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te Loo LM, Holla JFM, Vrijsen J, Driessen A, van Dijk ML, Linders L, van den Akker-Scheek I, Bouma A, Schans L, Schouten L, Rijnbeek P, Dekker R, de Bruijne M, van der Ploeg HP, van Mechelen W, Jelsma JGM. Implementation barriers and facilitators for referral from the hospital to community-based lifestyle interventions from the perspective of lifestyle professionals: A qualitative study. PLoS One 2024; 19:e0304053. [PMID: 38935601 PMCID: PMC11210764 DOI: 10.1371/journal.pone.0304053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/07/2024] [Indexed: 06/29/2024] Open
Abstract
PURPOSE A lifestyle front office (LFO) in the hospital is a not yet existing, novel concept that can refer patients under treatment in the hospital to community-based lifestyle interventions (CBLI). The aim of this study was to identify implementation barriers and facilitators regarding the implementation of an LFO in the hospital from the perspective of CBLI-professionals and to develop evidence-based implementation strategies to reduce these identified barriers. METHODS We conducted semi-structured interviews until data saturation, with 23 lifestyle professionals working in the community. A semi-structured topic guide was used, inquiring about (1) community-based lifestyle interventions; (2) their views about referral from the LFO; and (3) their preferences, needs and recommendations for collaboration with the LFO in the hospital. The online interviews lasted on average 46 minutes, were audio-recorded and transcribed verbatim. A thematic content analysis was conducted. Found barriers and facilitators regarding the LFO where mapped using the consolidated framework for implementation research (CFIR) whereafter evidence based strategies were developed using the CFIR-Expert Recommendations for Implementing Change Strategy Matching Tool V.1.0 (CFIR-ERIC). RESULTS Barriers and facilitators were divided into two main themes: 1) barriers and facilitators related to the referral from LFO to CBLI (i.e. financial, cultural, geographical, quality) and 2) barriers and facilitators related to the collaboration between LFO and CBLI (i.e. referral, communication platform and partnership). Thirty-seven implementation strategies concerning 15 barriers were developed and clustered into six overarching strategies: identify referral options, determine qualifications lifestyle professionals, develop support tools, build networks, facilitate learning collaboratives, and optimize workflow. CONCLUSIONS In this study, barriers and facilitators for the development of the LFO were found and matching implementation strategies were developed. Practical improvements, like identifying specific referral options or develop support tools, can be implemented immediately. The implementation of other strategies, like connecting care pathways in basic services, primary, secondary and tertiary care, will take more time and effort to come to full potential. Future research should evaluate all implemented strategies.
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Affiliation(s)
- Leonie M. te Loo
- Amsterdam UMC, Department of Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Centre of Expertise Prevention in Care and Wellbeing, Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
| | - Jasmijn F. M. Holla
- Centre of Expertise Prevention in Care and Wellbeing, Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, The Netherlands
| | - Joyce Vrijsen
- University Medical Center Groningen, Department of Orthopedics, University of Groningen, Groningen, The Netherlands
| | - Anouk Driessen
- Amsterdam UMC, Department of Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Marlinde L. van Dijk
- Amsterdam UMC, Department of Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Lilian Linders
- Centre of Expertise Prevention in Care and Wellbeing, Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
| | - Inge van den Akker-Scheek
- University Medical Center Groningen, Department of Orthopedics, University of Groningen, Groningen, The Netherlands
| | - Adrie Bouma
- University Medical Centre Groningen, Department Policy Development in Healthcare Relations, University of Groningen, Groningen, The Netherlands
| | - Leah Schans
- Huis voor de Sport Groningen, Groningen, The Netherlands
| | | | | | - Rienk Dekker
- University Medical Centre Groningen, Department of Rehabilitation, University of Groningen, Groningen, the Netherlands
| | - Martine de Bruijne
- Amsterdam UMC, Department of Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Hidde P. van der Ploeg
- Amsterdam UMC, Department of Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Willem van Mechelen
- Amsterdam UMC, Department of Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Judith G. M. Jelsma
- Amsterdam UMC, Department of Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
