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Diabetes mellitus, linked with insulin resistance and hyperglycaemia, is a leading cause of mortality. Glucose uptake through glucose transporter type 4, especially in skeletal muscle, is crucial for maintaining euglycaemia and is a key pathway targeted by antidiabetic medication. Abrus precatorius is a medicinal plant with demonstrated antihyperglycaemic activity in animal models, but its mechanisms are unclear. This study evaluated the effect of a 50% ethanolic (v/v) A. precatorius leaf extract on (1) insulin-stimulated glucose uptake and (2) related gene expression in differentiated C2C12 myotubes using rosiglitazone as a positive control, and (3) generated a comprehensive phytochemical profile of A. precatorius leaf extract using liquid chromatography-high resolution mass spectrometry to elucidate its antidiabetic compounds. A. precatorius leaf extract significantly increased insulin-stimulated glucose uptake, and insulin receptor substrate 1 and Akt substrate of 160 kDa gene expression; however, it had no effect on glucose transporter type 4 gene expression. At 250 µg/mL A. precatorius leaf extract, the increase in glucose uptake was significantly higher than 1 µM rosiglitazone. Fifty-five phytochemicals (primarily polyphenols, triterpenoids, saponins, and alkaloids) were putatively identified, including 24 that have not previously been reported from A. precatorius leaves. Abrusin, precatorin I, glycyrrhizin, hemiphloin, isohemiphloin, hispidulin 4′- O - β -D-glucopyranoside, homoplantaginin, and cirsimaritin were putatively identified as known major compounds previously reported from A. precatorius leaf extract. A. precatorius leaves contain antidiabetic phytochemicals and enhance insulin-stimulated glucose uptake in myotubes via the protein kinase B/phosphoinositide 3-kinase pathway by regulating insulin receptor substrate 1 and Akt substrate of 160 kDa gene expression. Therefore, A. precatorius leaves may improve skeletal muscle insulin sensitivity and hyperglycaemia. Additionally, it is a valuable source of bioactive phytochemicals with potential therapeutic use for diabetes. [ABSTRACT FROM AUTHOR]

Although considered an abundant source of agricultural by-products, avocado (Persea americana Mill.) seed, with several biological activities and bioactive components, might become a promising resource for phytopharmaceutical development. In this study, through bioassay-guided isolation of the main α -glucosidase inhibitors in avocado seed, we discovered the major α -glucosidase inhibitor to be avocado seed oligomeric proanthocyanidin complex (ASOPC). Thiolysis and UPLC-DAD-HRESIMS showed the presence of A- and B-type procyanidins, and B-type propelargonidin with (epi)afzelechin as extension unit. Mean degree of polymerization (mDP) of ASOPC was calculated as 7.3 ± 1. Furthermore, ASOPC appeared to be a strong, reversible, competitive inhibitor of α -glucosidase, with IC50 value of 0.1 µg/mL, which was significantly lower than Acarbose (IC50 = 75.6 µg/mL), indicated that ASOPC is a potential natural α -glucosidase inhibitor. These findings would contribute to the direction of utilizing avocado seed bioactive components with the possibility to be used as natural anti-diabetic agents. [ABSTRACT FROM AUTHOR]

Objective. To explore the perceptions of nursing professionals regarding facilitators and barriers to the implementation of expanded nursing functions in a state in central Mexico. Methods. Qualitative descriptive phenomenological study. During 2022, 18 semi-structured interviews were conducted with three types of informants: a) head nurses at state-level facilities; b) head nurses at local-level facilities; and c) heads of health units and operational nursing staff who have direct contact with patients. Results. The following facilitators were identified: willingness to adopt the strategy (seen as favorable by managers and acceptable by nursing staff); reorganization of functions (simplification of processes and analysis of the situation of health units); access to training; and characteristics of nursing staff (professionalization, work experience, and favorable attitude). Barriers included: conditions at the first level of care (personnel shortages, too many administrative activities, lack of physical space, materials, supplies, and consumables), resistance to change (professional jealousy of other disciplines and duplication of tasks), staff salaries, lack of training, not trusted with expanded duties, and attitude of patients (resistance to nursing care). Conclusions. By understanding the perceptions of nursing professionals, we can identify key elements for the successful expansion of nursing functions through expansion of the competencies of operational staff. Reorganization and proper management at different levels of decision-making will be necessary. [ABSTRACT FROM AUTHOR]

Hypertension and diabetes are modifiable cardiovascular disease (CVD) risk factors that contribute to nearly one-third of all deaths in the Americas Region each year (2.3 million deaths). Despite advances in the detection and clinical management of hypertension and diabetes, there are substantial gaps in their implementation globally and in the Region. The considerable overlap in risk factors, prognosis, and treatment of hypertension and diabetes creates a unique opportunity for a unified implementation model for management at the population level. This report highlights one such high-profile effort, the Pan American Health Organization's "HEARTS in the Americas" program, based on the World Health Organization's HEARTS Technical Package for Cardiovascular Disease Management in Primary Health Care. The HEARTS program aims to improve the implementation of preventive CVD care in primary health systems using six evidence-based, pragmatic components: Healthy-lifestyle counseling, Evidence-based protocols, Access to essential medicines and technology, Risk-based CVD management, Team-based care, and Systems for monitoring. To date, HEARTS implementation projects have focused primarily on hypertension given that it is the leading modifiable CVD risk factor and can be treated cost-effectively. The objective of this report is to describe opportunities for integration of diabetes clinical care and policy within the HEARTS hypertension framework. A substantial global burden of disease could be averted with integrated primary care management of these conditions. Thus, there is an urgency in applying lessons from HEARTS to close these implementation gaps and improve the integrated detection, treatment, and control of diabetes and hypertension. [ABSTRACT FROM AUTHOR]

Hypertension and diabetes are modifiable cardiovascular disease (CVD) risk factors that contribute to nearly one-third of all deaths in the Americas Region each year (2.3 million deaths). Despite advances in the detection and clinical management of hypertension and diabetes, there are substantial gaps in their implementation globally and in the Region. The considerable overlap in risk factors, prognosis, and treatment of hypertension and diabetes creates a unique opportunity for a unified implementation model for management at the population level. This report highlights one such high-profile effort, the Pan American Health Organization's "HEARTS in the Americas" program, based on the World Health Organization's HEARTS Technical Package for Cardiovascular Disease Management in Primary Health Care. The HEARTS program aims to improve the implementation of preventive CVD care in primary health systems using six evidence-based, pragmatic components: Healthy-lifestyle counseling, Evidence-based protocols, Access to essential medicines and technology, Risk-based CVD management, Team-based care, and Systems for monitoring. To date, HEARTS implementation projects have focused primarily on hypertension given that it is the leading modifiable CVD risk factor and can be treated cost-effectively. The objective of this report is to describe opportunities for integration of diabetes clinical care and policy within the HEARTS hypertension framework. A substantial global burden of disease could be averted with integrated primary care management of these conditions. Thus, there is an urgency in applying lessons from HEARTS to close these implementation gaps and improve the integrated detection, treatment, and control of diabetes and hypertension. [ABSTRACT FROM AUTHOR]

Objective. In 2021, Mexico launched the HEARTS program to improve the prevention and control of cardiovascular disease (CVD) risk factors in 20 primary care facilities in the states of Chiapas and Yucatán. This study projects the annual cost of program implementation and discusses budgetary implications for scaling up the program. Methods. We obtained district-level data on treatment protocols, medication costs, and other resources required to prevent and treat CVD. We used the HEARTS Costing Tool to estimate total and per-patient costs. A "partial implementation" scenario calculated the costs of implementing HEARTS if existing pharmacological treatment protocols are left in place. The second scenario, "full implementation," examined costs if programs use HEARTS pharmacological protocol. Results. Respectively in the partial and full implementation scenarios, total annual costs to implement and operate HEARTS were $260 023 ($32.1 per patient/year) and $255 046 ($31.5 per patient/year) in Chiapas, and $1 000 059 ($41.3 per patient/year) and $1 013 835 ($43.3 per patient/year) in Yucatán. In Chiapas, adopting HEARTS standardized treatment protocols resulted in a 9.7 % reduction in annual medication expenditures relative to maintaining status-quo treatment approaches. In Yucatán, adoption was $12 875 more expensive, in part because HEARTS hypertension treatment regimens were more intensive than status quo regimens. Conclusion. HEARTS in the Americas offers a standardized strategy to treating and controlling CVD risk factors. In Mexico, approaches that may lead to improved program affordability include adoption of the recommended HEARTS treatment protocols with preferred medications and task shifting of services from physicians to nurses and other providers. [ABSTRACT FROM AUTHOR]

