Results from a population-based survey O ur objective was to evaluate the diagnostic proficiency of the World Health Organization (WHO) and the National Cholesterol Education Program (NCEP)-III definitions (1,2) for the metabolic syndrome in a Mexican nationwide, population-based survey. Details of the sampling procedures have been previously described (3). The population was composed of 2,158 men and women aged 20 -69 years sampled after a 9-to 12-h fasting period. For the WHO criteria, insulin resistance was diagnosed if a nondiabetic case had fasting insulin concentrations Ն126 pmol/l (21 U/ml) (Ͼ75th percentile in Mexican adults). The ageadjusted prevalence was 13.61% for the WHO criteria (n ϭ 268) and 26.6% for the NCEP-III definition (n ϭ 574). After excluding patients with diabetes, the prevalence was 9.2 and 21.4%, respectively. The agreement between the definitions was assessed in 1,969 subjects; 189 cases were eliminated due to the lack of a urine sample.The number of abnormal cases was lower using the WHO criteria. Only 237 of the 545 subjects (43.4%) who fulfilled the NCEP criteria were diagnosed as affected using the WHO definition. Just 16 of 253 cases (6.3%) detected by the WHO definition did not fulfill the NCEP definition. The agreement between the criteria was moderate ( ϭ 0.507). On the other hand, the subjects diagnosed using the WHO recommendations had a worse profile than the cases detected by the NCEP-III definition only-they had a higher BMI and higher non-HDL cholesterol, triglyceride, and glucose concentrations. The demonstration of insulin resistance among the nondiabetic population caused the lack of agreement in 202 of the 242 cases that fulfilled the NCEP definition but failed the WHO criteria. Other reasons for disparity were the higher thresholds used by the WHO criteria; these differences explained the lack of agreement in 66 of the 152 cases with diabetes.In conclusion, the prevalence of the metabolic syndrome is influenced by the selection of the diagnostic criteria. The WHO criteria identified a lower number of cases than the NCEP-III definition. These differences were explained mainly by the inclusion of abnormally high insulin concentrations as a diagnostic criterion. However, the presence of insulin resistance may help to identify patients more severely affected (4). We had previously assessed the effect of complete blockade of the renin-angiotensin system (RAS) in patients with advanced diabetic nephropathy (type 2 diabetes) and severe proteinuria (2). To do so, we studied 10 patients on prior treatment with ACE inhibitors at recommended doses, to which 50 mg/day of Losartan was added. CARLOS A. AGUILAR-SALINASAfter 3 months of the combined therapy, urinary protein excretion decreased from a mean of 6.9 (95% CI 4.3-9.6) to 5.8 g/24 h (3-8.6) (P ϭ 0.025) and, with the exception of two patients, was reduced in all cases. The proteinuria/ urinary creatinine ratio also decreased from 7.6 (4.2-11.05) to 6.0 g/g (3.2-8.7) (P ϭ 0.02). In one patient in which proteinuria did not ...

At the University of Michigan Medical School in 1990, the authors investigated the effects of faculty facilitators' levels of content expertise on the educational process and learning outcomes of small-group teaching sessions. The study was conducted in a microbiology course for second-year students in which four small-group sessions were used to replace 38 hours of lecture and laboratory time. The interactions between 11 expert and ten non-expert faculty facilitators and 156 students were observed and coded. The students' levels of knowledge and satisfaction were measured. The results indicate that, although significant differences in faculty-student interactions were not observed, the students in the 11 groups led by the content experts had higher levels of satisfaction and higher examination scores.

Aim This study examined the long-term impact of a 24-month, empowerment-based diabetes self-management support (DSMS) intervention on sustaining health-gains achieved from previous diabetes self-management education (DSME). Methods This report is based on 60 African-American adults with type 2 diabetes (n=89 recruited at baseline) who completed the study. Prior to the intervention, all participants received 6 months of mailed DSME consisting of weekly educational newsletters coupled with clinical feedback. The intervention consisted of 88 weekly group-based sessions that participants were encouraged to attend as frequently as they needed. Sessions were guided by participants’ self-management questions and also emphasized experiential learning, coping, goal-setting, and problem-solving. Baseline, 6-month, and 30-month assessments measured A1C, weight, body mass index (BMI), blood pressure, lipids, self-care behaviors, and QOL. Results Post 6-month DSME, participants demonstrated significant improvements for diastolic BP (p<0.05), serum cholesterol (p<0.001), healthy diet (p<0.01), blood glucose monitoring (p<0.05) and foot exams (p<0.01). Post 24-month intervention, participants sustained the improvements achieved from the 6-month DSME and reported additional improvements for healthy diet (p<0.05), carbohydrate spacing (p<0.01), insulin use, (p<0.05), and quality of life (p<0.05). Conclusions Findings suggest that an empowerment-based DSMS model can sustain or improve diabetes-related health gains achieved from previous short-term DSME.