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Andersen AMJ, Jervelund SS, Maindal HT, Hempler NF. Acquisition, application, and distribution of health literacy from culturally sensitive type 2 diabetes education among Arabic-Speaking migrants in Denmark: A longitudinal qualitative analysis. Scand J Caring Sci 2024; 38:523-535. [PMID: 38031875 DOI: 10.1111/scs.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 10/06/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Effective self-management of type 2 diabetes requires adequate health literacy (HL) and a supportive network. Diabetes self-management education and support programmes play a crucial role in improving these factors. However, limited research exists on how such programmes can support health literacy among migrants and facilitate the dissemination of knowledge within their social networks. AIM This study aimed to investigate the perspectives of Arabic-speaking informants with a migrant background in relation to how their type 2 diabetes-related health literacy was acquired, applied and distributed within social networks through participation in a culturally sensitive diabetes self-management education and support (DSMES) programme. METHODS Semi-structured interviews were conducted with 12 informants during the programme and three to 7 months later, from September 2019 to May 2020. Abductive analysis was applied using HL and distributed health literacy (DHL) theory as frameworks. RESULTS The analysis generated three themes: (1) sources of health information and the development of health literacy; (2) changes towards active self-management; and (3) distributed health literacy. Prior to programme participation, informants faced challenges in navigating conflicting information from family, friends and social media. After participating in the programme, they reported improvements in HL, particularly in knowledge acquisition. Many became more actively engaged in decision-making and exhibited improved health behaviours, such as dietary choices. Nonetheless, some informants continued to struggle with choosing appropriate prevention and treatment strategies. Notably, certain informants acted as HL mediators, sharing their newly acquired knowledge within their social networks in Denmark and abroad. CONCLUSION Culturally sensitive diabetes self-management education programmes have the potential to enhance HL among migrants, leading to the distribution of relevant diabetes knowledge within their social networks. Future studies should explore how members of migrants' social networks perceive their supportive role in type 2 diabetes management. Programmes can benefit from emphasising critical HL and exploring how participant-informants effectively communicate diabetes-related knowledge within their networks to address misinformation and conflicting information.
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Affiliation(s)
- Anne Mette Juul Andersen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen K, Denmark
| | - Signe Smith Jervelund
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen K, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
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Agyemang C, van der Linden EL, Chilunga F, van den Born BH. International Migration and Cardiovascular Health: Unraveling the Disease Burden Among Migrants to North America and Europe. J Am Heart Assoc 2024; 13:e030228. [PMID: 38686900 PMCID: PMC11179927 DOI: 10.1161/jaha.123.030228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/26/2023] [Indexed: 05/02/2024]
Abstract
Europe and North America are the 2 largest recipients of international migrants from low-resource regions in the world. Here, large differences in cardiovascular disease (CVD) morbidity and death exist between migrants and the host populations. This review discusses the CVD burden and its most important contributors among the largest migrant groups in Europe and North America as well as the consequences of migration to high-income countries on CVD diagnosis and therapy. The available evidence indicates that migrants in Europe and North America generally have a higher CVD risk compared with the host populations. Cardiometabolic, behavioral, and psychosocial factors are important contributors to their increased CVD risk. However, despite these common denominators, there are important ethnic differences in the propensity to develop CVD that relate to pre- and postmigration factors, such as socioeconomic status, cultural factors, lifestyle, psychosocial stress, access to health care and health care usage. Some of these pre- and postmigration environmental factors may interact with genetic (epigenetics) and microbial factors, which further influence their CVD risk. The limited number of prospective cohorts and clinical trials in migrant populations remains an important culprit for better understanding pathophysiological mechanism driving health differences and for developing ethnic-specific CVD risk prediction and care. Only by improved understanding of the complex interaction among human biology, migration-related factors, and sociocultural determinants of health influencing CVD risk will we be able to mitigate these differences and truly make inclusive personalized treatment possible.
