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Resumen Objetivo Identificar la asociacion de la educacion en diabetes y terapia medica en nutricion con metas de control de indicadores de riesgo cardiovascular y habitos dieteticos en pacientes con diabetes mellitus tipo 2. Material y metodos Estudio transversal analitico en 395 pacientes de atencion primaria. Se realizaron mediciones de HbA1c, glucosa y perfil de lipidos en ayuno, presion arterial, peso, circunferencia de cintura y composicion corporal. Los habitos dieteticos se midieron a traves del «Instrumento para medir el estilo de vida en los pacientes con diabetes mellitus tipo 2» (IMEVID), en la dimension nutricion. La terapia medica nutricional (TMN) y la educacion en diabetes (ED), se considero como recibida por el paciente cuando esta fue otorgada en su clinica de atencion. Resultados Se incluyeron 68% mujeres, con una mediana de seis anos de diagnostico de diabetes. Recibieron ED y TMN un 21%, solo ED o TMN 28% y 51% ninguna de ellas. La HbA1c fue menor en pacientes con ED y TMN (7,7 ± 1,9% vs. 8,7 ± 2,3%, 8,4 ± 2,2%; p = 0,003), respectivamente. En pacientes con ED y TMN hubo una mayor proporcion que realizo ejercicio fisico, menor consumo de tabaco, mejores habitos dieteticos (p 7% cuando solo recibieron ED o TMN o ninguna de ellas, mayor tiempo de diagnostico de la enfermedad y seguir con menor frecuencia una dieta para el control de la enfermedad (p Conclusion La educacion en diabetes y la terapia medica nutricional favorecen las metas de control de riesgo cardiovascular y mejores habitos dieteticos del paciente con diabetes tipo 2.

Insulin resistance (IR) is a state prior to the development of type 2 diabetes (T2D) and it is reversible with lifestyle modification. However, it is underdiagnosed due to the difficulty in its measurement.To evaluate the diagnostic performance of the FINDRISC questionnaire to identify IR.An analytical cross-sectional study was performed in adults aged 20 to 60 years without previous diagnosis of T2D. Those using steroids and pregnant women were excluded. IR was diagnosed through the Triglycerides/glucose index. A ROC curve was used to establish the cut-off point for the diagnosis of IR. Sensitivity, specificity, predictive values and likelihood ratios were calculated. Risk measurement for IR was performed with the FINDRISC instrument.A total of 253 participants were included, with a prevalence of IR of 60.8%. The area under the curve of the FINDRISC instrument was 0.813 (95% confidence interval [95% CI] 0.759-0.865), with a cut-off point of 8. Sensitivity was 94.8% and specificity was 48.5%, positive predictive value was 74% and negative 86%, with a positive likelihood ratio of 1.84 and a negative of 0.11.The FINDRISC instrument is a useful screening tool to identify subjects with IR at the first level of care. A score ≥ 8 identifies subjects with IR.la resistencia a la insulina (RI) es un estado previo al desarrollo de diabetes tipo 2 (DT2) y es reversible con modificación en el estilo de vida. Sin embargo, este estado se encuentra subdiagnosticado por la dificultad en su medición.evaluar el desempeño diagnóstico del cuestionario FINDRISC para identificar RI.se realizó un estudio transversal analítico en adultos de 20 a 60 años sin diagnóstico previo de DT2. Fueron excluidos quienes utilizaran esteroides y mujeres embarazadas. La RI fue diagnosticada mediante el índice triglicéridos/glucosa. Una curva ROC fue utilizada para establecer el punto de corte para el diagnóstico de RI. Se calculó sensibilidad, especificidad, valores predictivos y razones de verosimilitud. La medición del riesgo para RI se realizó con el instrumento FINDRISC.se incluyeron 253 participantes, con una prevalencia de RI de 60.8%. El área bajo la curva del instrumento FINDRISC fue de 0.813 (intervalo de confianza del 95% [IC 95%] 0.759-0.865), con un punto de corte de 8. La sensibilidad fue de 94.8%, con una especificidad de 48.5%, valor predictivo positivo de 74% y negativo de 86%, con una razón de verosimilitud positiva de 1.84 y una negativa de 0.11.el instrumento FINDRISC puede ser una herramienta útil para identificar a sujetos con resistencia a la insulina en el primer nivel de atención. Un puntaje igual o mayor que 8 identifica a sujetos con RI.

The patient with diabetes mellitus type requires to receive education about the disease aimed at improving knowledge and skills for their control. The objective of this study is to evaluate the efficacy of nutritional therapy and education through a multimedia site on the level of knowledge and metabolic control in patients with type 2 diabetes.Open-label clinical trial of 12 months of follow-up in 161 patients with type 2 diabetes. A total of 101 patients were assigned to the intervention group with nutrition therapy (TN) + Nutriluv (multimedia site in diabetes), 80 patients to the TN control group. The glycosylated hemoglobin (HbA1c), glucose, cholesterol, triglycerides, LDL and HDL cholesterol were measured at the beginning and end. Weight, waist circumference, percentage of fat, systolic blood pressure and diastolic blood pressure were recorded. The level of knowledge was measured with the Diabetes Knowledge Questionnaire (DKQ24).The knowledge in diabetes improved in the group with TN+Nutriluv compared with the TN group (P0.05). HbA1c, HDL, diastolic blood pressure and waist circumference, improved in the group with TN+Nutriluv (P0.05). In the group with TN, cholesterol HDL, diastolic blood pressure, waist circumference and the fat percentage was increased (P0.05). They had a higher risk of having an HbA1c7% who had more years of diagnosis of diabetes.The use of a multimedia site with education in diabetes, improves knowledge, HbA1c, and other indicators of cardiovascular risk in diabetes type 2 patients.

