1
|
Alvear Durán S, Sanchez-Del-Hierro G, Gomez-Correa D, Enriquez A, Sanchez E, Belec M, Casapulla S, Grijalva MJ, Shubrook JH. A pilot of a modified diabetes prevention program in Quito, Ecuador. J Osteopath Med 2021; 121:905-911. [PMID: 34668365 DOI: 10.1515/jom-2020-0175] [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] [Received: 07/05/2020] [Accepted: 07/12/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT Diabetes has become a global noninfectious pandemic with rates rapidly rising around the globe. The major drivers of this increase in type 2 diabetes are obesity, an increase in processed foods, and a decrease in physical activity. In the United States, the National Diabetes Prevention Program (NDPP) has proven to be an effective lifestyle intervention to delay or prevent new-onset type 2 diabetes. However, there is limited evidence that such a lifestyle program will work in a South American community. OBJECTIVES This pilot program aims to determine if a modified version of the Centers for Disease Control and Prevention (CDC) Diabetes Prevention Program (DPP) would be feasible in an Ecuadorian population. The goals of this pilot program were a 7% weight loss, >150 min of physical activity per week, and a reduction of fat calories to yield a reduced risk of type 2 diabetes. This program was led by family medicine physicians and was offered to people with prediabetes in Quito, Ecuador. METHODS The program was modified to include only the first half of the DPP curriculum, which included a schedule of 16 classes in the first 6 months. Further, the program was provided in Spanish and modified to be more culturally specific to this population. Participants were recruited from the faculty and staff of Pontifical Catholic University of Ecuador (Pontificia Universidad Católica del Ecuador [PUCE]) in Quito. Outcomes measured included A1c reduction, weight loss, increase in physical activity minutes, and progression to type 2 diabetes mellitus (T2DM). RESULTS The sample included 33 people with prediabetes. The mean age of the participants was 52 years (range, 41-66 years), the mean body mass index (BMI) was 27.6 kg/m2 (range, 21.0-40.3 kg/m2), and the mean HbA1C was 6.2% (range, 5.7-6.4%). The attendance was 97.8% at 6 months. The mean weight loss was 3.4 kg per participant (range, 1.5 kg weight gain to 8.3 kg weight loss); in percentage points, this was a mean weight loss of 3.6% (range, 2.3% gain to 11.8% weight loss). Three-fourths of the participants lost weight (78.3%). The majority of participants (75.8%) met the target physical activity level of 150 min per week, and all participants increased their physical activity levels from baseline. No participants progressed to type 2 diabetes during this study. CONCLUSIONS The DPP 6 month pilot was effective in this population with prediabetes in Ecuador. The largest changes were made in physical activity time. Holding the program at worksites and providing lunch were key factors in the very high retention rate in this study.
Collapse
Affiliation(s)
- Susana Alvear Durán
- Facultad de Medicina, Center for Research on Health in Latin America, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Galo Sanchez-Del-Hierro
- Facultad de Medicina, Center for Research on Health in Latin America, Pontifical Catholic University of Ecuador, Quito, Ecuador.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Diego Gomez-Correa
- Family Practice Resident, Facultad de Medicina, Hospital Vozandes Quito, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Andrés Enriquez
- Family Practice Resident, Facultad de Medicina, Hospital Un Canto a la Vida, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Enver Sanchez
- Family Practice Resident, Facultad de Medicina, Hospital Un Canto a la Vida, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Melissa Belec
- Family Practice Resident, University of Minnesota - North Memorial, Minneapolis, MN, USA
| | - Sharon Casapulla
- Department of Primary Care, Office of Rural and Underserved Programs, Diabetes Institute, Infectious and Tropical Disease Institute, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Mario J Grijalva
- Department of Biomedical Sciences, Infectious and Tropical Disease Institute, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA.,Center for Research on Health in Latin America, School of Biological Sciences, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | | |
Collapse
|
2
|
Ruilova GA, Caspi LV, García LA, Vicente VC, Hierro GSD, Durán SA. Programas de formacion en medicina familiar en iberoamerica. Rev Bras Med Fam Comunidade 2016. [DOI: 10.5712/rbmfc11(0)1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
En el siglo XXI los sistemas de salud buscan fortalecer su estructura y funcionamiento enfocándose en la estrategia de Atención Primaria de Salud, para lo cual se necesitan recursos humanos de alta calidad. Para alinear los sistemas de salud sobre la base de los valores que guían esta estrategia hacen falta políticas ambiciosas en la formación de recursos humanos competentes y suficientes. La medicina familiar, como disciplina orientada hacia la atención curativa, integral y continua, hacia la promoción de la salud y prevención de enfermedades, así como hacia la prestación de servicios en los diferentes niveles de atención, es el eje que permite cumplir dicho fortalecimiento. El médico familiar, previo a su papel como especialista, pasa por un proceso de formación en la residencia. En Iberoamérica existen pocas residencias de Medicina Familiar, y muchos programas no acreditan la calidad necesaria para formar un recurso humano médico competitivo. La respuesta académica de las instituciones en la mayoría de los países latinoamericanos ha sido muy diversa; y en algunos casos ha servido para cubrir la brecha entre la necesidad de personal y la oferta formativa, debido a la urgencia político-gubernamental. Esta revisión desea mostrar la actualidad de los programas de formación en Iberoamérica. Metodología: Se realizó una búsqueda bibliográfica en varias bibliotecas virtuales, así zomo literatura gris en páginas de sociedades científicas. Se recopilaron datos de líderes de opinión en la “V Cumbre Iberoamericana de Medicina Familiar” celebrada en Quito, Ecuador, en Abril de 2014. Resultados: Se obtuvieron los siguientes datos: Los tiempos en formación en Medicina Familiar en países Iberoamericanos varían entre 2 y 4 años; el 61% de los países (11 de 18) ofertan 3 años de formación, el 22,2% 4 años, y 11% 2 años (Cuba y Venezuela); en el 63,6% (7 de 11 países), el título de Medicina Familiar es obligatorio para la práctica. Conclusiones: En Iberoamérica, los programas de residencia en medicina familiar están dirigidos a corregir las deficiencias en la formación de los médicos generales y cerrar la brecha para satisfacer las necesidades de salud pública. Sin embargo, estos programas todavía carecen de muchos elementos de la formación en medicina familiar para alcanzar las competencias estandarizadas en todo el mundo. Por otra parte, si existen deficiencias en los programas de formación con las competencias y si sus necesidades no están basadas en normas internacionales, la formación resultante no produce los espe cos de alta calidad capaces de resolver el 80% de los problemas de salud que presentan los pacientes.
Collapse
|