Abstract Introduction: The nursing process is the method that allows us to administer care to people with chronic diseases through the disease stages, that is, assessment, diagnostic reasoning, nursing care plan and evaluation. Objective: Evaluate a nursing care plan for an older adult with type 2 diabetes mellitus and osteoporosis with a focus on therapeutic health education. Methodology: Observational, descriptive, and longitudinal clinical case study of a 63-year-old patient with diabetes mellitus and osteoporosis; the Marjory Gordon instrument was used for assessment, and standardized language was used for diagnostic reasoning, planning, execution and evaluation. Under bioethical principles, this is a minimal risk research, and the privacy and data of the elderly are protected. Results: Alteration was found in the pattern of perception/maintenance of health, nutritional/metabolic, exercise activity and coping with stress; with the establishment of activities to control glucose, priority was given to prescribed diet, exercise, adherence to treatment and coping with stress. Acceptance of the disease, learning to take capillary glucose and glycemic control was achieved, as well as adherence to the prescribed diet and exercise. Conclusions: Therapeutic health education achieved adherence to pharmacological and non-pharmacological treatment, as well as the acceptance of the health status, which allows acquiring self-control of the disease. Continuous and long-term follow-up is important due to the pathological progress, age and general deterioration of the patient.

Abstrato Introdução. O processo de enfermagem é o método que nos permite administrar a assistência a pessoas com doenças crônicas por meio dos estágios da doença, ou seja, avaliação, raciocínio diagnóstico, plano de assistência de enfermagem e avaliação. Objetivo: Avaliar um plano de cuidados de enfermagem para um adulto mais velho com diabetes mellitus tipo 2 e osteoporose com foco na educação terapêutica em saúde. Metodologia: Estudo de caso clínico observacional, descritivo e longitudinal de uma paciente de 63 anos com diabetes mellitus e osteoporose; para a avaliação foi utilizado o instrumento Marjory Gordon para raciocínio diagnóstico, planejamento, execução e avaliação, para raciocínio diagnóstico, planejamento, execução e avaliação, foi utilizada a linguagem padronizada. De acordo com os princípios bioéticos, essa é uma pesquisa de risco mínimo, e a privacidade e os dados dos idosos são protegidos. Resultados: Foi encontrada alteração no padrão de percepção/manutenção da saúde, nutricional/metabólico, atividade física e enfrentamento do estresse; com o estabelecimento de atividades para controlar a glicose, a prioridade foi dada à dieta prescrita, aos exercícios, à adesão ao tratamento e ao enfrentamento do estresse. Houve aceitação da doença, aprendizado da medição da glicose capilar e controle glicêmico, além de adesão à dieta e aos exercícios prescritos. Conclusões: A educação terapêutica em saúde conseguiu a adesão ao tratamento farmacológico e não farmacológico, bem como a aceitação do estado de saúde, que permite adquirir o autocontrolo da doença, sendo importante a monitorização contínua e a longo prazo da evolução patológica, da idade e da deterioração geral do paciente.

Resumen Introducción: El proceso de enfermería es el método que nos permite administrar los cuidados a personas con enfermedades crónicas a través de sus etapas: valoración, razonamiento diagnóstico, plan de cuidados de enfermería y evaluación. Objetivo: Evaluar un plan de cuidados de enfermería a una adulta mayor con diabetes mellitus tipo 2 y osteoporosis con enfoque a la educación para la salud terapéutica. Metodología: Estudio de caso clínico, observacional, descriptivo y longitudinal, a paciente de 63 años con diabetes mellitus y osteoporosis; para la valoración se empleó el instrumento de Marjory Gordon, para el razonamiento diagnóstico, planeación, ejecución y evaluación se utilizó el lenguaje estandarizado de enfermería. Bajo los principios bioéticos es una investigación de riesgo mínimo, se protege la privacidad y datos del adulto mayor. Resultados: Se encontró alteración en el patrón percepción / mantenimiento de la salud, nutricional / metabólico, actividad ejercicio y afrontamiento del estrés; estableciendo actividades para el control de su glucosa, se priorizó en dieta prescrita, ejercicio, adherencia al tratamiento y afrontamiento al estrés. Se logró aceptación de la enfermedad, aprendizaje de toma de glucosa capilar y control glucémico, además del apego a dieta y ejercicio prescrito. Conclusiones: La educación para la salud terapéutica logró el apego al tratamiento farmacológico y no farmacológico, así como la aceptación del estado de salud le permite adquirir el autocontrol de su enfermedad, es importante el seguimiento continuo y a largo plazo por el avance patológico, edad y deterioro general de la paciente.

Abstract Type 2 Diabetes Mellitus (T2DM) is a set of metabolic disorders that increase the risk of multisystemic diseases. In Mexico, Clinical Practice Guidelines (CPG) have been proposed for the healthcare of people with T2DM, from prevention to rehabilitation. However, although these guidelines emphasize the active participation of patients in their treatment to enhance treatment adherence, the necessary information on the procedures has not been provided. Therefore, the aim of this paper is to propose Human-Centered Design Thinking (HCDP) as a strategy for this purpose. The steps that constitute this methodology are described, as well as the results found in the international literature. The coherence of the HCDP with Mexican CPG recommendations is discussed, as is the importance of the methodological clarity provided by this model to improve treatment adherence in people with T2DM.

Resumen La diabetes mellitus tipo 2 (DMT2) es un conjunto de desórdenes metabólicos que aumenta el riesgo de afecciones multisistémicas. En México se han propuesto Guías de Práctica Clínica (GPC) para la atención de la salud en personas con DMT2, que van desde la prevención hasta la rehabilitación. Sin embargo, a pesar de enfatizar la participación activa de los pacientes en sus tratamientos para mejorar la adherencia al tratamiento, no cuenta con procedimientos claros. Por ello, el objetivo de este trabajo es proponer el pensamiento de diseño centrado en la persona (PDCP) como una estrategia para esta meta. Se describen los pasos que integran esta metodología, así como los resultados observados en la literatura internacional. Se discute la coherencia del PDCP con las recomendaciones de las GPC mexicanas, y la importancia de la claridad metodológica que brinda este modelo para mejorar la adherencia al tratamiento en personas con DMT2.