Resumen Introduccion El paciente con diabetes mellitus tipo 2 requiere recibir educacion acerca de la enfermedad dirigida a mejorar los conocimientos y habilidades para su control. El objetivo de este estudio fue evaluar la eficacia de la terapia nutricia y de la educacion a traves de un sitio multimedia, sobre el nivel de conocimientos y control metabolico en pacientes con diabetes tipo 2. Material y metodos Ensayo clinico abierto de 12 meses de seguimiento en 161 pacientes con diabetes tipo 2. Se asignaron 101 pacientes al grupo de intervencion con terapia nutricional (TN) + Nutriluv (sitio multimedia), 80 pacientes al grupo control con TN. Se midio al inicio y al final la hemoglobina glucosilada (HbA1c), glucosa, colesterol, trigliceridos, colesterol LDL y HDL. Se registro el peso, la circunferencia de cintura, el porcentaje de grasa, la presion arterial sistolica y la diastolica. El nivel de conocimientos se midio con el cuestionario de conocimientos en diabetes DKQ24 (por sus siglas en ingles). Resultados Los conocimientos en diabetes mejoraron en el grupo con TN+Nutriluv comparado con el grupo TN (p 7% quienes tuvieron mas anos de diagnostico de la diabetes. Conclusion El uso de un sitio multimedia para proveer educacion en diabetes mejora los conocimientos, el HbA1c y otros indicadores de riesgo cardiovascular en pacientes con diabetes tipo 2.

Background Health beliefs are relevant to consider in patients with type 2 diabetes since disease control depends mainly on the patient’s behaviour. The aim of this study was to assess the association between health beliefs and glycated hemoglobin levels in Mexican patients with type 2 diabetes. Methods An analytical cross-sectional study was conducted, and 336 patients were included. Fasting blood levels of glycated hemoglobin, glucose, cholesterol; triglycerides, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) were measured. Body fat percentage, weight, height; waist circumference, and systolic and diastolic blood pressures were also obtained. A previously validated self-administered questionnaire was used to assess the health beliefs with regards to non-pharmacological treatment. Health beliefs were classified as positive, neutral, and negative. Results The average age of patients was 54.7 ± 8.5 years, with a higher proportion of females (69%). The questionnaire had a good internal consistency with a Cronbach’s alpha score of 0.83. More than 90% of patients attributed a health benefit to diet and exercise, 30 to 40% experienced barriers, and more than 80% had a perception of complications associated to uncontrolled diabetes. Patients with positive health beliefs had lower HbA1c levels (8.2 ± 1.7%) compared to those with neutral (9.0 ± 2.3%), or negative (8.8 ± 1.8%; p = 0.042). The LDL-c levels were lower (p = 0.03), and HDL-c levels were higher (0.002) in patients with positive heath beliefs. Conclusions Positive health beliefs are associated with better metabolic control indicators in patients with type 2 diabetes.

