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Krakauer M, Gómez AM, Almeda-Valdes P, Manrique H, Ruiz Morosini ML, Godoy Jorquera G, Nunes Salles JE, Sanhueza Costa D, de Azeredo Siqueira R, Faradji RN, Rincón Ramírez A, Ré M, Fériz Bonelo K, Proietti A, Lavalle-González FJ. Type 2 diabetes in latin America: recommendations on the flash glucose monitoring system. Diabetol Metab Syndr 2024; 16:106. [PMID: 38769575 PMCID: PMC11103952 DOI: 10.1186/s13098-024-01343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/01/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE To establish recommendations through the consensus of a Latin American experts panel on the use of the flash glucose monitoring system (fCGM) in people living with type 2 diabetes mellitus (T2DM) regarding the benefits and challenges of using the fCGM. METHODS An executive committee of experts was created, comprised by a panel of fifteen physicians, including endocrinologists and internal medicine physicians, with expertise in management of adult patients with T2DM. The experts were from various countries: Colombia, Chile, Peru, Mexico, Argentina, and Brazil. The modified Delphi method was used, considering a consensus level of at least 80% of the participants. A seventeen-item instrument was developed to establish recommendations on the use of fCGM in patients with T2DM in Latin American. RESULTS The number of glucose scans recommended per day with the fCGM for patients managed with oral antidiabetic drugs or basal insulin was a median of 6 scans per day, and for those managed with multiple insulin doses, a median of 10 scans per day was recommended. Additionally, a holistic and individualized management approach was recommended, taking into account new treatment directions and identifying patients who would benefit from the use of the fCGM. CONCLUSION Continuous use of the fCGM is recommended for people living with T2DM, regardless of their type of treatment. These metrics must be evaluated individually for each patient profile.
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Affiliation(s)
| | - Ana M Gómez
- Pontifical Javeriana University, Bogotá, Colombia
| | - Paloma Almeda-Valdes
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | - Matías Ré
- CINME Metabolic Research Center, Buenos Aires, Argentina
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2
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Garnica-Cuéllar JC, Lavalle-González FJ, Magaña-Serrano JA, Almeda-Valdés P, Cetina-Canto JA, Chávez-Iñíguez JS, Garza-García CA, González-Chávez A, González-Gálvez G G, Medina-Chávez JH, Pimentel-Morales G, Sánchez-Pedraza V. [Consensus on the use of iSGLT2 in the treatment of patients with type 2 diabetes mellitus]. GAC MED MEX 2022; 158:1-14. [PMID: 35080818 DOI: 10.24875/gmm.m21000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although in recent years in Mexico the quality of diabetes mellitus (DM) care has improved and access to health services and medications has increased, there is a lack of adherence to the recommendations of the clinical guidelines, which could explain the poor glycemic control in many of the patients with DM. Sodium-glucose cotransporter type 2 (iSGLT2) inhibitors have been the last class of antidiabetic agents to receive approval from the Food and Drug Administration (FDA) and COFEPRIS (Mexico). In order to improve the use of SGLT2i in clinical practice in Mexico, this paper presents the recommendations issued by a panel of eleven Mexican experts based on the new published evidence for the treatment of patients with DM2.
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Affiliation(s)
- Juan C Garnica-Cuéllar
- Departamento de Endocrinología del Centro Médico Nacional 20 de noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, Méx
| | - Fernando J Lavalle-González
- Clínica de Diabetes HU, Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - José A Magaña-Serrano
- División de Insuficiencia Cardiaca y Trasplante, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Méx
| | - Paloma Almeda-Valdés
- Departamento de Endocrinología y Metabolismo, Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Méx
| | - José A Cetina-Canto
- Departamento de Medicina Interna y Endocrinología, Hospital Regional, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mérida, Yuc., México
| | - Jonathan S Chávez-Iñíguez
- Departamento de Nefrología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jal., México
| | | | - Antonio González-Chávez
- Clínica para la Atención Integral del Paciente con Diabetes y Obesidad, Hospital General de México Dr Eduardo Liceaga, Ciudad de México, Méx
| | | | - Juan H Medina-Chávez
- Departamento de Medicina Interna y Geriatría, Coordinación Técnica de Excelencia, Clínica Instituto Mexicano del Seguro Social, Ciudad de México, Méx
| | - Gela Pimentel-Morales
- Servicio de Hemodinámica, Cardiología Clínica y Cardiología, Hospital de Cardiología Centro Médico Nacional Siclo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Méx
| | - Valentín Sánchez-Pedraza
- Servicio de Endocrinología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, Méx. México
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Violante-Cumpa JR, Lavalle-González FJ, Mancillas-Adame LG, Ávila-Hipólito ED, Violante-Cumpa KA. Gestational diabetes mellitus and COVID-19, clinical characteristics and review of the literature. Prim Care Diabetes 2021; 15:887-889. [PMID: 34389278 PMCID: PMC8326005 DOI: 10.1016/j.pcd.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 06/18/2021] [Accepted: 07/29/2021] [Indexed: 01/27/2023]
Abstract
There is a lack of information about the maternal-fetal outcomes in patients with gestational diabetes and concomitant COVID-19; and there is even less information about the outcomes of pregnant women with gestational diabetes and COVID-19. We present a case of a primigravidae of 20-year-old woman with gestational diabetes and COVID-19 and a review of the literature.