Resumen Objetivo: recopilar información de factores de riesgo de la enfermedad arterial coronaria en población adulta evidenciados mediante estudios de aleatorización mendeliana. Métodos: de acuerdo con las recomendaciones de la escala para la Evaluación de Artículos de Revisión Narrativa (SANRA), se realizó una revisión desde el usuario de la Universidad Militar Nueva Granada en las bases de datos de PubMed, EMBASE y BIREME. Resultados: se obtuvieron 757 artículos, luego se aplicaron los criterios de inclusión y exclusión, y se eligieron 29 artículos en los que se investiga la asociación de la enfermedad arterial coronaria con la apolipoproteína B, colesterol LDL, triglicéridos, colesterol total, apolipoproteina C3, proteína de transferencia de ésteres de colesterol, HDL, omega 6, lipoproteína (a), obesidad, hemoglobina A1C, diabetes mellitus tipo 2, glucosa en ayunas, inicio del hábito de fumar, presión arterial, hormona paratiroidea sérica, niveles de fosfato sérico, enfermedad del hígado graso no alcohólico, síndrome de ovario poliquístico, globulina fijadora de hormonas sexuales, testosterona, filoquinona circulante, proteína gla de la matriz inactiva, antioxidantes circulantes derivados de la dieta, glicina, homocisteína, ácido úrico, marcadores inflamatorios, hemoglobina, hematocrito y recuento de glóbulos rojos. Conclusión: esta revisión sugiere nuevos estudios con información genética colombiana para respaldar los factores de riesgo aquí presentados, teniendo en cuenta que en ninguno de los estudios evaluados se utilizó información genética latinoamericana, lo cual puede limitar la extrapolación de los resultados.

Summary: Objective: To compile information on risk factors for coronary artery disease in the adult population evidenced by Mendelian randomization studies.. Methods: A search was carried out from the user of the Nueva Granada Military University in the databases of PubMed, EMBASE and BIREME and a narrative review of the literature was carried out in accordance with the recommendations of the scale for the Evaluation of Narrative Review Articles (SANRA). Results: 757 articles were obtained, after the application of inclusion and exclusion criteria, 29 articles were chosen that investigated the association of apolipoprotein B, LDL cholesterol, triglycerides, total cholesterol, apolipoprotein C3, cholesterol ester transfer protein, HDL, omega 6, lipoprotein (a), obesity, hemoglobin A1C, type 2 diabetes mellitus, fasting glucose, smoking initiation, blood pressure, serum parathyroid hormone, serum phosphate levels, non-alcoholic fatty liver disease, polycystic ovary syndrome , sex hormone-binding globulin, testosterone, circulating phylloquinone, inactive matrix protein gla, circulating dietary-derived antioxidants, glycine, homocysteine, uric acid, inflammatory markers, hemoglobin, hematocrit, and red blood cell count, with coronary artery disease. Conclusion: This review suggests new studies with Colombian genetic information to support the risk factors presented here, considering that none of the studies evaluated used Latin American genetic information, which may limit the extrapolation of the results.

Resumo O acúmulo de produtos finais de glicação avançada (AGEs, do inglês advanced glycation end-products) provoca comprometimento morfofuncional dos rins. Os níveis de AGEs podem ser estimados de forma não invasiva por autofluorescência da pele (sAF). Exploramos se a sAF elevada prediz desfechos renais em indivíduos com diabetes tipo 2 (DT2). O estudo foi realizado como uma análise predefinida do Estudo Brasileiro sobre Diabetes, uma coorte prospectiva de centro único de adultos com DT2. Foram considerados os dados de 155 indivíduos acompanhados por até 1.716 dias. A incidência de eventos renais adversos maiores (MAKE, por sua sigla em inglês) foi de 9,6%. Indivíduos com sAF acima da mediana apresentaram maior incidência de MAKEs (4,6% vs. 21%; p = 0,002), com HR de 3,39 [IC 95%: 1,06–10,85; p = 0,040] após ajuste por idade e sexo. A alteração média da TFGe ajustada foi de 1,08 unidades (EP: 1,15; IC95%: –1,20, 3,37) no grupo de baixa sAF e de –5,19 unidades [EP: 1,93; IC95%: –9,10, –1,29] no grupo de elevada sAF (diferença entre sujeitos: F: 5,62; p = 0,019). O grupo sAF elevada apresentou maior prevalência de declínio rápido em comparação ao grupo sAF baixa (36,7% vs. 15,8%; p = 0,028). Em conclusão, a sAF elevada foi relacionada ao aumento da incidência de MAKEs e ao declínio mais rápido da TFGe entre indivíduos com DT2. Tal fato deve ser considerado pelos profissionais de saúde ao identificar indivíduos mais propensos a complicações renais relacionadas ao diabetes. AGEs, (AGEs endproducts end products end-products rins sAF. . (sAF) DT2 DT (DT2) Diabetes 15 1716 1 716 1.71 dias MAKE, MAKE (MAKE 96 9 6 9,6% 4,6% 46 4 (4,6 vs 21% 21 0,002, 0002 0,002 , 0 002 0,002) 339 3 39 3,3 IC 95% 95 1,06–10,85 1061085 06 10 85 0,040 0040 040 sexo 108 08 1,0 EP (EP 1,15 115 IC95% IC95 120 20 –1,20 3,37 337 37 519 5 19 –5,1 [EP 1,93 193 93 910 –9,10 –1,29 129 29 diferença sujeitos F 5,62 562 62 0,019. 0019 0,019 019 0,019) 36,7% 367 36 7 (36,7 15,8% 158 8 0,028. 0028 0,028 028 0,028) conclusão (sAF (DT2 171 71 1.7 9,6 4,6 (4, 000 0,00 00 33 3, 1,06–10,8 106108 0,04 004 04 1, 1,1 11 IC9 12 –1,2 51 –5, 1,9 91 –9,1 5,6 56 001 0,01 01 36,7 (36, 15,8 0,02 02 (DT 17 1. 9, 4, (4 0,0 1,06–10, 10610 –1, –5 –9, 5, 36, (36 15, ( 0, 1,06–10 1061 –1 – –9 (3 1,06–1 106 1,06– 1,06

