Papers by Paloma Almeda-Valdes
Frontiers in endocrinology, Mar 22, 2024
Background: Patients with type 2 diabetes are at an increased risk of chronic kidney disease (CKD... more Background: Patients with type 2 diabetes are at an increased risk of chronic kidney disease (CKD) hence it is recommended that they receive annual CKD screening. The huge burden of diabetes in Mexico and limited screening resource mean that CKD screening is underperformed. Consequently, patients often have a late diagnosis of CKD. A regional minimal-resource model to support risk-tailored CKD screening in patients with type 2 diabetes has been developed and globally validated. However, population heath and care services between countries within a region are expected to differ. The aim of this study was to evaluate the performance of the model within Mexico and compare this with the performance demonstrated within the Americas in the global validation. Methods: We performed a retrospective observational study with data from primary care (Clinic Specialized in Diabetes Management in Mexico City), tertiary care (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirań) and the Mexican national survey of health and nutrition (ENSANUT-MC 2016). We applied the minimal-resource model across the datasets and evaluated model performance metrics, with the primary interest in the sensitivity and increase in the positive predictive value (PPV) compared to a screen-everyone approach.
PLOS global public health, Feb 13, 2024
Diabetes and poor glycemic control are significant predictors of severity and death in the COVID-... more Diabetes and poor glycemic control are significant predictors of severity and death in the COVID-19 disease. The perception of this risk in individuals with type 2 diabetes (T2D) could modify coping styles, leading to behaviors associated with better self-care and metabolic control. Theoretically, active coping is associated with better glycemic control in patients with T2D. Nonetheless, information during extreme risk like the COVID-19 pandemic is still limited. Our objective was to evaluate the association between coping styles and risk perception in the COVID-19 pandemic and the change in metabolic parameters. This is a prospective study that included individuals with T2D treated in a tertiary care center during the COVID-19 outbreak who returned to follow-up one year later. We assessed coping styles and risk perception with the Extreme Risk Coping Scale and the risk perception questionnaire. Clinical characteristics and metabolic parameters were registered in both visits. Groups were compared using Kruskal Wallis tests, and changes in metabolic parameters were assessed with Wilcoxon rank sum tests. Our sample included 177 participants at baseline, and 118 concluded the study. Passive coping was more frequent in women. Lowrisk perception was associated with higher age, lower psychiatric comorbidities, and lower frequency of psychiatric treatment compared with other risk perception groups. Patients with active coping plus high-risk perception did not have a change in metabolic parameters at follow-up, whereas patients with other coping styles and lower risk perception had an increase in total cholesterol, LDL-cholesterol, and triglycerides. There were no differences by coping group or by risk perception in glycemic control.
Gaceta Medica De Mexico, Oct 6, 2021
Antecedentes: La rigidez arterial central aórtica (RACA) es un factor de riesgo cardiovascular in... more Antecedentes: La rigidez arterial central aórtica (RACA) es un factor de riesgo cardiovascular independiente. La resistencia a la insulina (RI) contribuye al riesgo asociado a RACA. Objetivo: Evaluar la asociación entre RI y RACA en una población mexicana sin diabetes. Métodos: La RI se estimó con HOMA2-IR y (Homeostatic Model Assessment 2-Insulin Resistance) otros subrogados (METS-IR [Metabolic score for IR], QUICKI [Quantitative Insulin Sensitivity Check Index], TyG [ratio triglicéridos/glucosa], TyG*IMC [TyG*índice de masa corporal] y TG/HDL [ratio TG/lipoproteínas de alta densidad]). Se evaluó la RACA mediante el análisis de velocidad de onda del pulso carotídeo-femoral (VOP cf) y el índice de aumentación estandarizado (AI-75). Se realizaron correlaciones bivariante entre los subrogados y la VOP cf. RACA aumentada se definió como VOP cf arriba del percentil 90. Se obtuvieron puntos de corte y área bajo la curva (ABC) para cada subrogado para estimar RACA aumentada. Resultados: Se incluyó 358 pacientes. Se encontró una correlación entre HOMA2-IR y VOP cf ; esta correlación se replicó con los subrogados. METS-IR y TyG*IMC tuvieron el mayor grado de correlación con VOP cf. Al ajustar, las correlaciones con Ty-G*IMC, METS-IR, HOMA2-IR y QUICKI mantuvieron significancia. La correlación con AI-75 fue mayor para HOMA2-IR. METS-IR y TyG mostraron la mejor ABC. Los pacientes con prediabetes tuvieron mayor VOP cf. Conclusiones: La relación entre la RI y la RACA está presente desde etapas no diabéticas; esta asociación puede conllevar mayor riesgo cardiovascular.
