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Diabetes care 11/2012; 35(11):e77. · 8.09 Impact Factor
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ABSTRACT: OBJECTIVE: To evaluate the association between carotid intima-media thickness, buccodental status, and glycemic control in patients with type 1 diabetes. METHODS: Cross-sectional study with consecutive cases attended in an outpatient clinic (n = 69). Medical and clinical dental history, HbA1c, lipid profile, treatment period, and daily insulin dosage were recorded. Sociodemographic data and anthropometrical measurements were obtained by standardized questionnaire. Doppler real-time ultrasound was performed by a single experienced vascular radiologist blinded to the study. Assessment of buccodental status was done by the Maxillofacial Unit of the Pediatrics Hospital, and an oral scrape culture was collected. RESULTS: The mean age was 11.7 ± 3.0 years, with diabetes 5.1 ± 3.3 years. Mean HbA1c was 8.5 ± 1.7%. Primary teeth were present in 52.2% and bacterial plaque in 94.2%. Buccodental conditions featured caries (63.8%), gingivitis (84%), and enamel demineralization (26.1%): white spot lesions (18.8%) and cavitated lesions (7.3%). Bacteria associated with caries were found in 44.1%. Patients in the highest HbA1c tertile (>8.5%) had greater frequency of buccodental conditions and were positive for Streptococcus mutans and Candida albicans; also, cIMT increased and vessel compliance decreased compared to those in the lowest tertile (<7.0%) (p < 0.05). CONCLUSIONS: More buccodental conditions and carotid intima-media thickness increase appeared in the patients with HbA1c level > 8.5%, suggesting onset of atherosclerosis. The correlation between buccodental status and HbA1c values may indicate the connection between inflammatory states of atherosclerosis and type 1 diabetes.
Pediatric Diabetes 05/2012; · 2.16 Impact Factor
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ABSTRACT: The objective was to determine the effect of metformin on the concentrations of resistin and other markers of insulin resistance or inflammation (C-reactive protein, cytokines, body weight, HbA1c, among others) in minors with glucose intolerance. Patients aged 4 to 17 years with glucose intolerance were studied. They were randomized to receive 850 mg of either metformin or placebo twice daily for 12 weeks, during which all followed an iso-caloric diet and an exercise program. High sensitivity C-reactive protein, TNF-alpha, IL-6, IL1-beta, resistin, leptin, adiponectin, glucose, insulin, HbA1c, lipid profile and transaminases were measured at the beginning and at the end of the period. Fifty-two patients were included, 11.9±2.6 years old; 28 (12 males/16 females) received metformin and 24 placebo (11 males/13 females). Baseline characteristics were similar between groups (except for body mass index, which in the metformin group was slightly higher). Percentage weight loss was greater in the metformin group (-5.86% vs 2.75%, P<.05). At study end, there were statistically significant differences in resistin concentrations, even after adjusting for confounding variables (F=7.714; P<.006). Also, metformin was associated with a significant decrease in HOMA-IR index (P=.032) and HbA1c levels (P=.001), but no change was observed in the concentration of other markers of inflammation. Metformin resulted in significant reductions of plasma resistin levels in minors with glucose intolerance. This change is independent of its effects on body weight. In contrast, metformin did not alter the concentration of inflammatory markers.