Abstract The accumulation of advanced glycation end-products (AGEs) elicits morphofunctional kidney impairment. AGEs levels can be noninvasively estimated by skin autofluorescence (SAF). We explored whether high SAF predicts kidney outcomes in type 2 diabetes (T2D) individuals. The study was conducted as a predefined analysis of the Brazilian Diabetes Study, a prospective single-center cohort of T2D adults. Data from 155 individuals followed for up to 1716 days were considered. The incidence of major adverse kidney events (MAKE) was 9.6%. Individuals with above-median SAF had a higher incidence of MAKEs (4.6% vs. 21%; p = 0.002), with an HR of 3.39 [95% CI: 1.06–10.85; p = 0.040] after adjustment by age and gender. The mean adjusted eGFR change was 1.08 units (SE: 1.15; 95%CI: –1.20, 3.37) in the low SAF and –5.19 units [SE: 1.93; 95%CI: –9.10, –1.29] in the high SAF groups (between-subject difference: F: 5.62, p = 0.019). The high-SAF group had a greater prevalence of rapid decliners than the low-SAF group (36.7% vs. 15.8%; p = 0.028). In conclusion, high SAF was related to increased incidence of MAKEs and faster decline in eGFR among T2D subjects. This should be considered by healthcare providers when identifying individuals more prone to diabetes-related kidney complications. endproducts end products (AGEs impairment SAF. . (SAF) TD T D (T2D Study singlecenter single center adults 15 171 MAKE (MAKE 96 9 6 9.6% abovemedian above median 4.6% 46 4 (4.6 vs 21% 21 0.002, 0002 0.002 , 0 002 0.002) 339 3 39 3.3 95% 95 [95 CI 1.06–10.85 1061085 1 06 10 85 0.040 0040 040 gender 108 08 1.0 SE (SE 1.15 115 95%CI 95CI 120 20 –1.20 3.37 337 37 519 5 19 –5.1 [SE 1.93 193 93 910 –9.10 –1.29 129 29 betweensubject between subject difference F 562 62 5.62 0.019. 0019 0.019 019 0.019) highSAF lowSAF 36.7% 367 36 7 (36.7 15.8% 158 8 0.028. 0028 0.028 028 0.028) conclusion subjects diabetesrelated complications (SAF 17 9.6 4.6 (4. 000 0.00 00 33 3. [9 1.06–10.8 106108 0.04 004 04 1. 1.1 11 12 –1.2 51 –5. 1.9 91 –9.1 56 5.6 001 0.01 01 36.7 (36. 15.8 0.02 02 9. 4. (4 0.0 [ 1.06–10. 10610 –1. –5 –9. 5. 36. (36 15. ( 0. 1.06–10 1061 –1 – –9 (3 1.06–1 106 1.06– 1.06

Introduction: The liver plays a critical role in glucose and lipid homeostasis. Insulin resistance (IR) has been increasingly recognized as a primary etiological factor in metabolic disorders. Hepatic insulin resistance (HIR) is a specific manifestation of IR characterized by the liver's reduced responsiveness to insulin despite elevated circulating insulin levels. Objective: This review aims to elucidate the role of HIR in the pathogenesis of metabolic disorders, focusing on its relationship with metabolic dysfunction-associated fatty liver disease (MAFLD) and type 2 diabetes mellitus (T2DM). Methods: A comprehensive literature search was conducted to explore the underlying mechanisms of HIR, its clinical implications, and its association with MAFLD and T2DM. Results: HIR is characterized by impaired insulin-mediated glucose uptake and increased hepatic glucose output. This metabolic dysfunction contributes to the development of hepatic steatosis, dyslipidemia, and insulin resistance in peripheral tissues. The interplay between HIR and lipogenesis is important in the progression of MAFLD and its association with T2DM, and could be described as a hepatic equivalent of T2DM. Conclusion: The understanding of a T2DM-like condition in the liver is decisive for developing more targeted and effective treatments.

Introdução: O fígado desempenha um papel crítico na homeostase da glicose e lipídios. A resistência à insulina (RI) tem sido cada vez mais reconhecida como um fator etiológico primário em distúrbios metabólicos. A resistência à insulina hepática (RIH) é uma manifestação específica da RI caracterizada pela redução da resposta hepática à insulina, apesar dos níveis elevados de insulina circulante. Objetivo: Este manuscrito visa avaliar o papel da RIH na patogênese dos distúrbios metabólicos, com foco em sua relação com a doença hepática gordurosa associada à disfunção metabólica (DHGDM) e o diabetes mellitus tipo 2 (DMT2). Métodos: Foi realizada uma busca abrangente na literatura para explorar os mecanismos subjacentes da RIH, suas implicações clínicas e sua associação com a DHGDM e o DMT2. Resultados: A RIH é caracterizada pela redução da captação de glicose mediada pela insulina e pelo aumento da produção hepática de glicose. Essa disfunção metabólica contribui para o desenvolvimento de esteatose hepática, dislipidemia e RI em tecidos periféricos. A interação entre RIH e lipogênese é importante na progressão da DHGDM e sua associação com o DMT2, podendo ser descrita como um equivalente hepático do DMT2. Conclusão: A compreensão de uma condição semelhante ao DMT2 no fígado é decisiva para o desenvolvimento de tratamentos mais direcionados e eficazes.

