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Background and Aims: It has been suggested that magnesium deficiency is associated with the triggering of acute phase response, which may contribute to type 2 diabetes and cardiovascular disease risk. We undertook this study to determine whether oral magnesium supplementation modifies serum levels of high-sensitivity C-reactive protein (hsCRP) in apparently healthy subjects with prediabetes and hypomagnesemia. Methods: A total of 62 men and non-pregnant women aged 18–65 year, with new diagnosis of prediabetes (glucose 5.6 <7.0 mmol/L and/or post-load glucose ≥7.7 <11.1 mmol/L) and hypomagnesemia (serum magnesium levels <0.74 mmol/L) were enrolled in a clinical double-blind placebo-controlled trial and randomly allocated to receive either magnesium chloride (30 mL of MgCl2 5% solution) or NaHCO3 0.1% solution, once daily for 3 months. Results: At basal conditions, anthropometric and biochemical variables were similarly distributed in both groups. At the end of follow-up, participants who received magnesium chloride showed higher serum magnesium levels (0.86 ± 0.08 vs. 0.69 ± 0.16 mmol/L, p = 0.002) and lower hsCRP levels (4.8 ± 15.2 vs. 17.1 ± 21.0 nmol/L, p = 0.01) compared with participants in the control group. Conclusions: Oral magnesium supplementation decreases hsCRP levels in apparently healthy subjects with prediabetes and hypomagnesemia. [ABSTRACT FROM AUTHOR]

Background and Aims: There are no studies that elucidate whether the role of inflammation in the increase of urinary albumin is independent, mediated by family history or by risk factors acquired during life in the offspring of subjects with type 2 diabetes. We undertook this study to evaluate whether elevated C-reactive protein (CRP) levels are independently associated with urinary albumin-to-creatinine ratio (UACR) in the offspring of subjects with diabetic nephropathy. Methods: A total of 64 healthy males and healthy nonpregnant females, offspring of subjects with diabetic nephropathy, aged 18–69 years, and with body mass index ≤35 kg/m2 were enrolled in a cross-sectional study. Hypertension, glucose metabolic disorders, metabolic syndrome, smoking, alcohol intake, chronic or acute infections, renal disease, neoplasm, cardiovascular disease, degenerative disease, intake of anti-inflammatory drugs, exercise, or sexual intercourse in the previous 72 h were exclusion criteria. Subjects with high-sensitivity CRP (hsCRP) levels ≥3.0 mg/dL were compared with a gender- and age-matched control group of subjects with hsCRP levels <3.0 mg/dL. Results: The multivariate linear regression analysis showed that hsCRP (B = 0.50, β = 0.583, p = 0.02), total body fat (B = −2.80, β = 0.473, p = 0.03), BMI (B = −1.45, β = 0.390, p = 0.04) and waist circumference (B = 0.89, β = 0.407, p = 0.04) are predictors for elevation of UACR (Table 2). However, in the stepwise model only hsCRP (B = 0.674; β = 0.314; p = 0.04) remained significantly associated with UACR. Conclusions: Our results show that independent of the primary risk factors, elevated hsCRP levels are associated with UACR. [Copyright &y& Elsevier]

Background: Cardiovascular (CV) risk factors are influenced by behavioral, cultural, and social factors, suggesting that acculturation plays a significant role in the emergency and growth of chronic disease. The objective of this study was to determine the relation between CV risk factors and the main components of acculturation, in Yaquis and Tepehuanos Indians from Mexico. Methods: This was a cross-sectional population-based study in Yaquis and Tepehuanos communities from the Yaqui Valley in Sonora and the Sierra Madre Occidental Mountains in Durango, in northwest Mexico. Acculturation status is different in both ethnic groups, with Tepehuanos living in small and remote communities retaining their traditional lifestyle and Yaquis living in well-communicated communities that have assumed Westernized lifestyles. Results: A total of 278 indigenous (120 Tepehuanos and 158 Yaquis) were randomly enrolled. Prevalence of obesity (48.1 and 6.7%, p <0.001), diabetes (18.3 and 0.83%, p <0.001), hypertriglyceridemia (43.0 and 15.0%, p <0.001), alcohol consumption (46.8 and 26.6%, p >0.001), and smoking (29.7 and 15.0%, p = 0.006) were significantly higher in Yaquis Indians. High blood pressure (6.3 and 3.3%, p = 0.40) and low HDL-cholesterol (42.4 and 34.2%, p = 0.22) were similar between Yaquis and Tepehuanos. Multivariate regression analysis adjusted by sex and age showed a significant association between calorie intake from saturated fat, but not other nutrients of customary diet, with hyperglycemia (OR 7.4, 95% CI 2.6–20.1), hypertriglyceridemia (OR 3.1, 95% CI 1.5–6.3), and obesity (OR 3.4, 95% CI 1.6–10.1). Conclusions: Among the components of acculturation, intake of saturated fat is the most strongly associated with the development of CV risk factors. [Copyright &y& Elsevier]