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Affiliation(s)
- Jorge R Violante-Cumpa
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av. s/n Col. Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
| | - Fernando J Lavalle-González
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av. s/n Col. Mitras Centro, Monterrey, Nuevo León, 64460, Mexico.
| | - Leonardo G Mancillas-Adame
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av. s/n Col. Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
| | - Edmundo D Ávila-Hipólito
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av. s/n Col. Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
| | - Karla A Violante-Cumpa
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av. s/n Col. Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
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4
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Krakauer M, Botero JF, Lavalle-González FJ, Proietti A, Barbieri DE. A review of flash glucose monitoring in type 2 diabetes. Diabetol Metab Syndr 2021; 13:42. [PMID: 33836819 PMCID: PMC8035716 DOI: 10.1186/s13098-021-00654-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/18/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Continuous glucose monitoring systems are increasingly being adopted as an alternative to self-monitoring of blood glucose (SMBG) by persons with diabetes mellitus receiving insulin therapy. MAIN BODY The FreeStyle Libre flash glucose monitoring system (Abbott Diabetes Care, Witney, United Kingdom) consists of a factory-calibrated sensor worn on the back of the arm which measures glucose levels in the interstitial fluid every minute and stores the reading automatically every 15 min. Swiping the reader device over the sensor retrieves stored data and displays current interstitial glucose levels, a glucose trend arrow, and a graph of glucose readings over the preceding 8 h. In patients with type 2 diabetes (T2D) receiving insulin therapy, pivotal efficacy data were provided by the 6-month REPLACE randomized controlled trial (RCT) and 6-month extension study. Compared to SMBG, the flash system significantly reduced the time spent in hypoglycemia and frequency of hypoglycemic events, although no significant change was observed in glycosylated hemoglobin (HbA1c) levels. Subsequent RCTs and real-world chart review studies have since shown that flash glucose monitoring significantly reduces HbA1c from baseline. Real-world studies in both type 1 diabetes or T2D populations also showed that flash glucose monitoring improved glycemic control. Higher (versus lower) scanning frequency was associated with significantly greater reductions in HbA1c and significant improvements in other measures such as time spent in hypoglycemia, time spent in hyperglycemia, and time in range. Additional benefits associated with flash glucose monitoring versus SMBG include reductions in acute diabetes events, all-cause hospitalizations and hospitalized ketoacidosis episodes; improved well-being and decreased disease burden; and greater treatment satisfaction. CONCLUSION T2D patients who use flash glucose monitoring might expect to achieve significant improvement in HbA1c and glycemic parameters and several associated benefits.
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Affiliation(s)
- Marcio Krakauer
- Department of Technology (Coordinator) SBD-Brazilian Diabetes Society, Science Valley Research Center, Liga de Diabetes, ABC Medical School, Avenida 12 de Outubro 286, Santo André, SP, CEP 09030-640, Brazil.
| | | | | | - Adrian Proietti
- Institute of Diabetes and Applied Technology (IDTA), Buenos Aires, Argentina
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Davies MJ, Russell-Jones D, Barber TM, Lavalle-González FJ, Galstyan GR, Zhu D, Baxter M, Dessapt-Baradez C, McCrimmon RJ. Glycaemic benefit of iGlarLixi in insulin-naive type 2 diabetes patients with high HbA1c or those with inadequate glycaemic control on two oral antihyperglycaemic drugs in the LixiLan-O randomized trial. Diabetes Obes Metab 2019; 21:1967-1972. [PMID: 31124299 PMCID: PMC6772132 DOI: 10.1111/dom.13791] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 01/08/2023]
Abstract
In this post hoc analysis of the randomized controlled LixiLan-O trial in insulin-naive patients with type 2 diabetes mellitus (T2DM) not controlled with metformin, with or without a second oral antihyperglycaemic drug (OAD), the efficacy and safety of the fixed-ratio combination, iGlarLixi (insulin glargine 100 U [iGlar] and lixisenatide [Lixi]), compared to its individual components was assessed in two patient subgroups: group 1) baseline HbA1c ≥9% (n = 134); group 2) inadequate control (HbA1c ≥7.0% and ≤9.0%) despite administration of two OADs at screening (n = 725). Treatment with iGlarLixi resulted in significantly greater reduction in least squares mean HbA1c compared to treatment with iGlar or Lixi alone in both subgroups (group 1: 2.9%, 2.5%, 1.7% and group 2: 1.5%, 1.2%, 0.7%, respectively). Target HbA1c less than 7% was achieved in more than 70% of patients using iGlarLixi in both subgroups, while mitigating the weight gain observed with use of iGlar alone. Rates of hypoglycaemic events were low overall. These results suggest that treatment with iGlarLixi achieves superior glycaemic control compared to treatment with iGlar or Lixi alone in T2DM patients with HbA1c ≥9% or in those inadequately controlled with two OADs.