Background: Restricting dietary sodium consumption has been considered a major component of self-care management in heart failure (HF); however, the evidence supporting this recommendation has not been conclusive. The Study of Dietary Intervention Under 100 MMOL in Heart Failure (SODIUM-HF) trial aims to assess the effects of dietary sodium reduction on clinical outcomes in a HF population using a pragmatic design to provide empirical evidence to guide dietary sodium intake recommendations in patients with chronic HF. Methods: SODIUM-HF is a multicentre, open-label, blinded adjudicated endpoint, randomized controlled trial in ambulatory patients with chronic HF. This trial involves participants recruited from sites in Canada, Australia, New Zealand, Mexico, Colombia, and Chile, who are followed up to 24 months. Rationale and methods of the SODIUM-HF trial were published elsewhere. As an international pragmatic dietary trial, SODIUM-HF was designed to address several challenges, such as defining the most suitable intervention to account for country-specific variations in food intake and availability. In SODIUM-HF, we implemented the Nutrition-Care Model to provide a comprehensive intervention delivered directly to patients, focusing on modifying the nutrient composition of the diet (sodium restriction), using a personalized counselling and close follow-up. Results: Available upon completion of the trial. Conclusions: This long-term dietary trial is one of the first in its type in the HF field. This article describes in detail the rationale and methods for the dietary intervention employed and the region-specific adaptation of the SODIUM-HF intervention, so that the learning and processes taken in this trial can be applied to future multicountry dietary clinical trials. Résumé: Contexte: La restriction de l’apport en sodium alimentaire est considérée comme étant un élément important de l’auto-prise en charge de l’insuffisance cardiaque (IC); or, les données à l’appui de cette recommandation ne sont pas concluantes. L’étude SODIUM-HF (Study of Dietary Intervention Under 100 MMOL in Heart Failure) vise à évaluer en contexte réel les effets de la réduction de l’apport en sodium alimentaire sur les résultats cliniques au sein d’une population de patients atteints d’IC, afin d’obtenir des données empiriques qui serviront à orienter les recommandations en matière d’apport en sodium alimentaire chez les patients atteints d’IC chronique. Méthodologie: L’étude SODIUM-HF est un essai multicentrique contrôlé avec répartition aléatoire et mené en mode ouvert auprès de patients ambulatoires atteints d’IC chronique, dont les paramètres sont évalués à l’insu. Les participants sont recrutés dans des centres situés au Canada, en Australie, en Nouvelle-Zélande, au Mexique, en Colombie et au Chili, et font l’objet d’un suivi pendant 24 mois. La raison d’être et la méthodologie de l’étude SODIUM-HF sont présentées ailleurs. Comme il s’agit d’une étude internationale sur l’alimentation menée en contexte réel, l’étude SODIUM-HF a été conçue de manière à résoudre plusieurs difficultés, dont la façon la plus appropriée de tenir compte des variations entre pays en matière d’apport alimentaire et de disponibilité des aliments. L’étude met en œuvre le processus de soins en nutrition, afin d’assurer directement auprès des patients une intervention exhaustive axée sur la modification de la composition en nutriments de l’alimentation (restriction de l’apport en sodium) et faisant appel à des conseils personnalisés et à un suivi étroit. Résultats: Les résultats seront publiés à la fin de l’étude. Conclusions: Cette étude de longue durée sur l’alimentation est l’une des premières en son genre dans le domaine de l’IC. Les auteurs décrivent en détail la raison d’être et la méthodologie des mesures d’intervention alimentaire employées ainsi que les adaptations propres à chaque région mises en œuvre dans le cadre de l’étude SODIUM-HF, afin que les apprentissages et les processus issus de l’étude puissent être utilisés dans d’autres études cliniques multinationales sur l’alimentation.

Objective: the aim of this study was to identify dietary patterns in a sample of patients with type-2 diabetes, and to evaluate their association with markers of metabolic control. Methods: a cross-sectional study in 395 patients with type-2 diabetes in primary care was conducted. Fasting blood levels of glycated hemoglobin (A1c), glucose, total cholesterol, low- (LDL-c) and high-density lipoprotein cholesterol (HDL-c), and triglycerides were measured. Waist circumference, body mass index (BMI), and blood pressure were evaluated. Dietary intake was assessed by a food frequency questionnaire, and dietary patterns were derived by cluster analysis. Three dietary patterns were identified: 'fruits and vegetables', 'dairy and sweetened beverages', and 'diverse with alcohol'. Results: an association between the 'dairy and sweetened beverages' dietary pattern and A1c levels was identified (ß = 0.61; 95 % CI: 0.09, 1.12, p = 0.021), considering the 'fruits and vegetables' dietary pattern as the reference group. We also observed a trend towards an adjusted increased risk of A1c ≥ 7 % (odds ratio [OR]: 1.56; 95 % CI: 0.92, 2.64; p = 0.099) and an increased risk of BMI ≥ 25 kg/m2 (OR: 2.62, 95 % CI: 1.20, 5.71, p = 0.015) among patients in the 'dairy and sweetened beverages' dietary pattern as compared to the reference group. Conclusions: a dietary pattern characterized by a high intake of full-fat dairy and sweetened beverages was associated with higher A1c levels and increased risk of high glucose and BMI when compared to a dietary pattern with a higher consumption of fruits and vegetables.Objetivo: el objetivo de este estudio fue identificar los patrones dietéticos de una muestra de pacientes con diabetes de tipo 2 y evaluar su asociación con los marcadores de control metabólico. Métodos: se realizó un estudio transversal de 395 pacientes con diabetes de tipo 2 en atención primaria. Se estimaron los niveles de hemoglobina glicosilada (A1c), glucosa, colesterol total, colesterol de lipoproteínas de baja (LDL-c) y alta densidad (HDL-c), y triglicéridos en ayunas. Se evaluaron el perímetro de la cintura, el índice de masa corporal (IMC) y la presión arterial. La ingesta dietética se evaluó mediante un cuestionario de frecuencia de alimentos y los patrones dietéticos se obtuvieron mediante un análisis de conglomerados. Se identificaron tres patrones dietéticos: "frutas y verduras", "lácteos y bebidas azucaradas" y "diversos con alcohol". Resultados: se identificó una asociación entre el patrón dietético de "productos lácteos y bebidas azucaradas" y los niveles de A1c (ß = 0,61; IC del 95 %: 0,09, 1,12, p = 0,021), considerando el patrón dietético de "frutas y verduras" como grupo de referencia. También se observó una tendencia a un mayor riesgo ajustado de A1c ≥ 7 % (odds ratio [OR]: 1,56; IC del 95 %: 0,92, 2,64; p = 0,099) y un mayor riesgo de IMC ≥ 25 kg/m2 (OR: 2,62; IC del 95 %: 1,20, 5,71, p = 0,015) entre los pacientes del patrón "lácteos y bebidas azucaradas" en comparación con el grupo de referencia. Conclusiones: el patrón dietético caracterizado por un alto consumo de lácteos y bebidas azucaradas se asoció con niveles más altos de A1c y un mayor riesgo de elevación de la glucosa y el IMC, en comparación con un patrón dietético con mayor consumo de frutas y verduras.