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Affiliation(s)
- Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMCUniversity of Amsterdam, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Division of Endocrinology, Diabetes, and Metabolism, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Eva L. van der Linden
- Department of Public and Occupational Health, Amsterdam UMCUniversity of Amsterdam, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Department of Vascular Medicine, Amsterdam UMCUniversity of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Felix Chilunga
- Department of Public and Occupational Health, Amsterdam UMCUniversity of Amsterdam, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Bert‐Jan H. van den Born
- Department of Public and Occupational Health, Amsterdam UMCUniversity of Amsterdam, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Department of Vascular Medicine, Amsterdam UMCUniversity of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
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Mertens E, Ocira J, Sagastume D, Vasquez MS, Vandevijvere S, Peñalvo JL. The future burden of type 2 diabetes in Belgium: a microsimulation model. Popul Health Metr 2024; 22:8. [PMID: 38654242 DOI: 10.1186/s12963-024-00328-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE To forecast the annual burden of type 2 diabetes and related socio-demographic disparities in Belgium until 2030. METHODS This study utilized a discrete-event transition microsimulation model. A synthetic population was created using 2018 national register data of the Belgian population aged 0-80 years, along with the national representative prevalence of diabetes risk factors obtained from the latest (2018) Belgian Health Interview and Examination Surveys using Multiple Imputation by Chained Equations (MICE) as inputs to the Simulation of Synthetic Complex Data (simPop) model. Mortality information was obtained from the Belgian vital statistics and used to calculate annual death probabilities. From 2018 to 2030, synthetic individuals transitioned annually from health to death, with or without developing type 2 diabetes, as predicted by the Finnish Diabetes Risk Score, and risk factors were updated via strata-specific transition probabilities. RESULTS A total of 6722 [95% UI 3421, 11,583] new cases of type 2 diabetes per 100,000 inhabitants are expected between 2018 and 2030 in Belgium, representing a 32.8% and 19.3% increase in T2D prevalence rate and DALYs rate, respectively. While T2D burden remained highest for lower-education subgroups across all three Belgian regions, the highest increases in incidence and prevalence rates by 2030 are observed for women in general, and particularly among Flemish women reporting higher-education levels with a 114.5% and 44.6% increase in prevalence and DALYs rates, respectively. Existing age- and education-related inequalities will remain apparent in 2030 across all three regions. CONCLUSIONS The projected increase in the burden of T2D in Belgium highlights the urgent need for primary and secondary preventive strategies. While emphasis should be placed on the lower-education groups, it is also crucial to reinforce strategies for people of higher socioeconomic status as the burden of T2D is expected to increase significantly in this population segment.
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Affiliation(s)
- Elly Mertens
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Junior Ocira
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Access-To-Medicines Research Centre, Faculty of Economics and Business, KU Leuven, Louvain, Belgium
| | - Diana Sagastume
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Maria Salve Vasquez
- Department of Epidemiology and Public Health, Service of Health Information, Sciensano, Brussels, Belgium
| | - Stefanie Vandevijvere
- Department of Epidemiology and Public Health, Service of Health Information, Sciensano, Brussels, Belgium
| | - José L Peñalvo
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
- Global Health Institute, University of Antwerp, Antwerp, Belgium.
- National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
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Alramah T, Cherian P, Al-Khairi I, Abu-Farha M, Thanaraj TA, Albatineh AN, Safadi F, Ali H, Abdul-Ghani M, Tuomilehto J, Koistinen HA, Al-Mulla F, Abubaker J. Evaluating the correlation of sclerostin levels with obesity and type 2 diabetes in a multiethnic population living in Kuwait. Front Endocrinol (Lausanne) 2024; 15:1392675. [PMID: 38711986 PMCID: PMC11070556 DOI: 10.3389/fendo.2024.1392675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/09/2024] [Indexed: 05/08/2024] Open
Abstract
Obesity and Type 2 Diabetes Mellitus (T2DM) are intricate metabolic disorders with a multifactorial etiology, often leading to a spectrum of complications. Recent research has highlighted the impact of these conditions on bone health, with a particular focus on the role of sclerostin (SOST), a protein molecule integral to bone metabolism. Elevated circulating levels of SOST have been observed in patients with T2DM compared to healthy individuals. This study aims to examine the circulating levels of SOST in a multiethnic population living in Kuwait and to elucidate the relationship between SOST levels, obesity, T2DM, and ethnic background. The study is a cross-sectional analysis of a large cohort of 2083 individuals living in Kuwait. The plasma level of SOST was measured using a bone panel multiplex assay. The study found a significant increase in SOST levels in individuals with T2DM (1008.3 pg/mL, IQR-648) compared to non-diabetic individuals (710.6 pg/mL, IQR-479). There was a significant gender difference in median SOST levels, with males exhibiting higher levels than females across various covariates (diabetes, IR, age, weight, and ethnicity). Notably, SOST levels varied significantly with ethnicity: Arabs (677.4 pg/mL, IQR-481.7), South Asians (914.6 pg/mL, IQR-515), and Southeast Asians (695.2 pg/mL, IQR-436.8). Furthermore, SOST levels showed a significant positive correlation with gender, age, waist circumference, systolic and diastolic blood pressure, fasting blood glucose, HbA1c, insulin, total cholesterol, triglycerides, HDL, LDL, ALT, and AST (p-Value ≥0.05). South Asian participants, who exhibited the highest SOST levels, demonstrated the most pronounced associations, even after adjusting for age, gender, BMI, and diabetes status (p-Value ≥0.05). The observed correlations of SOST with various clinical parameters suggest its significant role in the diabetic milieu, particularly pronounced in the South Asian population compared to other ethnic groups.