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Affiliation(s)
- Melanie J Davies
- Department of Health Services, Diabetes Research Centre, University of Leicester, Leicester General Hospital and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - David Russell-Jones
- Department of Diabetes and Endocrinology, University of Surrey, Guildford, UK
| | - Thomas M Barber
- Translational Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Gagik R Galstyan
- Diabetic Foot Department, Endocrinology Research Center, Moscow, Russia
| | - Dalong Zhu
- Department of Endocrinology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | | | | | - Rory J McCrimmon
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
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Hernández-Rodríguez CE, Estrada Zúñiga CM, De la O-Cavazos ME, Montes-Tapia FF, Gerez-Martínez P, Lavalle-González FJ, Garza CT. Vaspin, a Compensatory Mechanism Against High Glucose Levels Since Birth? J Clin Res Pediatr Endocrinol 2019; 11:125-131. [PMID: 30325336 PMCID: PMC6571537 DOI: 10.4274/jcrpe.galenos.2018.2018.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Hormones produced by fat tissue, adipokines, produced during intrauterine life have recently been implicated in fetal growth. Vaspin is an adipokine expressed in visceral adipose tissue and has insulin-sensitizing effects. Elevated serum vaspin concentrations are associated with alterations in insulin sensitivity. We aimed to determine if vaspin concentrations in cord blood from healthy, term newborns differ among those born small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). A secondary objective was to determine whether an association existed between vaspin and anthropometric measurements, glucose and insulin levels in the newborn. METHODS The study population included healthy term newborns, 30 subjects in the SGA, 12 in the AGA, and 34 in the LGA group. Anthropometry was documented in all subjects. Blood was taken from the umbilical cord vein from each child for later analysis for vaspin, insulin and glucose concentrations. RESULTS Cord blood vaspin, insulin and glucose concentrations were not different between the three study groups. A negative correlation between vaspin and glucose concentrations was demonstrated in the whole cohort (r=-0.364, p=0.001). This correlation was also observed in the LGA group (r=-0.482, p=0.004). Glucose concentrations significantly predicted vaspin concentrations (r2=0.132, p=0.001). CONCLUSION We found a negative association between glucose and vaspin concentrations in umbilical cord blood. In addition there was a predictive association between blood glucose and resulting vaspin concentration, suggesting that vaspin can be used as a predictor of alterations in the insulin-glucose metabolism from birth.
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Affiliation(s)
- Citlalli E. Hernández-Rodríguez
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Univeristario “Dr. Jose E. Gonzalez”, Department of Pediatrics, Monterrey, Mexico
| | - Cynthia M. Estrada Zúñiga
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Univeristario “Dr. Jose E. Gonzalez”, Department of Pediatrics, Monterrey, Mexico
| | - Manuel E. De la O-Cavazos
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Univeristario “Dr. Jose E. Gonzalez”, Department of Pediatrics, Monterrey, Mexico
| | - Fernando F. Montes-Tapia
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Univeristario “Dr. Jose E. Gonzalez”, Department of Pediatrics, Monterrey, Mexico
| | - Patricia Gerez-Martínez
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Univeristario “Dr. Jose E. Gonzalez”, Department of Pediatrics, Monterrey, Mexico
| | - Fernando J. Lavalle-González
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Univeristario “Dr. Jose E. Gonzalez”, Department of Endocrinology, Monterrey, Mexico
| | - Consuelo Treviño Garza
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Univeristario “Dr. Jose E. Gonzalez”, Department of Pediatrics, Monterrey, Mexico,* Address for Correspondence: Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Univeristario “Dr. Jose E. Gonzalez”, Department of Pediatrics, Monterrey, Mexico Phone: +52(81)83469959 E-mail:
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Medrano-De-Ávila C, Castillo-Castro C, Lavalle-González FJ. Comment on Lacy et al. Long-term Glycemic Control and Dementia Risk in Type 1 Diabetes. Diabetes Care 2018;41:2339-2345. Diabetes Care 2019; 42:e68. [PMID: 30894390 DOI: 10.2337/dc18-2467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Carolina Medrano-De-Ávila
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Carolina Castillo-Castro
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Fernando J Lavalle-González
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Schernthaner G, Lavalle-González FJ, Davidson JA, Jodon H, Vijapurkar U, Qiu R, Canovatchel W. Canagliflozin provides greater attainment of both HbA1c and body weight reduction versus sitagliptin in patients with type 2 diabetes. Postgrad Med 2016; 128:725-730. [DOI: 10.1080/00325481.2016.1210988] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | | | - Jaime A. Davidson