Objective. To describe the spatial distribution of tuberculosis-diabetes comorbidity and identify the social determinants of the double burden of disease in the period from 2012 to 2018 in Brazil. Method. In the present ecological study, municipalities were the unit of analysis. All cases of tuberculosis reported from 2012 to 2018 to the National Notifiable Disease Information System SINAN were included. Socioeconomic variables covering employment, income, and development, and the primary care coverage indicator were analyzed as determinants. The global Moran's I statistic was used to verify spatial autocorrelation in the comorbidity rate. The local Moran statistic was used to delimit tuberculosis-diabetes clusters: high/high cluster (municipalities with high rates of tuberculosis-diabetes comorbidity with neighboring municipalities also presenting high comorbidity rates) and low/low cluster (municipalities with tuberculosis-diabetes comorbidity below the mean, surrounded by municipalities with low comorbidity rates). Results. A high proportion of tuberculosis-diabetes was detected in most Brazilian regions. Spatial autocorrelation was observed for tuberculosis-diabetes comorbidity, as well as a high-high comorbidity cluster encompassing 88 municipalities located mostly in the Northeast, Southeast, and South, with mean tuberculosis-diabetes prevalence of 28.04%. The variables "percent population living in households with more than two people per bedroom," "percent unemployment in the population above 18 years of age" and "per capita income" were associated with the presence of comorbidity. Conclusion. The results showed a non-random distribution of tuberculosis-diabetes comorbidity, with high-risk areas and associated explanatory variables. The findings underscore the need to operationalize cooperation between tuberculosis and diabetes programs, with the aim of controlling both the individual diseases and the tuberculosis-diabetes syndemic. [ABSTRACT FROM AUTHOR]

Objective. To describe prevalence of chronic diseases and evaluate associations between comorbidities and quality of life in gynecologic cancer patients in Puerto Rico. Methods. A cross-sectional study among 233 women aged ≥21 years with a gynecologic cancer diagnosis. Through telephone interviews, information on comorbidities, quality of life, and other covariates were assessed. Quality of life included six items, assessing physical and mental health. Multivariate logistic regression models were used to estimate magnitude of association between the comorbidities under study (diabetes, cardiovascular and autoimmune diseases) and quality-of-life items, through adjusted prevalence odds ratio (aPOR; 95% confidence interval [CI]). Results. Most women (90.1%) reported one or more comorbidities in addition to their cancer diagnosis; cardiovascular diseases (63.1%) were more common than autoimmune diseases (37.3%) and diabetes (33.9%). Between 30% and 40% of the sample indicated dysfunctions in their general health (39.5%) and frequent physical (33.9%) and mental distress (31.8%). Adjusting for age and gross family income, women with autoimmune diseases presented higher prevalence of frequent limitations for daily activities (aPOR 2.00; 95% CI 1.05-3.81), poor general health (aPOR 3.52; 95% CI 1.90-6.49), frequent mental distress (aPOR 2.19; 95% CI 1.19-4.03), and dissatisfaction with life (aPOR 4.86; 95% CI 1.82-12.95) compared to those who did not report autoimmune diseases. No associations with cardiovascular diseases and diabetes were observed. Conclusions. Quality-of-life dysfunctions were highly prevalent in this population of gynecologic cancer patients. Suffering from autoimmune comorbidities significantly exacerbated those dysfunctions. [ABSTRACT FROM AUTHOR]

Objective: This evidence-based practice (EBP) initiative sought to improve perioperative glucose management by developing a quality improvement protocol to guide EBP at the bedside. Design: Evidence-based practice/quality improvement. Setting and Participants: Our organization is a 350-bed level two trauma center in western Colorado. Inclusion criteria are patients with T2DM completing bariatric surgery. Measurements: Primary outcomes were postoperative BG levels and secondary outcomes included intra-operative dexamethasone dosing. Outcomes: Between October 2021 and July 2022 optimal BG increased by 49 percent after implementing an insulin protocol. Dexamethasone dosing was not clinically significant in postoperative BG levels in this population. Conclusion: Use of an insulin protocol can improve perioperative glucose management. This has important implications for practice when we consider the comorbidity reductions following bariatric surgery extends the life expectancy of patients with diabetes by over 9 years and diabetes resolution alone correlates to a $5.4 million dollar savings for every 1000 surgical patients. These outcomes are likely to increase the use of bariatric surgery as a public health measure to reduce the twin epidemics of obesity and diabetes. [ABSTRACT FROM AUTHOR]

• We proposed a dual stack network for detecting multiple diseases simultaneously. • This dual stack network contains two subnetworks. • The first subnetwork is based on a stacked sparse autoencoder extracting features. • The second subnetwork is based on a stacking framework to find optimal results. • The proposed method shows effectiveness on a multi disease dataset. Diabetes mellitus and chronic kidney disease are two severe chronic diseases in the world, affecting the quality of a patient's life. However, detecting these two diseases often applies professional medical techniques such as a Fasting Plasma Glucose test and estimating the glomerular filtration rate (eGFR) measurement, which usually requires a blood test. Given the various inconveniences and risks in existing conventional diagnostic approaches, noninvasive healthcare systems based on intelligent electronic detection/prevention are preferred. To achieve this goal, we propose a progressively trainable network, i.e., dual stack network (DsNet), to distinguish patients with chronic kidney disease, diabetes mellitus from healthy people simultaneously through analyzing the facial images of candidates. The first stack subnetwork extracts high-level representative features from the facial images effectively. While the second stack subnetwork can further analyze the extracted high-level features from the first stack subnetwork, before classifying the two diseases from healthy individuals simultaneously. Extensive experiments on a dataset with 229 healthy samples, 236 diabetes, and 200 chronic kidney disease patients show that our proposed method generated the F1-score of 95.33%, 98.17%, and 94.67% for detecting chronic kidney disease, diabetes, and healthy samples respectively. Our proposed DsNet achieves significant improvements compared with other traditional noninvasive detection approaches. [ABSTRACT FROM AUTHOR]

Objectives. To assess the association between childhood hunger experiences and the prevalence of chronic diseases later in life. Methods. A cross-sectional study was conducted using baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative study of persons aged 50 years and older (n = 9 412). Univariate and bivariate analyses were used to describe the sample, and multivariate logistic regressions to examine the association between childhood hunger and hypertension, diabetes, arthritis and osteoporosis. Adjusted odds ratios and predicted probabilities were calculated. Results. 24.7% of Brazilians aged 50 and over experienced hunger during childhood. This harmful exposure was significantly more common among non-white people, individuals with lower educational attainment, lower household income and heavy manual laborers. Regional variation was also observed, as the prevalence of individuals reporting childhood hunger was higher in the North and Northeast regions. The multivariate analysis revealed that older adults who reported having experienced hunger during childhood had 20% higher odds of developing diabetes in adulthood (aOR = 1.20, 95% CI: 1.02 -- 1.41) and 38% higher odds of developing osteoporosis (aOR = 1.38, 95% CI: 1.15 -- 1.64) than adults who did not experience hunger during childhood, after controlling for covariates. Conclusions. The study showed an association between childhood hunger and two chronic diseases in later life: diabetes and osteoporosis. This work restates that investing in childhood conditions is a cost-effective way to have a healthy society and provides evidence on relationships that deserve further investigation to elucidate underlying mechanisms. [ABSTRACT FROM AUTHOR]

