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Licensed Unlicensed Requires Authentication Published by De Gruyter September 4, 2019

Providing quality care for children and adolescents with diabetes from lower-income families in Mexico

María Elena Mota-Oropeza, Hannah Elizabeth Bartley, Norma Daniela Hernández-Pérez, Arely Gutiérrez Lara, Nancy Alejandra Vázquez-López, Maria Francisa Flores, Mariana Marroquín Velázquez, Maria José Castañeda-Saldivar, Angela Christine Middlehurst, Alicia Josephine Jenkins and Graham David Ogle

Abstract

Background

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).

Methods

An analysis of 2017 Annual Clinical Data Sheets of 306 subjects from five Mexican centers was performed.

Results

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).

Conclusions

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.


Corresponding author: Adj. Professor Graham David Ogle, Life for a Child Program, Diabetes NSW & ACT, Glebe, NSW 2037, Australia; and NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW 2006, Australia, Phone: +61 400 683 574
aCo-First Authors.

Acknowledgments

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.

  1. 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.

  2. 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.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. 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.

  6. Conflict of interest statement: None of the authors have any conflicts of interest with respect to this study.

  7. Institutional review board statement: The study was reviewed and approved by the Federación Mexicana de Diabetes, A.C.

  8. Data sharing statement: Not relevant.

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Received: 2019-08-07
Accepted: 2019-08-08
Published Online: 2019-09-04
Published in Print: 2019-10-25

©2019 Walter de Gruyter GmbH, Berlin/Boston

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