- Touchstone Diabetes Center, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Rong Qiu
- Janssen Research & Development, LLC, Raritan, NJ, USA
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Lavalle-González FJ, Chiquete E. Patients' empowerment, physicians' perceptions, and achievement of therapeutic goals in patients with type 1 and type 2 diabetes mellitus in Mexico. Patient Prefer Adherence 2016; 10:1349-57. [PMID: 27555751 PMCID: PMC4968990 DOI: 10.2147/ppa.s107437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Physicians' perception may not parallel objective measures of therapeutic targets in patients with diabetes. This is an issue rarely addressed in the medical literature. We aimed to analyze physicians' perception and characteristics of adequate control of patients with diabetes. PATIENTS AND METHODS We studied information on physicians and their patients who participated in the third wave of the International Diabetes Management Practices Study registry in Mexico. This analysis was performed on 2,642 patients, 203 with type 1 diabetes mellitus (T1DM) and 2,439 with type 2 diabetes mellitus (T2DM), treated by 200 physicians. RESULTS The patients perceived at target had lower hemoglobin A1c (HbA1c) and fasting blood glucose than those considered not at target. However, overestimation of the frequency of patients with HbA1c <7% was 41.5% in patients with T1DM and 31.7% in patients with T2DM (underestimation: 2.8% and 8.0%, respectively). The agreement between the physicians' perception and the class of HbA1c was suboptimal (κ: 0.612). Diabetologists and endocrinologists tested HbA1c more frequently than primary care practitioners, internists, or cardiologists; however, no differences were observed in mean HbA1c, for both T1DM (8.4% vs 7.2%, P=0.42) and T2DM (8.03% vs 8.01%, P=0.87) patients. Nevertheless, insulin users perceived at target, who practiced self-monitoring and self-adjustment of insulin, had a lower mean HbA1c than patients without these characteristics (mean HbA1c in T1DM: 6.8% vs 9.6%, respectively; mean HbA1c in T2DM: 7.0% vs 10.1%, respectively). CONCLUSION Although there is a significant physicians' overestimation about the optimal glycemic control, this global impression and characteristics of patients' empowerment, such as self-monitoring and self-adjustment of insulin, are associated with the achievement of targets.
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Affiliation(s)
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Correspondence: Erwin Chiquete, Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlapan, Ciudad de México, Código Postal 14000, México, Tel +52 54 87 0900 ext 5052, Fax +52 56 55 1076, Email
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Lavalle-González FJ, Eliaschewitz FG, Cerdas S, Chacon MDP, Tong C, Alba M. Efficacy and safety of canagliflozin in patients with type 2 diabetes mellitus from Latin America. Curr Med Res Opin 2016; 32:427-39. [PMID: 26579834 DOI: 10.1185/03007995.2015.1121865] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This post hoc analysis evaluated the efficacy and safety of canagliflozin, a sodium glucose co-transporter 2 inhibitor, in patients with type 2 diabetes mellitus (T2DM) from Latin America. RESEARCH DESIGN AND METHODS Analyses were performed in subgroups of patients from Latin America based on data from three individual, 26-week, placebo-controlled studies of canagliflozin (monotherapy [n = 116/584], add-on to metformin [n = 199/918], and add-on to metformin plus sulfonylurea [n = 76/469]) and three individual, 52-week, active-controlled studies of canagliflozin (add-on to metformin versus sitagliptin [n = 240/1101], add-on to metformin versus glimepiride [n = 155/1450], and add-on to metformin plus sulfonylurea versus sitagliptin [n = 156/755]). MAIN OUTCOME MEASURES Changes from baseline in HbA1c, body weight, and systolic blood pressure (BP) with canagliflozin 100 and 300 mg versus placebo or active comparator (i.e., sitagliptin or glimepiride) were evaluated in the overall study populations and Latin American subgroups. Safety was assessed based on adverse event (AE) reports. RESULTS Canagliflozin 100 and 300 mg provided reductions in HbA1c, body weight, and systolic BP across studies in patients from Latin America that were generally similar to those seen in the overall populations of patients with T2DM. The AE profile in patients from Latin America was equivalent to that in the overall populations; higher rates of genital mycotic infections and osmotic diuresis-related AEs were seen with canagliflozin versus comparators. Limitations of this study include the post hoc analysis of data and the small sample size of patients from Latin America. CONCLUSION Canagliflozin improved glycemic control, reduced body weight and systolic BP, and was generally well tolerated in patients with T2DM from Latin America. CLINICAL TRIAL REGISTRATION NCT01081834; NCT01106677; NCT01106625; NCT00968812; NCT01137812.
