Diabetes Care in Venezuela

Background: The incidence of type 2 diabetes (T2D) and its economic burden have increased in Venezuela, posing difficult challenges in a country already in great turmoil. Objectives: The aim of this study was to review the prevalence, causes, prevention, management, health policies, and challenges for successful management of diabetes and its complications in Venezuela. Methods: A comprehensive literature review spanning 1960 to 2015 was performed. Literature not indexed also was reviewed. The weighted prevalence of diabetes and prediabetes was estimated from published regional and subnational population-based studies. Diabetes care strategies were analyzed. Findings: In Venezuela, the weighted prevalence of diabetes was 7.7% and prediabetes was 11.2%. Diabetes was the fifth leading cause of death (7.1%) in 2012 with the mortality rate increasing 7% per year from 1990 to 2012. In 2012, cardiovascular disease and diabetes together were the leading cause of disability-adjusted life years.T2D drivers are genetic, epigenetic, and lifestyle, including unhealthy dietary patterns and physical inactivity. Obesity, insulin resistance, and metabolic syndrome are present at lower cutoffs for body mass index, homeostatic model assessment, and visceral or ectopic fat, respectively. Institutional programs for early detection and/or prevention of T2D have not been established. Most patients with diabetes (∼87%) are cared for in public facilities in a fragmented health system. Local clinical practice guidelines are available, but implementation is suboptimal and supporting information is limited. Conclusions: Strategies to improve diabetes care in Venezuela include enhancing resources, reducing costs, improving education, implementing screening (using Latin America Finnish Diabetes Risk Score), promoting diabetes care units, avoiding insulin levels as diagnostic tool, correct use of oral glucose tolerance testing and metformin as first-line T2D treatment, and reducing health system fragmentation. Use of the Venezuelan adaptation of the transcultural Diabetes Nutrition Algorithm for lifestyle recommendations and the Latin American Diabetes Association guidelines for pharmacologic interventions can assist primary care physicians in diabetes management

From Sea to Shining Sea and the Great Plains to Patagonia: A Review on Current Knowledge of Diabetes Mellitus in Hispanics/Latinos in the US and Latin America

The past two decades have witnessed many advances in the prevention, treatment, and control of diabetes mellitus (DM) and its complications. Increased screening has led to a greater recognition of type 2 diabetes mellitus (type 2 DM) and prediabetes; however, Hispanics/Latinos, the largest minority group in the US, have not fully benefited from these advances. The Hispanic/Latino population is highly diverse in ancestries, birth places, cultures, languages, and socioeconomic backgrounds, and it populates most of the Western Hemisphere. In the US, the prevalence of DM varies among Hispanic/Latino heritage groups, being higher among Mexicans, Puerto Ricans, and Dominicans, and lower among South Americans. The risk and prevalence of diabetes among Hispanics/Latinos are significantly higher than in non-Hispanic Whites, and nearly 40% of Hispanics/Latinos with diabetes have not been formally diagnosed. Despite these striking facts, the representation of Hispanics/Latinos in pharmacological and non-pharmacological clinical trials has been suboptimal, while the prevalence of diabetes in these populations continues to rise. This review will focus on the epidemiology, etiology and prevention of type 2 DM in populations of Latin American origin. We will set the stage by defining the terms Hispanic, Latino, and Latin American, explaining the challenges identifying Hispanics/Latinos in the scientific literature and databases, describing the epidemiology of diabetes—including type 2 DM and gestational diabetes mellitus (GDM)—and cardiovascular risk factors in Hispanics/Latinos in the US and Latin America, and discussing trends, and commonalities and differences across studies and populations, including methodology to ascertain diabetes. We will discuss studies on mechanisms of disease, and research on prevention of type 2 DM in Hispanics/Latinos, including women with GDM, youth and adults; and finalize with a discussion on lessons learned and opportunities to enhance research, and, consequently, clinical care oriented toward preventing type 2 DM in Hispanics/Latinos in the US and Latin America