Background: We undertook this study to assess the hypothesis that hypomagnesemia is associated with depressive symptoms in older people with diabetes. Methods: A total of 55 type 2 diabetic patients, aged 65 years or older, with depressive symptoms were compared with a control group of diabetic subjects without depressive symptoms in an age- and gender-matched case/control study. A score ≥11 points in the Yesavage''s scale was used for defining depressive symptoms, and hypomagnesemia was defined by serum magnesium levels <0.74 mmol/L. Well-known causes for depression as well as diseases and drugs that may cause depressive symptoms or hypomagnesemia were exclusion criteria. Results: Serum magnesium levels were significantly lower among depressive than control diabetic subjects (0.74 ± 0.25 vs. 0.86 ± 0.29 mmol/L, p = 0.02). Twenty four (43.6%) and 7 (12.7%) individuals in the case and control group exhibited low serum magnesium levels (p = 0.0006). The adjusted logistic regression analysis showed an independent association between hypomagnesemia and depressive symptoms (OR 1.79; CI95% 1.1–6.9, p = 0.03). Conclusions: Our results suggest that hypomagnesemia is independently associated with depressive symptoms in older people with diabetes. [Copyright &y& Elsevier]

Background: Because obesity masks the need for screening, there is no previous description of dyslipidemia in healthy normal-weight children. The aims of this study were a) to determine the prevalence of disorders in lipid profile among non-obese prepubertal children, and b) to establish its association with the family history (FH) of high blood pressure (HBP), type 2 diabetes (T2-DM), and obesity. Methods: A random sample of 439 healthy normal-weight children, 218 girls and 221 boys, aged 10–13 years and Tanner stage 1–2 were enrolled in a community-based cross-sectional study carried out in Durango, in northern Mexico. For verifying accuracy of FH, a direct detailed medical history including anthropometric and laboratory measurements was directly obtained from both parents. Results: Among parents, prevalence (95% CI) of T2-DM, HBP, and obesity was 8.3% (3.5–14.3), 14.2% (8.6–24.6), and 28.5% (24–33), and for hypercholesterolemia, low HDL-cholesterol, high LDL-cholesterol, hypertriglyceridemia, and mixed hyperlipidemia 17.9 % (15–20), 27.8% (25–30), 14.3% (12–16), 32.3% (29–35), and 9.8 % (8–12), respectively. Among children, prevalence (95% CI) for high total cholesterol, low HDL-cholesterol, high LDL-cholesterol, isolated hypertriglyceridemia, and mixed hyperlipidemia was 15.9% (12.6–19.5); 6.2% (4.0–8.5); 14.6% (11.4–18.0); 9.3% (6.7–12.2); and 3.6% (2.1–5.8), respectively. Sex- and birth weight-adjusted odds ratio (95% CI) showed that FH of T2-DM, but not of HBP and obesity, was associated with hypercholesterolemia (2.1; 1.2–6.2), low HDL-cholesterol (1.8; 1.1–5.7), and hypertriglyceridemia (2.3; 1.1–6.4). Conclusions: Non-obese children in this sample display a high prevalence of abnormalities in lipid profile associated with FH of T2-DM. [Copyright &y& Elsevier]

Background: Recently, the Expert Committee of the American Diabetes Association proposed to decrease the lower limit for normal fasting plasma glucose (FPG) levels to 5.6 mmol/L. In this regard, the aim of this study was to determine the effect of lowering the criterion for normal FPG on the identification of subjects with impaired glucose tolerance (IGT) and metabolic syndrome (MS). Methods: We carried out a cross-sectional analysis of a population-based study from Durango, Mexico. This study enrolled 844 apparently healthy men and nonpregnant women aged 34 to 64 years. Diagnosis of IGT was based on 2-h post-load plasma glucose concentration ≥7.8 mmol/L and <11.1 mmol/L, and MS by the definition of National Cholesterol Education Program. Results: The diagnosis of IGT and MS was established in 161 (19.1%) and 190 (22.5%) individuals, respectively. Lowering the cut-off point of FPG from 6.1 to 5.6 mmol/L identified more subjects with IGT, 53/161 (32.9%) vs. 132/161 (82.0%) (p <0.0001). It also identified more subjects with MS, from 88/190 (46.3%) vs. 169/190 (88.9%) (p = 0.0001). Lowering of the FPG cut-off point to 5.6 mmol/L improved the positive likelihood ratio for identifying subjects with IGT from 1.91 to 2.55 and the negative likelihood ratio from 0.81 to 0.27. Lowering the FPG cut-off point to 5.6 mmol/L did not significantly change the positive likelihood ratio for identifying MS from 3.65 to 3.18 and improved the negative likelihood ratio from 0.61 to 0.15. Conclusions: Lowering the cut-off point of IFG to 5.6 mmol/L improves the predictive discrimination of IFG for identifying subjects with IGT or MS. [Copyright &y& Elsevier]