Objective. To describe the mortality trends of diabetes mellitus (DM) in Colombia, by sex and age group, from 1979 to 2017. Methods. We carried out an ecological study using mortality data from the Colombian National Administrative Department of Statistics. Crude and age-standardized annual mortality rates per 100 000 people were estimated. Trends of standardized rates were described by sex and age groups. Joinpoint regression models were performed to study mortality trends. Results. Throughout the whole period, the total number of DM recorded deaths in Colombia was 200 650, 58% (116 316) in women (p<0.05). The age-standardized mortality rates (ASMR) by sex increased from 13.2 to 26.6 deaths per 100 000 in women and from 10.1 to 22.7 in men from 1979 to 1999. We observed a decrease from 26.6 to 15.4 per 100 000 in women, and from 22.7 to 15.9 in men for the period 1999-2017. The joinpoint regression analysis showed that the average annual percentage change of the period did not vary in both sexes (men: -0.2%, 95% CI -1.0 to 1.4%; women: 0.7%, 95% CI -0.1 to 1.6%). Conclusions. The DM mortality showed a decreasing trend after 2000 in women and 2004 in men. Primary and secondary prevention programs must continue to be strengthened for an earlier diagnosis of diabetes. [ABSTRACT FROM AUTHOR]

As a kind of traditional Chinese medicine extract, curcumin has been proven to be effective in inhibiting inflammation and apoptosis in pancreatic islet β cells in the streptozotocin-induced diabetes mellitus rat model, although the underlying mechanism has not yet been clarified. To examine the effect of curcumin on inflammation and apoptosis in pancreatic islet β cells, we established a type 2 diabetes rat model by feeding the animals a high-fat diet and intraperitoneally injecting streptozotocin. The curcumin was administered by intraperitoneal injection. The rat body weight, fasting blood glucose, intraperitoneal glucose tolerance tests, and insulin tolerance tests were recorded and analyzed. Hematoxylin and eosin staining was used for morphological analysis, and a TUNEL assay was performed to detect the apoptotic cells. The expression levels of proteins related to oxidative stress, inflammation and apoptosis were detected by Western blotting and ELISA. Curcumin administration significantly decreased fasting blood glucose and promoted recovery of pancreas function in type 2 diabetes rats. In curcumin-treated rats, the pancreatic tissue destruction and apoptosis index were reduced. The expression of IL-1 β , IL-6, TNF- α , caspase-3, Bax, and malondialdehyde were significantly reduced, and Bcl-2, superoxide dismutase 2, and glutathione peroxidase were significantly increased. Curcumin inhibited the expression of phosphorylated JNK and NF- κ B proteins to block the RAGE/JNK/NF- κ B signaling pathway. In conclusion, these results indicate that curcumin blocks the phosphorylation of JNK and NF- κ B protein to inhibit this signaling pathway, thereby further inhibiting inflammation and apoptosis in pancreatic islet β cells. Curcumin has potential value for the treatment of diabetes. [ABSTRACT FROM AUTHOR]

In Brazil, the promotion, protection, and recovery of health are among the initiatives provided by the public and universal Unified Health System (SUS). The primary healthcare level (PHC), the preferred point of access to the system, plays the role of coordinating and ordinating health care services and actions in the network. In the context of PHC, feeding and nutrition efforts must be aligned with National Feeding and Nutrition Policy (PNAN) guidelines and may be supported by feeding and nutritional surveillance actions. Data from PHC information systems and population surveys show that excess weight affects more than half the adult population of Brazil, and that consumption of ultra-processed foods is on the rise. This scenario requires that health care teams be prepared to prioritize initiatives for users with chronic diseases, using risk stratification, stabilization of the disease, and enhancement of supported self-care with a focus on diet and physical activity. At the same time, considering the country's epidemiological profile, teams must carry out initiatives to fight undernutrition and prevent anemia and hypovitaminosis A to address the multiple burden of malnutrition. The present article describes the current scenario of feeding and nutrition initiatives implemented at the PHC level in Brazil via the SUS. [ABSTRACT FROM AUTHOR]

Objective. To estimate the cost attributable to arterial hypertension, diabetes and obesity in the Unified Health System of Brazil in 2018. Method. The study estimated the cost attributable to non-communicable chronic diseases based on relative risk and population prevalence of hypertension, diabetes, and obesity, considering the cost of hospitalizations, outpatient procedures, and medications distributed by the SUS to treat these diseases. Cost data were obtained from SUS information systems. The analysis explored the cost of disease according to sex and age in the adult population. Results. The total cost of hypertension, diabetes, and obesity in the SUS reached R$ 3.45 billion (95%CI: 3.15- 3.75) in 2018, that is, more than US$ 890 million. Of this amount, 59% referred to the treatment of hypertension, 30% to diabetes, and 11% to obesity. The age group from 30 to 69 years accounted for 72% of the total costs, and women accounted for 56%. When obesity was considered separately as a risk factor for hypertension and diabetes, the cost attributable to this diseases reached R$ 1.42 billion (95%CI: 0.98-1.87), i.e., 41% of the total cost. Conclusions. The estimates of costs attributable to the main chronic diseases associated with inadequate diet revealed a heavy economic burden of these disorders for the SUS. The data show the need to prioritize integrated and intersectoral policies for the prevention and control of hypertension, diabetes, and obesity, and may support the advocacy for interventions such as fiscal and regulatory measures to ensure that the objectives of the United Nations Decade of Action on Nutrition are met. [ABSTRACT FROM AUTHOR]

Highlights • A body surface feature-based method is proposed for Diabetes Mellitus detection. • Five modalities including tongue, face, sublingual vein, pulse and odor are exploited. • A novel multi-modal method with gaussian process prior is proposed. • The correlation across various modalities is extracted. • Experimental results show the superiority of the method. Abstract In recent year, the number of people who are suffering from the Diabetes Mellitus (DM) has increased remarkably and the detection of DM disease has attracted much attention. Different from some existing methods which are invasive, Traditional Chinese Medicine (TCM) provides a non-invasive strategy for DM diagnosis by exploiting some features in the body surface, including the tongue, face, sublingual vein, pulse and odor. Since a combination of these modalities would contribute to improving detection performance, a novel multi-modal learning method is proposed to learn a shared latent variable among the tongue, face, sublingual, pulse and odor information, which efficiently exploits the correlation. In detail, the raw images or signals of five modalities are first captured through our non-invasive devices. Their corresponding features are then extracted, respectively. Finally, a shared auto-encoder gaussian process latent variable model (SAGP) is introduced to learn a latent variable for various modalities in a non-linear and generative way. An efficient algorithm is designed to optimize the proposed model. The DM detection experiments are conducted on a dataset composed of 548 Healthy and 356 DM samples collected by us and the results substantiate the superiority of the proposed method. [ABSTRACT FROM AUTHOR]

Abstract Many government and health organizations around the world have arrived at the same conclusion, that the number of people suffering from Diabetes Mellitus is growing every year and will continue to grow. Recently, researchers have developed a novel noninvasive method to detect this disease by analyzing its facial block features. Compared with the traditional diagnostic tool that analyzes a blood sample, the novel method is noninvasive in nature. That being said, there are still many challenges yet to be resolved in this area. In this paper an improved noninvasive method to detect Diabetes Mellitus is proposed using the Probabilistic Collaborative Representation based Classifier with facial key block color features. The Probabilistic Collaborative Representation based Classifier was proposed in 2016 and is a combined classifier which joints the probabilistic theory and the Collaborative Representation based Classifier. The Collaborative Representation based Classifier was developed from the Sparse Representation based Classifier through the use of the l 2 -norm function to replace the l 1 -norm of the Sparse Representation based Classifier. Experimental results performed on a dataset consisting of 142 Healthy individuals and 284 diabetes patients showed that the proposed method outperforms seven other classifiers. [ABSTRACT FROM AUTHOR]