Abstract Objective: This systematic review aims to clarify COVID-19’s impact on the onset of T2D in adults. Material and methods: Following PRISMA guidelines, this systematic review sourced data from multiple databases from 2019 to April 20th, 2023. Two reviewers handled screening, with a third-party resolving disagreement. The focus was on COVID-19 cases with post-infection T2D symptoms persisting for two or more months. Exclusions included those outside the 18-70 age range, prior T2D history, pregnancy, and animal studies. Rayyan software facilitated article screening, STATA 18 performed meta-analysis, and bias was assessed using JBI tools. The study is registered in PROSPERO (ID: CRD42023414096). Results: A total of 173 articles were retrieved, of which 23 (11.6%) remained for extraction. 13 cohort studies with 11.551.026 participants were included for the meta-analysis, which found that the COVID-19 population had 1.4 greater risk of being diagnosed with T2D in comparison with the population without COVID-19or with other respiratory diseases. The other study designs were narratively analyzed, describing similar results as the meta-analysis. Discussion: New onset T2D is a potential consequence of LC. While T2D increases COVID-19 complications, the relationship appears bidirectional. Given the novelty of the topic and potential newer studies, further reviews are needed to understand LC’s impact on chronic diseases like T2D globally. Further studies should be carried out on this specific topic that could raise the burden of T2D between all the other symptoms that may be caused by LC. In addition, it is necessary to adapt the interventions according to each country’s possibilities.

Resumen Objetivo: El objetivo de esta revisión es aclarar el impacto del COVID-19 en nuevos diagnósticos de DM2. Material y Métodos: Esta revisión se elaboró en base a las guías PRISMA. Dos revisores realizaron una búsqueda en bases de datos, incluyendo artículos desde el 2019 hasta el 20 de abril de 2023 en adultos, diagnosticados al menos una vez con COVID-19, sin diagnóstico previo de DM2. Excluyeron: embarazadas, niños y diabetes mellitus I. Esta revisión se registró en PROSPERO (ID: CRD42023414096) el 6 de abril de 2023. Resultados: Un total de 173 artículos se obtuvieron luego de la búsqueda, de los cuales 23 (11,6%) quedaron para extracción. 13 estudios de cohorte con 11.551.026 participantes se incluyeron en el metaanálisis, que encontraron que la población que tuvo COVID tiene un 1,4 veces más riesgo de ser diagnosticados con DM2 en comparación a quienes no tuvieron el diagnóstico o fueron diagnosticados con otra patología respiratoria. Los diseños de estudio se describieron narrativamente, describiendo resultados similares a los del metaanálisis. Discusión: El nuevo diagnóstico de DM2 es una potencial consecuencia de LC. Mientras aumenta la DM2, aumentan las complicaciones de COVID-19, la relación aparenta ser bidireccional. Ya que estos hallazgos son medianamente recientes, no existe mucha evidencia disponible al respecto, por lo tanto, se requiere un mayor número de estudios al respecto, además de la creación de nuevas políticas de salud pública ad hoc a las posibilidades de cada país.

RESUMEN Introducción: los pacientes con enfermedad renal crónica con requerimiento de terapia sustitutiva renal (hemodiálisis) son frecuentes en el Paraguay, lo que afecta la calidad de vida de los que la padecen. Objetivo: conocer la calidad de vida de los pacientes con enfermedad renal crónica en tratamiento hemodialítico en el Departamento de Nefrología del Centro Médico Nacional-Hospital Nacional en el período 2022-2023. Metodología: observacional, descriptivo, de corte transversal realizado en el Departamento de Nefrología del Centro Médico Nacional-Hospital Nacional de Paraguay. Se incluyeron en el estudio 189 pacientes en que acudieron para tratamiento hemodialítico entre los años 2022-2023. La muestra fue censal. Para determinar la calidad de vida se utilizó el cuestionario Kidney Disease Quality of Life - 36 ítems. Los datos fueron analizados con el programa Epiinfo. Resultados: la edad media de los pacientes fue de 53 años, varones 58.2 %. El 98 % refirió la presencia de algún tipo de comorbilidad concomitante, las más frecuentes fueron diabetes Mellitus 43 % e hipertensión arterial 86 %. La media de meses en tratamiento hemodialítico fue de 20 meses. El cuestionario, Kidney Disease Quality of Life - 36 ítems, arrojó puntajes promedios menores a 50 en el componente mental (65.08) y en el componente físico (71.95) así como en la subescala carga de la enfermedad (55.55). Conclusión: la mayoría de los pacientes con enfermedad renal crónica con tratamiento hemodialítico en el Hospital Nacional evidencian una baja calidad de vida.

ABSTRACT Introduction: patients with chronic kidney disease requiring renal replacement therapy (hemodialysis) are common in Paraguay, which affects the quality of life of those who suffer from it. Objective: to know the quality of life of patients with chronic kidney disease undergoing hemodialysis treatment in the Departmento de Nefrología of the Centro Médico Nacional-Hospital Nacional in the period 2022-2023. Methodology: observational, descriptive, cross-sectional carried out in the Nephrology Department of the Centro Médico Nacional-Hospital Nacional of Paraguay. 189 patients who came for hemodialysis treatment between 2022-2023 were included in the study. The sample was census. To determine quality of life, the Kidney Disease Quality of Life questionnaire - 36 items was used. The data were analyzed with the Epi Info program. Results: the average age of the patients was 53 years, 58.2 % men. 98 % reported the presence of some type of concomitant comorbidity, the most frequent being diabetes mellitus 43 % and arterial hypertension 86 %. The average number of months on hemodialysis treatment was 20 months. The questionnaire, Kidney Disease Quality of Life - 36 items, showed average scores less than 50 in the mental component (65.08) and in the physical component (71.95) as well as in the burden of the disease subscale (55.55). Conclusion: the majority of patients with chronic kidney disease with hemodialysis treatment at the National Hospital show a low quality of life.

