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J Pediatr Endocrinol Metab. 2019 Sep 4. pii: /j/jpem.ahead-of-print/jpem-2019-0363/jpem-2019-0363.xml. doi: 10.1515/jpem-2019-0363. [Epub ahead of print]

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

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Asociaciόn Mexicana de Diabetes en Jalisco, A.C., Jalisco, Mexico.
Life for a Child Program, Diabetes NSW & ACT, Glebe, NSW, Australia.
NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
Asociaciόn Mexicana de Diabetes en Nuevo León, A.C., Monterrey, Nuevo León, Mexico.
Asociaciόn Mexicana de Diabetes en Guanajuato, A.C., León, Guanajuato, Mexico.
Asociaciόn Mexicana de Diabetes en el Estado de Guerrero, A.C., Acapulco, Guerrero, Mexico.
Asociaciόn Mexicana de Diabetes en el Suresté, A.C., Mérida, Mexico.


Background The objective of this study was to determine the demographic and clinical features of youth supported by member associations of the Federación Mexicana de Diabetes and the Life for a Child Program (LFAC). Methods An analysis of 2017 Annual Clinical Data Sheets of 306 subjects from five Mexican centers was performed. Results Type 1 diabetes (T1D) was diagnosed in 292 subjects; 54.6% were female, with six diagnosed aged <6 months (genetic tests not yet conducted). Type 2 diabetes (T2D) or other types were diagnosed in 11 and three subjects, respectively. T1D diagnosis age ranged 0.0-22.6 years with a peak at 8 years. The mean ± standard deviation (SD) diabetes duration was 5.3 ± 3.5 years (range 0.0-21.0 years), with a mean ± SD subject age at check-up of 13.3 ± 4.3 years. Of the T1D subjects, 1.0%, 6.7%, 13.7% and 78.6% were receiving 1, 2, 3 and ≥4 insulin injections/day with a mean ± SD daily dose of 0.92 ± 0.34 U/kg. The median number of blood glucose tests/week was 40. The mean/median hemoglobin A1c (HbA1c) levels for those with duration ≥6 months were 8.7/8.4% (72/68 mmol/mol) and were higher in adolescents vs. children. Elevated body mass index SD, triglycerides (≥150 mg/dL) and non-high-density lipoprotein (HDL)-cholesterol (≥130 mg/dL) were common: 7.6%, 11.0% and 12.7% (n = 288, 218 and 180, respectively). Serum creatinine levels were normal in all tested subjects (n = 194). Conclusions Youth with diabetes in less-resourced families in Mexico are achieving reasonable glycemia. Most T1D patients use a basal bolus insulin regimen and test blood glucose several times daily. Some subjects have adverse vascular risk factor profiles. Further attention is needed to prevent chronic complications. Monogenic diabetes is very likely in some youth, and genetic testing is indicated.


HbA1c; Mexico; adolescents; children; diabetes; lipids


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