Challenges associated with insulin therapy progression among patients with type 2 diabetes: Latin American MOSAIc study baseline data

Background: Poor glycemic control in patients with type 2 diabetes is commonly recorded worldwide; Latin America (LA) is not an exception. Barriers to intensifying insulin therapy and which barriers are most likely to negatively impact outcomes are not completely known. The objective was to identify barriers to insulin progression in individuals with type 2 diabetes mellitus (T2DM) in LA countries (Mexico, Brazil, and Argentina). Methods: MOSAIc is a multinational, non-interventional, prospective, observational study aiming to identify the patient-, physician-, and healthcare-based factors affecting insulin intensification. Eligible patients were ≥18 years, had T2DM, and were treated with insulin for ≥3 months with/without oral antidiabetic drugs (OADs). Demographic, clinical, and psychosocial data were collected at baseline and regular intervals during the 24-month follow-up period. This paper however, focuses on baseline data analysis. The association between glycated hemoglobin (HbA1c) and selected covariates was assessed. Results: A trend toward a higher level of HbA1c was observed in the LA versus non-LA population (8.40 ± 2.79 versus 8.18 ± 2.28; p ≤ 0.069). Significant differences were observed in clinical parameters, treatment patterns, and patient-reported outcomes in LA compared with the rest of the cohorts and between Mexico, Brazil, and Argentina. Higher number of insulin injections and lower number of OADs were used, whereas a lower level of knowledge and a higher level of diabetes-related distress were reported in LA. Covariates associated with HbA1c levels included age (-0.0129; p < 0.0001), number of OADs (0.0835; p = 0.0264), higher education level (-0.2261; p = 0.0101), healthy diet (-0.0555; p = 0.0083), self-monitoring blood glucose (-0.0512; p = 0.0033), hurried communication style in the process of care (0.1295; p = 0.0208), number of insulin injections (0.1616; p = 0.0088), adherence (-0.1939; p ≤ 0.0104), and not filling insulin prescription due to associated cost (0.2651; p = 0.0198). Conclusion: MOSAIc baseline data showed that insulin intensification in LA is not optimal and identified several conditions that significantly affect attaining appropriate HbA1c values. Tailored public health strategies, including education, should be developed to overcome such barriers.Centro de Endocrinología Experimental y Aplicad

Challenges associated with insulin therapy progression among patients with type 2 diabetes: Latin American MOSAIc study baseline data

Background: Poor glycemic control in patients with type 2 diabetes is commonly recorded worldwide; Latin America (LA) is not an exception. Barriers to intensifying insulin therapy and which barriers are most likely to negatively impact outcomes are not completely known. The objective was to identify barriers to insulin progression in individuals with type 2 diabetes mellitus (T2DM) in LA countries (Mexico, Brazil, and Argentina). Methods: MOSAIc is a multinational, non-interventional, prospective, observational study aiming to identify the patient-, physician-, and healthcare-based factors affecting insulin intensification. Eligible patients were ≥18 years, had T2DM, and were treated with insulin for ≥3 months with/without oral antidiabetic drugs (OADs). Demographic, clinical, and psychosocial data were collected at baseline and regular intervals during the 24-month follow-up period. This paper however, focuses on baseline data analysis. The association between glycated hemoglobin (HbA1c) and selected covariates was assessed. Results: A trend toward a higher level of HbA1c was observed in the LA versus non-LA population (8.40 ± 2.79 versus 8.18 ± 2.28; p ≤ 0.069). Significant differences were observed in clinical parameters, treatment patterns, and patient-reported outcomes in LA compared with the rest of the cohorts and between Mexico, Brazil, and Argentina. Higher number of insulin injections and lower number of OADs were used, whereas a lower level of knowledge and a higher level of diabetes-related distress were reported in LA. Covariates associated with HbA1c levels included age (-0.0129; p < 0.0001), number of OADs (0.0835; p = 0.0264), higher education level (-0.2261; p = 0.0101), healthy diet (-0.0555; p = 0.0083), self-monitoring blood glucose (-0.0512; p = 0.0033), hurried communication style in the process of care (0.1295; p = 0.0208), number of insulin injections (0.1616; p = 0.0088), adherence (-0.1939; p ≤ 0.0104), and not filling insulin prescription due to associated cost (0.2651; p = 0.0198). Conclusion: MOSAIc baseline data showed that insulin intensification in LA is not optimal and identified several conditions that significantly affect attaining appropriate HbA1c values. Tailored public health strategies, including education, should be developed to overcome such barriers.Centro de Endocrinología Experimental y Aplicad

Challenges associated with insulin therapy progression among patients with type 2 diabetes: Latin American MOSAIc study baseline data

Poor glycemic control in patients with type 2 diabetes is commonly recorded worldwide; Latin America (LA) is not an exception. Barriers to intensifying insulin therapy and which barriers are most likely to negatively impact outcomes are not completely known. The objective was to identify barriers to insulin progression in individuals with type 2 diabetes mellitus (T2DM) in LA countries (Mexico, Brazil, and Argentina).Fil: Linetzky, Bruno. Ely Lilly Interamerica ; ArgentinaFil: Curtis, Brad. Eli Lilly and Company; Estados UnidosFil: Frechtel, Gustavo Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; Argentina. Hospital Sirio Libanés; ArgentinaFil: Montenegro, Renan. Universidade Estadual do Ceará; BrasilFil: Escalante Pulido, Miguel. Hospital de Especialidades del Centro Médico de Occidente IMSS; MéxicoFil: Stempa, Oded. Eli Lilly and Company Mexico; MéxicoFil: De Lana, Janaina Martins. Eli Lilly and Company Brasil; BrasilFil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; Argentin

CracidMex1: a comprehensive database of global occurrences of cracids (Aves, Galliformes) with distribution in Mexico

Cracids are among the most vulnerable groups of Neotropical birds. Almost half of the species of this family are included in a conservation risk category. Twelve taxa occur in Mexico, six of which are considered at risk at national level and two are globally endangered. Therefore, it is imperative that high quality, comprehensive, and high-resolution spatial data on the occurrence of these taxa are made available as a valuable tool in the process of defining appropriate management strategies for conservation at a local and global level. We constructed the CracidMex1 database by collating global records of all cracid taxa that occur in Mexico from available electronic databases, museum specimens, publications, “grey literature”, and unpublished records. We generated a database with 23,896 clean, validated, and standardized geographic records. Database quality control was an iterative process that commenced with the consolidation and elimination of duplicate records, followed by the geo-referencing of records when necessary, and their taxonomic and geographic validation using GIS tools and expert knowledge. We followed the geo-referencing protocol proposed by the Mexican National Commission for the Use and Conservation of Biodiversity. We could not estimate the geographic coordinates of 981 records due to inconsistencies or lack of sufficient information in the description of the locality.Given that current records for most of the taxa have some degree of distributional bias, with redundancies at different spatial scales, the CracidMex1 database has allowed us to detect areas where more sampling effort is required to have a better representation of the global spatial occurrence of these cracids. We also found that particular attention needs to be given to taxa identification in those areas where congeners or conspecifics co-occur in order to avoid taxonomic uncertainty. The construction of the CracidMex1 database represents the first comprehensive research effort to compile current, available global geographic records for a group of cracids. The database can now be improved by continuous revision and addition of new records. The CracidMex1 database will provide high quality input data that could be used to generate species distribution models, to assess temporal changes in species distributions, to identify priority areas for research and conservation, and in the definition of management strategies for this bird group. This compilation exercise could be replicated for other cracid groups or regions to attain a better knowledge of the global occurrences of the species in this vulnerable bird family