The relationship of anthropometric and body composition indicators with the evolution of kidney disease in patients with type 2 diabetes, is still inconsistent.To identify the association of indicators of kidney disease with indicators of metabolic and anthropometric control in patients with type 2 diabetes.An analytical cross-sectional study was carried out in 395 patients of the first level of care. The glucose, glycosylated hemoglobin (HbA1c), creatinine and lipid profile were measured. The kidney disease (CKD) was made when urinary albumin excretion (UAE)30 mg/g and with a reduction in the level of glomerular filtration rate60 mL/min/1.73 m2, using the CKD-formula. Weight and waist circumference were measured, as well as the body composition through bioimpedance.Seventeen percent of the population has a diagnosed with CKD with alteration of the UAE and 6.6% had a reduced GFR. A longer time of diagnosis of the diabetes, higher HbA1c level and body fat were associated with an UAE30 mg/g, (p0.05). The decline in GFR (60 mL/min/1.73 m2) was associated with older age, being a woman, greater waist circumference, and a higher percentage of body fat (p0.05).A higher level of waist circumference and a lower percentage of body fat are associated with a greater evolution of chronic kidney disease in patients with type 2 diabetes. Glycemic uncontrol is identified in patients with high urinary albumin excretion.la relación de los indicadores antropométricos y de composición corporal, con la evolución de la enfermedad renal en pacientes con diabetes tipo 2 sigue siendo controversial.identificar la asociación de los indicadores de la enfermedad renal con indicadores de control metabólico y antropométricos en pacientes con diabetes tipo 2.se realizó un estudio transversal analítico en 395 pacientes del primer nivel de atención. La glucosa, hemoglobina glucosilada (HbA1c), perfil de lípidos y creatina se midió en ayuno. La enfermedad renal crónica (ERC) se consideró cuando la excreción de albumina urinaria (EAU)30 mg/g y con la reducción del nivel de la tasa de filtrado glomerular60 mL/min/1.73 m2, utilizando la ecuación CKD-EPI. Se midió el peso y circunferencia de cintura, así como la composición corporal a través de bioimpedancia.un 17% de la población presentó ERC con alteración de la EAU y 6.6% con una TFG reducida. Un mayor tiempo de diagnóstico de la enfermedad, mayor nivel de HbA1c y menor nivel grasa corporal se asoció a una EAU30 mg/g, (p0.05). La disminución de la TFG (60 mL/min/1.73 m2) se asoció con mayor edad, ser mujer, tener mayor circunferencia de cintura y menor porcentaje de grasa corporal (p0.05).un mayor nivel de circunferencia de cintura y menor porcentaje de grasa corporal se asocian a mayor evolución de la ERC en pacientes con diabetes tipo 2. El descontrol glucémico se identificó en pacientes con mayor excreción de albumina urinaria.

To identify the association of diabetes education or medical nutrition therapy with the goals of control of cardiovascular risk indicators and dietary habits in patients with type 2 diabetes mellitus.Analytical cross-sectional study in 395 primary care patients. HbA1c, fasting glucose and lipid profile, blood pressure, weight, waist circumference, and body composition were measured. Dietary habits were measured using the «Instrument for measuring lifestyle in patients with type 2 diabetes mellitus» (IMEVID), in the nutrition dimension. Medical nutrition therapy (MNT) and diabetes education (DE) were considered as received by the patient when provided in their healthcare clinic.Women comprised 68% of the patients, with a median of 6 years from diabetes diagnosis. Of the patients, 21% received DE and MNT, 28% DE or MNT, and 51% received neither. The HbA1c was lower in the patients with DE and MNT (7.7% ± 1.9% vs. 8.7% ± 2.3%, 8.4% ± 2.2%; p = .003) respectively. In the patients with DE and MNT, a higher proportion took physical exercise, consumed less tobacco, and had better dietary habits (p.05). Patients who received DE and MNT achieved HbA1c and HDL-c control levels. A greater risk of HbA1c7% was identified when they only received DE or MNT or neither, a longer time since diagnosis of the disease and less frequent adherence to a diet to control the disease (p.05).Diabetes education and medical nutritional therapy favour the goal of cardiovascular risk control and better dietary habits in the patient with type 2 diabetes.

Background Education is the mainstay of medical management of chronic non communicable diseases such as diabetes mellitus. Aim To assess the effects of a multimedia diabetes education intervention and nutritional therapy on lifestyle changes and metabolic control of patients with type 2 diabetes mellitus. Material and Methods We studied 219 patients with type 2 diabetes mellitus aged 56 ± 8 years (28% males). They received education through a multimedia site about control indicators, complications, nutrition and physical exercise, among others. They also received a personalized nutritional therapy. They were followed-up for one year. At baseline and the end of follow up they were weighed, and their waist circumference and blood pressure were measured. A fasting blood sample was withdrawn to measure glucose, glycosylated hemoglobin and lipid profile. Lifestyles were assessed using a self-administered questionnaire called IMEVID. Results The median duration of diabetes was six years. During the follow up, patients had a significant reduction in body weight, waist circumference and blood pressure and improvements in glycosylated hemoglobin, HDL and LDL cholesterol. Seven and 13% of patients reported favorable lifestyles at baseline and the end of follow up, respectively (p < 0.01). Compared with their counterparts with unfavorable lifestyles, patients with a favorable lifestyle had a significantly lower weight and glycosylated hemoglobin at the end of follow up. Conclusions The educational intervention along with nutritional therapy improved metabolic control and lifestyles in this group of diabetic patients.