For non-invasively investigating the interaction between insulin and glucose, mathematical modeling is very helpful. In this paper, we propose a new model for insulin-glucose regulatory system based on the well-known prey and predator models. The results of previous researches demonstrate that chaos is a common feature in complex biological systems. Our results are in accordance with previous studies and indicate that glucose-insulin regulatory system has various dynamics in different conditions. One interesting feature of this new model is having hidden attractor for some set of parameters. The result of this paper might be helpful for better understanding of regulatory system that contains glucose, insulin, and diseases such as diabetes, hypoglycemia, and hyperinsulinemia. [ABSTRACT FROM AUTHOR]

Introduction: Nonalcoholic fatty liver disease (NAFLD) presents a broad spectrum of histopathological alterations, from steatosis to liver cirrhosis. Patients with diabetes mellitus (DM) present increased incidence and severity of NAFLD. Objective: The goal of this study was to determine the prevalence and severity of NAFLD in patients with obesity with and without diabetes who are undergoing bariatric surgery. Method: The evaluation of liver biopsies was carried out through NAFLD activity score (NAS) to evaluate the degree of hepatic steatosis, presence of ballooning, inflammatory activity, and degree of fibrosis. Results: A total of 154 patients who have undergone bariatric surgery with intraoperative biopsy were observed and divided into two body mass index (BMI) ranges: from 35 to 44.9kg/m² and from 45 to 54.9. In totla, 32 (20.8%) of 154 patients had diabetes and 122 (79.2%) did not have diabetes. Patients with DM were significantly older than patients without the disease, presenting 41.29±9.40 years versus 36.71±10.13 years in the group with a BMI of 35 to 44.9kg/m2 (p=0.049); and 45.13±7.10 years versus 37.00±9.24 years in the group with BMI of 45 to 54.9kg/m² (p=0.024). In the histological evaluation, patients with DM from the BMI group of 35 to 44.9kg/m² had a strong association with a higher prevalence and severity of steatosis, balloning, inflammation, fibrosis, and steatohepatitis. Conclusion: The present study confirms the high prevalence of NAFLD in patients with morbid obesity. Prevalence and severity increase proportionally to BMI and who have DM as comorbidity. [ABSTRACT FROM AUTHOR]

PPARγ agonists are widely used medications in diabetes mellitus therapy. Their role in improving adipose tissue function contributes to antidiabetic effects. The extracts of Dodonaea viscosa have been reported to exert antidiabetic activity. However, the effective mediators and the underlying mechanisms were largely unknown. In this study, we investigated the action on PPARγ transactivation and adipocyte modulation of two typical flavonoid constituents from D. viscosa, 5,4'-dihydroxy-7,8-dimethoxyflavanone and aliarin. Our results showed that 5,4'-dihydroxy-7,8-dimethoxyflavanone and aliarin were potential partial PPARγ agonists. The compounds induced adipogenesis in 3T3-L1 cells, with an upregulated adiponectin mRNA level and enhanced insulin sensitivity. The favorable effects of 5,4'-dihydroxy-7,8-dimethoxyflavanone, aliarin, and other flavonoid constituents on adipocytes might contribute to the antidiabetic efficacy of D. viscosa. [ABSTRACT FROM AUTHOR]

Objective. To examine the historical trends of premature death due to cardiovascular disease and diabetes mellitus (CVD-DM) in the Caribbean and to identify any associations between these trends and health care expenditure. Methods. Death data were obtained from the World Health Organization Mortality Database; population data, from the United Nations World Population prospects; and health care expenditure data, from the World Bank. In all, 17 Caribbean countries had mortality data; however, only 11 had both mortality and health care expenditure data available. The analyses explored country-level trends in age-standardized CVD-DM mortality rates using 3-year moving averages from 1995 - 2014 for women and men. Associations between secular mortality rate change and health care expenditure were considered. Results. CVD-DM mortality rates ranged from 10.7 - 247.1 per 100 000, with a mean of 92.3 and standard deviation of 47.6. Of the 17 countries, 12 showed a reduction in premature CVD-DM mortality in both men and women, with others either showing no improvement or increases. Mortality rates for men were 1.46 times higher than for women. On average, there was a 68% increase in health care expenditure, with a 15.4% fall in CVD-DM mortality in women and 4.9% in men. Mixed effects modelling demonstrated a weak association between health care expenditure and declining CVD-DM mortality for both women -0.006 (95%CI = -0.014 - 0.001) and men -0.008 (95%CI = -0.017 - 0.001). Conclusions. Findings suggest that progress has been made to reduce premature CVD-DM related mortality in a number of Caribbean countries. Differences between countries may be partly related to differences in health care system performance, although further research that considers confounders is needed. [ABSTRACT FROM AUTHOR]

Objective. To assess the feasibility of implementing a physician-based, patient-centered counseling intervention model in Ecuador to improve the ability of primary care physicians (PCPs) to reduce cardiovascular disease (CVD) risk factors among patients. Methods. This was a randomized clinical trial conducted in primary care clinics in Quito in 2014 - 2016. Participants included 15 PCPs and their adult patients at high risk of developing type-2 diabetes. A physician-based and patient-centered counseling program was delivered to eight PCPs. Seven PCPs who did not receive the training comprised the control group. The patient experience was assessed by a patient exit interview (PEI). Assessment of the patient's anthropometrics, blood pressure, and blood biochemistry parameters were conducted. Changes within and between groups were estimated utilizing chisquare, ANOVA, paired t-tests, and coefficient with intervention. Results. A total of 197 patients participated, 113 in the intervention care group (ICG) and 84 in the usual care group (UCG); 99 patients (87.6%) in the ICG and 63 (75%) in the UCG completed the study. Counseling steps, measured by the PEI, were significantly higher in the ICG (8.9±1.6 versus 6.6±2.3; P = 0.001). Comparison of the estimated difference between the ICG and the UCG showed greater decreases in HbA1c and total cholesterol in the ICG. Within the ICG, there were significant improvements in weight, BMI, HbA1C, total cholesterol, and LDL-cholesterol. Conclusions. Training PCPs in a patient-centered behavioral intervention for CVD risk factor reduction is feasible and efficacious for reducing CVD risk factors in Ecuador. Developed and developing countries alike could benefit from such an intervention. [ABSTRACT FROM AUTHOR]

Objective. To measure the prevalence of various care services offered to the elderly with diabetes mellitus in Brazil, and to assess the social inequalities in these services. Methods. This cross-sectional, population-based study was carried out in 2013. The care services offered were evaluated in terms of the following eight indicators: recommendations to lower carbohydrates, to measure blood glucose, and to examine the feet; requests made for blood tests, for glycated hemoglobin tests, and for glycemic curve tests; and whether service users had had their eyes or feet examined in the previous year. We used the slope index of inequality and the concentration index to assess the inequalities among wealth quintiles. Results. A total of 1 685 elderly persons with diabetes were evaluated. Overall, 41.7% of them had had their eyes examined in the preceding year, 35.4% had had their feet examined in the preceding year, and 10.9% had been offered all eight of the care services. The largest absolute differences (in percentage points) between the first (poorest) and fifth (richest) wealth quintiles in terms of the care services that were offered to the users were for: a recommendation to measure blood glucose (25.8), a glycated hemoglobin test request (27.4), a glycemic curve test request (31.9), having the eyes examined in the preceding year (29.3), and having the feet examined in the preceding year (27.0). Conclusion. There were notable inequalities in the prevalences of the care services. In the future, measurement of blood glucose and examination of the feet should be emphasized, especially for elderly persons in a lower socioeconomic level. [ABSTRACT FROM AUTHOR]

