Martha Eugenia Fajardo

Adherence to treatment and social support in patients with non-insulin dependent diabetes mellitus

We carried out a cross-sectional study to investigate factors associated with adherence to diet and medication in non-insulin-dependent diabetes mellitus (NIDDM) patients. A total of 200 patients not seeking treatment from clubs for diabetics from two hospitals in León, Mexico, accepted inclusion. Patients interviewed had a mean age of 58.8 (53.3-56.4, 95% C.I.) years. We evaluated adherence to diet and medication, knowledge on diabetes, social support, familys structure and functioning (with a modified McMaster model), metabolic control, and complications. Stepwise multiple regression procedure showed that adherence to diet was associated with years since diagnosis (p = 0.003) and with social support (p = 0.007). Adherence to medication was associated with social support (p = 0.002), and the age of the spouse (p = 0.016). Adherence to medication was lower in patients from families with rigid control than in the group with Laissez-faire type of control (p = 0.010) or the group with flexible control (p = 0.002). Social support was lower in the group with chaotic control than that in the group with flexible control (p < 0.001). Compliance to diet was associated with peripheral neuropathy and plasma creatinine, and adherence to medication with plasma glucose and peripheral neuropathy. We concluded that (1) adherence to treatment in NIDDM patients is associated with social support; (2) some aspects related to the family, such as the age of the spouse and the control of behavior, were also associated with compliance to treatment; and (3) it is important for the practicing physicians, and for institutional programs, to consider factors associated with adherence to treatment.

Effect of atorvastatin on chronic periodontitis: a randomized pilot study

AIM We studied the effect of atorvastatin (ATV) treatment on bone loss prevention in subjects with chronic periodontitis. MATERIAL AND METHODS In this controlled double-blind study, 38 subjects with chronic periodontitis were randomized into two groups, paired by age to receive ATV (20 mg) or placebo daily for 3 months. Periodontal mechanical treatment was carried out in both groups at baseline. Clinical and radiographic parameters and bone turnover markers were assessed at baseline and at 3 months. RESULTS Periodontal disease conditions improved in both groups. After comparing the figures of change, significant improvements were observed in cholesterol levels (Δ=-58.5 ± 37.6 versusΔ=5.4 ± 41.2 mg/dl, p<0.0002), low-density lipoprotein levels (Δ=-48.1 ± 31.7 versusΔ=1.9 ± 42.8 mg/dl, p<0.002), dental mobility (Δ=-0.17 ± 0.11 versusΔ=-0.06 ± 0.11%, p<0.04), and the distance from the crestal alveolar bone to the cemento-enamel junction (Δ=-0.75 ± 0.7 versusΔ=0.09 ± 0.4 mm, p<0.0006) in the ATV group. CONCLUSIONS The results suggest that ATV might have beneficial effects on bone alveolar loss and tooth mobility in subjects with periodontal disease.

Menopause in normal and uncomplicated NIDDM women: physical and emotional symptoms and hormone profile

OBJECTIVE To compare the physical characteristics, emotional symptoms and metabolic conditions of menopausal women with and without non insulin dependent diabetes mellitus (NIDDM). METHODS We studied 100 menopausal women 45-72 years of age, 51 with and 49 without NIDDM, in a cross-sectional design. Biological characteristics were collected and emotional symptoms were assessed with a modified Hamilton and Bech-Rafaelsen scale, scoring depression, anxiety, non specific symptoms of depression (NSSD) and the empty nest syndrome (ENS). Weight, body mass index (BMI), waist/hip and abdomen/hip ratios and percent of body fat were registered. The sulfoconjugated form of the dehydroepiandrosterone (DHEAS), follicle stimulating hormone (FSH), cortisol and fasting, as well as postprandial insulin/glucose ratios, were measured in blood. RESULTS Women with NIDDM had earlier mean age for menopause, more central obesity and less peripheral fat; they had also more prevalent emotional symptoms than non diabetic menopausal women. In women with NIDDM, symptoms were associated with years since diagnosis and with BMI. In non diabetic menopausal women schooling and attitudes to sexuality were associated with symptoms. FSH was inversely associated with BMI in both diabetic and non diabetic women; postprandial insulin/glucose ratio was correlated with central obesity in the group without NIDDM and cortisol with sitting systolic blood pressure (SBP) in the group with NIDDM. CONCLUSION The diagnosis of NIDDM and its metabolic conditions were associated with an increased frequency of some symptoms in menopausal women.