RESUMEN Introducción: la diabetes mellitus es una patología prevalente y por ello la implementación de estrategias prácticas para su diagnóstico son importantes desde la Atención Primaria. Objetivo: determinar los parámetros laboratoriales de los pacientes de la Unidad de Salud Familiar del barrio Chaipe (Encarnación, Paraguay) con moderado a muy alto riesgo de diabetes mellitus tipo 2 según la prueba de FINDRISK. Metodología: estudio prospectivo, observacional, descriptivo, transversal. Se incluyeron pacientes mayores de 18 años que acudieron a consultar en la Unidad de Salud Familiar del barrio Chaipe desde setiembre del 2022 a febrero del 2023. Se aplicó la prueba de FINDRISK para seleccionar a aquellos con moderado a muy alto riesgo de diabetes mellitus tipo 2 para las determinaciones laboratoriales. Resultados: la muestra estuvo conformada por 142 pacientes, con rango de edad menor a 45 años y predominio del sexo femenino. El 42,96 % tenía índice de masa corporal aumentado y 62,68 % circunferencia abdominal de riesgo. El 52,11 % no realizaba actividad física y el 27,46 % no consumía frutas y verduras diariamente. El 25,35 % eran hipertensos, el 11,97 % presentó en alguna oportunidad glicemia elevada y el 56,34 % tenía familiares con diabetes mellitus. El 4,93 % presentó glicemia ≥ 126 mg/dl y el 10,56 % valores de hemoglobina glicosilada (HBA1C) ≥ 6,5 %. El 14,08 % presentó colesterol total ≥ 200 mg/dl y 19,72 % triglicéridos ≥ 150 mg/dl. El 26,65 % presentó 3 o más criterios para síndrome metabólico y se encontró una relación significativa con el riesgo de diabetes mellitus. Conclusiones: se encontró una proporción significativa de pacientes con parámetros laboratoriales de glicemia, HBA1C, colesterol y triglicéridos aumentados.

ABSTRACT Introduction: diabetes mellitus is a prevalent pathology and therefore the implementation of practical strategies for its diagnosis are important from Primary Care. Objective: to determine the laboratory parameters of patients from the United Family Healthcare of the Chaipe neighborhood (Encarnación, Paraguay) with moderate to very high risk of diabetes mellitus type 2 according to the FINDRISK test. Methodology: prospective, observational, descriptive, cross-sectional study. Patients over 18 years of age who came to consult at the United Family Healthcare in the Chaipe neighborhood from September 2022 to February 2023 were included. The FINDRISK test was applied to select those with moderate to very high risk of diabetes mellitus type 2 for the laboratory’s determinations. Results: the sample was made up of 142 patients, with an age range of less than 45 years and a predominance of the female sex. 42.96 % had an increased body mass index and 62.68 % had an abdominal circumference at risk. 52.11 % did not do physical activity and 27.46 % did not consume fruits and vegetables daily. 25.35 % were hypertensive, 11.97 % had high blood glucose at some point and 56.34 % had family members with diabetes mellitus. 4.93 % had blood glucose ≥ 126 mg/dl and 10.56 % had glycosylated hemoglobin (HBA1C) values ≥ 6.5 %. 14.08 % had total cholesterol ≥ 200 mg/dl and 19.72 % had triglycerides ≥ 150 mg/dl. 26.65 % presented 3 or more criteria for metabolic syndrome and a significant relationship was found with the risk of diabetes mellitus. Conclusions: a significant proportion of patients with increased laboratory parameters of glycemia, HBA1C, cholesterol and triglycerides were found.

RESUMEN Introducción: las enfermedades del pie relacionadas a la diabetes mellitus representan una de las causas de mayor morbilidad e incapacidad en las personas con diabetes mellitus tipo 2, siendo la causa más frecuente de ingreso hospitalario en dicho grupo. Objetivo: describir las características clínicas de los pacientes con enfermedad del pie relacionadas a la diabetes mellitus del Hospital Nacional 2022-2023. Metodología: se seleccionaron 113 pacientes portadores de diabetes mellitus tipo 2 con pie diabético mayores de 18 años. Se evaluaron las variables demográficas, medidas antropométricas, características de la enfermedad, comorbilidades y características clínicas del pie. Resultados: de los 113 estudiados 42 pacientes (37 %) correspondieron al sexo femenino y 71 (63 %) al sexo masculino, promedio de edad fue de 65 años DE 12,191. 75 pacientes (66 %) presentaron pie diabético, con lesión Wagner grado 4. El 81 % (92) tenía hipertensión arterial, sedentarismo 65 % (84), en menor frecuencia pacientes con sobrepeso 38 % (43), obesidad 25 % (38), tabaquismo 23 % (26) y dislipidemia 18 % (20). Conclusión: las características clínicas de los pacientes con diabetes tipo 2 con lesión en el pie coinciden con otros trabajos obtenidos a nivel mundial. Es muy importante prestar atención a este grupo de riesgo, mediante medidas preventivas y realizar el tratamiento precoz para disminuir las complicaciones.

ABSTRACT Introduction: foot diseases related to diabetes mellitus represent one of the causes of greatest morbidity and disability in people with type 2 diabetes mellitus, being the most frequent cause of hospital admission in said group. Objective: to describe the clinical characteristics of patients with foot disease related to diabetes mellitus at Hospital Nacional 2022-2023. Methodology: 113 patients with type 2 diabetes mellitus with diabetic foot over 18 years of age were selected. Demographic variables, anthropometric measurements, disease characteristics, comorbidities, and clinical characteristics of the foot were evaluated. Results: of the 113 studied, 42 patients (37 %) were female and 71 (63 %) were male, average age was 65 years SD 12,191. 75 patients (66 %) presented diabetic foot, with Wagner grade 4 lesion. 81 % (92) had high blood pressure, sedentary lifestyle 65 % (84), less frequently overweight patients 38 % (43), obesity 25% (38) ), smoking 23 % (26) and dyslipidemia 18 % (20). Conclusion: the clinical characteristics of patients with type 2 diabetes with foot injury coincide with other works obtained worldwide. It is very important to pay attention to this risk group, through preventive measures and carry out early treatment to reduce complications.