Objective. To describe the estimated prevalence of noncommunicable diseases and their common risk factors among the adult population of Curitiba, Paraná, Brazil, based on results of the EPIdemiology of CURitiba: EvaluAtion of Noncommunicable diseases (EPICUREAN) study. Methods. This was a cross-sectional, population-based survey of 1 103 residents of Curitiba, grouped by age (18 - 39 years of age, 40 - 59, and ≥ 60 years), conducted in August 2013 - August 2014. Household interviews, anthropometry, blood pressure measurements, and fasting capillary glycemia were performed during two visits to each participant. The analyses included frequency distribution and prevalence estimates of main outcomes. Prevalence estimates, weighted by age and sex, were presented as absolute numbers and percentages. Results. Prevalence estimates for self-reported depression were 21.2%; hypertension, 31.2%; diabetes, 9.1%; self-reported dyslipidemia, 21.7%; obesity, 21.2%; current smoking, 16.1%; binge drinking, 23.4%; and insufficient physical activity, 35.1%. Prevalences of diabetes and hypertension were higher among individuals with less schooling and the elderly. Binge drinking and leisure-time physical activity were more prevalent in young adults. Men presented higher prevalences of overweight, current smoking, and harmful use of alcohol. Obesity and moderateto- severe risk of depression were more frequent among women and those with lower income. Conclusions. The prevalence of NCDs and common risk factors among the adult population of Curitiba are high and reveal a gradient of vulnerabilities by age, sex, education level, and income. To address health inequities and meet the needs of different population groups, the health system should monitor NCDs and risk factors and implement equitable public health policies. [ABSTRACT FROM AUTHOR]

Objective. To estimate the mortality attributable to diabetes mellitus (DM) as recorded by Peru's Ministry of Health and its association with the human development index (HDI). Methods. This was an ecological study based on a secondary analysis of death records belonging to the Ministry of Health for the period from 2005 to 2014. A death was considered attributable to DM if the underlying cause of death given in the death record was DM. Mortality attributable to DM has been presented descriptively and in terms of geospatial analyses, and Spearman's rho was used to test for an association between the difference in the mortality attributable to DM (between 2005-2006 and 2013-2014) and the HDI in Peru's various departments. Results. In the 10-year period under evaluation, 25 074 records listed DM as the underlying cause of death. The mortality rate attributable to DM per 100 000 population increased from 5.7 in 2005 to 9.5 in 2014. This accounted for 2.7% of the deaths recorded during the study period: 3.5% in coastal areas, 1.4% in the highlands, and 2.5% in the rainforest region. A direct association was found between the HDI and the difference in mortality attributable to DM (Spearman's rho = 0.41; p = 0.04). Conclusions. Mortality attributable to DM increased over the study period. It was highest in coastal areas, intermediate in the rainforest region, and lowest in the highlands. A direct association was found between the HDI and the difference in mortality attributable to DM. [ABSTRACT FROM AUTHOR]

The electrical activity of a three dimensional fractional-order model of pancreatic β -cells is numerically studied. The dynamics of the model is understood through the Adams–Bashforth–Moulton predictor corrector scheme, which is a time-domain approach. By considering both integer-order and fractional-order models, we highlight some differences in their dynamics characteristics. It is shown that the fractional model can give rise to chaotic dynamics due to the existence of a Smale horseshoe. Some behaviors related with diabetes mellitus are also reported. The fractional model gets closer to the real biological behavior, thus provides motivation in modeling biological systems with fractional order derivatives. [ABSTRACT FROM AUTHOR]

Introduction: Determine whether socio-demographic, habits and risk factors are associated with a better tensional control in type 2 diabetes in primary care patients in order to identify a specific target population for compensatory interventions improving diabetes control and reducing its morbi-mortality. Material and Methods: Cross-sectional study in primary care. Randomized type 2 diabetes patient data collection by their volunteer family doctors, proportionally stratified from the 5 Portuguese continental regions. Variables: blood pressure, age, gender, education, diabetes duration, HbA1c, smoking habits, weight, waist circumference, physical activity and adherence to medication. Bivariate and logistic regression analysis to evaluate each measured variable's independent association with uncontrolled blood pressure (≥ 140/90). Results: 709 patients were included in the study, 60.2% men, mean age 66.12 ± 10.47 years. In logistic regression analysis, the factors independently associated to uncontrolled BP were lower education (p = 0.014), shorter diabetes duration (p = 0.002), higher waist circumference (p < 0.001), higher pulse pressure (p < 0.001), higher physical activity level (p = 0.043) and being a smoker (p < 0.001). Discussion: The main limitations are the fact that the sample was not totaly random and included only primary care patients, a possible inter-observer bias and being a cross-sectional study, thus not providing information on temporal relation or causality. Conclusion: The sub-group of people with diabetes identified to have worse tensional control should have a different and more intensive approach in primary care. We recommend further longitudinal and population based confirmatory research. [ABSTRACT FROM AUTHOR]

To support doctors in planning insulin therapy for juvenile diabetic patients, we propose in this paper a new approach to the generation of formal medical guidelines. In the first stage of our approach, we cluster static patients’ data to obtain patient cohorts with similar medical characteristics. In the second stage, for every patient of the cohort, we model the course of the disease. Using discretization and a symbolic time scale, we convert numerical data to the sequence of events. Then, we define the notion of a compound event reflecting the basic unit of the pre-meal insulin therapy. The course of the disease is modeled as a sequence of compound events. To discover the patterns of such events, we propose a new algorithm based on the concept of frequent episodes. The patterns that were obtained are presented to physicians in form of a graph that illustrates the possible pathway of the therapy. Using the proposed approach, it is possible to model both mutual similarity and repetitiveness of the prescribed treatments. The proposed method was evaluated using the actual medical data of juvenile diabetic patients. We obtained encouraging results that have been evaluated positively by doctors. [ABSTRACT FROM AUTHOR]

Objectives: To describe the time trend of mortality attributable to diabetes mellitus DM) in Argentina in the years 1990-2013, by age and sex. Methods: Crude, age-specific, and age-adjusted rates of DM mortality in Argentina were calculated for the period 1990-2013. Mortality data were obtained from the Statistical Report on Deaths issued by the Department of Statistics and Health Information. An analysis of this trend was carried out through joinpoint regression models. Results: Analysis of the trend of crude and age-adjusted DM mortality rates yielded a statistically significant model in which mortality increased between 1990 and 2001 and declined thereafter. Furthermore, for age-adjusted rates, there was a significant downward trend of mortality in women (AAPC -1.10, 95%CI -1.70 to -0.50). Age-specific mortality rates multiplied with every 10-year increment in age. All age groups older than 50 years showed a growing mortality trend between 1990 and 2001. Conclusions: DM mortality mainly affects people over the age of 50 and men. A significant downward trend in age-adjusted DM mortality rates was observed for women. These findings highlight the importance of developing policies for prevention and early detection, as well as of proper coding of multiple causes of death. [ABSTRACT FROM AUTHOR]

Objective. To estimate the rate of drug resistance among pulmonary tuberculosis (PTB) cases in the state of Mato Grosso do Sul, Brazil, and specifically in the border areas with Paraguay and Bolivia, as well as to identify associated risk factors. Method. The present cross-sectional, epidemiological study focused on PTB cases recorded between January 2007 and December 2010 in the State Reportable Disease Information System with results of susceptibility tests to rifampicin, isoniazid, ethambutol, and streptomycin. Dependent variables were development of resistance to a single drug or any combination of drugs. Independent variables were being a new or treated case, living in border areas, presence/absence of diabetes, and history of alcoholism. Results. There were 789 TBP cases with susceptibility testing. The following characteristics were associated with resistance: treated case (P=0.0001), border region (P=0.0142), alcoholism (P=0.0451), and diabetes (P=0.0708). The rates of combined, primary, and acquired resistance for the state were 16.3%, 10.6%, and 39.0%, vs. 22.3%, 19.2%, and 37.5% for the border region. The rates of combined, primary, and acquired multidrug resistance for the state were 1.8%, 0.6%, and 6.3%, vs. 3.1%, 1.2%, and 12.5% for the border region. Conclusions. In the border region, the state should investigate drug resistance in all patients with respiratory symptoms, determine the pattern of resistance in confirmed cases, adopt directly observed treatment for cases of PTB, and develop health actions together with neighboring countries. Across the state, the levels of acquired resistance should be monitored, with investigation of resistance in all treated cases and implementation of directly observed treatment especially among patients with diabetes or alcoholism. [ABSTRACT FROM AUTHOR]