Gonadotropins at menopause: the influence of obesity, insulin resistance, and estrogens

UNLABELLED Obese, postmenopausal women have lower FSH levels. To determine whether this is due to higher estrogen exposure, we compared feedback gonadotropin sensitivity and its relation to insulin resistance in four groups of obese and lean, postmenopausal women. Group one was treated with 400 mg troglitazone (TG) daily for two weeks; 150 clomiphene citrate (CC) was added daily for the second week. Group two received 150 mg CC daily for a week. Group three received 1000 mg metformin (MET) daily for two weeks, with 120 mg raloxifene (RAL) added during the second week. Group four received 120 mg RAL for a week. Before and after each period, a serum pool was obtained from samples taken every minute during a 10 ml interval. The women recruited for this study were categorized as obese or lean based on BMI >/= 29 or BMI < 29, respectively. Obese, menopausal women had lower FSH (45.5 IU/l) and LH (16.2 IU/l) values than those of lean (64.1 IU/l and 23.0 IU/l), but the obese menopausal women had higher leptin, DHEAS, glucose, insulin, and HOMA-IR levels. Log [FSH] was associated with BMI (r = -0.53, P < 0.000001) and number of pregnancies (r = -0.37, P = 0.0009). TG treatment did not change HOMA-IR or gonadotropin levels, but DHEAS and androstenedione levels decreased significantly. CC alone or together with TG, diminished FSH (-7.9 and -9.2) and LH (-2.5 and -3.6) concentrations, with a greater reduction in lean women. MET reduced glucose and the HOMA-IR index without affecting gonadotropin or steroid levels. CONCLUSIONS obese, menopausal women have lower FSH levels due to greater estrogen exposure, by mechanisms unrelated to insulin resistance.

Factors associated with estrogen receptors-α (ER-α) and -β (ER-β) and progesterone receptor abundance in obese and non obese pre- and post-menopausal women

There is scarce information about the factors associated with estrogen receptors (ER) at menopause. In 113 volunteers pre- and post-menopausal healthy women, grouped as with and without obesity, estrogen receptors-alpha and -beta, and progesterone receptor (PR) were measured by immunohistochemistry in skin punch biopsies obtained from the external gluteal area. In pre-menopausal women, biopsies and a blood sample were performed between days 7 and 14 of the cycle. Serum hormone levels were measured by immunoradiometric assay or radioimmunoassay. After menopause, ER and PR amounts decreased significantly. At pre-menopause, obese women had lower PR levels than non obese (P<.006). In the post-menopausal group, obese women showed higher ER-alpha (P<.03) and ER-beta (P<.02) levels than the non obese group. In the analysis of factors associated with the amount of steroid receptors for the total group, log[ER-alpha], log[ER-beta], and log[PR] were associated with age (P<.002, <.005, and <.004, respectively). The log[ER-alpha] was also associated with log[FSH] (P<.0008); meanwhile, the log[PR] showed a marginal correlation with log[FSH]. In pre-menopausal women no factor associated with any of the three receptors was found. In post-menopausal women log[ER-alpha] was associated with log[estrone] and log[DHEAS] (P<.003 and <.02, respectively). log[PR] was associated with BMI (P<.002), years since menopause (P<.05), and log[DHEAS] (P<.003). We concluded that ER and PR diminish sharply at post-menopause. At this stage the amount of receptors depends on several factors such as BMI, years since menopause, and androgen precursors.

Association of the TNF-α -308G/A polymorphism with family history of type 2 diabetes mellitus in a Mexican population.