Kidney disease is one of the main complications in the diabetic patient. Risk factors such as obesity, dyslipidemia, and hyperglycemia have been associated with increased urinary albumin excretion (UAE) and decreased glomerular filtration rates (GFR). However, the data are inconsistent. The objective of this study was to identify the primary risk factors associated with kidney disease in Mexican patients with type 2 diabetes.A cross-sectional study was done in 395 patients with type 2 diabetes from four primary-care clinics. From fasting venous blood samples, the serum creatinine, glucose, glycated hemoglobin (HbA1c), and lipid profiles were measured. The diagnosis of diabetic kidney disease (DKD) was made by measuring GFR with the CKD-EPI equation, and the UAE from the first morning urination, according to the KDIGO 2012 Guidelines. Weight and waist circumference (WC), as well as body composition through the method of bioimpedance, were measured.Fourteen percent of the study population was diagnosed with DKD. Higher age and higher triglyceride levels were associated with a greater risk of DKD (p0.05). In a multivariate analysis, higher age (OR = 1.06, 95% CI 1.02-1.11), triglyceride level (OR = 2.4, 95% CI 1.18-4.92), WC (OR = 1.09, 95% CI 1.03-1.15), and smoking (OR 2.6, 95% CI 1.07-6.49) were associated to DKD.Higher triglyceride levels, greater WC, and smoking are risk factors associated to DKD. An early diagnosis and opportune treatment for several cardiometabolic risk factors associated to DKD and cardiovascular disease should be identified and treated.

Objetivo Evaluar la eficacia de la educacion a traves de un sistema de informacion multimedia en el control del paciente con diabetes tipo 2. Metodo Ensayo clinico abierto aleatorizado. El grupo de intervencion fue instruido para consultar una herramienta educativa multimedia en la sala de espera de los consultorios, misma que fue disenada de acuerdo a las caracteristicas de la poblacion y centrada en automonitoreo de indicadores, informacion sobre diabetes tipo 2 y nutricion. Se midieron en sangre venosa las concentraciones de glucosa, hemoglobina glucosilada (HbA1c), trigliceridos, colesterol total, colesterol ligado a lipoproteinas de alta densidad (HDL-c) y colesterol ligado a lipoproteinas de baja densidad. Con la t de Student pareada se evaluo el efecto de la intervencion. Resultados Se incluyeron 2334 pacientes, 958 en el grupo de intervencion y 1376 en el grupo control. Se observo en el grupo de intervencion un incremento del HDL-c (de 40.45 a 47.40 mg/dl; p = 0.001) y una disminucion de los trigliceridos (de 227.78 a 210.38 mg/dl; p = 0.001). En el grupo control disminuyeron los trigliceridos (de 232.64 a 210.84 mg/dl; p = 0.016). En ambos grupos se incremento de forma significativa el colesterol total. No se observaron cambios en los valores de glucosa y HbA1c posterior a la intervencion. Conclusion La implementacion de un sistema de informacion multimedia mejora el HDL-c y los trigliceridos del paciente con diabetes. Se requiere un reforzamiento continuo de la intervencion educativa por parte del profesional de la salud para incidir en el control glucemico y otros indicadores del control metabolico. Objective To evaluate the efficacy of education through a multimedia information system, in controlling patients with type 2 diabetes. Methods Randomized open clinical trial. The intervention group was trained to consult an educative multimedia tool in the waiting room, which was developed according to the population characteristics and centered on monitoring indicators, information on type 2 diabetes and nutrition. Venous blood concentrations of glucose, glycated hemoglobin (HbA1c), triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were measured. Paired t Student was used to assess the effect of the intervention. Results 2,334 patients were included, 958 in the intervention group and 1,376 in the control group. In the intervention group, an increase in HDL-c values was observed (from 40.45 to 47.40 mg/dL; p=0.001) as well as a descent on triglycerides values (from 227.78 to 210.38 mg/dL; p=0.001). There was a reduction on triglycerides levels in the control group (from 232.64 to 210.84 mg/dL; p=0.016). There was a significative increase in total cholesterol values in both groups. There were no changes in the mean values of glucose and HbA1c after the intervention. Conclusion Implementation of a multimedia information system improves HDL-c and triglycerides in patients with diabetes. There is a need for a continuous reinforcement of the educative intervention by health professionals to improve glycemic and other indicators in metabolic control.