Resumen El objetivo de esta investigación fue analizar la relación de resistencia a la insulina, sobrepeso y obesidad. Con una población de 2574 pacientes con diagnóstico de obesidad y sobrepeso, se obtuvo una muestra de 334 pacientes. Se realizó un estudio de tipo descriptivo, documental, retrospectivo, transversal y correlacional. Para la recolección de datos se empleó las historias clínicas registradas en el sistema operativo AS400 de IBM, de atención médica del Instituto Ecuatoriano de Seguridad Social. El resultado total de los pacientes perteneció al sexo femenino con un porcentaje del 77.84 %, residencia urbana (73.65 %) e instrucción superior (60.5 %). El 52.8 % de los individuos registró un IMC >30kg/m2. Los pacientes adultos jóvenes de instrucción superior, sexo masculino y sector urbano registraron la mayor prevalencia de resistencia a la insulina, siendo ésta del 61.7 %. En el análisis bivariado los pacientes con obesidad mórbida presentaron mayor riesgo de resistencia a la insulina (RP:1.5; IC95 %:1. 29; 1.77). Se estableció una relación significativa entre el antecedente familiar de diabetes mellitus tipo 2 y el riesgo de presentar resistencia a la insulina (p<0.001; RP: 1.32; IC 95 %: 1.12: 1.56). Los valores de hiperglucemia, hiperinsulinemia e hiperuricemia, así como de AST Y ALT elevadas registraron una relación significativamente con HOMA-IR >3. Se concluye que la resistencia a la insulina es una entidad frecuente en pacientes con sobrepeso y obesidad, identificándose una mayor prevalencia en el género masculino, misma que predispone a la progresión de enfermedades crónicas.

Abstract This research aimed to analyze the relationship between insulin resistance, overweight and obesity. A population of 2,574 patients diagnosed with obesity and overweight was obtained, considering a sample of 334 patients. A descriptive, documentary, retrospective, cross-sectional, and correlational study was conducted. For data collection, the medical records recorded in the IBM AS400 operating system for the Ecuadorian Social Security Institute's medical care were used. The total result of the patients belonged to the female sex with a percentage of 77.84%, urban residence (73.65%), and higher education (60.5%). 52.8% of the individuals registered a BMI > 30kg/m2. Young adult patients with higher education, male sex, and urban sector registered the highest insulin resistance prevalence, 61.7%. In the bivariate analysis, patients with morbid obesity presented a higher risk of insulin resistance (PR: 1.5; 95% CI: 1. 29, 1.77). A significant relationship was established between family history of type 2 diabetes mellitus and the risk of developing insulin resistance (p<0.001; PR: 1.32; 95% CI: 1.12: 1.56). The values of hyperglycemia, hyperinsulinemia, hyperuricemia, and elevated AST and ALT were significantly related to HOMA-IR > 3. It was concluded that insulin resistance is a frequent entity in overweight and obese patients, with a higher prevalence identified in the male gender, which predisposes to the progression of chronic diseases.

Resumen La presión arterial media es un indicador indirecto del grado de perfusión orgánica, la cual podría variar en pacientes con y sin diabetes mellitus-2. El objetivo fue determinar las diferencias y riesgo de alteraciones en la presión arterial media de adultos con y sin diabetes mellitus-2 de la población peruana según datos de la encuesta demográfica de salud familiar. Se realizó un estudio observacional, analítico, retrospectivo y transversal;. Los datos provinieron de la encuesta demográfica y de salud familiar-2022 (ENDES-2022), se incluyó adultos diabéticos y no diabéticos. Las variables fueron: presión arterial media, diabetes mellitus-2, sexo y se incluyeron las variables: edad, consumo de alcohol, nivel educativo e índice de masa corporal para el análisis multivariado. Se realizó la prueba de Chi-cuadrado de Pearson, la prueba T student para muestras independientes, Odds Ratio crudo y ajustado mediante regresión logística binaria. El promedio de presión arterial media en diabéticos fue de 94,81 y 93,52 mmHg en la primera y segunda medición y en no diabéticos de 89,18 y 88,02 mmHg. La presión arterial media alta fue más frecuente en diabéticos que en no diabéticos; En el modelo logístico, incluyendo las variables sexo y edad, los diabéticos tuvieron un riesgo 2 veces mayor que los no diabéticos de alteraciones en la presión arterial media tanto en la primera como en la segunda medición. En conclusión, la diabetes mellitus-2 incrementa la presión arterial media y representa un factor de riesgo para la elevación de la presión arterial media en la población peruana.

Abstract Mean arterial pressure is an indirect indicator of the degree of organ perfusion, which could vary in diabetics and non-diabetics. The objective of this research was to determine the differences and risk of alterations in the mean arterial pressure of adults with and without diabetes mellitus-2 of the Peruvian population according to data from the family health demographic survey. An observational, analytical, retrospective and cross-sectional study was carried out. The data came from the demographic and family health survey-2022 (ENDES-2022). Diabetic and non-diabetic adults were included. The variables were mean arterial pressure, diabetes mellitus-2, sex, and the variables age, alcohol consumption, educational level, and body mass index were included for multivariate analysis. Pearson's Chi-square test, student's T test for independent samples, crude Odds Ratio and adjusted by binary logistic regression were performed. The mean arterial pressure in diabetics was 94.81 and 93.52 mmHg in the first and second measurements, and in non-diabetics it was 89.18 and 88.02 mmHg. High mean arterial pressure was more frequent in diabetics than in non-diabetics. In the logistic model, including the variables sex and age, diabetics had a risk twice as high as non-diabetics for alterations in mean arterial pressure in both the first and second measurements. In conclusion, diabetes mellitus-2 increases mean arterial pressure and represents a risk factor for elevated mean arterial pressure in the Peruvian population.

RESUMEN Introducción: la obesidad, la edad, el estilo de vida sedentario y los antecedentes familiares de diabetes mellitus se han descrito como factores de riesgo para la diabetes mellitus tipo 2 (DM2). Objetivo: determinar el riesgo probable de desarrollar DM2 en los próximos 10 años en mujeres trabajadoras de un hospital de referencia en Asunción, Paraguay. Metodología: este estudio descriptivo observacional de corte transversal se llevó a cabo entre médicos, enfermeras y personal administrativo. Se recopilaron datos durante tres meses utilizando la prueba FINDRISK para evaluar el riesgo de diabetes, la cual consta de ocho preguntas sobre la edad, el índice de masa corporal, el perímetro de la cintura, la actividad física, el consumo de frutas y verduras, antecedentes de presión arterial alta y glucosa elevada, y diabetes diagnosticada en familiares. Para el análisis de los datos se utilizaron estadísticas descriptivas en forma de frecuencias y porcentajes, así como estadísticas analíticas con la prueba de Mann Whitney y Kruskal Wallis. Resultados: un total de 112 mujeres participaron en el estudio, con más del 40% en el rango de edad de 31 a 40 años. El perímetro de cintura de 80-88 cm. fue el más común, con 38,4%. Se encontró que el 33% de las participantes tenían sobrepeso. Casi el 60% no realizaba actividad física diaria. Más del 38% tenían antecedentes de diabetes en familiares de primer grado. El 67,9% de las encuestadas tenían algún riesgo de desarrollar DM2 en los próximos 10 años, y 22 de ellas presentaron un riesgo alto o muy alto según la prueba FINDRISK. Las participantes de 35 años o más tenían un riesgo significativamente mayor (Chi; p=0,008). Conclusión: se detectó una alta prevalencia de sobrepeso y obesidad, siendo el 67,9% de las encuestadas quienes mostraron algún grado de riesgo de desarrollar DM2 en los próximos 10 años, de los cuales casi el 20% presentaban un riesgo categorizado como alto o muy alto.

