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Shen J, Kondal D, Rubinstein A, Irazola V, Gutierrez L, Miranda JJ, Bernabé-Ortiz A, Lazo-Porras M, Levitt N, Steyn K, Bobrow K, Ali MK, Prabhakaran D, Tandon N. A Multiethnic Study of Pre-Diabetes and Diabetes in LMIC. Glob Heart 2017; 11:61-70. [PMID: 27102023 DOI: 10.1016/j.gheart.2015.12.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Diabetes mellitus is one of the leading causes of death and disability worldwide. Approximately three-quarters of people with diabetes live in low- and middle-income countries, and these countries are projected to experience the greatest increase in diabetes burden. OBJECTIVES We sought to compare the prevalence, awareness, treatment, and control of diabetes in 3 urban and periurban regions: the Southern Cone of Latin America and Peru, South Asia, and South Africa. In addition, we examined the relationship between diabetes and pre-diabetes with known cardiovascular and metabolic risk factors. METHODS A total of 26,680 participants (mean age, 47.7 ± 14.0 years; 45.9% male) were enrolled in 4 sites (Southern Cone of Latin America = 7,524; Peru = 3,601; South Asia = 11,907; South Africa = 1,099). Detailed demographic, anthropometric, and biochemical data were collected. Diabetes and pre-diabetes were defined as a fasting plasma glucose ≥126 mg/dl and 100 to 125 mg/dl, respectively. Diabetes control was defined as fasting plasma glucose <130 mg/dl. RESULTS The prevalence of diabetes and pre-diabetes was 14.0% (95% confidence interval [CI]: 13.2% to 14.8%) and 17.8% (95% CI: 17.0% to 18.7%) in the Southern Cone of Latin America, 9.8% (95% CI: 8.8% to 10.9%) and 17.1% (95% CI: 15.9% to 18.5%) in Peru, 19.0% (95% CI: 18.4% to 19.8%) and 24.0% (95% CI: 23.2% to 24.7%) in South Asia, and 13.8% (95% CI: 11.9% to 16.0%) and 9.9% (95% CI: 8.3% to 11.8%) in South Africa. The age- and sex-specific prevalence of diabetes and pre-diabetes for all countries increased with age (p < 0.001). In the Southern Cone of Latin America, Peru, and South Africa the prevalence of pre-diabetes rose sharply at 35 to 44 years. In South Asia, the sharpest rise in pre-diabetes prevalence occurred younger at 25 to 34 years. The prevalence of diabetes rose sharply at 45 to 54 years in the Southern Cone of Latin America, Peru, and South Africa, and at 35 to 44 years in South Asia. Diabetes and pre-diabetes prevalence increased with body mass index. South Asians had the highest prevalence of diabetes and pre-diabetes for any body mass index and normal-weight South Asians had a higher prevalence of diabetes and pre-diabetes than overweight and obese individuals from other regions. Across all regions, only 79.8% of persons with diabetes were aware of their diagnosis, of these only 78.2% were receiving treatment, and only 36.6% were able to attain glycemic control. CONCLUSIONS The prevalence of diabetes and pre-diabetes is alarmingly high among urban and periurban populations in Latin America, South Asia, and South Africa. Even more alarming is the propensity for South Asians to develop diabetes and pre-diabetes at a younger age and lower body mass index compared with individuals from other low and middle income countries. It is concerning that one-fifth of all people with diabetes were unaware of their diagnosis and that only two-thirds of those under treatment were able to attain glycemic control. Health systems and policy makers must make concerted efforts to improve diabetes prevention, detection, and control to prevent long-term consequences.
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Affiliation(s)
- Jia Shen
- Emory Clinical Cardiovascular Research Institute, Atlanta, GA, USA.