To evaluate the effect of a multimedia education program and nutrition therapy on metabolic control in patients with type 2 diabetes. What is the effect of a multimedia education program and nutritional therapy on metabolic control in type 2 diabetes? A randomized clinical trial was conducted in 351 patients randomly assigned to either an experimental group receiving a multimedia diabetes education program (MDE) and nutrition therapy (NT) (NT + MDE: n = 173), or to a control group who received nutrition therapy only (NT: n = 178). At baseline, 7, 14, and 21 months, the glycated hemoglobin (HbA1c), glucose, cholesterol, triglycerides, LDL-cholesterol, and HDL-cholesterol were measured. Weight, body mass index (BMI), waist circumference (WC), fat percentage, fat and lean mass, systolic blood pressure (SBP), and diastolic (DBP) were also recorded. Glycated hemoglobin decreased in both groups, although the group with NT + MDE had a greater reduction, with a difference of −0.76% (95%CI −1.33 to −0.19) at 7 months and −0.73% (95%CI −1.37 to −0.09) at 21 months. Only in the NT + MDE did the glucose decrease at 7 (−41.2 mg/dL; 95%CI −52.0 to −30.5), 14 (−27.8 mg/dL; 95%CI −32.6 to −23.1), and 21 months (−36.6 mg/dL; 95%CI −46.6 to −26.6). Triglycerides and the atherogenic index decreased in both groups at 7 and 14 months; while only in the NT + MDE group did it decrease at 21 months. (p

Objetivo: evaluar la saturación de oxígeno en extremidades pélvicas de acuerdo con la presencia de pie diabético en pacientes con diabetes mellitus tipo 2 (dm2). Métodos: estudio transversal analítico. Se incluyeron pacientes con dm2 de más de cinco años de evolución, de 20 a 80 años de edad que acudieron a la Unidad de Medicina Familiar (umf) no. 28, en la Ciudad de México. Para estadificar la severidad del pie diabético se utilizó la clasificación de Meggit-Wagner, se consideró la presencia de pie diabético en pacientes de grados 1 a 3. Mediante oximetría de pulso se determinó el valor de saturación de oxígeno (SpO2) en extremidades pélvicas. Se evaluaron otras variables como atrofia y resequedad en la piel, antecedente de hipertensión arterial, índice de masa corporal (imc) y descontrol glucémico. Se realizó prueba de χ2 para diferencia de proporcionesy U de Mann-Whitney para diferencia de medianas. Para conocer los factores de riesgo asociados a pie diabético se realizó un modelo de regresión logística. Resultados: se incluyó un total de 126 pacientes, 23% presentó pie diabético (n=29), de los cuales, 90% presentó Meggit-Wagner grado 1 (n=26) y 10% Wagner grado 3 (n=3). Los pacientes con pie diabético mostraron una mediana de SpO2 90% en comparación con una SpO2 95% en los pacientes sin pie diabético (pConclusión: los pacientes con pie diabético mostraron menor SpO2. Un nivel de saturación menor a 90% es un factor de riesgo independiente de otros factores para el desarrollo de pie diabético.

Objetivo: determinar el impacto del estilo de vida y de sus diferentes componentes en el control glucémico de los pacientes con diabetes mellitus tipo 2 (dm2). Métodos: diseño transversal analítico, se llevó a cabo en una unidad de medicina familiar en la Ciudad de México, de agosto a octubre de 2015. Se incluyó a 330 participantes con dm2, de 20 a 60 años bajo tratamiento farmacológico. Se utilizó el Instrumento para Medir el Estilo de Vida en Diabéticos (Imevid). Para medir el control glucémico se utilizó hemoglobina glucosilada (HbA1c), se consideró control glucémico un nivel de Hb1Ac Resultados: 70.3% (232) de los participantes se encontró en el grupo de edad de 51-60 años, 90.6% (299) presentó alguna comorbilidad, la hipertensión arterial sistémica fue la más frecuente. 48.8% (161) presentó sobrepeso y 14.8% (49) obesidad. 35.8% (118) de los participantes presentaron buen estilo de vida, 43.9% (145) se encontraba en control glucémico. La mediana de Hb1Ac en pacientes con mal estilo de vida fue de 9% en comparación con el grupo que tenía buen estilo de vida con 6.4%, (pConclusiones: el estilo de vida no saludable es un factor de riesgo para el descontrol glucémico. El estilo de vida, comorbilidades, tiempo de evolución de dm2 e imc explican 85.3% del descontrol glucémico.

Objective.To assess the association of dietary fiber on current everyday diet and other dietary components with glycated hemoglobin levels (HbA1c), glucose, lipids profile, and body weight body weight, in patients with type 2 diabetes.Methods.A cross-sectional survey of 395 patients with type 2 diabetes was performed. HbA1c, fasting glucose, triglycerides, and lipids profile were measured. Weight, waist circumference, blood pressure, and body composition were measured. Everyday diet with a semiquantitative food frequency questionnaire was evaluated. ANOVA, Kruskal-Wallis, chi-square tests and multivariate logistic regression were used in statistical analysis.Results.Higher fiber intake was associated with a low HbA1c, high HDL-c levels, low weight, and waist circumference. The highest tertile of calories consumption was associated with a higher fasting glucose level and weight. The highest tertile of carbohydrate consumption was associated with a lower weight. The lowest tertile of total fat and saturated fat was associated with the highest tertile of HDL-c levels, and lower saturated fat intake was associated with lower weight(p<0.05).Conclusions.A higher content of fiber in the diet reduces HbA1c and triglycerides, while improving HDL-c levels. Increasing fiber consumption while lowering calorie consumption seems to be an appropriate strategy to reduce body weight and promote blood glucose control.

