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/02/2016] [Indexed: 01/17/2023] Open
Abstract
Background The effects of non-nutritive sweeteners (NNS) on glucose metabolism and appetite regulating hormones are not clear. There is an ongoing debate concerning NNS use and deleterious changes in metabolism. Objectives The aim of this review is to analyze the scientific available evidence regarding the effects of NNS on glucose metabolism and appetite regulating hormones. Data Sources and Study Eligibility Criteria We identified human observational studies evaluating the relation between NNS consumption and obesity, diabetes, and metabolic syndrome, in addition to clinical trials evaluating the effects of NNS in glucose metabolism and appetite regulating hormones. Results Fourteen observational studies evaluating the association between NNS consumption and the development of metabolic diseases and twenty-eight clinical trials studying the effects of NNS on metabolism were included. Finally, two meta-analyses evaluating the association between the consumption of NNS-containing beverages and the development of type 2 diabetes were identified. Conclusions Some observational studies suggest an association between NNS consumption and development of metabolic diseases; however, adiposity is a confounder frequently found in observational studies. The effects of the NNS on glucose metabolism are not clear. The results of the identified clinical trials are contradictory and are not comparable because of the major existing differences between them. Studies evaluating specific NNS, with an adequate sample size, including a homogeneous study group, identifying significant comorbidities, with an appropriate control group, with an appropriate exposure time, and considering adjustment for confounder variables such as adiposity are needed.
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Affiliation(s)
- Alonso Romo-Romo
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Endocrinology and Metabolism, México City, México
| | - Carlos A. Aguilar-Salinas
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Endocrinology and Metabolism, México City, México
| | - Griselda X. Brito-Córdova
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Endocrinology and Metabolism, México City, México
| | - Rita A. Gómez Díaz
- Medical Research Unit in Clinical Epidemiology, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México City, México
| | - David Vilchis Valentín
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Endocrinology and Metabolism, México City, México
| | - Paloma Almeda-Valdes
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Endocrinology and Metabolism, México City, México
- * E-mail:
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Aguilar-Olivos NE, Almeda-Valdes P, Aguilar-Salinas CA, Uribe M, Méndez-Sánchez N. The role of bariatric surgery in the management of nonalcoholic fatty liver disease and metabolic syndrome. Metabolism 2016; 65:1196-207. [PMID: 26435078 DOI: 10.1016/j.metabol.2015.09.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [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: 08/01/2015] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. NAFLD is strongly associated with obesity and metabolic syndrome (MetS). Current treatment of NAFLD is based on weight reduction. Bariatric surgery is the most effective treatment for morbid obesity and its associated metabolic comorbidities. There is evidence indicating that bariatric surgery improves histological and biochemical parameters of NAFLD, but currently is not considered a treatment option for NAFLD. The aim of this work is to review the evidence for the effects of bariatric surgery on NAFLD and the MetS. We found that insulin resistance, alterations in glucose metabolism, hypertension, plasma lipids, transaminases, liver steatosis, steatohepatitis and fibrosis improve after bariatric surgery. Weight loss and improvement of NAFLD are greater after RYGB than after other interventions. These findings were obtained from retrospective or cohort studies. There are no studies designed to evaluate liver-specific mortality, liver transplantation, or quality of life. Patients with indications for bariatric surgery will benefit from the improvements in the MetS and NAFLD.
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Affiliation(s)
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Misael Uribe
- Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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Janka-Zires M, Almeda-Valdes P, Uribe-Wiechers AC, Juárez-Comboni SC, López-Gutiérrez J, Escobar-Jiménez JJ, Gómez-Pérez FJ. Topical Administration of Pirfenidone Increases Healing of Chronic Diabetic Foot Ulcers: A Randomized Crossover Study. J Diabetes Res 2016; 2016:7340641. [PMID: 27478849 PMCID: PMC4958428 DOI: 10.1155/2016/7340641] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/31/2016] [Indexed: 01/08/2023] Open
Abstract
Only 30 percent of chronic diabetic foot ulcers heal after 20 weeks of standard treatment. Pirfenidone is a drug with biological, anti-inflammatory, and antifibrotic effects. The aim of this study was to evaluate the effect of topical pirfenidone added to conventional treatment in noninfected chronic diabetic foot ulcers. This was a randomized crossover study. Group 1 received topical pirfenidone plus conventional treatment for 8 weeks; after this period, they were switched to receive conventional treatment only for 8 more weeks. In group 2, the order of the treatments was the opposite. The end points were complete ulcer healing and size reduction. Final data were obtained from 35 ulcers in 24 patients. Fifty-two percent of ulcers treated with pirfenidone healed before 8 weeks versus 14.3% treated with conventional treatment only (P = 0.025). Between 8 and 16 weeks, 30.8% ulcers that received pirfenidone healed versus 0% with conventional treatment (P = 0.081). By week 8, the reduction in ulcer size was 100% [73-100] with pirfenidone versus 57.5% with conventional treatment [28.9-74] (P = 0.011). By week 16, the reduction was 93% [42.7-100] with pirfenidone and 21.8% [8-77.5] with conventional treatment (P = 0.050). The addition of topical pirfenidone to conventional treatment significantly improves the healing of chronic diabetic noninfected foot ulcers.