| | - Dimple Kondal
- Public Health Foundation of India & Center for Chronic Disease Control, New Delhi, India
| | - Adolfo Rubinstein
- South American Center for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Vilma Irazola
- South American Center for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Laura Gutierrez
- South American Center for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Lazo-Porras
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Naomi Levitt
- Chronic Diseases Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Krisela Steyn
- Chronic Diseases Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Kirsten Bobrow
- Chronic Diseases Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Mohammed K Ali
- Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Dorairaj Prabhakaran
- Public Health Foundation of India & Center for Chronic Disease Control, New Delhi, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
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Seclen SN, Rosas ME, Arias AJ, Medina CA. Elevated incidence rates of diabetes in Peru: report from PERUDIAB, a national urban population-based longitudinal study. BMJ Open Diabetes Res Care 2017; 5:e000401. [PMID: 28878935 PMCID: PMC5574423 DOI: 10.1136/bmjdrc-2017-000401] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/03/2017] [Accepted: 06/10/2017] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE A recent report from a non-nationally representative, geographically diverse sample in four separate communities in Peru suggests an unusually high diabetes incidence. We aimed to estimate the national diabetes incidence rate using PERUDIAB, a probabilistic, national urban population-based longitudinal study. RESEARCH DESIGN AND METHODS 662 subjects without diabetes, selected by multistage, cluster, random sampling of households, representing the 24 administrative and the 3 (coast, highlands and jungle) natural regions across the country, from both sexes, aged 25+ years at baseline, enrolled in 2010-2012, were followed for 3.8 years. New diabetes cases were defined as fasting blood glucose ≥126 mg/dL or on medical diabetes treatment. RESULTS There were 49 cases of diabetes in 2408 person-years follow-up. The weighted cumulative incidence of diabetes was 7.2% while the weighted incidence rate was estimated at 19.5 (95% CI 13.9 to 28.3) new cases per 1000 person-years. Older age, obesity and technical or higher education were statistically associated with the incidence of diabetes. CONCLUSION Our results confirm that the incidence of diabetes in Peru is among the highest reported globally. The fast economic growth in the last 20 years, high overweight and obesity rates may have triggered this phenomenon.
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Affiliation(s)
- Segundo Nicolas Seclen
- Diabetes, Hypertension and Lipids Unit, Institute of Gerontology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Moises Ernesto Rosas
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Arturo Jaime Arias
- Technical Direction of Demography and Social Indicators, National Institute of Statistics and Informatics, Lima, Peru
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103
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Tzoulaki I, Elliott P, Kontis V, Ezzati M. Worldwide Exposures to Cardiovascular Risk Factors and Associated Health Effects: Current Knowledge and Data Gaps. Circulation 2016; 133:2314-33. [PMID: 27267538 DOI: 10.1161/circulationaha.115.008718] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Information on exposure to, and health effects of, cardiovascular disease (CVD) risk factors is needed to develop effective strategies to prevent CVD events and deaths. Here, we provide an overview of the data and evidence on worldwide exposures to CVD risk factors and the associated health effects. Global comparative risk assessment studies have estimated that hundreds of thousands or millions of CVD deaths are attributable to established CVD risk factors (high blood pressure and serum cholesterol, smoking, and high blood glucose), high body mass index, harmful alcohol use, some dietary and environmental exposures, and physical inactivity. The established risk factors plus body mass index are collectively responsible for ≈9.7 million annual CVD deaths, with high blood pressure accounting for more CVD deaths than any other risk factor. Age-standardized CVD death rates attributable to established risk factors plus high body mass index are lowest in high-income countries, followed by Latin America and the Caribbean; they are highest in the region of central and eastern Europe and central Asia. However, estimates of the health effects of CVD risk factors are highly uncertain because there are insufficient population-based data on exposure to most CVD risk factors and because the magnitudes of their effects on CVDs in observational studies are likely to be biased. We identify directions for research and surveillance to better estimate the effects of CVD risk factors and policy options for reducing CVD burden by modifying preventable risk factors.
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Affiliation(s)
- Ioanna Tzoulaki
- From Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece (IT); MRC-PHE Centre for Environment and Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); School of Public Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); Imperial College Wellcome Trust Centre for Global Health Research, London, UK (P.E., M.E.); and WHO Collaborating Centre on NCD Surveillance and Epidemiology, London, UK (P.E., M.E.)
| | - Paul Elliott
- From Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece (IT); MRC-PHE Centre for Environment and Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); School of Public Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); Imperial College Wellcome Trust Centre for Global Health Research, London, UK (P.E., M.E.); and WHO Collaborating Centre on NCD Surveillance and Epidemiology, London, UK (P.E., M.E.)
| | - Vasilis Kontis
- From Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece (IT); MRC-PHE Centre for Environment and Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); School of Public Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); Imperial College Wellcome Trust Centre for Global Health Research, London, UK (P.E., M.E.); and WHO Collaborating Centre on NCD Surveillance and Epidemiology, London, UK (P.E., M.E.)
| | - Majid Ezzati
- From Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece (IT); MRC-PHE Centre for Environment and Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); School of Public Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); Imperial College Wellcome Trust Centre for Global Health Research, London, UK (P.E., M.E.); and WHO Collaborating Centre on NCD Surveillance and Epidemiology, London, UK (P.E., M.E.).