Nutrition, Metabolism and Cardiovascular Diseases, 2020
Salinas CA, the Metabolic Syndrome Study Group, Increased visceral fat accumulation modifies the ... more Salinas CA, the Metabolic Syndrome Study Group, Increased visceral fat accumulation modifies the effect of insulin resistance on arterial stiffness and hypertension risk, Nutrition, Metabolism and Cardiovascular Diseases,
Cell, Jan 29, 2017
Type 2 diabetes (T2D) affects Latinos at twice the rate seen in populations of European descent. ... more Type 2 diabetes (T2D) affects Latinos at twice the rate seen in populations of European descent. We recently identified a risk haplotype spanning SLC16A11 that explains ∼20% of the increased T2D prevalence in Mexico. Here, through genetic fine-mapping, we define a set of tightly linked variants likely to contain the causal allele(s). We show that variants on the T2D-associated haplotype have two distinct effects: (1) decreasing SLC16A11 expression in liver and (2) disrupting a key interaction with basigin, thereby reducing cell-surface localization. Both independent mechanisms reduce SLC16A11 function and suggest SLC16A11 is the causal gene at this locus. To gain insight into how SLC16A11 disruption impacts T2D risk, we demonstrate that SLC16A11 is a proton-coupled monocarboxylate transporter and that genetic perturbation of SLC16A11 induces changes in fatty acid and lipid metabolism that are associated with increased T2D risk. Our findings suggest that increasing SLC16A11 function ...
Journal of the American College of Cardiology, Mar 1, 2022
Journal of the Endocrine Society, May 1, 2021
Introduction: Our lab has previously identified three distinct subtypes of developmentally and fu... more Introduction: Our lab has previously identified three distinct subtypes of developmentally and functionally white adipocytes and have shown that they each differentially contribute to adipose depots (Lee, KY et al. EMBO J. 2019). Dermal white adipose tissue (dWAT), a layer of adipocytes embedded in the skin below the dermis, has recently been shown to play a role in crucial physiologic processes including thermogenesis, the regulation of aging, scar formation, and wound healing. The purpose of this proposal is to investigate the contribution of three adipocyte subtypes to dWAT. Objectives: The primary objectives of this project are to determine the number of preadipocytes and adipocytes from each of three subtypes present in dWAT. Methodology: Lineage tracing analysis was performed by crossing transgenic mice harboring cre-recombinase under the control of promoter/enhancer elements of each of the three marker genes, Wilms tumor 1, transgelin, or myoxovirus 1 to dual-fluorescent reporter mice. These three mice lines mark Type 1-3 preadipocytes and adipocytes, respectively. dWAT was collected from X week old mice, and adipocyte identities were determined by confocal microscopy. Preadipocyte contribution of these subpopulations was determined by FACS analysis. Results: We found that Type 2 (~45%) and Type 3 (~25%), but not Type 1 preadipocytes significantly contributed to the dWAT preadipocyte cellular population. We also found a similar pattern for the adipocyte populations. Type 1, 2, and 3 adipocytes were found to comprise ~3%, 17%, and 7% of mature adipocytes, respectively. These studies demonstrate that Type 2 and Type 3 adipocytes contribute to the composition of dWAT. Summary/Conclusion: These studies demonstrate that Type 2 and Type 3 adipocytes and preadipocytes significantly contribute to the composition of dWAT. Since these adipocyte subpopulations have different functional properties, including metabolism and response to inflammatory cytokines, the contribution of these adipocyte subtypes may impact the crucial physiologic processes mediated by dWAT.