A growing body of interest on the possible beneficial role of chromium, magnesium, and antioxidant supplements in the treatment of diabetes has contributed to debate about their value for reaching metabolic control and to prevent chronic complications in diabetic subjects. In this article we use a systematic approach focused on clinically based evidence from clinical trials regarding the benefits of chromium, magnesium, and antioxidant supplements as complementary therapies in type 2 diabetes. Chromium, magnesium, and antioxidants are essential elements involved in the action of insulin and energetic metabolism, without serious adverse effects. However, at present there is insufficient clinically based evidence and its routine use in the treatment of type 2 diabetes is still controversial. Because the most frequent origin of deficiencies in micronutrients is an inadequate diet, health care providers should invest more effort on nutrition counseling rather than focusing on micronutrient supplementation in order to reach metabolic control of their patients. Results from long-term trials are needed in order to assess the safety and beneficial role of chromium, magnesium, and antioxidant supplements as complementary therapies in the management of type 2 diabetes. [Copyright &y& Elsevier]

: BackgroundOur objective was to develop an anthropometric-based index (abdominal volume index, AVI) for estimating overall abdominal volume and to determine its relationship with presence of impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM).: MethodsWe conducted a cross-sectional, population-based study between November 1998 and June 2001 among 746 men and non-pregnant women randomly recruited from Durango City in northern Mexico. AVI was calculated using volume formulas for cylinder (V = πr2h) and vertical cone V = (1/3)πr2h. The formula developed was AVI = [2 cm (waist)2 + 0.7 cm (waist-hip)2]/1,000, which estimates overall abdominal volume between symphysis of pubis and xiphoid appendix and theoretically includes intra-abdominal fat and adipose tissue volumes.: ResultsReceiver operating curve (ROC) scatter plot showed as best cut-off value of AVI for estimation of obesity, corresponding to 24.5 liters (L). Logistic regression analysis adjusted by age and sex showed higher odds ratio between AVI and IGT 1.6 (95% confidence interval [95% CI] 1.1–9.1, p = 0.01) as well as between AVI and DM 2.1 (95% CI 1.3–7.9, p = 0.001) than odds ratio (OR) estimated by other anthropometric obesity criteria such as waist-to-hip ratio, body mass index, truncated cone, and waist circumference.: ConclusionsAVI is a reliable and easy-to-calculate anthropometric tool for estimation of overall abdominal volume that is shown to be strongly related to IGT and DM. [Copyright &y& Elsevier]

Objective: To evaluate the association of hypomagnesemia with prehypertension (preHTN) and hypertension in children.Study Design: A total of 3954 apparently healthy Mexican children were enrolled in a cross-sectional study. Exclusion criteria were type 2 diabetes; hepatic, renal, or endocrine disease; impaired fasting glucose; chronic diarrhea; and intake of vitamins or magnesium supplements in the previous 6 months. preHTN was defined by systolic and/or diastolic blood pressure ≥90th to <95th percentile and hypertension by systolic and/or diastolic blood pressure ≥95th percentile, according to age, sex, and height percentile. Hypomagnesemia was defined by serum magnesium concentration <1.8 mg/dL (<0.74 mmol/L). To control for potential sources of bias related to age, participants were allocated into 2 groups, aged 6-10 years and 11-15 years.Results: The prevalence of preHTN and hypertension was 12.2% and 6.4%, respectively, in children aged 6-10 years and 13.9% and 10.6% in those aged 11-15 years. Hypomagnesemia was identified in 59 children with preHTN (27.3%) and 52 (45.6%) with hypertension in the 6-10 year age group, and in 115 children with preHTN (36.0%) and 109 (49.6%) with hypertension in the 11-15 year age group. Adjusted multiple logistic regression analysis showed that in children in both age groups, hypomagnesemia was associated with both preHTN (6-10 years: OR, 2.18, P < .0005; 11-15 years: OR, 1.38, P = .018) and hypertension (6-10 years: OR, 4.87, P < .0005; 11-15 years: OR, 1.83, P = .0002).Conclusion: Our results indicate that serum magnesium level <1.8 mg/dL is significantly associated with preHTN and hypertension in apparently healthy children. [ABSTRACT FROM AUTHOR]