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104
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Miranda JJ, Taype-Rondan A, Tapia JC, Gastanadui-Gonzalez MG, Roman-Carpio R. Hair follicle characteristics as early marker of Type 2 Diabetes. Med Hypotheses 2016; 95:39-44. [PMID: 27692164 PMCID: PMC5073072 DOI: 10.1016/j.mehy.2016.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 08/14/2016] [Indexed: 01/17/2023]
Abstract
Type 2 Diabetes mellitus (DM2) includes a continuum of metabolic disorders characterized by hyperglycemia that causes several chronic long-term complications such as coronary artery disease, peripheral arterial disease, nephropathy, and neuropathy. The hair follicle could reveal signs of early vascular impairment, yet its relationship to early metabolic injuries has been largely ignored. We propose that in earlier stages of the continuum of DM2-related metabolic disorders, a group of susceptible patients who do not yet meet the diagnostic criteria to be considered as persons with DM2 may present chronic vascular impairment and end organ damage, including hair follicle damage, which can be evaluated to identify an early risk marker. This hypothesis is based in the association found between insulin resistance and alopecia in non-diabetic persons, and the hair loss on the lower limbs as a manifestation of long-term peripheral arterial disease among subjects with DM2. In order to test this hypothesis, studies are required to evaluate if hair follicle characteristics are related to and can predict hyperglycemic complications, and if they do so, which feature of the hair follicle, such as hair growth, best characterizes such DM2-related conditions. If this hypothesis were proven to be true, significant advances towards a personalized approach for early prevention strategies and management of DM2 would be made. By focusing on the hair follicles, early stages of metabolic-related organ damage could be identified using non-invasive low-cost techniques. In so doing, this approach could provide early identification of DM2-susceptible individuals and lead to the early initiation of adequate primary prevention strategies to reduce or avoid the onset of large internal organ damage.
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Affiliation(s)
- J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Alvaro Taype-Rondan
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jose Carlos Tapia
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Gabriela Gastanadui-Gonzalez
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Roman-Carpio
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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105
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Bennett PH, Magliano DJ, Alberti KG, Zimmet P. Liberating non-communicable disease data. Lancet Diabetes Endocrinol 2016; 4:815-6. [PMID: 27567937 DOI: 10.1016/s2213-8587(16)30220-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 11/24/2022]
Affiliation(s)
| | | | | | - Paul Zimmet
- Department of Medicine, Monash University, Melbourne, VIC, Australia
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106
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Zimmet P, Alberti KG, Magliano DJ, Bennett PH. Diabetes mellitus statistics on prevalence and mortality: facts and fallacies. Nat Rev Endocrinol 2016; 12:616-22. [PMID: 27388988 DOI: 10.1038/nrendo.2016.105] [Citation(s) in RCA: 439] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Diabetes mellitus is one of the most important public health challenges of the twenty-first century. Until the past decade, it has been seriously underrated as a global health threat. Major gaps exist in efforts to comprehend the burden nationally and globally, especially in developing nations, due to a lack of accurate data for monitoring and surveillance. Early attempts to obtain accurate data, discussed in this article, seem to have been cast aside so, at present, these needs remain unmet. Existing international efforts to assemble information fall far short of requirements. Current estimates are imprecise, only providing a rough picture, and probably underestimate the disease burden. The methodologies that are currently used, and that are discussed in this Perspectives article, are inadequate for providing a complete and accurate assessment of the prevalence of diabetes mellitus. International consensus on uniform standards and criteria for reporting national data on diabetes mellitus prevalence as well as for common complications of diabetes mellitus and mortality need to be developed.
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Affiliation(s)
- Paul Zimmet
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia
| | - K George Alberti
- Department of Endocrinology and Metabolism, Imperial College, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Dianna J Magliano
- Baker IDI Heart and Diabetes Institute, 99 Commercial Road, Melbourne, VIC 3004, Australia
| | - Peter H Bennett
- National Institutes of Health, 1550 East Indian School Road, Phoenix, Arizona 85014, USA
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107
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Telo GH, Cureau FV, de Souza MS, Andrade TS, Copês F, Schaan BD. Prevalence of diabetes in Brazil over time: a systematic review with meta-analysis. Diabetol Metab Syndr 2016; 8:65. [PMID: 27610204 PMCID: PMC5015260 DOI: 10.1186/s13098-016-0181-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/29/2016] [Indexed: 01/04/2023] Open
Abstract
Diabetes is one of the most important epidemic diseases of this century and the number of people with diabetes has more than doubled over the past three decades. Our aim was to estimate the prevalence of diabetes in the adult Brazilian population and analyze the trends for the last three decades through a systematic review with meta-analysis. This review included observational studies published between 1980 and 2015, which were independently identified by two reviewers in five databases. Random effect models were used to estimate the prevalence and trends of diabetes. In total, 50 articles were included in this review. Three different patterns for diabetes diagnosis were identified: self-report (36 studies), fasting glucose (7 studies), and complex diagnosis (fasting glucose, oral glucose tolerance test, and self-report; 7 studies). The prevalence of diabetes was 5.6 % (95 % CI 5.0-6.3; I(2) = 100 %) by self-report, 6.6 % (95 % CI 4.8-8.9; I(2) = 94 %) by fasting glucose, and 11.9 % (95 % CI 7.7-17.8 I(2) = 100 %) by complex diagnosis. In trend analyses, we observed an increase in the prevalence of diabetes over time. The biggest increase was detected in studies using complex diagnosis: 7.4 % (95 % CI 7.1-7.7) in the 1980s to 15.7 % (95 % CI 9.8-24.3) in the 2010s. In conclusion, despite high heterogeneity, this study observed a high prevalence of diabetes in Brazilian adults over time and with a progressive increase in the last 35 years.