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Affiliation(s)
| | - Freddy G Eliaschewitz
- b b Hospital Israelita Albert Einstein and CPClin Clinical Research Center , São Paulo , Brazil
| | - Sonia Cerdas
- c c Hospital Cima, Centro de Investigacíon Clínica San Agustín , San José , Costa Rica
| | | | - Cindy Tong
- e e Janssen Research & Development, LLC , Raritan, NJ , USA
| | - Maria Alba
- e e Janssen Research & Development, LLC , Raritan, NJ , USA
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11
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García-Compeán D, González-González JA, Lavalle-González FJ, González-Moreno EI, Maldonado-Garza HJ, Villarreal-Pérez JZ. The treatment of diabetes mellitus of patients with chronic liver disease. Ann Hepatol 2015; 14:780-8. [PMID: 26436350 DOI: 10.5604/16652681.1171746] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
About 80% of patients with liver cirrhosis may have glucose metabolism disorders, 30% show overt diabetes mellitus (DM). Prospective studies have demonstrated that DM is associated with an increased risk of hepatic complications and death in patients with liver cirrhosis. DM might contribute to liver damage by promoting inflammation and fibrosis through an increase in mitochondrial oxidative stress mediated by adipokines. Based on the above mentioned the effective control of hyperglycemia may have a favorable impact on the evolution of these patients. However, only few therapeutic studies have evaluated the effectiveness and safety of antidiabetic drugs and the impact of the treatment of DM on morbidity and mortality in patients with liver cirrhosis. In addition, oral hypoglycemic agents and insulin may produce hypoglycemia and lactic acidosis, as most of these agents are metabolized by the liver. This review discusses the clinical implications of DM in patients with chronic liver disease. In addition the effectiveness and safety of old, but particularly the new antidiabetic drugs will be described based on pharmacokinetic studies and chronic administration to patients. Recent reports regarding the use of the SGLT2 inhibitors as well as the new incretin-based therapies such as injectable glucagon-like peptide-1 (GLP-1) receptor agonists and oral inhibitors of dipeptidylpeptidase-4 (DPP-4) will be discussed. The establishment of clear guidelines for the management of diabetes in patients with CLD is strongly required.
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Affiliation(s)
- Diego García-Compeán
- Gastroenterology Service, University Hospital Dr. José E. González and Medical School
| | | | - Fernando J Lavalle-González
- Endocrinology Service and Department of Internal Medicine, University Hospital Dr. José E. González and Medical School. Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | | | - Jesús Zacarías Villarreal-Pérez
- Endocrinology Service and Department of Internal Medicine, University Hospital Dr. José E. González and Medical School. Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Abstract
Biosimilar insulins have the potential to increase access to treatment among patients with diabetes mellitus, reduce treatment costs, and expand market competition. The patents for several insulins are soon to expire, meaning there is room for copies of these products--or 'biosimilars'--to join the marketplace. It is vital that similar safety and efficacy to the innovator product is demonstrated for biosimilars. This presents many possible manufacturing and regulatory challenges. Complex manufacturing processes mean that even small differences between manufacturers can have a potential impact on the final product. Several companies are currently developing biosimilar insulins or are already producing these products in emerging markets with different regulatory requirements. For insulin biosimilars to be licensed in more established markets, manufacturers will need to meet the rigid criteria set out by agencies such as the European Medicines Agency and US Food and Drug Administration, and fulfill several pre-clinical, clinical, and pharmacovigilance surveillance criteria. As a result of differing regulatory requirements, there are possible gaps in the publically available clinical data to support the safety and efficacy of biosimilar insulins from around the world current as of July 2014. This review summarizes the current biosimilar insulin landscape.