Metabolism: clinical and experimental 03/2012; 61(9):1247-55. · 2.59 Impact Factor
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ABSTRACT: Measuring quality of life (QOL) is important, but to date, questionnaires to measure QOL in Mexican patients with osteoporosis (OP) have not been validated. A study was carried out to culturally adapt and validate the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) in a Mexican population. Interviews were performed with 160 women, 80 patients with at least one vertebral fracture, and 80 patients with OP as determined by the World Health Organization criteria. Several cultural modifications were made to the Spanish version of the QUALEFFO. Content validity was assessed by a group of experts, and a pilot study was undertaken. At the same time, the Spanish version of the Short Form 36 (Medical Outcomes Study) was applied. The mean age of patients was 71.9 +/- 11.1. The QOL questionnaire showed a test-retest reproducibility (R (i) = 0.94) and internal consistency (alpha = 0.92), while social function scored low (alpha = 0.46). Concurrent validity was significant (r = -0.837, p < 0.001). Significant differences were found between the two groups for pain (p < 0.05), physical function (p < 0.01), social function (p < 0.01), mental function (p < 0.05), and number of fractures (p < 0.001). Discriminatory characteristics between the groups were significant for physical (p < 0.001), social (p < 0.001), and mental (p < 0.02) function. The cultural adaptation of the QUALEFFO was consistent, homogenous, and discriminative. It also showed deterioration in the QOL group of Mexicans with vertebral fractures. The QUALEFFO can be used in a Mexican population to measure the QOL in patients with vertebral fractures after some cultural modifications to take into account local sensibilities.
Clinical Rheumatology 03/2008; 27(2):151-61. · 2.00 Impact Factor
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M Teresa Villarreal-Molina,
M Teresa Flores-Dorantes,
Olimpia Arellano-Campos,
Marisela Villalobos-Comparan,
Maricela Rodríguez-Cruz,
Angel Miliar-García,
Adriana Huertas-Vazquez,
Marta Menjivar,
Sandra Romero-Hidalgo, Niels H Wacher,
M Teresa Tusie-Luna,
Miguel Cruz,
Carlos A Aguilar-Salinas,
Samuel Canizales-Quinteros
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ABSTRACT: The ATP-binding cassette transporter A1 (ABCA1) R230C variant is associated with low HDL cholesterol levels, obesity, and the metabolic syndrome in Mexican-Mestizos. Because a pivotal role for ABCA1 in pancreatic beta-cell function was recently observed in the mouse model, we assessed the association of this variant with type 2 diabetes in this population.
The initial group included 446 unrelated Mexican individuals: 244 with type 2 diabetes aged 20-69 years (121 with onset </=45 years), and 202 nondiabetic control subjects aged >50 years. An independent study group included 242 type 2 diabetic case subjects and 225 control subjects with similar characteristics.
R230C/C230C genotypes were significantly more frequent in type 2 diabetic individuals (24.6%) than in control subjects (11.4%) in the initial study group (OR 2.501; P = 0.001). After stratifying by age at diagnosis, the association was significant only in the early-onset group (age at diagnosis </=45 years) (OR 3.776, P = 3.3 x 10(-6)). Both associations remained significant after adjusting for admixture (P = 0.0008 and P = 8.1 x 10(-6), respectively). Similar trends were observed in the independent study group, and the combined analysis of both populations showed a highly significant association of the R230C variant with type 2 diabetes, particularly with that of early onset (P = 7.6 x 10(-6) and 9.4 x 10(-8), respectively).
The R230C ABCA1 variant is associated with type 2 diabetes, particularly of early onset, in the Mexican-Mestizo population.
Diabetes 02/2008; 57(2):509-13. · 8.29 Impact Factor
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ABSTRACT: To compare the carotid artery intima-media thickness in Hispanic pediatric type 1 diabetic patients against that in healthy control subjects matched for age, sex, height, and BMI.
The evaluation consisted of anthropometric measurements, biochemical parameters, and a carotid Doppler and real-time ultrasound, in which carotid artery intima-media thickness (cIMT), peak systolic velocity, and end diastolic velocity were measured using standardized procedures.