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Affiliation(s)
- Gabriela H. Telo
- Internal Medicine Department, Medical School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, CEP 90035-903 Brazil
| | - Felipe Vogt Cureau
- Postgraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Martina S. de Souza
- Internal Medicine Department, Medical School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, CEP 90035-903 Brazil
| | - Thais S. Andrade
- Internal Medicine Department, Medical School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, CEP 90035-903 Brazil
| | - Fabiana Copês
- Internal Medicine Department, Medical School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, CEP 90035-903 Brazil
- Departament of Nutrition, Universidade Federal do Pampa, Campus Itaqui, Brazil
| | - Beatriz D. Schaan
- Internal Medicine Department, Medical School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, CEP 90035-903 Brazil
- Postgraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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108
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Li X, Cai X, Ma X, Jing L, Gu J, Bao L, Li J, Xu M, Zhang Z, Li Y. Short- and Long-Term Effects of Wholegrain Oat Intake on Weight Management and Glucolipid Metabolism in Overweight Type-2 Diabetics: A Randomized Control Trial. Nutrients 2016; 8:nu8090549. [PMID: 27618090 PMCID: PMC5037534 DOI: 10.3390/nu8090549] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 12/23/2022] Open
Abstract
Glycemic control and weight reduction are primary goals for the management of overweight and obese type 2 diabetes mellitus (T2DM). Effective management cannot be achieved without an appropriate diet. Our study aimed to evaluate the short- and long-term effects of oat intake and develop a reasonable dietary plan for overweight T2DM patients. A randomized control trial, registered under ClinicalTrials.gov (Identification code: NCT01495052), was carried out among adult T2DM patients. A subgroup of 298 overweight subjects was selected and received a 30-day centralized intervention and 1-year free-living follow-up. Participants were randomly allocated to one of the following four groups. The usual care group (n = 60) received no intervention; the healthy diet group (n = 79) received a low-fat and high-fiber diet (“healthy diet”); the 50 g-oats group (n = 80) and 100 g-oats group (n = 79) received the “healthy diet” with the same amount of cereals replaced by 50 g and 100 g oats respectively. Anthropometric, blood glycemic and lipid variables were measured. For the 30-day intervention, significant differences in the changes of FPG (fasting plasma glucose), PPG (postprandial plasma glucose), HbA1c (glycosylated hemoglobin), HOMA-IR (homeostasis model assessment of insulin resistance), TC (total cholesterol), TG (total triglycerides), and LDL-c (low-density lipoprotein cholesterol) were observed among the four groups. Compared to the healthy diet group, the 50 g-oats group had a bigger reduction in PPG (mean difference (MD): −1.04 mmol/L; 95% CI: −2.03, −0.05) and TC (MD: −0.24 mmol/L; 95% CI: −0.47, −0.01); the 100 g-oats group had a bigger reduction in PPG (MD: −1.48 mmol/L; 95% CI: −2.57, −0.39), HOMA-IR (MD: −1.77 mU·mol/L2; 95% CI: −3.49, −0.05), TC (MD: −0.33 mmol/L; 95% CI: −0.56, −0.10) and LDL-c (MD: −0.22 mmol/L; 95% CI: −0.41, −0.03). In the 1-year follow-up, greater effects in reducing weight (MD: −0.89 kg; 95% CI: −1.56, −0.22), HbA1c (MD: −0.64%; 95% CI: −1.19, −0.09) and TG (MD: −0.70 mmol/L; 95% CI: −1.11, −0.29) were observed in the 100 g-oats group. In conclusion, short- and long-term oat intake had significant effects on controlling hyperglycemia, lowering blood lipid and reducing weight. Our study provided some supportive evidence for recommending oat as a good whole grain selection for overweight diabetics.