Background and Aims: Several studies show that high serum C-reactive protein (CRP) levels are associated with an increased risk of diabetes, data that strongly supports a possible role for inflammation in diabetogenesis. The aim of this study was to determine whether elevated CRP levels are associated with fasting plasma glucose (FPG) and/or postload glucose levels according to the glucose tolerance status. Methods: A total of 169 healthy males and non-pregnant females aged 18–65 years were enrolled in a population-based cross-sectional study. Individuals were allocated into groups with a new diagnosis of normal glucose tolerance (NGT) (n = 82), impaired fasting glucose (IFG) (n = 54), and impaired glucose tolerance (IGT) (n = 33). Elevated CRP was defined by CRP levels >3.0 and <10.0 mg/L, IFG by FPG ≥100 and <126 mg/dL, and IGT by plasma glucose concentration 2 h postload ≥140 and <200 mg/dL. A multiple regression linear analysis adjusted by body mass index, waist circumference, and lipid profile was performed to evaluate the association between CRP levels (independent variable) with FPG and 2 h postload glucose levels (dependent variables). Results: Multivariate linear regression analysis showed a significant association between hsCRP levels with FPG (β = 0.536; 95% CI 1.03–5.1, p = 0.005) and 2 h postload glucose (β = 0.209; 95% CI 1.31–2.97, p = 0.01) in the IGT group, but not with FPG (β = 0.147; 95% CI 0.55–2.0, p = 0.25) and 2 h postload glucose (β = 0.151; 95% CI 0.83–3.2, p = 0.24) in the IFG group. Conclusions: Elevated CRP levels are associated with FPG and 2 h postload glucose in the individuals with IGT, but not in subjects with IFG or NGT. [Copyright &y& Elsevier]

Background: Epidemiological evidence shows a strong relationship between decreased serum magnesium levels (DSML) and insulin resistance. As nonalcoholic steatohepatitis (NASH) seems to be related to insulin resistance, the aim of this study was to determine the potential relationship between DSML and NASH in obese subjects. Methods: We compared obese individuals with the diagnosis of diabetes, insulin-resistance, and non-insulin resistance to a control group of non-obese, non-insulin-resistant subjects. Participants were required to have negative viral markers and negligible alcohol intake. Other liver diseases and well-known causes for decreasing of magnesium were exclusion criteria. A liver biopsy was performed in subjects with aspartate aminotransferase (AST) and alanine aminotransferease (ALT) levels ≥40 IU/mL. Results: Of the 60 obese subjects, 20 were non-insulin resistant, 20 were insulin resistant, and 20 were type 2 diabetics. Twenty subjects were in the control group. Eleven (33.3%) diabetics, 14 (42.4%) insulin-resistant subjects, and 8 (24.2%) non-insulin-resistant subjects underwent liver biopsies. Diagnosis of NASH was established in 29 (36.2%) individuals. Subjects with the diagnosis of NASH exhibited lower serum magnesium levels of 1.7 ± 0.2 mg/dL (0.70 ± 0.08 mmol/L), and those with fibrosis showed the lowest serum magnesium concentration at 1.5 ± 0.3 mg/dL (0.62 ± 0.12 mmol/L). Multiple regression analysis adjusted by age showed that low serum magnesium concentration was independently related to a high HOMA-IR index (OR 7.6, CI 95% 2.1–11.2; p &#60;0.0001) and that a high HOMA-IR index was related to NASH (OR 6.5, CI 95% 1.5–8.8; p &#60;0.01). After adjusting for age and a high HOMA-IR index, hypomagnesemia remained independently related to NASH (OR 1.4, CI 95% 1.1–5.4; p &#60;0.05). Conclusions: The results of this study demonstrate an independent relationship between DSML and NASH. [Copyright &y& Elsevier]