Our objective was to evaluate the effects of a moderate calorie and carbohydrate-restricted diet on cardiovascular risk indicators in overweight or obese patients with prediabetes. A clinical trial was conducted in which 86 subjects presenting with overweight or obesity and prediabetes received a personalized diet of 1,200 to 1,700 calories with a distribution of 50 % carbohydrates, 20 % proteins, and 30 % fat. Body weight, fat mass, and lean mass were measured through bioimpedance. Glucose, total cholesterol, high density lipoprotein cholesterol and low density cholesterol, and triglycerides were measured. The measurements were taken at the beginning of, and at, 6 and 12 months during the intervention, and the differences were compared by paired Student's t and χ(2) tests. At 12 months, a significant reduction was noticed in body weight in patients with overweight and obesity (72.4 ± 7.8-69.6 ± 7.5 kg) (85.7 ± 14.8-80.2 ± 12.7 kg) with body mass index (28.2 ± 0.8-27.2 ± 2.1 kg/m(2)) (34.3 ± 3.5-32.1 ± 3.2 kg/m(2)), systolic (120.9 ± 14.2-112.4 ± 11.5 mmHg) (124.1 ± 11.9-115.7 ± 14.0 mmHg), diastolic blood pressures (79.0 ± 9.3-71.8 ± 8.3 mmHg) (80.4 ± 9.0-73.7 ± 13.1 mmHg), glucose (106.0 ± 8.9-95.9 ± 7.5 mg/dL) (107.3 ± 7.0-97.0 ± 8.2 mg/dL), and significant improvement on lipid profile (p < 0.05). The restrictions in the calorie and carbohydrate diet decrease the cardiovascular risk indicators in overweight or obese adults with prediabetes.

Childhood obesity is an important risk factor for the development of insulin resistance (IR) and its co-morbidities. However, visceral adipose tissue (VAT) rather than obesity appears to have a determining role in the development of IR. Adiponectin is considered a key molecule for protection against metabolic abnormalities related to IR. Several studies have documented that lower adiponectin concentrations are related to VAT, but the results are still controversial. We undertook this study to assess the association between VAT and adiponectin concentrations with respect to body mass index (BMI) and pubertal stage in children and adolescents.Eighty five subjects were studied (46 prepubertal and 39 pubertal) and classified according to BMI into obese and normal weight groups. All participants were given a clinical examination. Glucose, insulin, lipid profile and adiponectin were measured. VAT was estimated using helical computed tomography.In the prepubertal group, obese children had lower adiponectin concentrations than nonobese subjects (p0.001) but not in pubertal group (p = 0.67). When the total population was subclassified according to VAT, those with higher VAT had greater systolic and diastolic blood pressure, triglycerides, post-load glucose, insulin and HOMA-IR (p0.001) compared to those with less VAT. HDL-C and adiponectin values trends to diminish as VAT increased (p = 0.005 and p = 0.015, respectively).Adiponectin concentrations are inversely associated with VAT in children. The higher amount of VAT is related to metabolic abnormalities including lower values of adiponectin, which could confer a greater risk of developing type 2 diabetes mellitus and cardiovascular disease.

Introduccion La obesidad infantil se ha convertido en un grave problema de salud publica, en cuyos prevencion y tratamiento la terapia nutricional tiene un papel importante. Pacientes y metodo Ensayo clinico no aleatorizado realizado en 40 ninos y adolescentes con obesidad, a quienes se realizo una historia clinica completa, evaluacion de habitos de alimentacion a traves de encuesta de recordatorio de alimentos de 24 h y frecuencia de consumo de alimentos. Se determino en todos peso corporal, estatura, pliegues cutaneos, circunferencia de cintura y cadera y concentraciones sericas en ayunas de glucosa, colesterol total y sus fracciones de lipoproteinas de alta densidad (cHDL) y de baja densidad (cLDL) y trigliceridos. La intervencion nutricional consistio en identificar el consumo calorico y la cantidad de nutrientes consumidos, y se otorgo asesoria dirigida a modificar los habitos de alimentacion con una dieta normocalorica saludable. Despues de 4 meses se midieron nuevamente indicadores bioquimicos, antropometricos y dieteticos. Resultados Se observo una reduccion significativa en el peso corporal (de 56 ± 16,5 a 54,4 ± 16,1 kg), el indice de masa corporal (de 26,5 ± 3,7 a 25,1 ± 3,1), la circunferencia de cintura (de 86,4 ± 11,6 a 81,4 ± 11,4 cm) y la circunferencia media del brazo (de 29 ± 5 a 26 ± 4,2 mm). Se observo tambien una disminucion significativa del colesterol total (de 167,1 ± 30 a 156 ± 26,5 mg/dl) y el cLDL (de 103 ± 21,4 a 84,6 ± 26 mg/dl) y un incremento del cHDL (de 38 ± 7,8 a 43,4 ± 9,3 mg/dl). En todas las comparaciones se obtuvo p Conclusiones La asesoria dirigida a la modificacion de habitos de alimentacion es eficaz en la disminucion del peso corporal y la mejora del perfil de lipidos de ninos y adolescentes con obesidad.