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Affiliation(s)
- Xue Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK.
| | - Xiaxia Cai
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
- Department of Nutrition and Food Hygiene, School of Public Health, Capital Medical University, Beijing 100191, China.
| | - Xiaotao Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
- Department of Clinical Nutrition, China-Japan Friendship Hospital, Peking University, Beijing 100191, China.
| | - Lulu Jing
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Jiaojiao Gu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Lei Bao
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
- Department of Clinical Nutrition, International Hospital, Peking University, Beijing 100191, China.
| | - Jun Li
- The 153 Hospital of People's Liberation Army, Zhengzhou 450001, China.
| | - Meihong Xu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Zhaofeng Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Yong Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
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Hird TR, Pirie FJ, Esterhuizen TM, O’Leary B, McCarthy MI, Young EH, Sandhu MS, Motala AA. Burden of Diabetes and First Evidence for the Utility of HbA1c for Diagnosis and Detection of Diabetes in Urban Black South Africans: The Durban Diabetes Study. PLoS One 2016; 11:e0161966. [PMID: 27560687 PMCID: PMC4999239 DOI: 10.1371/journal.pone.0161966] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/15/2016] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Glycated haemoglobin (HbA1c) is recommended as an additional tool to glucose-based measures (fasting plasma glucose [FPG] and 2-hour plasma glucose [2PG] during oral glucose tolerance test [OGTT]) for the diagnosis of diabetes; however, its use in sub-Saharan African populations is not established. We assessed prevalence estimates and the diagnosis and detection of diabetes based on OGTT, FPG, and HbA1c in an urban black South African population. RESEARCH DESIGN AND METHODS We conducted a population-based cross-sectional survey using multistage cluster sampling of adults aged ≥18 years in Durban (eThekwini municipality), KwaZulu-Natal. All participants had a 75-g OGTT and HbA1c measurements. Receiver operating characteristic (ROC) analysis was used to assess the overall diagnostic accuracy of HbA1c, using OGTT as the reference, and to determine optimal HbA1c cut-offs. RESULTS Among 1190 participants (851 women, 92.6% response rate), the age-standardised prevalence of diabetes was 12.9% based on OGTT, 11.9% based on FPG, and 13.1% based on HbA1c. In participants without a previous history of diabetes (n = 1077), using OGTT as the reference, an HbA1c ≥48 mmol/mol (6.5%) detected diabetes with 70.3% sensitivity (95%CI 52.7-87.8) and 98.7% specificity (95%CI 97.9-99.4) (AUC 0.94 [95%CI 0.89-1.00]). Additional analyses suggested the optimal HbA1c cut-off for detection of diabetes in this population was 42 mmol/mol (6.0%) (sensitivity 89.2% [95%CI 78.6-99.8], specificity 92.0% [95%CI: 90.3-93.7]). CONCLUSIONS In an urban black South African population, we found a high prevalence of diabetes and provide the first evidence for the utility of HbA1c for the diagnosis and detection of diabetes in black Africans in sub-Saharan Africa.
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Affiliation(s)
- Thomas R. Hird
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Fraser J. Pirie
- Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Tonya M. Esterhuizen
- Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Brian O’Leary
- Research and Policy Department, Office of Strategy Management, eThekwini Municipality, Durban, South Africa
| | - Mark I. McCarthy
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, United Kingdom
| | - Elizabeth H. Young
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Manjinder S. Sandhu
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Ayesha A. Motala
- Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Sacks DB. Hemoglobin A1c and Race: Should Therapeutic Targets and Diagnostic Cutoffs Differ among Racial Groups? Clin Chem 2016; 62:1199-201. [PMID: 27386851 DOI: 10.1373/clinchem.2016.255166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 05/31/2016] [Indexed: 11/06/2022]
Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD.
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111
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Sattar N, Preiss D. Screening for diabetes in patients with cardiovascular disease: HbA1c trumps oral glucose tolerance testing. Lancet Diabetes Endocrinol 2016; 4:560-2. [PMID: 27039357 DOI: 10.1016/s2213-8587(16)00085-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 02/26/2016] [Accepted: 03/02/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, UK.
| | - David Preiss
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
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Hou YC, Lai CH, Wu YT, Yang SH. Gray matter alterations and correlation of nutritional intake with the gray matter volume in prediabetes. Medicine (Baltimore) 2016; 95:e3956. [PMID: 27336893 PMCID: PMC4998331 DOI: 10.1097/md.0000000000003956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The neurophysiology of prediabetes plays an important role in preventive medicine. The dysregulation of glucose metabolism is likely linked to changes in neuron-related gray matter. Therefore, we designed this study to investigate gray matter alterations in medication-naive prediabetic patients. We expected to find alterations in the gray matter of prediabetic patients.A total of 64 prediabetic patients and 54 controls were enrolled. All subjects received T1 scans using a 3-T magnetic resonance imaging machine. Subjects also completed nutritional intake records at the 24-hour and 3-day time points to determine their carbohydrate, protein, fat, and total calorie intake. We utilized optimized voxel-based morphometry to estimate the gray matter differences between the patients and controls. In addition, the preprandial serum glucose level and the carbohydrate, protein, fat, and total calorie intake levels were tested to determine whether these parameters were correlated with the gray matter volume.Prediabetic patients had lower gray matter volumes than controls in the right anterior cingulate gyrus, right posterior cingulate gyrus, left insula, left super temporal gyrus, and left middle temporal gyrus (corrected P < 0.05; voxel threshold: 33). Gray matter volume in the right anterior cingulate was also negatively correlated with the preprandial serum glucose level gyrus in a voxel-dependent manner (r = -0.501; 2-tailed P = 0.001).The cingulo-temporal and insula gray matter alterations may be associated with the glucose dysregulation in prediabetic patients.