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Affiliation(s)
- Tahani Alramah
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman, Kuwait
| | - Preethi Cherian
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman, Kuwait
| | - Irina Al-Khairi
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman, Kuwait
| | - Mohamed Abu-Farha
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman, Kuwait
- Department of Translational Research, Dasman Diabetes Institute, Dasman, Kuwait
| | | | | | - Fayez Safadi
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, United States
- Rebecca D. Considine Research Institute, Akron Children Hospital, Akron, OH, United States
| | - Hamad Ali
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Health Sciences Center, Kuwait University, Jabriya, Kuwait
| | - Muhammad Abdul-Ghani
- Department of Translational Research, Dasman Diabetes Institute, Dasman, Kuwait
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX, United States
| | - Jaakko Tuomilehto
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Heikki A. Koistinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Internal Medicine and Endocrinology, Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Fahd Al-Mulla
- Department of Translational Research, Dasman Diabetes Institute, Dasman, Kuwait
- Genetics and Bioinformatics Department, Dasman Diabetes Institute, Dasman, Kuwait
| | - Jehad Abubaker
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman, Kuwait
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Crișan D, Avram L, Grapă C, Nemeș A, Coman MV, Beldean-Galea MS, Coman RT, Călinici T, Donca V, Crăciun R. Unveiling Health Inequalities: Exploring Metabolic Dysfunction in Rural Roma Communities. Healthcare (Basel) 2024; 12:816. [PMID: 38667578 PMCID: PMC11050184 DOI: 10.3390/healthcare12080816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/29/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Europe's largest ethnic minority, the Roma, are often confronted with substantial obstacles that result in health disparities. Research indicates that there are elevated rates of both communicable and non-communicable diseases, such as metabolic syndrome (MetS), among Roma communities, often linked to living conditions, limited education, or poverty. This study centers on remote rural Roma settlements in Romania, evaluating the prevalence of metabolic dysfunction, obesity, and liver steatosis while considering socio-economic and lifestyle factors. METHODS Over a period of 36 months, local visits to a total of 25 rural Roma communities were conducted, where a medical team gathered information through a standardized questionnaire and conducted a physical exam on every participant. Liver steatosis was also recorded with the help of a portable wireless ultrasound device. RESULTS Our study included 343 participants, with a predominance of female subjects, representing 72.5% (n = 249) of the patients. The prevalence of obesity, defined by a body mass index (BMI) above 30 kg/m2, was 32.2% (n = 111). Arterial hypertension was found to have a prevalence of 54.1% (n = 185), with de novo hypertension being observed in 19.2% patients (n = 66). Type 2 diabetes mellitus was found in 28.9% patients (n = 99), with 19.5% being de novo cases. The prevalence of hepatic steatosis was 57.2% (n = 111/194). A positive association between metabolic features and at-risk behaviors was found. CONCLUSIONS This study underscores the transition from infectious to metabolic diseases in vulnerable communities and highlights the urgency of targeted public health strategies tailored to the unique needs of rural Roma populations, aiming to mitigate health disparities and promote equitable healthcare access.
