The objective of this study was to determine the demographic and clinical features of youth supported by member associations of the Federación Mexicana de Diabetes and the Life for a Child Program (LFAC).
An analysis of 2017 Annual Clinical Data Sheets of 306 subjects from five Mexican centers was performed.
Type 1 diabetes (T1D) was diagnosed in 292 subjects; 54.6% were female, with six diagnosed aged <6 months (genetic tests not yet conducted). Type 2 diabetes (T2D) or other types were diagnosed in 11 and three subjects, respectively. T1D diagnosis age ranged 0.0–22.6 years with a peak at 8 years. The mean ± standard deviation (SD) diabetes duration was 5.3 ± 3.5 years (range 0.0–21.0 years), with a mean ± SD subject age at check-up of 13.3 ± 4.3 years. Of the T1D subjects, 1.0%, 6.7%, 13.7% and 78.6% were receiving 1, 2, 3 and ≥4 insulin injections/day with a mean ± SD daily dose of 0.92 ± 0.34 U/kg. The median number of blood glucose tests/week was 40. The mean/median hemoglobin A1c (HbA1c) levels for those with duration ≥6 months were 8.7/8.4% (72/68 mmol/mol) and were higher in adolescents vs. children. Elevated body mass index SD, triglycerides (≥150 mg/dL) and non-high-density lipoprotein (HDL)-cholesterol (≥130 mg/dL) were common: 7.6%, 11.0% and 12.7% (n = 288, 218 and 180, respectively). Serum creatinine levels were normal in all tested subjects (n = 194).
Youth with diabetes in less-resourced families in Mexico are achieving reasonable glycemia. Most T1D patients use a basal bolus insulin regimen and test blood glucose several times daily. Some subjects have adverse vascular risk factor profiles. Further attention is needed to prevent chronic complications. Monogenic diabetes is very likely in some youth, and genetic testing is indicated.
We acknowledge the dedicated efforts of all the staff and volunteers at the centers involved in the study. We thank the T1D Exchange for sharing their current age-related HbA1c data, Jayanthi Maniam and Andrzej Januszewski for their help with statistics and Sarah Garnett for helping with calculation of the SD scores. This work was supported by the Leona M. and Harry B. Helmsley Charitable Trust. Hannah Elizabeth Bartley was partly funded by a University of Sydney Summer Research Scholarship. Alicia Jenkins is funded by a NHMRC (Australia) Practitioner Fellowship and is a Sydney Medical School Foundation Fellow.
Author contributions: MEMO collected the data and contributed to the manuscript; NAVL, MMV, FFR, DHP and AGL collected data and assisted with confirming patient information; HB analyzed the data and co-wrote the manuscript; AM assisted in data analysis and contributed to the manuscript; AJ helped with interpretation of the data and contributed to the manuscript; GO designed the study and co-wrote the manuscript.
Research funding: This work was supported by the Leona M and Harry B Helmsley Charitable Trust. HB was partly funded by a University of Sydney Summer Research Scholarship. AJJ is funded by a NHMRC (Australia) Practitioner Fellowship and is a Sydney Medical School Foundation Fellow.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
Conflict of interest statement: None of the authors have any conflicts of interest with respect to this study.
Institutional review board statement: The study was reviewed and approved by the Federación Mexicana de Diabetes, A.C.
Data sharing statement: Not relevant.
1. Ogle GD, Middlehurst AC, Silink M. The IDF Life for a Child Program Index of diabetes care for children and youth. Pediatr Diabetes. 2016;17:374–84.10.1111/pedi.12296Search in Google Scholar PubMed
2. Ogle GD, Kim H, Middlehurst AC, Silink M, Jenkins AJ. Financial costs for families of children with Type 1 diabetes in lower-income countries. Diabet Med 2016;33:820–6.10.1111/dme.12997Search in Google Scholar PubMed
4. World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. Report of a WHO/IDF Consultation, Geneva, 2006.Search in Google Scholar
5. World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva: WHO; 2006 [Internet]. http://hpps.kbsplit.hr/hpps-2008/pdf/dok03.pdf.Search in Google Scholar
6. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, et al. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007;85:660–7.10.2471/BLT.07.043497Search in Google Scholar PubMed PubMed Central
7. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114(Suppl 2):555–76.10.1542/peds.114.S2.555Search in Google Scholar PubMed
8. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro 3rd AF, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604–12.10.7326/0003-4819-150-9-200905050-00006Search in Google Scholar PubMed PubMed Central
9. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499–502.10.1093/clinchem/18.6.499Search in Google Scholar PubMed