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Affiliation(s)
- Yi-Cheng Hou
- Department of Nutrition, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
- School of Nutrition and Health Sciences, College of Public Health and Nutrition, Taipei Medical University
| | - Chien-Han Lai
- Department of Biomedical Imaging and Radiological Sciences
- Institute of Biophotonics, National Yang-Ming University, Taipei
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei City, Taiwan, ROC
| | - Yu-Te Wu
- Department of Biomedical Imaging and Radiological Sciences
- Institute of Biophotonics, National Yang-Ming University, Taipei
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, College of Public Health and Nutrition, Taipei Medical University
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113
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Nielsen ML, Pareek M, Leósdóttir M, Højlund K, Eriksson KF, Nilsson PM, Olsen MH. Follow-up duration influences the relative importance of OGTT and optimal timing of glucose measurements for predicting future type 2 diabetes. Eur J Endocrinol 2016; 174:591-600. [PMID: 26873227 DOI: 10.1530/eje-15-1221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/11/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the impact of follow-up duration on the incremental prognostic yield of a baseline oral glucose tolerance test (OGTT) for predicting type 2 diabetes and to assess the discrimination ability of blood glucose (BG) obtained at different time points during OGTT. DESIGN A prospective, population-based cohort study (Malmö Preventive Project) with inclusion of subjects from 1974 to 1992. METHODS A total of 5256 men without diabetes, who had BG measured at 0, 20, 40, 60, 90, and 120 min during OGTT (30 g/m2 glucose), were followed for 30 years. Incident type 2 diabetes was recorded using registries. The performance of OGTT added to a clinical prediction model (age, body mass index (BMI), diastolic blood pressure, fasting BG, triglycerides, and family history of diabetes) was assessed using Harrell's concordance index (C-index) and integrated discrimination improvement (IDI). RESULTS Median age was 48 years, mean BMI 24.9 kg/m2, and mean fasting BG 4.7 mmol/L. Models with added post-load BG performed better than the clinical model (C-index: P = 0.08 for BG at 120 min at 5 years, otherwise P ≤ 0.045; IDI: P ≥ 0.06 for BG at 60 and 90 min at 5 years, otherwise P ≤ 0.01). With a longer follow-up duration, C-index decreased, and the C-index increase associated with OGTT was attenuated. Models including BG at 60 or 90 min performed significantly better than the model with BG at 120 min, evident beyond follow-up of 10 and 5 years, respectively. CONCLUSIONS OGTT provided incremental prognostic yield for type 2 diabetes prediction. BG measured at 60 or 90 min provided better discrimination than BG at 120 min.
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Affiliation(s)
- Mette Lundgren Nielsen
- Cardiovascular and Metabolic Preventive ClinicDepartment of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
| | - Manan Pareek
- Cardiovascular and Metabolic Preventive ClinicDepartment of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
| | | | - Kurt Højlund
- Department of EndocrinologyOdense University Hospital, Odense, Denmark Section of Molecular Diabetes & MetabolismInstitute of Molecular Medicine & Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Peter M Nilsson
- Department of Clinical SciencesLund University, Skåne University Hospital, Malmö, Sweden
| | - Michael Hecht Olsen
- Cardiovascular and Metabolic Preventive ClinicDepartment of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark Hypertension in Africa Research Team (HART)North-West University, Potchefstroom, South Africa
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114
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Nieto-Martínez R, González-Rivas JP, Lima-Martínez M, Stepenka V, Rísquez A, Mechanick JI. Diabetes Care in Venezuela. Ann Glob Health 2016; 81:776-91. [DOI: 10.1016/j.aogh.2015.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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115
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Zhang M, Zhang H, Wang C, Ren Y, Wang B, Zhang L, Yang X, Zhao Y, Han C, Pang C, Yin L, Xue Y, Zhao J, Hu D. Development and Validation of a Risk-Score Model for Type 2 Diabetes: A Cohort Study of a Rural Adult Chinese Population. PLoS One 2016; 11:e0152054. [PMID: 27070555 PMCID: PMC4829145 DOI: 10.1371/journal.pone.0152054] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 03/08/2016] [Indexed: 11/24/2022] Open
Abstract
Some global models to predict the risk of diabetes may not be applicable to local populations. We aimed to develop and validate a score to predict type 2 diabetes mellitus (T2DM) in a rural adult Chinese population. Data for a cohort of 12,849 participants were randomly divided into derivation (n = 11,564) and validation (n = 1285) datasets. A questionnaire interview and physical and blood biochemical examinations were performed at baseline (July to August 2007 and July to August 2008) and follow-up (July to August 2013 and July to October 2014). A Cox regression model was used to weigh each variable in the derivation dataset. For each significant variable, a score was calculated by multiplying β by 100 and rounding to the nearest integer. Age, body mass index, triglycerides and fasting plasma glucose (scores 3, 12, 24 and 76, respectively) were predictors of incident T2DM. The model accuracy was assessed by the area under the receiver operating characteristic curve (AUC), with optimal cut-off value 936. With the derivation dataset, sensitivity, specificity and AUC of the model were 66.7%, 74.0% and 0.768 (95% CI 0.760–0.776), respectively. With the validation dataset, the performance of the model was superior to the Chinese (simple), FINDRISC, Oman and IDRS models of T2DM risk but equivalent to the Framingham model, which is widely applicable in a variety of populations. Our model for predicting 6-year risk of T2DM could be used in a rural adult Chinese population.