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Affiliation(s)
- Dana Crișan
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Lucreția Avram
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Cristiana Grapă
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Andrada Nemeș
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Maria-Virginia Coman
- “Raluca Ripan” Institute for Research in Chemistry, “Babeş-Bolyai” University, 400294 Cluj-Napoca, Romania;
| | | | - Radu-Tudor Coman
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
| | - Tudor Călinici
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
| | - Valer Donca
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Rareș Crăciun
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
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Pellegrino A, Calabrese M, Boddi M, Vacirca I, Baccari C, Bonvicini L, Venturelli F, Petrelli A, Di Napoli A, Perticone M, Rossi PG, Modesti PA. Cardiovascular risk and access to primary care: Comparisons among Chinese documented and undocumented immigrants. Diabetes Res Clin Pract 2024; 210:111645. [PMID: 38554810 DOI: 10.1016/j.diabres.2024.111645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/02/2024]
Abstract
AIMS The aim of this study was to examine main risk factors of undocumented Chinese migrants living in Italy when compared with Chinese migrants registered with National Health Service (NHS). METHODS A cohort of 3435 Chinese first-generation immigrants living in Prato underwent blood pressure (BP) measurement and blood tests. Hypertension was diagnosed for BP ≥ 140/90 mmHg at 2 visits, and/or antihypertensive drug use; type 2 diabetes (T2DM) for fasting glucose ≥ 126 mg/dL at 2 visits, and/or use of hypoglycemic drugs; hypercholesterolemia (HC) for cholesterol ≥ 240 mg/dL and/or statins use. Subjects diagnosed with hypertension, T2DM, or HC unaware of their condition were considered newly diagnosed. Comparisons were performed using multivariable adjusted logistic regression analysis. RESULTS A large proportion of Chinese migrants were undocumented (1766, 51 %); newly diagnoses of risk factors were performed especially among undocumented migrants; registration with NHS was associated with higher level of awareness for hypertension and T2DM and with 6 times higher rate of treatment for T2DM. Only a small minority of subjects with high cholesterol were treated with statins. CONCLUSIONS Undocumented immigrants had high prevalence of risk factors with lower levels of awareness than migrants registered with the NHS. Health policies targeting this hard-to-reach population needs to be improved.
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Affiliation(s)
- Alessio Pellegrino
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Maria Calabrese
- Diabetology Unit, Ospedale Misericordia e Dolce, Prato, Italy
| | - Maria Boddi
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Irene Vacirca
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cecilia Baccari
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Alessio Petrelli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Anteo Di Napoli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pietro Amedeo Modesti
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Medicina Sperimentale e Clinica, University of Florence, Florence, Italy.
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Lau DCW, Shaw E, Farris MS, McMullen S, Brar S, Cowling T, Chatterjee S, Quansah K, Kyaw MH, Girard LP. Prevalence of Adult Type 2 Diabetes Mellitus and Related Complications in Alberta, Canada: A Retrospective, Observational Study Using Administrative Data. Can J Diabetes 2024; 48:155-162.e8. [PMID: 38135113 DOI: 10.1016/j.jcjd.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/28/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease and a leading cause of morbidity/mortality in Canada. We evaluated the burden of T2DM in Alberta, Canada, by estimating the 5-year period prevalence of T2DM and rates of comorbidities and complications/conditions after T2DM. METHODS We conducted a population-based, retrospective study linking administrative health databases. Individuals with T2DM (≥18 years of age) were identified between 2008-2009 and 2018-2019 using a published algorithm, with follow-up data to March 2020. The 5-year period prevalence was estimated for 2014-2015 to 2018-2019. Individuals with newly identified T2DM, ascertained between 2010-2011 and 2017-2018 with a lookback period between 2008-2009 and 2009-2010 and a minimum 1 year of follow-up data, were evaluated for subsequent cardiovascular, diabetic, renal, and other complication/condition frequencies (%) and rates (per 100 person-years). Complications/conditions were stratified by atherosclerotic cardiovascular disease (ASCVD) status at index and age. RESULTS The 5-year period prevalence of T2DM was 11,051 per 100,000 persons, with the highest prevalence in men 65 to <75 years of age. There were 195,102 individuals included in the cohort (mean age 56.7±14.7 years). The most frequently reported complications/conditions (rates per 100 person-years) were acute infection (23.10, 95% confidence interval [CI] 23.00 to 23.30), hypertension (17.30, 95% CI 16.80 to 17.70), and dyslipidemia (12.20, 95% CI 11.90 to 12.40). Individuals who had an ASCVD event/procedure and those ≥75 years of age had higher rates of complications/conditions. CONCLUSIONS We found that over half of the individuals had hypertension or infection after T2DM. Also, those with ASCVD had higher rates of complications/conditions. Strategies to mitigate complications/conditions after T2DM are required to reduce the burden of this disease on individuals and health-care systems.
