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Desigualdades sociales y diabetes mellitus Translated title: Social inequalities and diabetes mellitus

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      Abstract

      Las desigualdades sociales producen efectos medibles en pérdidas de salud. Los determinantes sociales de la salud: el género, la etnia, el nivel de ingreso y la educación, constituyen, indiscutiblemente, la base protagónica de las disparidades en salud. La diabetes mellitus, constituida en uno de los principales problemas de salud a nivel global por su comportamiento epidémico en las últimas décadas, es una enfermedad notoriamente afectada por los aspectos sociales. De modo que el presente trabajo se encaminó a describir la influencia de los distintos determinantes sociales en el riesgo de desarrollar diabetes mellitus y en el pronóstico de la enfermedad. El trabajo incluye aspectos conceptuales generales del tema equidad en salud, y profundiza en el modo en el que cada uno de los determinantes sociales impacta en la susceptibilidad para el desarrollo de la diabetes mellitus, así como en el acceso a los servicios de salud de calidad, y, consecuentemente, en los resultados de salud. Adicionalmente, se incorporan algunos elementos que evidencian la peculiaridad que el tema adquiere en el contexto nacional. Se concluye que la inequidad social tiene una influencia directa en la situación actual de la diabetes mellitus a nivel global, de modo que reconocer sus implicaciones resulta imprescindible para orientar la formulación de estrategias y programas de prevención y control de esta enfermedad.

      Translated abstract

      Social inequalities bring about effects that can be measured up in health losses. The social determinants in health such as gender, ethnics, incomes and education are beyond doubts the leading basis for health inequalities. Diabetes mellitus, one of the main global health problems owing to its epidemic behavior in the last few decades, is a disease heavily affected by social elements. The present paper was aimed at describing the influence of the various social determinants over the risk of developing diabetes mellitus and over the disease prognosis. It covered general conceptual aspects about equity in health and delved into how each of the social determinants has an impact on the susceptibility to developing diabetes mellitus, on the access to quality health services, and consequently, on the health outcomes. Moreover, it included some elements that evidence the peculiarities of this topic within the domestic context. It was concluded that social inequalities have a direct effect on the present situation of diabetes mellitus worldwide, so knowing its implications becomes indispensable to direct the drawing up of prevention and control strategies programs for this disease.

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      National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants.

      Data for trends in glycaemia and diabetes prevalence are needed to understand the effects of diet and lifestyle within populations, assess the performance of interventions, and plan health services. No consistent and comparable global analysis of trends has been done. We estimated trends and their uncertainties in mean fasting plasma glucose (FPG) and diabetes prevalence for adults aged 25 years and older in 199 countries and territories. We obtained data from health examination surveys and epidemiological studies (370 country-years and 2·7 million participants). We converted systematically between different glycaemic metrics. For each sex, we used a Bayesian hierarchical model to estimate mean FPG and its uncertainty by age, country, and year, accounting for whether a study was nationally, subnationally, or community representative. In 2008, global age-standardised mean FPG was 5·50 mmol/L (95% uncertainty interval 5·37-5·63) for men and 5·42 mmol/L (5·29-5·54) for women, having risen by 0·07 mmol/L and 0·09 mmol/L per decade, respectively. Age-standardised adult diabetes prevalence was 9·8% (8·6-11·2) in men and 9·2% (8·0-10·5) in women in 2008, up from 8·3% (6·5-10·4) and 7·5% (5·8-9·6) in 1980. The number of people with diabetes increased from 153 (127-182) million in 1980, to 347 (314-382) million in 2008. We recorded almost no change in mean FPG in east and southeast Asia and central and eastern Europe. Oceania had the largest rise, and the highest mean FPG (6·09 mmol/L, 5·73-6·49 for men; 6·08 mmol/L, 5·72-6·46 for women) and diabetes prevalence (15·5%, 11·6-20·1 for men; and 15·9%, 12·1-20·5 for women) in 2008. Mean FPG and diabetes prevalence in 2008 were also high in south Asia, Latin America and the Caribbean, and central Asia, north Africa, and the Middle East. Mean FPG in 2008 was lowest in sub-Saharan Africa, east and southeast Asia, and high-income Asia-Pacific. In high-income subregions, western Europe had the smallest rise, 0·07 mmol/L per decade for men and 0·03 mmol/L per decade for women; North America had the largest rise, 0·18 mmol/L per decade for men and 0·14 mmol/L per decade for women. Glycaemia and diabetes are rising globally, driven both by population growth and ageing and by increasing age-specific prevalences. Effective preventive interventions are needed, and health systems should prepare to detect and manage diabetes and its sequelae. Bill & Melinda Gates Foundation and WHO. Copyright © 2011 Elsevier Ltd. All rights reserved.
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        Socioeconomic inequalities in health in 22 European countries.

        Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe. We obtained data on mortality according to education level and occupational class from census-based mortality studies. Deaths were classified according to cause, including common causes, such as cardiovascular disease and cancer; causes related to smoking; causes related to alcohol use; and causes amenable to medical intervention, such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education and income were obtained from health or multipurpose surveys. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality indexes. In almost all countries, the rates of death and poorer self-assessments of health were substantially higher in groups of lower socioeconomic status, but the magnitude of the inequalities between groups of higher and lower socioeconomic status was much larger in some countries than in others. Inequalities in mortality were small in some southern European countries and very large in most countries in the eastern and Baltic regions. These variations among countries appeared to be attributable in part to causes of death related to smoking or alcohol use or amenable to medical intervention. The magnitude of inequalities in self-assessed health also varied substantially among countries, but in a different pattern. We observed variation across Europe in the magnitude of inequalities in health associated with socioeconomic status. These inequalities might be reduced by improving educational opportunities, income distribution, health-related behavior, or access to health care. Copyright 2008 Massachusetts Medical Society.
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          The worldwide epidemiology of type 2 diabetes mellitus--present and future perspectives.

          Over the past three decades, the number of people with diabetes mellitus has more than doubled globally, making it one of the most important public health challenges to all nations. Type 2 diabetes mellitus (T2DM) and prediabetes are increasingly observed among children, adolescents and younger adults. The causes of the epidemic of T2DM are embedded in a very complex group of genetic and epigenetic systems interacting within an equally complex societal framework that determines behavior and environmental influences. This complexity is reflected in the diverse topics discussed in this Review. In the past few years considerable emphasis has been placed on the effect of the intrauterine environment in the epidemic of T2DM, particularly in the early onset of T2DM and obesity. Prevention of T2DM is a 'whole-of-life' task and requires an integrated approach operating from the origin of the disease. Future research is necessary to better understand the potential role of remaining factors, such as genetic predisposition and maternal environment, to help shape prevention programs. The potential effect on global diabetes surveillance of using HbA(1c) rather than glucose values in the diagnosis of T2DM is also discussed.
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            Author and article information

            Affiliations
            [1 ] Instituto Nacional de Endocrinología Cuba
            Contributors
            Role: ND
            Journal
            end
            Revista Cubana de Endocrinología
            Rev Cubana Endocrinol
            Editorial Ciencias Médicas (Ciudad de la Habana )
            1561-2953
            August 2013
            : 24
            : 2
            : 200-213
            S1561-29532013000200009

            http://creativecommons.org/licenses/by/4.0/

            Product
            Product Information: SciELO Cuba
            Categories
            ENDOCRINOLOGY & METABOLISM

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