TODAY - August 2017

Inside this issue: -- Mission trip to Northern Nigeria supports local Adventist hospital, regional outreach-- A Vision Coming into 2020 Focus-- Loma Linda University named a ‘2017 Great College to Work For’ by Chronicle of Higher Education-- Darryl VandenBosch joins LLU Medical Center administrative team-- Loma Linda University Health fellow wins $50,000 Amgen Young Investigator Award-- Loma Linda University researchers find links between meal frequency, BMI-- Cardiac patient honors nurse with 500th Healing Hands award-- Loma Linda University program enhances K-12 science, technology, engineering and math programs-- Hyperbaric Medicine Service receives accreditation-- International Heart Institute welcomes new director Jon Gardner-- San Manuel Gateway College to expand certification programs in San Bernardino-- Mini grants enable Loma Linda University Health to strengthen initiatives that are improving community health-- Loma Linda University strengthens healthcare leadership in Latin America with new certificate-- Blankets and craft kits donated to patients at LLUCH clinic-- Loma Linda University Health program aims to prevent prediabetes from becoming type 2 diabetes-- Loma Linda University Eye Institute opens new Retina Center-- ‘Life on the Line’ captures six regional Emmy Awardshttps://scholarsrepository.llu.edu/today/1155/thumbnail.jp

Large scale application of the Finnish diabetes risk score in Latin American and Caribbean populations: a descriptive study

BackgroundThe prevalence of type 2 diabetes (T2D) continues to increase in the Americas. Identifying people at risk for T2D is critical to the prevention of T2D complications, especially cardiovascular disease. This study gauges the ability to implement large population-based organized screening campaigns in 19 Latin American and Caribbean countries to detect people at risk for T2D using the Finnish Diabetes Risk Score (FINDRISC).MethodsThis cross-sectional descriptive analysis uses data collected in a sample of men and women 18 years of age or older who completed FINDRISC via eHealth during a Guinness World Record attempt campaign between October 25 and November 1, 2021. FINDRISC is a non-invasive screening tool based on age, body mass index, waist circumference, physical activity, daily intake of fruits and vegetables, history of hyperglycemia, history of antihypertensive drug treatment, and family history of T2D, assigning a score ranging from 0 to 26 points. A cut-off point of ≥ 12 points was considered as high risk for T2D.ResultsThe final sample size consisted of 29,662 women (63%) and 17,605 men (27%). In total, 35% of subjects were at risk of T2D. The highest frequency rates (FINDRISC ≥ 12) were observed in Chile (39%), Central America (36.4%), and Peru (36.1%). Chile also had the highest proportion of people having a FINDRISC ≥15 points (25%), whereas the lowest was observed in Colombia (11.3%).ConclusionsFINDRISC can be easily implemented via eHealth technology over social networks in Latin American and Caribbean populations to detect people with high risk for T2D. Primary healthcare strategies are needed to perform T2D organized screening to deliver early, accessible, culturally sensitive, and sustainable interventions to prevent sequelae of T2D, and reduce the clinical and economic burden of cardiometabolic-based chronic disease

The Prediabetes Detection and Physical Activity Intervention Delivery (PRE-PAID) Project

Prediabetes is a prevalent condition which is a precursor to type 2 diabetes (T2D) and physical activity is known to counter T2D. Given the potential for alleviating health care expenditures through the prevention or delay of T2D, targeting individuals with prediabetes using physical activity intervention is a critical research question. The aim of this project was to; i) identify persons with prediabetes and thus at high risk for developing T2D, ii) engage individuals with prediabetes in community-based, culturally-preferred physical activity classes led by culturally-matched instructors with the goal of improving glycemic control and iii) investigate how two modes of laboratory-based aerobic exercise intervention (high intensity intervals versus continuous moderate intensity) impact glycemic control in persons with prediabetes. Participants were recruited in various ethnic communities known to have high prevalence rates of T2D. Critical blood biomarkers and measures of physical and physiological fitness were assessed at different time points to ascertain the effectiveness of both community-based physical activity classes and two modes of laboratory-based exercise. The results of this project show that the PRE-PAID risk questionnaire coupled with point-of-care testing of glycated hemoglobin (A1C) are an effective tool for identifying persons with prediabetes who are at high risk for T2D. Individuals, who participated in community-based culturally matched physical activity classes, experienced improved glycemic control evidenced by reductions in A1C after 3 and 6 months plus improvements in resting blood pressure, combined hand grip strength and aerobic fitness after 6 months. There were no differences between the laboratory-based aerobic exercise interventions of high intensity intervals vs. continuous moderate intensity for any of the measured outcomes. However, the participants who underwent both laboratory exercise modes experienced significant improvements in glycemic control, beta cell function, waist circumference and aerobic fitness following 3 months of supervised exercise. This research provides evidence for early detection of persons with prediabetes and strategies for improving glycemic control and physical plus physiological fitness in this population. The observed improvements could potentially help prevent or delay the onset of T2D