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Dieuzeide G, Chuang LM, Almaghamsi A, Zilov A, Chen JW, Lavalle-González FJ. Safety and effectiveness of biphasic insulin aspart 30 in people with type 2 diabetes switching from basal-bolus insulin regimens in the A1chieve study. Prim Care Diabetes 2014; 8:111-117. [PMID: 23953707 DOI: 10.1016/j.pcd.2013.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/03/2013] [Accepted: 07/19/2013] [Indexed: 11/28/2022]
Abstract
AIMS Biphasic insulin aspart 30 allows fewer daily injections versus basal-bolus insulin regimens, which may improve adherence and treatment outcome. This sub-analysis of the observational A1chieve study assessed clinical safety and effectiveness of biphasic insulin aspart 30 in people with type 2 diabetes previously receiving basal-bolus insulin regimens. METHODS A1chieve was an international, open-label, 24-week study in people with type 2 diabetes starting/switching to biphasic insulin aspart 30, insulin detemir or insulin aspart. This sub-analysis assessed patients switching from insulin glargine- or neutral protamine Hagedorn insulin-based basal-bolus insulin regimens to biphasic insulin aspart 30. RESULTS 1024 patients were included. At 24 weeks, glycated haemoglobin and fasting plasma glucose were significantly reduced from baseline in both cohorts (all p<0.001). The proportion reporting any hypoglycaemia, major hypoglycaemia or nocturnal hypoglycaemia was significantly reduced after 24 weeks (all p<0.05). No serious adverse drug reactions were reported. Both cohorts had significantly improved health-related quality of life (HRQoL; p<0.001). CONCLUSIONS 24 weeks after switching from basal-bolus insulin regimens to biphasic insulin aspart 30, glycaemic control and HRQoL were significantly improved, and hypoglycaemia was significantly reduced. This suggests that people with type 2 diabetes inadequately controlled on basal-bolus insulin regimens can consider biphasic insulin aspart 30.
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Affiliation(s)
- Guillermo Dieuzeide
- Centro de Atención Integral en Diabetes, Endocrinología y Metabolismo, Chacabuco, Province of Buenos Aires, Argentina
| | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Alexey Zilov
- Department of Endocrinology, First Moscow State Medical University, Moscow, Russia
| | - Jian-Wen Chen
- Novo Nordisk Region International Operations A/S, Zurich, Switzerland.
| | - Fernando J Lavalle-González
- Endocrine Service at the University Hospital "Dr José E González" School of Medicine UANL, Monterrey, Mexico
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García-Compeán D, Jáquez-Quintana JO, Lavalle-González FJ, González-González JA, Maldonado-Garza HJ, Villarreal-Pérez JZ. Plasma cytokine levels imbalance in cirrhotic patients with impaired glucose tolerance and diabetes mellitus. A prospective study. Ann Hepatol 2014. [PMID: 24927611 DOI: 10.1016/s1665-2681(19)30847-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS To define if there is an imbalance in plasma levels of proinflammatory, fibrogenic and antifibrogenic cytokines in patients with liver cirrhosis (LC) and impaired glucose tolerance (IGT) or diabetes mellitus (DM). MATERIAL AND METHODS We randomly selected 54 out of 100 patients with LC who had normal fasting plasma glucose (FPG) levels. Three groups were formed based on an oral glucose tolerance test (OGTT) results: 18 patients were normal, 18 had IGT, and 18 had DM. Plasma levels of cytokines were measured: TNF- α, soluble tumor necrosis factor receptor 1 (sTNF-R1), leptin, TGF-β1, and hepatocyte growth factor (HGF). Also, fasting plasma insulin (FPI) levels were determined and HOMA2-IR was calculated. Results were compared with those of a control group of 18 patients without liver disease nor DM. Intergroup comparison was performed using non parametric tests. RESULTS Significantly higher sTNF-R1 and lower TGF-β1 were found in patients with IGT and DM compared to controls. Leptin, HGF, and TNF-α levels showed no significant differences. According to Child-Pugh classification all cytokines levels were impaired in groups B or C as compared to group A. Positive correlations between sTNF-R1 and HOMA2-IR and between leptin and HOMA2-IR were found. CONCLUSIONS IGT and DM were associated with abnormalities of sTNF-R1 and TGF-β1 compared to non cirrhotic controls. Among cirrhotic patients impairment of all cytokines were more marked in advanced liver disease. Finally, sTNF-R1 and leptin correlated with IR. These findings suggest that IGT and DM may be causally implicated with liver inflammation process.