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Affiliation(s)
- David C W Lau
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
| | - Eileen Shaw
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | - Megan S Farris
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | | | - Saman Brar
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | - Tara Cowling
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | - Satabdi Chatterjee
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut, United States
| | - Kobina Quansah
- Boehringer Ingelheim (Canada), Ltd, Burlington, Ontario, Canada
| | - Moe H Kyaw
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut, United States
| | - Louis P Girard
- Division of Nephrology, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Lahlou RA, Carvalho F, Pereira MJ, Lopes J, Silva LR. Overview of Ethnobotanical-Pharmacological Studies Carried Out on Medicinal Plants from the Serra da Estrela Natural Park: Focus on Their Antidiabetic Potential. Pharmaceutics 2024; 16:454. [PMID: 38675115 PMCID: PMC11054966 DOI: 10.3390/pharmaceutics16040454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
The Serra da Estrela Natural Park (NPSE) in Portugal stands out as a well-preserved region abundant in medicinal plants, particularly known for their pharmaceutical applications in diabetes prevention and treatment. This comprehensive review explores these plants' botanical diversity, traditional uses, pharmacological applications, and chemical composition. The NPSE boast a rich diversity with 138 medicinal plants across 55 families identified as traditionally and pharmacologically used against diabetes globally. Notably, the Asteraceae and Lamiaceae families are prevalent in antidiabetic applications. In vitro studies have revealed their significant inhibition of carbohydrate-metabolizing enzymes, and certain plant co-products regulate genes involved in carbohydrate metabolism and insulin secretion. In vivo trials have demonstrated antidiabetic effects, including glycaemia regulation, insulin secretion, antioxidant activity, and lipid profile modulation. Medicinal plants in NPSE exhibit various activities beyond antidiabetic, such as antioxidant, anti-inflammatory, antibacterial, anti-cancer, and more. Chemical analyses have identified over fifty compounds like phenolic acids, flavonoids, terpenoids, and polysaccharides responsible for their efficacy against diabetes. These findings underscore the potential of NPSE medicinal plants as antidiabetic candidates, urging further research to develop effective plant-based antidiabetic drugs, beverages, and supplements.
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Affiliation(s)
- Radhia Aitfella Lahlou
- SPRINT Sport Physical Activity and Health Research & Innovation Center, Instituto Politécnico da Guarda, 6300-559 Guarda, Portugal; (R.A.L.); (F.C.)
| | - Filomena Carvalho
- SPRINT Sport Physical Activity and Health Research & Innovation Center, Instituto Politécnico da Guarda, 6300-559 Guarda, Portugal; (R.A.L.); (F.C.)
| | - Maria João Pereira
- CERENA/DER, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal;
| | - João Lopes
- iMed.ULisboa, Research Institute for Medicines, Faculdade de Farmácia, University of Lisboa, 1649-003 Lisboa, Portugal;
| | - Luís R. Silva
- SPRINT Sport Physical Activity and Health Research & Innovation Center, Instituto Politécnico da Guarda, 6300-559 Guarda, Portugal; (R.A.L.); (F.C.)
- CICS-UBI—Health Sciences Research Center, University of Beira Interior, 6201-506 Covilhã, Portugal
- CERES, Department of Chemical Engineering, University of Coimbra, 3030-790 Coimbra, Portugal
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10
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Bouchareb S, van der Heijden AA, van Diesen JA, van den Muijsenbergh M, Mennink S, de Vet HC, Blankenstein AH, Elders PJ. Cultural competency of GP trainees and GP trainers: a cross-sectional survey study. Scand J Prim Health Care 2024; 42:101-111. [PMID: 38109181 PMCID: PMC10851837 DOI: 10.1080/02813432.2023.2293927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVE To assess the cultural competence (CC) of GP trainees and GP trainers.Design and setting: A cross-sectional survey study was conducted at the GP Training Institute of Amsterdam UMC. SUBJECTS We included 92 GP trainees and 186 GP trainers. MAIN OUTCOME MEASURES We measured the three domains of cultural competency: 1) knowledge, 2) culturally competent attitudes and 3) culturally competent skills. Regression models were used to identify factors associated with levels of CC. Participants rated their self-perceived CC at the beginning and end of the survey, and the correlation between self-perceived and measured CC was assessed. RESULTS Approximately 94% of the GP trainees and 81% of the GP trainers scored low on knowledge; 45% and 42%, respectively, scored low on culturally competent attitudes. The level of culturally competent skills was moderate (54.3%) or low (48.4%) for most GP trainees and GP trainers. The year of residency and the GP training institute were significantly associated with one or more (sub-)domains of CC in GP trainees. Having >10% migrant patients and experience as a GP trainer were positively associated with one or more (sub-) domains of cultural competence in GP trainers. The correlation between measured and self-perceived CC was positive overall but very weak (Spearman correlation coefficient ranging from -0.1-0.3). CONCLUSION The level of cultural competence was low in both groups, especially in the knowledge scores. Cultural competence increased with experience and exposure to an ethnically diverse patient population. Our study highlights the need for cultural competence training in the GP training curricula.