AIMS We examined the possible association of the -308G/A polymorphism of the TNF-α promoter gene in type 2 diabetes mellitus (DM2) patients and in non-diabetic subjects with and without family history of DM2. METHODS We studied 87 non-diabetic subjects without DM2 family history in at least one of two generations, 48 non-diabetic subjects with DM2 family history and 95 DM2 patients. Genotyping was carried out by PCR-RFLP. RESULTS The frequency of TNF-α -308G/A genotype was significantly lower in non-diabetic subjects without DM2 relatives (6%) as compared to DM2 patients (24%) (odds ratio (OR)=5.24; 95% confidence interval (CI)=1.9-15.8, p<0.0005), but similar to non-diabetic subjects with DM2 relatives (29%) (OR=0.77; CI=0.3-1.7, p=0.4). Logistic regression analysis showed the association of TNF-α -308G/A polymorphism with DM2 family history (OR=5.80; CI=1.77-18.98, p<0.0003). CONCLUSIONS Our results suggest that TNF-α -308G/A polymorphism is associated with DM2 family history and is a risk factor for DM2.

Protective effect of DRB1 locus against type 2 diabetes mellitus in Mexican Mestizos

The aim of the study was to investigate the participation of human leukocyte antigen (HLA) class II alleles in the expression of type 2 diabetic and in nondiabetic subjects with and without family history of diabetes. The purpose was to evaluate any HLA association and to look for different patterns of insulin resistance and insulin secretion, comparing subjects with a low probability of developing diabetes, as a result of their family history. We recruited 87 healthy subjects without family history of diabetes, 48 healthy subjects with family history, and 47 type 2 diabetic patients. All of them were Mexican Mestizos of central Mexico. Using a standard 75-g oral glucose tolerance test, insulin resistance was determined and insulin secretion was assessed with the HOMA model. DRB1, DQA1 and DQB1 alleles were typed using polymerase chain reaction-sequence-specific oligonucleotide probe (PCR-SSOP) and sequence specific primers (PCR-SSP). Nondiabetic subjects had similar HOMA-IR and DeltaI 30/DeltaG 30 index (HOMA). A significant decreased frequency of DRB1*0403 (p = 0.01; odds ratio [OR] = 0.20) was demonstrated in type 2 diabetic patients, and DRB1*0701 (p = 0.02; OR = 0.17) in nondiabetics with family history of diabetes. These alleles associated with protection against type 2 diabetes, share glutamic acid at position-74 and were previously demonstrated to contribute to protection against type I diabetes.

Hormone and metabolic factors associated with leptin mRNA expression in pre- and postmenopausal women

Recent information has extended leptins action, beyond the control of appetite, to various sites of metabolic regulation. To better understand leptins role we studied its production in subcutaneous and visceral fat compartments before and after menopause. During elective abdominal surgery, biopsies of subcutaneous and omental tissues were taken from 20 women at pre- (BMI 28.4 +/- 4.5 kg/m2) and 10 at postmenopause (BMI 30.6 +/- 7.7 kg/m2). In both groups serum leptin levels were similar, and highly correlated with BMI. In subcutaneous adipose tissue, leptin mRNA expression was significantly higher in pre- than in postmenopausal women (50.4 +/- 20.5 amol/microg total RNA versus 34.5 +/- 24.9 amol/microg total RNA, respectively). Leptin mRNA expression in subcutaneous tissue was independently correlated with fasting glucose (R = 0.89, P < 0.006) at premenopause, and with serum estradiol (R = 0.77, P < 0.04) at postmenopause. Leptin mRNA expression in visceral fat was correlated with DHEAS (R = 0.86, P < 0.001), at premenopause. These results indicate that in both compartments, leptin production is sensitive to different but overlapping stimuli, conveying information about energy availability to central and peripheral sites under different conditions of estrogen exposure.

High-frequency FSH and LH pulses in obese menopausal women

We studied the pulsatile luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretory patterns, at early or intermediate years of menopause in seven normal women with different degrees of obesity, taking blood samples every minute for 40 min to 2 h. The hormones were assayed with an immunoradiometric assay (IRMA) system, analyzing with the cluster pulse algorithm. All women showed hormone pulses every 8–10 min. In five of them were found periods of discrete pulses with oscillations of high amplitude alternating with periods of pulses of low amplitude. In two cases, the high-frequency oscillatory pattern with low amplitude was found around low mean levels of 22.8 and 25.7 IU/L. The LH oscillatory pattern also had a high frequency, but at a lower level, giving a high FSH/LH ratio. The coincidence index of FSH with LH peaks was 76.6%. We concluded that at menopause, the frequency of FSH and LH secretion increases with a high FSH/LH ratio. Obese menopausal women may have the same high-frequency oscillatory patterns, but at low levels.