Objective. Develop a predictive dynamic model to estimate future scenarios for the incidence rate of type 2 diabetes mellitus (T2DM). Methods. A retrospective ecological study was conducted in 2013-2015 in the city of San Luis Potosí, Mexico. Secondary official data from the 58 municipalities making up the state of San Luis Potosí were analyzed. Linear correlation, multiple linear regression, and structural equations were carried out, and four predictive dynamic submodels were developed: T2DM, urban population, inhabited private dwellings that have television, and population aged 45-49 years. A holistic model was also developed. Results. The structural model explains 27.2% of total variance in type 2 diabetes mellitus. Percentage of inhabited dwellings that have television weighs 4.46 non-standard units on diabetes; that of urban population, 2.84; and that of population aged 45-49 years, 156.69. Estimated scenarios for T2DM per 100 000 population for the years 2015, 2020, 2025, and 2030 were 1,052.4, 1,413.7, 1,850.1, and 2,351.1 respectively. Conclusion. The T2DM scenario shows exponential growth from 2000 to 2030. Risk factors according to the weight they represent in occurrence of the disease were: population aged 45-49 years, inhabited private dwellings that have television, and urban population. [ABSTRACT FROM AUTHOR]

Objective. To obtain an evaluation of current type 2 diabetes mellitus (T2DM) clinical practice guidelines. Methods. Relevant guidelines were identified through a systematic search of MEDLINE/ PubMed. Pan American Health Organization (PAHO) country offices were also contacted to obtain national diabetes guidelines in use but not published/available online. Overall, 770 records were identified on MEDLINE/PubMed for citations published from 2008 to 2013. After an initial screening of these records, 146 were found to be guidelines related to diabetes. Inclusion and exclusion criteria were used to further refine the search and obtain a feasible number of guidelines for appraisal. Guideline evaluation was conducted by health professionals using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which was developed to address the issue of variability in guideline quality and assesses the methodological rigor and transparency in which a guideline is developed. A total of 17 guidelines were selected and evaluated. Results. Ten guidelines scored ≥ 70% and seven guidelines scored ≥ 80%. The range was 21%-100%. The mean scores for Latin America and the Caribbean (LAC) country guidelines (n = 6) were compared to the mean scores for non-LAC country guidelines (n = 11). International guidelines consistently scored notably higher in all domains and overall quality than LAC guidelines. Conclusions. Based on this study's findings, it is clear that T2DM clinical practice guideline development requires further improvements, particularly with regard to the involvement of stakeholders and editorial independence. This issue is most apparent for LAC country guidelines, as their quality requires major improvement in almost all aspects of the AGREE II criteria. Continued efforts should be made to generate and update high-quality guidelines to improve the management of increasingly prevalent noncommunicable diseases, such as T2DM. [ABSTRACT FROM AUTHOR]

To understand the status of prediabetes diagnosis and treatment in Latin America and to evaluate the use of metformin for diabetes prevention in this context. A panel of 15 diabetes experts from seven countries in Latin America met on 14 - 15 August 2014 in Lima, Peru, to review the available literature, discuss the role of prediabetes in type 2 diabetes mellitus and cardiovascular disease, analyze collected information, and make conclusions for prediabetes diagnosis and treatment in Latin America. Prediabetes diagnosis, screening, and treatment, including lifestyle changes, pharmacological treatment, and cost-effectiveness were discussed. Five resulting statements were issued for Latin America: prediabetes is a clinical and public health problem; health care systems do not currently diagnose/treat prediabetes; use of prediabetes risk detection tools are needed region-wide; treatment includes lifestyle changes, multidisciplinary education, and metformin; and registries of patient records and further studies should be supported. The expert panel concluded that in Latin America, preventive treatment through lifestyle changes and metformin are cost-effective interventions. It is important to improve prediabetes identification and management at the primary care level. [ABSTRACT FROM AUTHOR]

Objective. To obtain an evaluation of current type 2 diabetes mellitus (T2DM) clinical practice guidelines. Methods. Relevant guidelines were identified through a systematic search of MEDLINE/PubMed. Pan American Health Organization (PAHO) country offices were also contacted to obtain national diabetes guidelines in use but not published/available online. Overall, 770 records were identified on MEDLINE/PubMed for citations published from 2008 to 2013. After an initial screening of these records, 146 were found to be guidelines related to diabetes. Inclusion and exclusion criteria were used to further refine the search and obtain a feasible number of guidelines for appraisal. Guideline evaluation was conducted by health professionals using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which was developed to address the issue of variability in guideline quality and assesses the methodological rigor and transparency in which a guideline is developed. A total of 17 guidelines were selected and evaluated. Results. Ten guidelines scored ≥ 70% and seven guidelines scored ≥ 80%. The range was 21%-100%. The mean scores for Latin America and the Caribbean (LAC) country guidelines (n = 6) were compared to the mean scores for non-LAC country guidelines (n = 11). International guidelines consistently scored notably higher in all domains and overall quality than LAC guidelines. Conclusions. Based on this study's findings, it is clear that T2DM clinical practice guideline development requires further improvements, particularly with regard to the involvement of stakeholders and editorial independence. This issue is most apparent for LAC country guidelines, as their quality requires major improvement in almost all aspects of the AGREE II criteria. Continued efforts should be made to generate and update high-quality guidelines to improve the management of increasingly prevalent noncommunicable diseases, such as T2DM. [ABSTRACT FROM AUTHOR]

Objective. To describe the demographic and clinical manifestations of patients with chronic kidney disease (CKD), arterial hypertension, and/or diabetes mellitus, and to determine the association between the presence of these pathologies and the development of CKD. Methods. Analytic and cross-sectional study. The information, with a cutoff date of 30 June 2013, comes from the integrated database of CKD and patients with hypertension and diabetes, which the Colombian payer entities provided to the national fund for high-cost diseases (Cuenta de Alto Costo). A descriptive analysis was conducted and the prevalence of CKD and stage 5 CKD was determined. Crude odds ratios (OR) were used to determine the association between CKD and age, sex, and diabetes. Results. 2,599,419 records were analyzed, of which 40% corresponded to people with CKD. Overall, 74.9% of the population had hypertension and 6.4% had diabetes. The prevalence of CKD was 2.81%, with 94.3% of patients in stages 1 to 3. In patients with diabetes, the risk of presenting CKD is 1.03 (confidence interval of 95% [CI95%] 1.016-1.043). Among persons over 60 years of age, the risk of CKD is 2.15 (CI95% 2.140-2.167). Conclusions. 33.4% of patients with hypertension or diabetes have not been studied to determine the presence or absence of CKD. It is a priority to implement strategies for secondary and primary prevention in order to prevent the progression of CKD and reduce the prevalence of risk factors such as hypertension and diabetes. [ABSTRACT FROM AUTHOR]

Objective. To assess trends in 1) tuberculosis (TB) case notification by year and 2) cumulative treatment outcomes (stratified by type of TB) in relation to the proportion of indigenous population in municipalities in a countrywide study in Mexico for the period 2009-2013. Methods. This ecological operational research study used municipality data for the five-year study period. As no single identifier variable existed for indigenous persons, municipalities were categorized into one of three groups based on the proportion of their indigenous population (< 25% ("low"), ≥ 25% to < 50% ("medium"), and ≥ 50% ("high")). TB case notification rates (CNRs) were standardized to a 100 000 population. Results. For the first four years of the study period (2009 through 2012), for all new TB cases reported nationally, the municipalities with a high proportion of indigenous people (≥ 50%) had the highest CNRs (ranging from 20.8 to 17.7 over that period). In 2013, however, the CNR in the high proportion municipalities dropped to 16.7, lower than the CNR for that year in the municipalities with a medium proportion of indigenous people (P < 0.001). In the municipalities with low and medium proportions of indigenous people, the CNR hovered between 15.1 and 17.3 over the study period. For the 96 195 new TB cases reported over the study period, the treatment success rate ranged between 81% and 84% for all three municipality groups. For previously treated TB cases, CNRs ranged between 1.0 and 1.7 for all three groups over the study period. The average proportion of previously treated TB cases (of all TB cases) was 9% for the three groups in 2009 but dropped to 8% by 2013. The cumulative treatment success rate for all previously treated cases (a total of 8 763 for the study period) was 64% in municipalities with a low proportion of indigenous people, 61% in those with a medium proportion, and 69% in those with a high proportion. Conclusions. Despite the slightly higher CNR in municipalities with predominantly indigenous populations, there were no stark differences in TB burden across the three municipality groups. The authors were unable to confirm if the relatively low CNRs found in this study were a reflection of good TB program performance or if TB cases were being missed. A survey of TB prevalence in indigenous people, with individualized data, is needed to inform targeted TB control strategies for this group in Mexico. [ABSTRACT FROM AUTHOR]