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Affiliation(s)
- Ming Zhang
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
| | - Hongyan Zhang
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Chongjian Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Yongcheng Ren
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Bingyuan Wang
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Lu Zhang
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Xiangyu Yang
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Yang Zhao
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Chengyi Han
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Chao Pang
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, Henan, People’s Republic of China
| | - Lei Yin
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, Henan, People’s Republic of China
| | - Yuan Xue
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Jingzhi Zhao
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, Henan, People’s Republic of China
- * E-mail: (DH); (JZ)
| | - Dongsheng Hu
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- * E-mail: (DH); (JZ)
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116
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Abstract
BACKGROUND One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. METHODS We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence-defined as fasting plasma glucose of 7.0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs-in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. FINDINGS We used data from 751 studies including 4,372,000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4.3% (95% credible interval 2.4-7.0) in 1980 to 9.0% (7.2-11.1) in 2014 in men, and from 5.0% (2.9-7.9) to 7.9% (6.4-9.7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28.5% due to the rise in prevalence, 39.7% due to population growth and ageing, and 31.8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. INTERPRETATION Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries. FUNDING Wellcome Trust.
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117
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Liu M, Wang J, He Y, Jiang B, Wu L, Wang Y, Di Z, Zeng J. Awareness, treatment and control of type 2 diabetes among Chinese elderly and its changing trend for past decade. BMC Public Health 2016; 16:278. [PMID: 26987372 PMCID: PMC4797198 DOI: 10.1186/s12889-016-2874-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/16/2016] [Indexed: 12/25/2022] Open
Abstract
Background This study aims to evaluate the awareness, treatment, control rate of type 2 diabetes and its risk factors among Chinese community elderly, and also examine the changing trend for the past decade. Methods We conducted two population-based cross-sectional studies in a representative urban area of Beijing in 2001 and 2010 respectively, using with the same method. A total of 2,277 participants (943 male, 1,334 female) in 2001 and 2,102 participants (848 male, 1,254 female) in 2010 were recruited. All the participants diagnosed with diabetes were included in this study. Results The prevalence of diabetes was 21.4 % and 24.8 % in 2001 and 2010 respectively. Among participants with diabetes, 74.2 % were aware of the condition, 51.0 % were treated, 20.1 % well controlled the condition in 2001, and the corresponding rates were 78.5 %, 69.3 %,15.9 % in 2010 respectively. Higher education level and a positive family history were related to better management of diabetes, while obesity and alcohol drinking showed a reverse direction. Conclusions The prevalence and awareness of diabetes stayed high for the past decade. The treatment increased 18.3 % while the control rate decreased among community elderly for the past 10 years. It’s urgent to carry out effective measures to raise awareness, treatment, and control rate of diabetes in order to avoid growing disease burden in China.
