拉丁美洲的糖尿病预防跨文化研究。

Transculturalizing Diabetes Prevention in Latin America.

机构信息

Geriatric Research, Education, and Clinical Center (GRECC), Miami VA Healthcare System, South Florida Veterans Affairs Foundation for Research & Education, Miami, FL; Department of Physiology, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado" and Cardio-metabolic Unit 7, Barquisimeto, Venezuela.

The Andes Clinic of Cardio-Metabolic Studies, Timotes, Venezuela.

出版信息

Ann Glob Health. 2017 May-Aug;83(3-4):432-443. doi: 10.1016/j.aogh.2017.07.001. Epub 2017 Aug 24.

DOI:10.1016/j.aogh.2017.07.001

PMID:29221516

Abstract

BACKGROUND

Type 2 diabetes (T2D) imposes a heavy burden in developing countries, requiring effective primary prevention policies. Randomized clinical trials have identified successful strategies in T2D prevention. However, translating these results to real-life scenarios and adapting to ethnocultural differences is a major challenge. Transculturalization allows incorporating cultural factors to diabetes prevention strategies to optimize implementation of clinical trials results. The purpose of this paper is to review the transcultural adaptations developed for T2D prevention in Latin America (LA).

METHODS

A comprehensive literature review spanning 1960-2016 was performed, using "Diabetes," "Latin America," "Prevention," "Screening," and "Tools" as key words.

RESULTS

Two major tasks are underway in LA: adaptation of screening tools for high-risk individuals, and implementation of diabetes prevention programs. The Finnish Diabetes Risk Score (FINDRISC) is the most widely used screening tool to detect new cases of T2D and people with prediabetes, and it has been adapted (LA-FINDRISC) to include the waist circumference cutoff values appropriate for LA population (≥94 cm for men and ≥90 cm for women). The validation of the LA-FINDRISC performance depends on the local characteristics. A LA-FINDRISC score >10 may be the best cutoff to identify individuals with impaired glucose regulation in population-based studies, but a higher score (>12-14) might be more appropriate in a clinical setting. A shorter version of the FINDRISC using only the 4 variables with highest impact has been developed and validated in Colombia (ColDRISC). The translation of the Diabetes Prevention Program study in a Latino population in Venezuela found a significant improvement in cardiometabolic risk factors. An adaptation of the Diabetes Prevention Study in the DEMOJUAN study in Barranquilla, Colombia, reduced 2-hour postload glucose.

CONCLUSION

Successful transculturalization strategies have been implemented in screening tools and prevention programs in LA.

摘要

背景

2 型糖尿病（T2D）在发展中国家造成了沉重的负担，需要有效的初级预防政策。随机临床试验已经确定了 T2D 预防的成功策略。然而，将这些结果转化为现实场景并适应文化差异是一个主要挑战。文化转化允许将文化因素纳入糖尿病预防策略中，以优化临床试验结果的实施。本文的目的是回顾拉丁美洲（LA）进行的 T2D 预防的跨文化适应。

方法

对 1960 年至 2016 年的文献进行了全面的综述，使用“糖尿病”、“拉丁美洲”、“预防”、“筛查”和“工具”作为关键词。

结果

LA 正在进行两项主要任务：高风险个体的筛查工具的适应，以及糖尿病预防计划的实施。芬兰糖尿病风险评分（FINDRISC）是最广泛用于检测新的 T2D 和糖尿病前期个体的筛查工具，它已被改编（LA-FINDRISC）以纳入适合 LA 人群的腰围截止值（男性≥94cm，女性≥90cm）。LA-FINDRISC 性能的验证取决于当地的特点。在基于人群的研究中，LA-FINDRISC 评分>10 可能是识别葡萄糖调节受损个体的最佳截止值，但在临床环境中，较高的评分（>12-14）可能更合适。使用具有最高影响的 4 个变量的 FINDRISC 的较短版本已在哥伦比亚（ColDRISC）中得到开发和验证。委内瑞拉的拉丁裔人群中的糖尿病预防计划研究的翻译发现，心血管代谢危险因素有了显著改善。在哥伦比亚的 Barranquilla 进行的 DEMOJUAN 研究中，对糖尿病预防研究的改编降低了 2 小时餐后血糖。