Type 4 retinol binding protein (RBP4) is a novel adipocytokine that has been related with insulin resistance (IR). In pediatric population, RBP4 levels are higher in obese subjects compared with lean subjects. In adults with type 2 diabetes (T2D) a positive correlation has been found between RBP4 levels and hepatic steatosis (HS). There is scarce information on RBP4 levels in children and adolescents with T2D. The aim of our study was to evaluate RBP4 levels in T2D adolescents and its association to HS.

Background The beneficial effects of the Mediterranean diet have been amply proven in adults with cardiovascular risk factors. The effects of this diet have not been extensively assessed in pediatric populations with obesity, insulin resistance (IR) and metabolic syndrome (MetS). The aim of this study was to assess the efficacy of the Mediterranean style diet (MSD) to decrease cardiovascular risk factors in children and adolescents with obesity. Methods Participants were randomly assigned to a MSD rich in polyunsaturated fatty acids, fiber, flavonoids and antioxidants (60% of energy from carbohydrate, 25% from fat, and 15% from protein, (n = 24); or a standard diet (55% of carbohydrate, 30% from fat and 15% from protein, (n = 25), the caloric ingest was individualized. At baseline and 16-week of intervention, the glucose, triglycerides (TG), total cholesterol (TC), HDL-C, LDL-C were measured as well as the body composition and anthropometric data. The diet compliance was determined by the 24-hour recalls. Paired Student’s t and Macnemar’s test were used to compare effects in biochemical, body composition, anthropometric, and dietary variables. Results The MSD group had a significantly decrease in BMI, lean mass, fat mass, glucose, TC, TG, HDL-C and LDL-C. (p 100 mg/dL (p

Family interventions may improve glycemic control among diabetic patientsTo evaluate the association of glycemic control with family support and level of knowledge in patients with type 2 diabetes.Patients with type 2 diabetes completed a demographic survey. Glycosylated hemoglobin (HbA1c) was determined and glycemic control was defined as a value6,5%. Two validated instruments were applied to evaluate family support, stratifying it in three categories (low, medium and high) and the level of knowledge about diabetes.We studied 81 patients aged 32 to 65 years (53 females). Thirty six percent had an adequate glycemic control. Participants with a medium family support had three times greater risk of having an uncontrolled blood glucose than subjects with high family support. No significant association was found between the level of knowledge and glycemic control.Family support but not knowledge about the disease is associated with a better glycemic control of patients with type 2 diabetes.

Childhood obesity has become a serious public health problem. Nutritional therapy plays an important role in its prevention and treatment.A nonrandomized clinical trial was conducted in 40 obese children and adolescents who underwent a complete medical history and assessment of eating habits through 24-hour food recall and a frequency of food consumption questionnaire. In all patients, body weight, height, skinfold thickness, waist and hip circumferences and fasting glucose, total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, and triglyceride levels were measured. The nutritional intervention consisted of identifying the calorie consumption and nutrient intake, and participants were given advice aimed at changing eating habits with a healthy normocaloric diet. After 4 months, biochemical, anthropometric and dietary indicators were measured again.Significant reductions were observed in body weight (56.0 +/- 16.5 to 54.4 +/- 16.1 kg), body mass index (26.5 +/- 3.7 to 25.1 +/- 3.1), waist circumference (86.4 +/- 11.6 to 81.4 +/- 11.4 cm) and mid-arm circumference (29.0 +/- 5.0 to 26.0 +/- 4.2 mm). Significant reductions were also observed in total cholesterol (167.1 +/- 30.0 to 156.0 +/- 26.5 mg/dl) and LDL-cholesterol (103.0 +/- 21.4 to 84.6 +/- 26.0 mg/dl). A significant increase was found in HDL values (38.0 +/- 7.8 to 43.4 +/- 9.3 mg/dl). In all comparisons, the p-value was0.05.Counseling aimed at changing eating habits is effective in reducing body weight and improves lipid profile in children and adolescents with obesity.

to evaluate a personalized diet customize for present comorbidity, on metabolic control indicators and renal function.a non-randomized clinical trial was conducted during a three-month period in a group of patients with microalbuminuria and in a group with macroalbuminuria. The patients received personalized dietary counseling customize to their comorbidity (obesity, hypertension, and dislypidemia). The effect of the diet was measured through metabolic control variables: body mass index (BMI), waist circumference, fasting glucose levels, glycated hemoglobin (HbA(1))c and lipids profile; the renal function variables were: glomerular filtration rate (GFR) and urine albumin excretion (UAE). Statistical analysis was done with t-paired test.thirty-nine patients were included (21 women and 18 men). After the intervention, the weight and waist circumference had significantly decreased (p = 0.01); the fasting glucose levels and HbA(1)c were significantly lower (p = 0.001). The HDL-cholesterol increased significantly (p = 0.009); UAE decreased significantly in patients with micro and macroalbuminuria; 123.0 +/- 73.4 to 105.3 +/- 61.3 mg/24-h; p = 0.040 and 1482.7 +/- 1200.6 to 1093.5 +/- 601.8 mg/24-h; p = 0.02. The GFR increased in both groups: 68.9 +/- 35.4 to 74.7 +/- 41.6 mL/min, p = 0.04; and 62.2 +/- 26.6 to 68.5 +/- 25.3 mL/min, p = 0.02.the dietary intervention improved the metabolic control and renal function in type 2 diabetes patients with comorbidity.