A total of 52 diabetic patients and 47 control subjects were included. No significant differences existed in the characteristics between case and control subjects (mean age 11.8 +/- 3.1 vs. 11.8 +/- 2.8 years, weight 42.2 +/- 15.3 vs. 44.2 +/- 14.4 kg, height 1.45 +/- 0.15 vs. 1.47 +/- 0.15 m, BMI 19.3 +/- 3.2 vs. 19.9 +/- 4.4 kg/m2, systolic blood pressure 99.1 +/- 9.9 vs. 99.6 +/- 9 mmHg, and diastolic blood pressure 63 +/- 6.4 vs. 62.0 +/- 5.7 mmHg, respectively). The mean duration of diabetes was 4.8 +/- 3.2 years (range 6-144 months), and the mean A1C was 8.6 +/- 1.6%. A significantly higher cIMT was found in the patients with type 1 diabetes (0.463 +/- 0.04 vs. 0.441 +/- 0.04 mm; P = 0.001). In contrast, both peak systolic velocity (107.1 +/- 22.8 vs. 119.3 +/- 19.2, P < 0.005) and end diastolic velocity (28.4 +/- 6.0 vs. 33.0 +/- 7.0, P < 0.001) were higher in the control subjects.
Type 1 diabetes is associated with higher cIMT and decreased flow velocities in a Hispanic pediatric population.
Diabetes care 11/2007; 30(10):2599-602. · 8.09 Impact Factor
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ABSTRACT: The aim of this study was to describe the agreement between impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) in children with excess body weight using the original and the revised definitions of IFG.
Obese and overweight children aged 4-17 years were included (n = 533). Anthropometric parameters and biochemical tests (fasting and 2-h glucose tests after an oral glucose load [1.75 g/kg]) were performed. Case subjects with a fasting plasma glucose >/=126 mg/dl were excluded. The diagnostic parameters of the original and the revised definitions of IFG for detecting IGT were estimated. The analysis of agreement between these categories was made using the kappa test.
The prevalence of IFG increased from 6.2 to 13.3% using the new criteria. The prevalence of IFG became closer to the prevalence of IGT (14.8%). The revised criteria increased the sensitivity from 26.6 to 36.7%. However, the new IFG definition was not useful for identifying IGT cases. Of the 71 case subjects with IFG, only 29 (40.8%) had IGT. In addition, 50 case subjects with IGT (9.4%) and 13 with diabetes (2.4%) had a fasting glycemia <100 mg/dl. A poor agreement was found between the 2003 IFG definition and abnormal 2-h postchallenge plasma glucose (kappa = 0.359). The proportion of false-positive cases increased (36.3-59.1%) under the new definition.
The new definition modestly increases the sensitivity of IFG for detecting IGT in children with excess body weight. Despite this, more than one-half of these cases are not detected. In addition, the false-positive rate was increased by 61%.
Diabetes Care 09/2004; 27(9):2229-33. · 8.09 Impact Factor
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Diabetes Care 09/2003; 26(8):2470-1. · 8.09 Impact Factor
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ABSTRACT: This study was undertaken in order to ascertain the relative importance of different risk factors for perinatal mortality (PM) in a community of Chiapas, Mexico stressing the importance of antenatal and neonatal medical care.
Cases were stillbirth and early neonatal death (END). Two children born in the same hospital and/or day as the case were randomly selected as controls, in Tapachula, Chiapas, Mexico. Socioeconomic, cultural, maternal, pregnancy, delivery, product and medical care factors were recorded. Two analyses were performed using multiple logistic regression: one for stillbirths, the other for END.
PM rate was 46.7/1000; 142 cases and 284 controls were studied. Fifteen cases were excluded due to congenital malformations; 62 stillbirth and 65 END were analyzed. For stillbirth, pregnancy-delivery and maternal medical care factors resulted in the most strongly associated risk factors for PM (OR=27.5 95% CI 6.4-116.8), and within this index insufficient prenatal care had the strongest impact on PM (%population attributable risk (%PAR)=24%). For END, fetal conditions and the newborn medical care index had the strongest association with PM (OR=9.5 95% CI 1.5-60.3), and within the index inappropriate medical care of the newborn (%PAR=27%) was the most important variable.
Our results support the fact that insufficient prenatal care and failure to comply with the standards of care for labor, delivery and for the care of the newborn are strong predictors of PM.
Archives of Medical Research 35(6):554-62. · 1.88 Impact Factor