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Affiliation(s)
- Diego García-Compeán
- Gastroenterology Service Department of Internal Medicine, University Hospital "Dr. José E. González" and Medical School. Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Joel O Jáquez-Quintana
- Gastroenterology Service Department of Internal Medicine, University Hospital "Dr. José E. González" and Medical School. Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Fernando J Lavalle-González
- Endocrinology Service, Department of Internal Medicine, University Hospital "Dr. José E. González" and Medical School. Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - José A González-González
- Gastroenterology Service Department of Internal Medicine, University Hospital "Dr. José E. González" and Medical School. Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Héctor J Maldonado-Garza
- Gastroenterology Service Department of Internal Medicine, University Hospital "Dr. José E. González" and Medical School. Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Jesús Z Villarreal-Pérez
- Endocrinology Service, Department of Internal Medicine, University Hospital "Dr. José E. González" and Medical School. Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
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Lavalle-González FJ, Januszewicz A, Davidson J, Tong C, Qiu R, Canovatchel W, Meininger G. Efficacy and safety of canagliflozin compared with placebo and sitagliptin in patients with type 2 diabetes on background metformin monotherapy: a randomised trial. Diabetologia 2013; 56:2582-92. [PMID: 24026211 PMCID: PMC3825495 DOI: 10.1007/s00125-013-3039-1] [Citation(s) in RCA: 378] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 07/29/2013] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to evaluate the efficacy and safety of canagliflozin vs placebo and sitagliptin in patients with type 2 diabetes who were being treated with background metformin. METHODS This randomised, double-blind, four-arm, parallel-group, Phase 3 study was conducted at 169 centres in 22 countries between April 2010 and August 2012. Participants (N = 1,284) with type 2 diabetes aged ≥ 18 and ≤ 80 years who had inadequate glycaemic control (HbA1c ≥ 7.0% [53 mmol/mol] and ≤10.5% [91 mmol/mol]) on metformin therapy received canagliflozin 100 mg or 300 mg, sitagliptin 100 mg, or placebo (n = 368, 367, 366, 183, respectively) for a 26 week, placebo- and active-controlled period followed by a 26 week, active-controlled period (placebo group switched to sitagliptin [placebo/sitagliptin]) and were included in the modified intent-to-treat analysis set. Randomisation was performed using a computer-generated schedule; participants, study centres and the sponsor were blinded to group assignment. The primary endpoint was change from baseline in HbA1c at week 26; secondary endpoints included changes in HbA1c (week 52) and fasting plasma glucose (FPG), body weight, and systolic blood pressure (BP; weeks 26 and 52). Adverse events (AEs) were recorded throughout the study. RESULTS At week 26, canagliflozin 100 mg and 300 mg reduced HbA1c vs placebo (-0.79%, -0.94%, -0.17%, respectively; p < 0.001). At week 52, canagliflozin 100 mg and 300 mg demonstrated non-inferiority, and canagliflozin 300 mg demonstrated statistical superiority, to sitagliptin in lowering HbA1c (-0.73%, -0.88%,-0.73%, respectively); differences (95% CI) vs sitagliptin were 0% (-0.12, 0.12) and -0.15% (-0.27, -0.03), respectively. Canagliflozin 100 mg and 300 mg reduced body weight vs placebo (week 26: -3.7%, -4.2%, -1.2%, respectively; p < 0.001) and sitagliptin (week 52: -3.8%, -4.2%, -1.3%, respectively; p < 0.001). Both canagliflozin doses reduced FPG and systolic BP vs placebo (week 26) and sitagliptin (week 52) (p < 0.001). Overall AE and AE-related discontinuation rates were generally similar across groups, but higher with canagliflozin 100 mg. Genital mycotic infection and osmotic diuresis-related AE rates were higher with canagliflozin; few led to discontinuations. Hypoglycaemia incidence was higher with canagliflozin. CONCLUSIONS/INTERPRETATION Canagliflozin improved glycaemia and reduced body weight vs placebo (week 26) and sitagliptin (week 52) and was generally well tolerated in patients with type 2 diabetes on metformin. CLINICAL TRIAL REGISTRY ClinicalTrials.gov NCT01106677 FUNDING: This study was supported by Janssen Research & Development, LLC.
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Affiliation(s)
- F J Lavalle-González
- Endocrinology and Internal Medicine Department, Universidad Autonóma de Nuevo León, Avenida Madero y Gonzalitos, S/N Col. Mitras Centro, 64460, Monterrey, Nuevo León, Mexico,
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García-Compeán D, Jáquez-Quintana JO, González-González JA, Lavalle-González FJ, Villarreal-Pérez JZ, Maldonado-Garza HJ. [Diabetes in liver cirrhosis]. Gastroenterol Hepatol 2013; 36:473-82. [PMID: 23628170 DOI: 10.1016/j.gastrohep.2013.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 01/31/2013] [Indexed: 02/07/2023]
Abstract
The prevalence of overt diabetes mellitus (DM) in liver cirrhosis is about 30%. However, DM or impaired glucose tolerance can be observed in 90% after an oral glucose tolerance test in patients with normal fasting plasma glucose. Type 2 DM may produce cirrhosis, whereas DM may be a complication of cirrhosis. The latter is known as «hepatogenous diabetes». Overt and subclinical DM is associated with liver complications and death in cirrhotic patients. Treating diabetes is difficult in cirrhotic patients because of the metabolic impairments due to liver disease and because the most appropriate pharmacologic treatment has not been defined. It is also unknown if glycemic control with hypoglycemic agents has any impact on the course of the liver disease.
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Affiliation(s)
- Diego García-Compeán
- Servicio de Gastroenterología y Departamento de Medicina Interna, Hospital Universitario Dr. José E. González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, México.