Table 1. Main differences in both groups Total APS TRU+APS P N=112 N=57 (50,9%) N=55 (49,1%)
Gaceta Médica de México
Background: Data on visual impairment (VI) in patients with diabetes are necessary in order to gu... more Background: Data on visual impairment (VI) in patients with diabetes are necessary in order to guide economic and human resources for reducing its prevalence. Objective: To estimate the prevalence of diabetic retinopathy-related VI in patients with type 2 diabetes in a hospital-based setting. Material and methods: Cross-sectional study carried out from 2014 to 2019 in an ophthalmology outpatient clinic. Any VI was defined as corrected pin-hole visual acuity in the better eye of ≥ 0.24 logMAR. The presence of diabetic retinopathy (DR), diabetic macular edema (DME) and cataract was evaluated. Results: A total of 840 patients were included; median diabetes duration was 15 years. The prevalence of VI was 30%. DR was found in 62% of patients (30% had sight-threatening DR [STDR]), 17% had referable DME, and 3%, cataracts. The odds ratio for moderate or worse VI was 9.02 for STDR (p < 0.001), 5.89 for referable DME (p = 0.001), and 2.51 for cataract (p = 0.006). Conclusion: Thirty percent of participants had some degree of VI. Moderate or worse VI showed a strong association with STDR and referable DME.
Gaceta Médica de México
Antecedentes: Los datos sobre discapacidad visual (DV) en pacientes con diabetes son necesarios p... more Antecedentes: Los datos sobre discapacidad visual (DV) en pacientes con diabetes son necesarios para orientar los recursos económicos y humanos que disminuyan su prevalencia. Objetivo: Estimar la prevalencia de DV relacionada con retinopatía diabética en pacientes con diabetes tipo 2 en un entorno hospitalario. Material y métodos: Estudio transversal realizado de 2014 a 2019 en una consulta externa de oftalmología. Cualquier DV se definió como agudeza visual corregida con agujero estenopeico en el ojo con mejor visión (≥ 0.24 logMAR). Se evaluó la presencia de retinopatía diabética, edema macular diabético (EMD) y cataratas. Resultados: Se incluyeron 840 pacientes; la mediana de duración de la diabetes fue de 15 años. La prevalencia de DV fue de 30 %. Se encontró retinopatía diabética en 62 % (30 % tenía retinopatía diabética que amenazaba la visión [RDAV]); 17 %, EMD y 3 %, cataratas. La razón de momios para DV moderada o de mayor gravedad fue de 9.02 para RDAV (p < 0.001), 5.89 para EMD referible (p = 0.001) y 2.51 para catarata (p = 0.006). Conclusión: Treinta por ciento de los participantes tenía algún grado de DV. La DV moderada o de mayor gravedad mostró una fuerte asociación con RDAV y EMD referible.
International Journal of Environmental Research and Public Health
Arterial stiffness may be associated with glucose metabolism parameters, such as HbA1c, mainly vi... more Arterial stiffness may be associated with glucose metabolism parameters, such as HbA1c, mainly via insulin resistance. We aimed to investigate the association between arterial stiffness and HbA1c and explore the mediator effect of insulin resistance. In this cross-sectional study, arterial stiffness (pulse-wave velocity; PWV), HbA1c, and insulin resistance (METS-IR) were determined in Hispanic adults. In addition to sex and age, various biochemical measurements (glucose, lipid profile, etc.) and adipose tissue (fat mass and visceral fat mass) were considered as potential confounding variables. A multivariate regression analysis shows that HbA1c is associated with PWV, even after adjusting for several confounding variables. Importantly, the results show that insulin resistance mediated 17.9% of the effect of HbA1c over PWV. In conclusion, HbA1c may be a potential resource for predicting arterial stiffness due to the influence of insulin resistance in Hispanic subjects.