ABSTRACT Introduction: Obesity, age, sedentary lifestyle, and family history of diabetes mellitus are risk factors for type 2 diabetes mellitus (T2DM). Objective: determine the probable risk of developing T2DM in the next 10 years in working women at a reference hospital in Asunción, Paraguay. Methodology: This cross-sectional observational descriptive study was conducted with physicians, nurses, and administrative staff. Data were collected over three months using the FINDRISK test to assess diabetes risk, which consists of eight questions about age, body mass index, waist circumference, physical activity, fruit and vegetable consumption, history of blood pressure, high blood pressure and high glucose, and diabetes diagnosed in family members. Descriptive statistics in the form of frequencies and percentages, as well as analytical statistics using the Mann-Whitney and Kruskal-Wallis tests, were used to analyze the data. Results: A total of 112 women participated in the study, with more than 40% in the age range of 31-40 years. The waist circumference of 80-88 cm was the most common (38.4%). It was found that 33% of participants were overweight. Almost 60% of the participants did not perform daily physical activities. More than 38% of the first-degree relatives had a history of diabetes. Of the surveyed participants, 67.9%had some risk of developing T2DM in the next 10 years and 22 had a high or very high risk according to the FINDRISK test. Participants aged 35 years had a significantly higher risk (p=0.008). Conclusion: A high prevalence of overweight and obesity was observed, with 67.9% of the respondents showing some degree of risk for developing T2DM in the next 10 years, of which nearly 20% were categorized as high or very high risk.

RESUMEN Introducción: Las complicaciones de diabetes son una causa frecuente de discapacidad e invalidez. Objetivo: Determinar la supervivencia de la población con dictamen de invalidez por complicaciones de diabetes en el período 2016-2018. Métodos: Estudio observacional retrospectivo en población asegurada que recibió un dictamen de invalidez por complicaciones de diabetes mellitus tipo 2. Las variables estudiadas fueron: diagnósticos de los dictámenes de invalidez por complicaciones de diabetes tipo 2, años de supervivencia posteriores a la emisión del dictamen y características sociodemográficas. Resultados: Fueron 51 derechohabientes que recibieron un dictamen de invalidez por complicaciones de diabetes mellitus. Predominaron el sexo masculino y la edad promedio de 55,21 ± 9,14 años. El 72,6 % habita en zona urbana con buenas condiciones. Las complicaciones de diabetes más frecuentes fueron las circulatorias (33,3 %). El tiempo promedio de supervivencia fue de 4,7 años. Conclusiones: Se observaron diferencias en los tiempos medios de supervivencia entre las complicaciones retinopatía diabética vs complicaciones múltiples de diabetes que llevan al estado de invalidez. Los factores como el sexo o la situación geográfica del trabajador no influyen en el tiempo de supervivencia.

ABSTRACT Introduction: Complications of diabetes are a common cause of disability and invalidity. Objective: Determine the survival of the population insured by the Mexican Social Security Institute that received a disability ruling due to complications of type 2 diabetes mellitus at the Gineco-Pediatrics Hospital with Family Medicine No. 31 Mexicali Baja California in the period 2016-2018. Methods: Retrospective study in an insured population that received a disability ruling due to complications of type 2 diabetes mellitus. The variables studied were: diagnoses of the disability rulings due to complications of type 2 diabetes, years of survival after the ruling was issued, and characteristics. sociodemographic. Results: There were 51 beneficiaries who received a disability ruling due to complications of diabetes mellitus. Male sex predominated and the average age was 55.21 ± 9.14 years. 72.6% live in urban areas with good conditions. The most common diabetes complications were circulatory complications (33.3%). Average survival time was 4.7 years. Conclusions: Differences were observed in the mean survival times between diabetic retinopathy complications vs. multiple diabetes complications leading to disability. Factors such as the worker's sex or geographical location do not influence survival time.

ABSTRACT Introduction: Chronic Kidney Disease has gained interest due to its high morbidity and mortality rate. In addition to vascular causes and diabetes mellitus, an unknown cause has been identified in young farmers. Objective: This study aims to determine the prevalence of the population on hemodialysis, suspected of Chronic Interstitial Nephritis in agricultural communities, to categorize the true etiology of their renal pathology. Methodology: A descriptive observational design was applied during December 2022, January, and February 2023; and 684 patients of both sexes were surveyed in 8 hemodialysis centers in the Capital and the Central Department of Paraguay. Results: The prevalence of suspected cases due to the exposure to risk factors was 18.1%. This figure could be higher since 22.6% of patients with type 2 diabetes mellitus did not present clinical retinopathy or other clinical signs of the disease at the time of the diagnosis of kidney failure. This scenario warns us of a probable misdiagnosis in a considerable number of patients. Conclusion: The importance of this research lies in generating preventive actions in the agricultural population and raising awareness in the medical community about the diagnostic relevance of this pathology to improve the quality and prognosis of life in the Paraguayan population.