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Lavalle-González FJ, Chiquete E, de la Luz J, Ochoa-Guzmán A, Sánchez-Orozco LV, Godínez-gutiérrez SA. Achievement of therapeutic targets in Mexican patients with diabetes mellitus. ACTA ACUST UNITED AC 2012; 59:591-8. [DOI: 10.1016/j.endonu.2012.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 06/25/2012] [Accepted: 07/03/2012] [Indexed: 11/26/2022]
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Rodríguez-Gutiérrez R, Lavalle-González FJ, Martínez-Garza LE, Landeros-Olvera E, López-Alvarenga JC, Torres-Sepúlveda MR, González-González JG, Mancillas-Adame LG, Salazar-Gonzalez B, Villarreal-Pérez JZ. Impact of an exercise program on acylcarnitines in obesity: a prospective controlled study. J Int Soc Sports Nutr 2012; 9:22. [PMID: 22574901 PMCID: PMC3428650 DOI: 10.1186/1550-2783-9-22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 05/10/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Acylcarnitine (AC) transport dysfunction into the mitochondrial matrix is one of the pathophysiological mechanisms of type 2 diabetes mellitus (DM). The effect of an aerobic exercise (AE) program on this condition in obese subjects without DM is unclear. METHODS A prospective, randomized, longitudinal, interventional study in a University Research Center involved a 10-week AE program in 32 women without DM and a body mass index (BMI) greater than 27 kg/m2. (Cases n = 17; Controls n = 15). The primary objective was to evaluate the influence of a controlled AE program on beta-oxidation according to modifications in short, medium, and long-chain ACs. Secondary objectives were to define the behavior of amino acids, and the correlation between these modifications with metabolic and anthropometric markers. RESULTS The proportion of dropouts was 17% and 6% in controls and cases, respectively. In cases there was a significant reduction in total carnitine (30.40 [95% CI 28.2 to 35.6]) vs. (29.4 [CI 95% 25.1 to 31.7]) p = 0.0008 and long-chain AC C14 (0.06 [95% CI 0.05 to 0.08]) vs. (0.05 [95% CI 0.05 to 0.09]) p = 0.005 and in C18 (0.31 [95% CI 0.27 to 0.45]) vs. (0.28 [95% CI 0.22 to 0.32]) p = 0.03. Free fatty acid levels remained without change during the study in both groups. CONCLUSION In conclusion, a controlled 10-week AE program improved beta-oxidation by reducing long-chain ACs. This finding highlights the importance that AE might have in avoiding or reverting lipotoxicity, and in consequence, improving insulin sensitivity and pancreatic beta cell functional reserve.
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Affiliation(s)
- René Rodríguez-Gutiérrez
- Endocrinology Division, Internal Medicine Department, “Dr. José E. González”, University Hospital and Medical School of the Universidad Autónoma de Nuevo León, Ave. Madero y Ave. Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
| | - Fernando J Lavalle-González
- Endocrinology Division, Internal Medicine Department, “Dr. José E. González”, University Hospital and Medical School of the Universidad Autónoma de Nuevo León, Ave. Madero y Ave. Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
- Servicio de Endocrinología, Hospital Universitario Dr. José E. Gonzalez, Ave. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
| | - Laura E Martínez-Garza
- Genetics Department, Medical School of the Universidad Autónoma de Nuevo León, Ave. Madero y Dr. Eduardo Aguirre Pequeño s/n, Colonia Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
| | - Erick Landeros-Olvera
- Cardiovascular Exercise Laboratory, Nursing School of the Benemérita Universidad Autónoma de Puebla, 4 sur 104, Centro Histórico, Puebla, 72000, Mexico
| | - Juan C López-Alvarenga
- Investigation Department of the Hospital General de Mexico, O.D, Dr. Balmis No.148, Col. Doctores, Delegación, Cuauhtémoc, 06726, Mexico
| | - Maria R Torres-Sepúlveda
- Genetics Department, Medical School of the Universidad Autónoma de Nuevo León, Ave. Madero y Dr. Eduardo Aguirre Pequeño s/n, Colonia Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
| | - Jose G González-González
- Endocrinology Division, Internal Medicine Department, “Dr. José E. González”, University Hospital and Medical School of the Universidad Autónoma de Nuevo León, Ave. Madero y Ave. Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
| | - Leonardo G Mancillas-Adame
- Endocrinology Division, Internal Medicine Department, “Dr. José E. González”, University Hospital and Medical School of the Universidad Autónoma de Nuevo León, Ave. Madero y Ave. Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
| | - Bertha Salazar-Gonzalez
- Investigation Department, Nursing School, Universidad Autónoma de Nuevo León, Av. Gonzalitos 1500 Norte, Colonia Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
| | - Jesus Z Villarreal-Pérez
- Endocrinology Division, Internal Medicine Department, “Dr. José E. González”, University Hospital and Medical School of the Universidad Autónoma de Nuevo León, Ave. Madero y Ave. Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
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