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Affiliation(s)
- Siham Bouchareb
- Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Amber A.W.A van der Heijden
- Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Josine A.Y van Diesen
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- Pharos, National Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Sylvia Mennink
- Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henrica C.W de Vet
- Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annette H. Blankenstein
- Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Petra J.M Elders
- Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Färber F, Alonso-Perez E, Heidemann C, Du Y, Stadler G, Gellert P, O'Sullivan JL. Intersectional analysis of social disparities in type 2 diabetes risk among adults in Germany: results from a nationwide population-based survey. BMC Public Health 2024; 24:498. [PMID: 38365644 PMCID: PMC10874065 DOI: 10.1186/s12889-024-17903-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/26/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Differences in type 2 diabetes risk have been reported for several sociodemographic determinants including sex/gender or socioeconomic status. From an intersectional perspective, it is important to not only consider the role of social dimensions individually, but also their intersections. This allows for a deeper understanding of diabetes risk and preventive needs among diverse population groups. METHODS As an intersectionality-informed approach, multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was used in a population-based sample of adults without known diabetes in Germany from the cross-sectional survey "Disease knowledge and information needs- Diabetes mellitus (2017)". Diabetes risk was assessed by the German Diabetes Risk Score (GDRS, range 0-122 points), estimating the individual risk of developing type 2 diabetes within the next 5 years based on established self-reported risk factors. Nesting individuals in 12 intersectional strata defined by combining sex/gender, educational level, and history of migration, we calculated measures to quantify the extent to which individual differences in diabetes risk were explained at strata level, and how much this was due to additive or multiplicative intersectional effects of social determinants. RESULTS Drawing on data of 2,253 participants, we found good discriminatory accuracy of intersectional strata (variance partition coefficient = 14.00% in the simple intersectional model). Model-predicted GDRS means varied between 29.97 (corresponding to a "low risk" of < 2%) in women with high educational level and a history of migration, and 52.73 ("still low risk" of 2-5%) in men with low educational level without a history of migration. Variance in GDRS between strata was mainly explained by additive effects of social determinants (proportional change in variance to intersectional interaction model = 77.95%) with being male and having low educational level being associated with higher GDRS. There was no evidence of multiplicative effects in individual strata. CONCLUSIONS Type 2 diabetes risk differed between intersectional strata and can to some extent be explained at strata level. The role of intersectional effects was minor and needs to be further investigated. Findings suggest a need for specific preventive measures targeted at large groups with increased diabetes risk, such as men and persons with low educational level.
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Affiliation(s)
- Francesca Färber
- Institute of Medical Sociology and Rehabilitation Science, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Enrique Alonso-Perez
- Institute of Medical Sociology and Rehabilitation Science, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Einstein Center Population Diversity (ECPD) , Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany
| | - Yong Du
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany
| | - Gertraud Stadler
- Institute of Gender in Medicine (GiM), Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1 , 13353 , Berlin, Germany
| | - Paul Gellert
- Institute of Medical Sociology and Rehabilitation Science, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Einstein Center Population Diversity (ECPD) , Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site Berlin/Potsdam, Berlin, Germany
| | - Julie Lorraine O'Sullivan
- Institute of Medical Sociology and Rehabilitation Science, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Einstein Center Population Diversity (ECPD) , Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site Berlin/Potsdam, Berlin, Germany
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12