RESUMEN Introducción: La Enfermedad Renal Crónica ha cobrado interés debido a su alta tasa de morbimortalidad. Además de las causas vasculares y de la diabetes mellitus, se ha identificado una causa de Origen Desconocido en jóvenes agricultores. Objetivo: El objetivo del estudio es determinar la prevalencia de la población en hemodiálisis, sospechosa de la Nefritis Intersticial Crónica en Comunidades Agrícolas, para categorizar la verdadera etiología de su patología renal. Metodología: Se aplicó un diseño observacional descriptivo durante los meses de diciembre de 2022, enero y febrero de 2023; y se encuestó a 684 pacientes de ambos sexos en 8 centros de hemodiálisis de la Capital y el Departamento Central del Paraguay. Resultados: La prevalencia de casos sospechosos por la exposición a factores de riesgo resultó ser del 18.1%. Esta cifra podría ser mayor, ya que 22.6% de los pacientes con diabetes mellitus tipo 2, no presentó retinopatía clínica ni otros signos clínicos de la enfermedad al momento del diagnóstico de la falla renal. Este panorama nos advierte de un probable diagnóstico desacertado en una cantidad considerable de pacientes. Conclusión: La importancia de esta investigación se sustenta en generar acciones preventivas en la población agrícola y concientizar a la sociedad médica de la relevancia diagnóstica de esta patología para mejorar la calidad y pronóstico de vida en la población paraguaya.

ABSTRACT Introduction: Diabetes mellitus is a public health issue affecting an increasing number of workers, representing a disease exacerbated by work with a high social, economic, and personal cost. The nature of the work performed, coupled with occupational risks in a hospital setting, significantly contribute to the disease's progression. This study aims to address the impact of this disease on work and the role of Occupational Health in the prevention of exposure to occupational risk factors in the hospital environment, which can contribute to the metabolic imbalance of type I diabetes mellitus. Methodology: The methodology included search in PubMed, Science Direct, and Google Scholar databases, using keywords such as "diabetes mellitus, occupational medicine, risk factors and occupational health”. Filters were applied, considering publications from 2010 to 2024, totaling 463 works. Exclusion criteria focused on non-diabetes-related diseases, exclusive focus on Type II, and non-occupational approaches. Articles on diabetes and occupational health and safety published in Revista Portuguesa de Saúde Ocupacional were also considered, in a total of five studies. Sources also included Direção Geral de Saúde Clinical Guidance, a national epidemiological study, and a technical manual on workplace diabetes, totaling 30 references in the discussion. Results: The authors report two cases of healthcare professionals from a hospital unit, both diagnosed with Type I Diabetes at the age of five. Case 1: A 35-year-old healthcare assistant with a history of depressive syndrome and recent diabetic retinopathy diagnosis. Case 2: A 57-year-old nurse with diabetic retinopathy, nephropathy, neuropathy, undergoing treatment for osteomyelitis of the right big toe, without cardiovascular changes. In both they work or have worked in shifts, including night shifts, engaging in physically demanding tasks. Discussion/Conclusion: Diabetes is a chronic disease requiring continuous medical care and patient education, alongside support in preventing acute complications and reducing the risk of chronic complications. The incidence of new Type I Dm cases is higher between 12-14 years. During the transition to adulthood and entry into the job market, patients face disease stigma, treatment management challenges, and psychosocial workplace-related issues. Implementing preventive measures and monitoring these workers should help reduce work absenteeism, productivity loss, and income loss for the worker.

RESUMO Introdução: A Diabetes mellitus é um problema de Saúde Pública que afeta um número crescente de trabalhadores. Pode ser considerada uma doença agravada pelo trabalho com um elevado custo social, económico e pessoal. O tipo de trabalho realizado e as exposições a riscos laborais em contexto hospitalar, podem contribuir para a sua progressão, segundo alguns autores. Este trabalho pretende abordar o impacto desta patologia no trabalho e o papel da Saúde Ocupacional na evicção da exposição a fatores de risco laborais, em ambiente hospitalar, que contribuem para o descontrolo metabólico da Diabetes Melitus tipo I. Pretende-se identificar as exposições laborais que podem constituir fatores de risco modificáveis, interferem com a aptidão para o trabalho, podem aumentar a frequência de acidentes laborais e acelerar a progressão crónica da doença. Metodologia: Na metodologia de pesquisa e seleção de estudos utilizou as bases de dados PubMed, Science Direct e Google Scholar, com as palavras-chave “diabetes mellitus, occupational medicine, risk factors, occupational health”. Aplicaram-se filtros de revisão e revisão sistemática, considerando publicações de 2010 a 2024, totalizando 463 trabalhos. Critérios de exclusão incidiram em doenças não relacionadas à diabetes, exclusividade na tipo II e abordagens não ocupacionais. Foram ainda considerados os artigos sobre diabetes e saúde e segurança no trabalho publicados na Revista Portuguesa de Saúde Ocupacional, num total de cinco estudos. Incluíram-se a Norma de Orientação Clínica da DGS, um estudo epidemiológico nacional e um caderno técnico sobre diabetes no local de trabalho, totalizando 30 fontes na discussão. Descrição dos casos: Os autores reportam dois casos de profissionais de saúde de uma unidade hospitalar, ambos com diagnóstico de Diabetes tipo I aos cinco anos de idade. Caso 1: Uma auxiliar de ação médica de 35 anos, com antecedentes pessoais de síndrome depressivo e diagnóstico recente de retinopatia diabética. Caso 2: Uma enfermeira de 57 anos com retinopatia e nefropatia diabética, neuropatia, em tratamento para uma osteomielite do 1º dedo do pé direito, sem alterações cardiovasculares. Ambas trabalham ou trabalharam por turnos, com trabalho noturno e com tarefas fisicamente exigentes. Discussão/Conclusão: A diabetes é uma doença crónica que requer cuidados médicos contínuos e educação do doente, juntamente com apoio na prevenção de complicações agudas e redução do risco de complicações crónicas. A incidência de novos casos de Dm tipo I é maior entre os 12-14 anos. Na transição para a idade adulta e entrada no mercado laboral, os doentes podem ser sujeitos ao estigma da doença, ter dificuldade na gestão do tratamento e/ou desafios psicossociais relacionados com o trabalho. A instituição de medidas preventivas e monitorização destes trabalhadores deverá ajudar a reduzir o absentismo laboral, a perda de produtividade e a perda de rendimento para o trabalhador.