Objective . Cardiovascular diseases are the leading cause of mortality in the world. Although most of them are preventable, their prevalence continues to increase. The objective of this study was to estimate the prevalence of cardiovascular risk factors in an urban ambulatory adult hospital population in Asunción, Paraguay . Methods . A cross sectional study was undertaken in the population of patients en rolled in the AsuRiesgo prospective study on the prevention of cardiovascular dis ease, which focuses on promoting a healthy lifestyle. Patients 18 years of age or older who were encountered in doctors' waiting rooms in a tertiary care hospital were invited to participate. Each patient's clinical history, body measurements, and laboratory test results were obtained. Results . A total of 18 287 patients aged 51 ± 16 years were recruited. Of this group, 67.5% were female, with an average bodyweight of 77.5 ± 16.2 kg and a body mass index 29.7 ± 5.9 kg/m². The prevalence rates of a history of myocardial infarction, stroke, diabetes mellitus, and hypertension were 2.6%, 3%, 13.3%, and 53%, respectively, and the rates of smoking, unhealthy diet, sedentary lifestyle, and psychological stress were 29.3%, 41.2%, 58.2%, and 56.6%. The overall prevalence of obesity and overweight was 79.6%; the rates of prehypertension and systemic hypertension were 39% and 25%, respectively; and the prevalence of metabolic syndrome was 34.7%. Conclusions . Although the prevalence rates of smoking, systemic hypertension, and diabetes mellitus were low, those for obesity, sedentary lifestyle, psychological stress, unhealthy diet, and metabolic syndrome were very high. This finding demonstrates the need for global action to prevent disability and death from ischemic heart and cerebrovascular disease. It is urgent to implement programs to address these challenges on a national scale. [ABSTRACT FROM AUTHOR]

This analysis reviews cooperation between the four border states of the United States of America (Arizona, California, New Mexico, and Texas) and international partners in Mexico with regard to type 2 diabetes among Latinos. Binational cooperation, academic collaboration, preventative health initiatives, and efforts to improve health care access for the border population are highlighted. This meta- analysis of the literature points out causative factors of the increased type 2 diabetes prevalence among Latinos in the United States; an inverse correlation between diabetes and education and socioeconomic level; contributing factors, including barriers with language, health care payment, transportation, and underestimating diabetes implications; and a lack of social and environmental support for disease management. Medical and indirect costs in socioeconomic terms are also included. Cooperation between the United States and Mexico may be beneficial to promoting further collaborative efforts between these nations, and serve as a template for greater cooperative efforts to mitigate the substantial public health and socioeconomic implications of type 2 diabetes globally. [ABSTRACT FROM AUTHOR]

Objective. To compare the prevalence and patterns of depressive symptoms among women with type 2 diabetes in Puebla, Mexico, and Chicago, United States. Methods. Two cross-sectional studies were conducted independently, in Puebla (September 2010-March 2011) and in Chicago (January-July 2010). Depression symptomatology was evaluated in a random sample of 241 women self-reporting type 2 diabetes in Puebla and a convenience sample of 121 women of Mexican descent seeking care for type 2 diabetes in Chicago. Depressive symptomatology was measured by the Center for Epidemiologic Studies Depression Scale administered in either English or Spanish. Women were similarly socioeconomically disadvantaged with low education levels in both locations. Results. The Chicago sample of women reported higher levels of depression than the Puebla sample (38% versus 17%, P < 0.0001). Among those with comorbid depression and diabetes in both sites, minimal variations in symptoms were observed. Depressive symptoms, specifically the subjective element (feeling sad) and symptoms associated with diabetes (fatigue and sleep problems) were heightened in both groups. More frequent reporting of “feeling fearful” was statistically significant in Puebla. Conclusions. Despite a higher prevalence of depression among Mexican immigrant women with diabetes in the United States compared to Mexico, there was little variation in their depressive symptoms, regardless of residence. However, women in Mexico did report a higher incidence of fear. Screening for depression in patients with diabetes should take into account symptoms of fatigue and sleep and the bi-directional relationship of depression and diabetes. [ABSTRACT FROM AUTHOR]

mHealth is a practical, useful, and available tool for one-way or two-way communication between health professionals and patients. It is especially promising in countries such as Chile, with widespread and growing mobile telephone coverage that is very well accepted by the public. Our objective is to demonstrate the process for designing a mobile communication and monitoring model, aimed at providing communication between professionals in primary healthcare centers and their patients, to facilitate timely diagnosis and initiation of treatment for type 2 diabetes. This model's characteristics include use of mobile telephones as a communication tool, a one-way method (from health centers to patients), integration into in-person care delivered at health centers, use of different communication strategies (voice and written), and integrated functioning using open-source software. The system includes personalized communication, automated voice communication, and automated written communication using short message service (SMS). We describe the strategies and components of the system. The lessons learned include the contribution from successful implementation of COSMOS (consolidated online modulated operating systems), a technological innovation, to support the health care of people with suspected type 2 diabetes in primary healthcare centers. Working together with teams in the field is essential to this achievement. [ABSTRACT FROM AUTHOR]

Objective. Design and develop a mobile messaging system called mSalUV, which reminds patients with type 2 diabetes about taking their medication and attending appointments and promotes healthy lifestyles, and explore patient opinion regarding use of the system. Methods. The study had three stages: 1) design and development of mSalUV; 2) design and development of text messages; and 3) exploration of patient opinion regarding use of mSalUV. Results. The mSalUV system was created and around 40 text messages were designed. A total of 1 850 messages were sent during the 45 day intervention. Patients thought that mSalUV helped them to treat their disease and that it was easy to use, they were inclined to continue using the system in the future, and people close to them (family members and support networks) supported them using it. Furthermore, they perceived the system as “someone that cared about them.” Conclusions. The results suggest that a system such as mSalUV would be well accepted by its potential users; in this case, people with type 2 diabetes. This presents a very interesting scenario that will enable taking advantage of new technologies for health. Further research is needed to evaluate the system's efficiency and effectiveness. [ABSTRACT FROM AUTHOR]