Background and Aims Although the Glucose and Triglyceride levels (TyG) index is useful for identification of insulin resistance (IR) in different ethnic groups, it has not been evaluated in young adults. We undertook this study to evaluate the TyG index as a diagnostic test for IR in young adults. Methods A total of 5,538 healthy young adults, 3,795 (68.5%) non-pregnant women and 1,743 (31.5%) men, with an average age of 19.2 ± 1.4 years, were enrolled in a population-based cross-sectional study. To estimate diagnostic characteristics of the TyG index, a randomized subsample of the target population ( n = 75) was under euglycemic-hyperinsulinemic clamp test. Using the cutoff values obtained in the clamp study, the diagnostic concordance between TyG index and HOMA-IR was evaluated in the overall population. The TyG index was calculated as the Ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)]/2. Results Normal weight, overweight, and obesity were identified in 3,632 (65.6%), 1,355 (24.5%), and 551 (9.9%) participants. A total of 346 (9.1%) men and 278 (15.9%) women exhibited IR. The best cutoff value of TyG index for diagnosis of IR was 4.55 (sensitivity 0.687, negative predictive value (NPV) 0.844, and negative likelihood ratio (NLR) 0.47) for women and 4.68 (sensitivity 0.673, NPV 0.900, and NLR 0.45) for men. In normal-weight individuals the diagnostic concordance between TyG index and HOMA-IR was 0.934 and 0.915, in the overweight subjects was 0.908 and 0.895 and, in the obese participants 0.916 and 0.950, for men and women, respectively. Conclusions TyG index may be useful for screening IR in young adults. [ABSTRACT FROM AUTHOR]

Background and Aims Type 2 diabetes mellitus (DM2) confers a higher risk for active tuberculosis (TB). However, information on associated risk factors for latent tuberculosis infection (LTBI) inpatients with DM2 is limited. We conducted a cross-sectional study to elucidate the prevalence of LTBI and its associated factors on Mexican adults with DM2 receiving medical care at the Mexican Social Security Institute (IMSS). Methods Six hundred patients with DM2 without a prior history of TB from outpatient diabetes clinics were enrolled in the study. The tuberculin-skin-test (TST) was performed. The presence of LTBI was defined by a TST value of ≥5 mm. A standardized interview and physical examination were conducted to obtain clinical, demographic, and LTBI risk factor information; all subjects were laboratory tested to determine the presence of exclusion criteria. Microscopic examination of sputum samples and chest x-rays was performed to identify potential active TB. Subjects with any finding suggesting active TB or malignancy were excluded. A logistic regression model was used to identify variables associated with LTBI. Results LTBI prevalence among patients with DM2 was 51.3%. Risk factors for LTBI were living with a relative with TB, having been in prison, having hemoglobin values >14 g/dL, and glycosylated hemoglobin (HbA1c) values of >7%. Blood pressure, economic income, or anthropometric measurements were not associated risk factors. Conclusions Over one half of patients with DM harbor LTBI. Exposure to certain environmental conditions and poorly controlled DM2 (HbA1c >7.0%) were risk factors for having LTBI in persons with DM2. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this study was to compare the efficacy of glimepiride/metformin combination versus glibenclamide/metformin for reaching glycemic control in patients with uncontrolled type 2 diabetes mellitus. Patients and Methods: A randomized, double-blind, multicenter clinical trial was performed in 152 uncontrolled type 2 diabetic patients. Serum fasting and postprandial glucose, hemoglobin A1c (A1C), high-density lipoprotein cholesterol, and triglycerides were measured. After random allocation, all patients received two pills of glimepiride (1 mg)/metformin (500 mg) or glibenclamide (5 mg)/metformin (500 mg) po once a day. Dosage was increased to a maximum of four pills in order to reach the glycemic control goals (fasting glucose ≤7.2 mmol/l, postprandial glucose <10.0 mmol/l, A1C <7%, or an A1C ≥1% reduction). Statistical analyses were carried out using chi-square, ANOVA, or Student''s t test. The protocol was approved by an ethics committee and met all requirements needed to perform research in human subjects; all patients gave written informed consent. Results: Each study group included 76 patients. No significant differences in basal clinical and laboratory characteristics between groups were found. At the end of the study, A1C concentration was significantly lower in the glimepiride/metformin group (P=.025). A higher proportion of patients from the glimepiride group (44.6% vs. 26.8%, P<.05) reached the goal of A1C <7% at 12 months of treatment. A higher proportion of hypoglycemic events were observed in the glibenclamide group (28.9% vs. 17.1%, P<.047). Conclusion: Glimepiride/metformin demonstrated being more efficacious than glibenclamide/metformin at reaching the glycemic control goals with less hypoglycemic events in patients with uncontrolled type 2 diabetes mellitus. [Copyright &y& Elsevier]