10. DiMeglio LA, Carlo LA, Ethel C, Maria EC, Sabine E, et al. ISPAD Clinical Practice Consensus Guidelines 2018: glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes 2018;19:105–14.10.1111/pedi.12737Search in Google Scholar PubMed
11. Gómez-Díaz RA, Peŕez-Pérez G, Hernańdez-Cuesta IT, Rodriǵuez-García JD, Guerrero-López R, et al. Incidence of type 1 diabetes in Mexico: data from an institutional register 2000–2010. Diabetes Care 2012;35:e77.10.2337/dc12-0844Search in Google Scholar PubMed PubMed Central
13. Donaghue K, Wadwa R, Dimeglio L, Wong T, Chiarelli F, et al. Pediatric Diabetes ISPAD Clinical Practice Consensus Guidelines 2014 Compendium. Microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes 2014;15:257–69.10.1111/pedi.12180Search in Google Scholar PubMed
14. Shah AS, Maahs DM, Stafford JM, Dolan LM, Lang W, et al. Predictors of dyslipidemia over time in youth with type 1 diabetes: for the SEARCH for Diabetes in Youth study. Diabetes Care 2017;40:607–13.10.2337/dc16-2193Search in Google Scholar PubMed PubMed Central
15. Donaghue KC, Marcovecchio L, Wadwa RP, Chew EY, Wong T. ISPAD Clinical Practice Consensus Guidelines 2018: microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes 2018;27:262–74.10.1111/pedi.12742Search in Google Scholar
16. International Diabetes Federation. IDF Diabetes Atlas. 2017.Search in Google Scholar
17. Altamirano-Bustamante N, Islas-Ortega L, Robles-Valdes C, Garduno-Espinosa J, Morales-Cisneros G, et al. Economic family burden of metabolic control in children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2008;21:1163–8.10.1515/JPEM.2008.21.12.1163Search in Google Scholar PubMed
18. Klatman EL, Jenkins AJ, Ahmedani MY, Ogle GD. Blood glucose meters and test strips: global market and challenges to access in low-resource settings. Lancet Diabetes Endocrinol 2019;7:150–60.10.1016/S2213-8587(18)30074-3Search in Google Scholar PubMed
19. Hernandez-Cordero S, Cuevas-Nasu L, Moran-Ruan MC, Mendez-Gomez Humaran I, Avila-Arcos MA, et al. Overweight and obesity in Mexican children and adolescents during the last 25 years. Nutr Diabetes 2017;7:e247.10.1038/nutd.2016.52Search in Google Scholar PubMed PubMed Central
20. Clements MA, Foster NC, Maahs DM, Schatz DA, Olson BA, et al. Hemoglobin A1c (HbA1c) changes over time among adolescent and young adult participants in the T1D exchange clinic registry. Pediatr Diabetes 2016;17:327–36.10.1111/pedi.12295Search in Google Scholar PubMed
21. Faradji R, Valenzuela-Lara M, Diaz-Barriga MAP, Ferreira ACA, Bustamante MJF, et al. Results of the multi-centric RENACED Diabetes Type 1 in Mexico. In: The Official Journal of the ATTD, 2018 Conference abstracts; 2018. p. 092.Search in Google Scholar
22. McKnight JA, Wild SH, Lamb MJ, Cooper MN, Jones TW, et al. Glycaemic control of Type 1 diabetes in clinical practice early in the 21st century: an international comparison. Diabet Med 2015;32:1036–50.10.1111/dme.12676Search in Google Scholar PubMed
23. Witsch M, Kosteria I, Kordonouri O, Alonso G, Archinkova M, et al. Possibilities and challenges of a large international benchmarking in pediatric diabetology – the SWEET experience. Pediatr Diabetes 2016;17:7–15.10.1111/pedi.12432Search in Google Scholar PubMed
24. Ogle GD, von Oettingen JE, Middlehurst AC, Hanas R, Orchard TJ. Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels. Pediatr Diabetes 2019;20:93–8.10.1111/pedi.12801Search in Google Scholar PubMed
25. Evia-Viscarra ML, Guardado-Mendoza R, Rodea-Montero ER. Clinical and metabolic characteristics among Mexican children with different types of diabetes mellitus. PLoS One 2016;11:e0168377.10.1371/journal.pone.0168377Search in Google Scholar PubMed PubMed Central
26. Rubio-Cabezas O, Hattersley AT, Njolstad PR, Mlynarski W, Ellard S, et al. ISPAD Clinical Practice Consensus Guidelines 2014. The diagnosis and management of monogenic diabetes in children and adolescents. Pediatr Diabetes 2014;15(Suppl 2):47–64.10.1111/pedi.12192Search in Google Scholar PubMed
28. Jenkins AJ, Rowley KG, Lyons TJ, Best JD, Hill MA, et al. Lipoproteins and diabetic microvascular complications. Curr Pharm Des 2004;10:3395–418.10.2174/1381612043383188Search in Google Scholar PubMed
30. Medina-Bravo P, Medina-Urrutia A, Juárez-Rojas JG, Cardoso-Saldaña G, Jorge-Galarza E, et al. Glycemic control and high-density lipoprotein characteristics in adolescents with type 1 diabetes. Pediatr Diabetes 2013;14:399–406.10.1111/j.1399-5448.2012.00924.xSearch in Google Scholar PubMed
31. Kearney PM, Blackwell L, Collins R, Keech A, Simes J, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet (London, England) 2008;371:117–25.10.1016/S0140-6736(08)60104-XSearch in Google Scholar PubMed
©2019 Walter de Gruyter GmbH, Berlin/Boston