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Affiliation(s)
- Miao Liu
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jianhua Wang
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yao He
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China. .,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China. .,State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Bin Jiang
- Department of Chinese Traditional Medicine and Acupuncture, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Lei Wu
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yiyan Wang
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhang Di
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jing Zeng
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
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118
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Ikeda N. Secondary Data Analysis of National Surveys in Japan Toward Improving Population Health. J Epidemiol 2016; 26:106-14. [PMID: 26902170 PMCID: PMC4773486 DOI: 10.2188/jea.je20150319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Secondary data analysis of national health surveys of the general population is a standard methodology for health metrics and evaluation; it is used to monitor trends in population health over time and benchmark the performance of health systems. In Japan, the government has established electronic databases of individual records from national surveys of the population’s health. However, the number of publications based on these datasets is small considering the scale and coverage of the surveys. There appear to be two major obstacles to the secondary use of Japanese national health survey data: strict data access control under the Statistics Act and an inadequate interdisciplinary research environment for resolving methodological difficulties encountered when dealing with secondary data. The usefulness of secondary analysis of survey data is evident with examples from the author’s previous studies based on vital records and the National Health and Nutrition Surveys, which showed that (i) tobacco smoking and high blood pressure are the major risk factors for adult mortality from non-communicable diseases in Japan; (ii) the decrease in mean blood pressure in Japan from the late 1980s to the early 2000s was partly attributable to the increased use of antihypertensive medication and reduced dietary salt intake; and (iii) progress in treatment coverage and control of high blood pressure is slower in Japan than in the United States and Britain. National health surveys in Japan are an invaluable asset, and findings from secondary analyses of these surveys would provide important suggestions for improving health in people around the world.
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Affiliation(s)
- Nayu Ikeda
- Center for International Collaboration and Partnership, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
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119
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Boillat-Blanco N, Ramaiya KL, Mganga M, Minja LT, Bovet P, Schindler C, Von Eckardstein A, Gagneux S, Daubenberger C, Reither K, Probst-Hensch N. Transient Hyperglycemia in Patients With Tuberculosis in Tanzania: Implications for Diabetes Screening Algorithms. J Infect Dis 2015; 213:1163-72. [PMID: 26609005 DOI: 10.1093/infdis/jiv568] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/19/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) increases tuberculosis risk while tuberculosis, as an infectious disease, leads to hyperglycemia. We compared hyperglycemia screening strategies in controls and patients with tuberculosis in Dar es Salaam, Tanzania. METHODS Consecutive adults with tuberculosis and sex- and age-matched volunteers were included in a case-control study between July 2012 and June 2014. All underwent DM screening tests (fasting capillary glucose [FCG] level, 2-hour CG [2-hCG] level, and glycated hemoglobin A1c [HbA1c] level) at enrollment, and cases were tested again after receipt of tuberculosis treatment. Association of tuberculosis and its outcome with hyperglycemia was assessed using logistic regression analysis adjusted for sex, age, body mass index, human immunodeficiency virus infection status, and socioeconomic status. Patients with tuberculosis and newly diagnosed DM were not treated for hyperglycemia. RESULTS At enrollment, DM prevalence was significantly higher among patients with tuberculosis (n = 539; FCG level > 7 mmol/L, 4.5% of patients, 2-hCG level > 11 mmol/L, 6.8%; and HbA1c level > 6.5%, 9.3%), compared with controls (n = 496; 1.2%, 3.1%, and 2.2%, respectively). The association between hyperglycemia and tuberculosis disappeared after tuberculosis treatment (adjusted odds ratio [aOR] for the FCG level: 9.6 [95% confidence interval {CI}, 3.7-24.7] at enrollment vs 2.4 [95% CI, .7-8.7] at follow-up; aOR for the 2-hCG level: 6.6 [95% CI, 4.0-11.1] vs 1.6 [95% CI, .8-2.9]; and aOR for the HbA1c level, 4.2 [95% CI, 2.9-6.0] vs 1.4 [95% CI, .9-2.0]). Hyperglycemia, based on the FCG level, at enrollment was associated with tuberculosis treatment failure or death (aOR, 3.3; 95% CI, 1.2-9.3). CONCLUSIONS Transient hyperglycemia is frequent during tuberculosis, and DM needs confirmation after tuberculosis treatment. Performance of DM screening at tuberculosis diagnosis gives the opportunity to detect patients at risk of adverse outcome.
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Affiliation(s)
- Noémie Boillat-Blanco
- Ifakara Health Institute Swiss Tropical and Public Health Institute Department of Sciences, University of Basel Infectious Diseases Service
| | | | - Maliwasa Mganga
- Kinondoni Municipal Council, National Tuberculosis Program, Dar es Salaam, United Republic of Tanzania
| | | | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne University Hospital
| | - Christian Schindler
- Swiss Tropical and Public Health Institute Department of Sciences, University of Basel
| | - Arnold Von Eckardstein
- Institute of Clinical Chemistry, University of Zurich, University Hospital of Zurich, Switzerland
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute Department of Sciences, University of Basel
| | - Claudia Daubenberger
- Swiss Tropical and Public Health Institute Department of Sciences, University of Basel
| | - Klaus Reither
- Ifakara Health Institute Swiss Tropical and Public Health Institute Department of Sciences, University of Basel
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute Department of Sciences, University of Basel
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