Kidney health for everyone everywhere - from prevention to detection and equitable access to care

The global burden of chronic kidney disease (CKD) is rapidly increasing, with a projection of becoming the 5th most common cause of years of life lost globally by 2040. Aggravatingly, CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume up to 3% of the annual healthcare budget in high-income countries. Crucially, however, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions – be it primary, secondary or tertiary. This article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tract, as well as exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, management of co-morbidities such as cardiovascular disease is a highly recommended preventative intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to support the preventive approach. While national policies and strategies for non-communicable diseases might be present in a country, specific policies directed toward education and awareness about CKD screening, management and treatment are often lacking. Hence, there is an urgent need to increase the awareness of the importance of preventive measures among populations, professionals and policy makers

The UP AMIGOS project: Testing the predictive validity of the 2007 Pediatric Expert Committee Recommendations in Latinos

Background. Mexicans are disproportionately affected by cardiovascular disease and there is mounting evidence that Mexicans may be genetically prone to the development of cardiovascular disease (CVD) risk factors. Objective. There were three aims of study. The first aim was to identify the prevalence of three CVD risk factors in Mexican young adults: (1) non-alcoholic fatty liver disease (NAFLD), (2) dyslipidemia, and (2) impaired fasting glucose. The second aim was to test the sensitivity and specificity of the Pediatric Expert Committee Recommendations (PECR) in identifying Mexicans with these three cardiovascular disease risk factors. Finally, the third aim was to explore ways to improve the clinical screening algorithm. Methods. In this cross-sectional study, data for UP AMIGOS were collected from 9,974 participants (age 18- to 21-years-old) living in Central Mexico. Participants underwent a health screen that included: a questionnaire, anthropometric measurements (i.e. height, weight, waist circumference, blood pressure), a physician-conducted history and physical, and venipuncture for blood biomarkers. Analysis. In order to determine prevalence of CVD risk factors, descriptive statistics were run making comparisons in prevalence by sex and weight category: normal weight, overweight, or obese. The value of the PECR was measured with sensitivity, specificity, and positive predictive value, with additional tests for significant associations. Alternative algorithms were explored using classification and regression tree analysis. Results. NALFD (17.1 to 45.5%) and dyslipidemia (44.8%) were fairly prevalent. In contrast, impaired fasting glucose (IFG) was rare (4.0%). Each CVD risk factor increased with increasing levels of adiposity. The PECR provided a reasonable clinical screen for NALFD, but was fairly insensitive in detecting those with dyslipidemia or IFG. Multiple exploratory analyses revealed more sensitive screening solutions for each individual CVD disease risk factor, but at the cost of having a less parsimonious clinical screen. Significance. Mexican adolescents and young adults already have a high prevalence of CVD risk factors. These risk factors may go unnoticed and eventually convert to irreversible disease, unless a valid, predictive screening protocol is established. Based on this analysis, screening recommendations are three-fold: (1) Universal screening for dyslipidemia is recommended for Mexican young adults, (2) IFG screening is not recommended in adolescents or young adults, (3) the PECR may be a reasonable clinical screen for NALFD, but more data is needed

A Developmental Project Focusing on Young Adult Hispanic-Americans

Reducing diabetes risk among Hispanic-American adults in the United States is a critical public health need and programs targeting young Hispanic-American adults with prediabetes can reduce the risk for developing diabetes. The purpose of this project was twofold: (a) to examine the literature related to diabetes prevention best practices among young adult Hispanic-Americans with prediabetes and (b) create an intervention program to promote these best practices to delay or reverse the trajectory toward diabetes. The inclusion criteria for the literature review were studies with at least a 12-month follow-up and reported outcomes related to changes in diet, increased exercise, and the effects of psychotherapy as modeled in the Diabetes Prevention Program (DPP). Studies that met these inclusion criteria for the period 2002 through January 2016 were evaluated and 11 studies supported the development of recommendations for future implementation. Pender\u27s health promotion model provided useful theoretical support for the effectiveness of individual health behavior changes to reduce the risk of developing diabetes. Based on the literature review, proposed interventions included dietary interventions, behavior modifications, and both aerobic and resistance exercise training adapted for the young adult Hispanic-American population. The planned interventions will fill an evidence-to-practice gap in application of the DPP. The program when implemented will promote social change through lifestyle modifications among young adult Hispanic-Americans with prediabetes and is expected to improve dietary intake, weekly exercise, fasting glucose, and glucose tolerance and support weight loss, all of which can delay or stop progression to diabetes