Naringin, chemically 4',5,7- trihydroxyflavanone-7-rhamnoglucoside, is a major flavanone glycoside obtained from tomatoes, grapefruits, and many other citrus fruits. It has been experimentally documented to possess numerous biological properties such as antioxidant, anti-inflammatory, and antiapoptotic activities. In vitro and in vivo studies have further established the usefulness of naringin in various preclinical models of atherosclerosis, cardiovascular disorders, diabetes mellitus, neurodegenerative disorders, osteoporosis, and rheumatological disorders. Apart from this, naringin has also exerted chemopreventive and anticancer attributes in various models of oral, breast, colon, liver, lung, and ovarian cancer. This wide spectrum of biological expediency has been documented to be a result of either the upregulation of various cell survival proteins or the inhibition of inflammatory processes, or a combination of both. Due to the scarcity of human studies on naringin, this review focuses on the various established activities of naringin in in vitro and in vivo preclinical models, and its potential therapeutic applications using the available knowledge in the literature. Additionally, it also encompasses the pharmacokinetic properties of naringin and its inhibition of CYP isoenzymes, and the subsequent drug interactions. Moreover, further clinical research is evidently needed to provide significant insights into the mechanisms underlying the effects of naringin in humans. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is one of the major health problems in Africa. The conventional oral synthetic antidiabetic drugs available to manage the disease are costly and not readily affordable to the majority of the affected population. Interestingly, the continent is endowed with a tremendous number of medicinal plants that have been explored for their folkloric treatment of diabetes mellitus. Scientific investigations have validated the antidiabetic potentials of a number of these medicinal plants but there is no repository with information on these scientifically investigated plants as a guide for future research. In this review article, all of the in vivo antidiabetic studies conducted between January 2000 and July 2013 on African plants are systematically compiled with a closer look at some relevant plants from the continent's subregions. Plants of the Asteraceae and Lamiaceae families are the most investigated, and West Africa has the highest number of investigated plants. Although promising results were reported in many cases, unfortunately, only a few studies reported the partial characterization of bioactive principles and/or mechanisms of action. It is hoped that government agencies, pharmaceutical industries, and the scientific community will have a look at some of these plants for future research and, if possible, subsequent commercialization. [ABSTRACT FROM AUTHOR]

Two new xanthones, 1,8-dihydroxy-3-methoxyxanthone 7-O-[α-L-rhamnopyranosyl(1→2)-β- D-glucopyranoside] (1) and 1,8- dihydroxy-3- methoxyxanthone 7-O-[α-L-rhamnopyranosyl (1→3)-α-L-rhamno-pyranosyl (1→2)-β-D-xylopyranoside] (2), together with 26 known xanthones (3-28), were isolated from the aqueous ethanol extract of the traditional Chinese herb Swertia mussotii. Their structures were elucidated via spectroscopic analyses including 2D NMR. The inhibition of α-glucosidase by the isolated xanthones was evaluated by an in vitro high-throughput screening assay. Our results indicated that 1,3,5,8-tetrahydroxyxanthone is the best inhibitor with an IC50 value of 5.33 ± 0.09 μM, while the O-glycosylated xanthones were poor α-glycosidase inhibitors. [ABSTRACT FROM AUTHOR]

Objective. To assess whether U.S.-Mexico border residents with diabetes 1) experience greater barriers to medical care in the United States of America versus Mexico and 2) are more likely to seek care and medication in Mexico compared to border residents without diabetes. Methods. A stratified two-stage randomized cross-sectional health survey was conducted in 2009-2010 among 1 002 Mexican American households. Results. Diabetes rates were high (15.4%). Of those that had diabetes, most (86%) reported comorbidities. Compared to participants without diabetes, participants with diabetes had slightly greater difficulty paying US$ 25 ( P = 0.002) or US$ 100 ( P = 0.016) for medical care, and experienced greater transportation and language barriers ( P = 0.011 and 0.014 respectively) to care in the United States, but were more likely to have a person/place to go for medical care and receive screenings. About one quarter of participants sought care or medications in Mexico. Younger age and having lived in Mexico were associated with seeking care in Mexico, but having diabetes was not. Multiple financial barriers were independently associated with approximately threefold-increased odds of going to Mexico for medical care or medication. Language barriers were associated with seeking care in Mexico. Being confused about arrangements for medical care and the perception of not always being treated with respect by medical care providers in the United States were both associated with seeking care and medication in Mexico (odds ratios ranging from 1.70 -2.76). Conclusions. Reporting modifiable barriers to medical care was common among all participants and slightly more common among 1) those with diabetes and 2) those who sought care in Mexico. However, these are statistically independent phenomena; persons with diabetes were not more likely to use services in Mexico. Each set of issues (barriers facing those with diabetes, barriers related to use of services in Mexico) may occur side by side, and both present opportunities for improving access to care and disease management. [ABSTRACT FROM AUTHOR]

Lyumjev is indicated to improve glycemic control in adults with diabetes mellitus. [ABSTRACT FROM AUTHOR]

Objective. To estimate the 2009 prevalence of diagnosed diabetes in Puerto Rico among adults ≥ 20 years of age in order to gain a better understanding of its geographic distribution so that policymakers can more efficiently target prevention and control programs. Methods. A Bayesian multilevel model was fitted to the combined 2008-2010 Behavioral Risk Factor Surveillance System and 2009 United States Census data to estimate diabetes prevalence for each of the 78 municipios (counties) in Puerto Rico. Results. The mean unadjusted estimate for all counties was 14.3% (range by county, 9.9%-18.0%). The average width of the confidence intervals was 6.2%. Adjusted and unadjusted estimates differed little. Conclusions. These 78 county estimates are higher on average and showed less variability (i.e., had a smaller range) than the previously published estimates of the 2008 diabetes prevalence for all United States counties (mean, 9.9%; range, 3.0%-18.2%). [ABSTRACT FROM AUTHOR]

This article describes epidemiological evidence on the association between alcohol use and diabetes, and the implications for clinical management and public health policies in the Americas. Heavy alcohol use is a risk factor for both diabetes and poor treatment adherence, despite evidence that moderate drinking can protect against type 2 diabetes under some circumstances. The burden of disease from diabetes associated with excessive alcohol consumption warrants both clinical and public health measures. On the clinical level, research on early interventions to prevent hazardous drinking shows that new screening, brief intervention, and referral techniques are effective ways to manage hazardous drinking in primary care settings. On the population level, restrictions on alcohol marketing and other alcohol control policies reduce the frequency and intensity of alcohol consumption in at-risk populations. These policy actions are recommended within the context of the World Health Organization's global strategy to reduce the harmful use of alcohol. [ABSTRACT FROM AUTHOR]

Objective. Identify and describe population groups with greater risk and morbidity profiles for type II diabetes, hypertension, and tobacco-related illnesses. Methods. A cross-sectional study was carried out of 840 families under the care of 12 family doctors and nurses in Havana, Cuba. A model-based cluster analysis was used to identify subpopulations with specific morbidity and risk profiles. Key indicators of the subpopulations were compared. Results. A subpopulation with a high disease burden and a particular risk profile was identified and described. The determining factor in defining this group is the subjective perception of their economic situation. The families in this group have the highest household density of diabetes, hypertension, and tobacco-related illnesses and are distributed among all the facilities visited. On average, the subpopulation consisted of smaller families and have between two and three years less schooling, a more negative perception of their economic situation, and an older average age, when compared to the study group as a whole. Conclusions. Subpopulations were identified with higher proportions of the disease burden and with particular risk profiles. These subpopulations exhibit certain features consistent with trends in the social structure of Cuban families that have been evolving over the past two decades. [ABSTRACT FROM AUTHOR]

There is a traditional belief among Eastern people that opium may have ameliorating effects on cardiovascular risk factors, especially diabetes; thus, it is widely used among diabetic patients. We attempted to investigate the association of opium consumption with coronary artery disease (CAD) in diabetic patients. A cross-sectional study was conducted on diabetic patients undergoing coronary angiography in our center. Out of 1925 diabetic patients included in the study, 228were opium users, and the remaining 1697 non-opium users were used as a pool of potential comparators. Propensity scores were used to match the 228 opium consumers with 228 matched comparators for age, sex, and smoking status. The Gensini score and extent score were respectively used to assess the angiographic severity and extent of CAD. The mean Gensini score (86.9 ± 62.7 vs. 59.6 ± 43.4, p < 0.0001) and extent score (7.1 ± 2.9 vs. 5.9 ± 2.9, p < 0.0001) were significantly higher in opium user diabetic patients than in non-opium users. After adjustment for potential confounders, a dose-response relationship was observed between dose of opium and the Gensini score (β = 0.27, p = 0.04). There were no significant differences between the routes of opium administration (inhalation vs. oral) regarding the severity and extent of CAD. In conclusion, exposure to opium in diabetic patients may be positively associated with the risk of CAD, and with the angiographically determined severity and extent of the disease. Furthermore, dosage of opium consumption may correlate with severity of CAD. [ABSTRACT FROM AUTHOR]