Investigative Ophthalmology & Visual Science, 2018
Medicina interna de México, May 15, 2015
Type 2 diabetes mellitus is a disease with a complex pathophysiology, in which glucose often rema... more Type 2 diabetes mellitus is a disease with a complex pathophysiology, in which glucose often remains elevated despite the use of currently available glucose lowering drugs. The inhibitors of the type 2 sodium glucose cotransporter (iSGLT 2 of antihyperglycemic agents that target the kidneys; the objective be
Journal of clinical and translational endocrinology case reports, Jun 1, 2020
Adrenal cystic lymphangiomas are unusual entities with a very low prevalence that are typically d... more Adrenal cystic lymphangiomas are unusual entities with a very low prevalence that are typically discovered incidentally. We describe a 45-year-old male known for hypertension that was referred to our endocrinology department for right adrenal incidentaloma. Seven months prior referral, he presented right hypochondrium pain, vomiting and nausea and imaging studies included a computer tomography that revealed an irregularshaped right adrenal lesion (42 × 23 mm), with scattered calcifications in the medial branch and heterogenous contrast enhancement and contrast-enhanced computer tomography showed an absolute wash-out of 28% and hyperattenuating areas (> 90 HU). Physical examination was unremarkable. Hormonal studies were all within normal range. Due to the findings of imaging studies and lack of biochemical findings a presumptive diagnosis of non-producing adrenal carcinoma was made. Laparoscopic of right adrenalectomy was carried out. Macroscopic appearance of the resected right adrenal surface showed a 3.0 × 2.5 cm whitish-grayish multicystic lesion with solid areas that replaced all adrenal medulla and almost all the cortex. Microscopic examination revealed multiple cystic channels lined with endothelial cells without atypia or mitotic figures. On immunohistochemical examination, anti-calretinin, anti-D2-40 and anti-Factor VIII were all positive confirming the diagnosis of adrenal cystic lymphangioma. It is a rare pathology that should be considered as part of the differential diagnosis during the evaluation of adrenal gland masses.
Annals of Hepatology, 2005
Médica Sur, 2003
Artículo de revisión edigraphic.com Cáncer de primario desconocido. Revisión basada en evidencias
Revista mexicana de endocrinología, metabolismo y nutrición, Nov 15, 2022
Objetivo: Evaluar el uso del sistema flash de monitoreo de glucosa en México, respecto a: a) frec... more Objetivo: Evaluar el uso del sistema flash de monitoreo de glucosa en México, respecto a: a) frecuencia de determinaciones de glucosa; b) su asociación con marcadores glucémicos, y c) su comparación con lo observado a nivel mundial. Métodos: Los resultados glucémicos se desidentificaron y se cargaron a una base de datos cuando los lectores de Freestyle Libre™ se conectaron a una computadora con internet. La información analizada comprendió 1,021,032 lectores a nivel mundial (incluyendo 4,972 lectores mexicanos). Se calcularon los parámetros glucémicos incluyendo hemoglobina glucosilada (HbA1c) estimada, tiempos arriba, abajo y en rango. Resultados: Los usuarios mexicanos tuvieron un promedio de 14.9 mediciones diarias vs. 13.2 a nivel mundial (p < 0.05). En México, los grupos de determinaciones más bajas y más altas, en promedio 3.9 y 40.8 veces al día tuvieron una HbA1c estimada del 7.18 y 6.74%, respectivamente (p < 0.05). En ambas poblaciones, conforme aumentaba la frecuencia de determinaciones, aumentaba el tiempo en rango. En México, el porcentaje de tiempo en rango aumentó del 65.0 al 68.4% (p < 0.05). Conclusiones: Los usuarios mexicanos tuvieron una mayor frecuencia de determinaciones que a nivel global. Similar a los hallazgos mundiales, a mayor frecuencia de determinaciones, mejor control glucémico.
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Papers by Paloma Almeda-Valdes