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Affiliation(s)
- Marcela Janka-Zires
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Endocrinology and Metabolism Department, Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080 Mexico City, CDMX, Mexico
| | - Paloma Almeda-Valdes
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Endocrinology and Metabolism Department, Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080 Mexico City, CDMX, Mexico
- *Paloma Almeda-Valdes:
| | - Ana Cecilia Uribe-Wiechers
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Endocrinology and Metabolism Department, Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080 Mexico City, CDMX, Mexico
| | - Sonia Citlali Juárez-Comboni
- Grupo Ángeles, Camino a Santa Teresa 1055, Colonia Héroes de Padierna, Magdalena Contreras, 10700 Mexico City, CDMX, Mexico
| | - Joel López-Gutiérrez
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Endocrinology and Metabolism Department, Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080 Mexico City, CDMX, Mexico
| | | | - Francisco J. Gómez-Pérez
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Endocrinology and Metabolism Department, Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080 Mexico City, CDMX, Mexico
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Almeda-Valdes P, Altamirano-Barrera A, Uribe M, Méndez-Sánchez N. Metabolic Features of Alcoholic Liver Disease. Rev Recent Clin Trials 2016; 11:220-226. [PMID: 27527894 DOI: 10.2174/1574887111666160815102725] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/17/2016] [Accepted: 06/04/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Alcoholic Liver Disease (ALD) can be defined as the hepatic manifestations caused by excessive alcohol intake. ALD comprises a spectrum from simple steatosis to cirrhosis. OBJECTIVE To review diverse clinical and metabolic characteristics and their impact in ALD. CONCLUSION The concurrence of metabolic alterations, including obesity and diabetes, and alcohol consumption increase the risk of liver injury and also the morbidity and mortality associated with chronic liver disease.
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Affiliation(s)
| | | | | | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Col. Toriello Guerra, ZP 14050, Mexico City, Mexico
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Almeda-Valdes P, Altamirano-Barrera A, Méndez-Sánchez N. Insights in non-alcoholic fatty liver disease pathophysiology with lipidomic analyses. Ann Hepatol 2015; 14:567-9. [PMID: 26019047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Paloma Almeda-Valdes
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran. Endocrinology and Metabolism Department. Mexico City, Mexico
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Almeda-Valdes P, Aguilar-Olivos N, Uribe M, Méndez-Sánchez N. Common features of the metabolic syndrome and nonalcoholic fatty liver disease. Rev Recent Clin Trials 2015; 9:148-58. [PMID: 25514910 DOI: 10.2174/1574887109666141216103908] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 01/27/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is an important cause of chronic liver disease; including simple steatosis, steatohepatitis, fibrosis, or cirrhosis. The metabolic syndrome (MS) is the existence of metabolic alterations that confer an increased risk for developing cardiovascular disease and diabetes. NAFLD and MS frequently coexist and 90% of NAFLD patients have more than one manifestation of the MS. In addition, both entities are related to other comorbid conditions. Scientific advances in the understanding of the association between NAFLD and the MS have identified insulin resistance as a key aspect in the pathophysiology of both diseases. Knowledge gained from these advances can be applied clinically in the management and prevention of NAFLD, the MS, and associated metabolic alterations. Cardiovascular disease is the leading cause of death in patients with NAFLD and the MS, therefore adequate diagnosis and effective treatment are critical. This review analyzes current evidence of the association between NAFLD and the MS. The growing prevalence of both entities is highlighted. Next, the common mechanisms leading to insulin resistance are discussed. Manifestations and diagnosis of the MS and NAFLD are reviewed, pointing out the associated comorbid conditions shared by both diseases. Finally, a brief overview regarding NAFLD treatment is presented.
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Affiliation(s)
| | | | | | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Col. Toriello Guerra, ZP 14050, Mexico City, Mexico.
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Barranco-Fragoso B, Almeda-Valdes P, Aguilar-Olivos N, Méndez-Sánchez N. The role of small heterodimer partner in hepatic lipid homeostasis. Ann Hepatol 2015; 14:286-7. [PMID: 25671841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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