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Schäfer I, Tajdar D, Walther L, Bittner L, Lühmann D, Scherer M. Impact of two COVID-19 lockdowns on HbA1c levels in patients with type 2 diabetes and associations with patient characteristics: a multicentre, observational cohort study over three years. Front Public Health 2024; 11:1272769. [PMID: 38249413 PMCID: PMC10796585 DOI: 10.3389/fpubh.2023.1272769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Glycemic effects of COVID-19 lockdowns on patients with type 2 diabetes (T2D) are controversial. In this long-term observation, we aimed (1) to analyze changes in HbA1c levels during lockdowns in Germany, and (2) to investigate whether diabetes medication, comorbidities, and sociodemographic data influenced these changes. Materials and methods This cohort study observed 1,089 patients aged ≥18 years over the years 2019 to 2021. Patients were recruited from 14 physicians specialized on diabetes. As dependent variable, 7,987 HbA1c values were analyzed by multivariable linear regression adjusted for random effects of physicians and patients. Results Patients had a median age of 68 (60/76) years and 623 (57.2%) were male. Before the pandemic, median HbA1c level (in %) was 6.9 (6.3/7.7). Average HbA1c level increased during first lockdown (0.21,0.11/0.31,p < 0.001), after first lockdown (0.23,0.18/0.28,p < 0.001), during second lockdown (0.40,0.33/0.47,p < 0.001) and after second lockdown (0.27,0.18/0.36,p < 0.001). The increase of HbA1c levels was more pronounced in male patients (0.08,0.01/0.15,p = 0.019), if patients did not have German as native language (0.12,0.01/0.23,p = 0.041) and if they were widowed (0.19,0.05/0.32,p = 0.008). End organ damages (0.12,0.01/0.23,p = 0.039), atherosclerotic cardiovascular disease (ASCVD; 0.23,0.10/0.36,p = 0.001) and cardiovascular events (0.25,0.10/0.40,p = 0.001) as well as oral medication (0.09,0.03/0.15,p = 0.002), intermediate- or long-acting insulins (0.24,0.16/0.32,p < 0.001), and fast-acting or mixed insulins (0.30,0.23/0.36,p < 0.001) were also related to a greater increase in HbA1c levels. Conclusion Both lockdowns resulted in a significant increase in HbA1c levels. In particular, patients with ASCVD, cardiovascular events, and insulin therapy appear to be at risk for worsening glycemic control in crisis and thus require special medical attention. Clinical Trial Registration ClinicalTrials.gov (NCT04821921).
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13
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Formagini T, Brooks JV, Roberts A, Bullard KM, Zhang Y, Saelee R, O'Brien MJ. Prediabetes prevalence and awareness by race, ethnicity, and educational attainment among U.S. adults. Front Public Health 2023; 11:1277657. [PMID: 38164446 PMCID: PMC10758124 DOI: 10.3389/fpubh.2023.1277657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Racial and ethnic minority groups and individuals with limited educational attainment experience a disproportionate burden of diabetes. Prediabetes represents a high-risk state for developing type 2 diabetes, but most adults with prediabetes are unaware of having the condition. Uncovering whether racial, ethnic, or educational disparities also occur in the prediabetes stage could help inform strategies to support health equity in preventing type 2 diabetes and its complications. We examined the prevalence of prediabetes and prediabetes awareness, with corresponding prevalence ratios according to race, ethnicity, and educational attainment. Methods This study was a pooled cross-sectional analysis of the National Health and Nutrition Examination Survey data from 2011 to March 2020. The final sample comprised 10,262 U.S. adults who self-reported being Asian, Black, Hispanic, or White. Prediabetes was defined using hemoglobin A1c and fasting plasma glucose values. Those with prediabetes were classified as "aware" or "unaware" based on survey responses. We calculated prevalence ratios (PR) to assess the relationship between race, ethnicity, and educational attainment with prediabetes and prediabetes awareness, controlling for sociodemographic, health and healthcare-related, and clinical characteristics. Results In fully adjusted logistic regression models, Asian, Black, and Hispanic adults had a statistically significant higher risk of prediabetes than White adults (PR:1.26 [1.18,1.35], PR:1.17 [1.08,1.25], and PR:1.10 [1.02,1.19], respectively). Adults completing less than high school and high school had a significantly higher risk of prediabetes compared to those with a college degree (PR:1.14 [1.02,1.26] and PR:1.12 [1.01,1.23], respectively). We also found that Black and Hispanic adults had higher rates of prediabetes awareness in the fully adjusted model than White adults (PR:1.27 [1.07,1.50] and PR:1.33 [1.02,1.72], respectively). The rates of prediabetes awareness were consistently lower among those with less than a high school education relative to individuals who completed college (fully-adjusted model PR:0.66 [0.47,0.92]). Discussion Disparities in prediabetes among racial and ethnic minority groups and adults with low educational attainment suggest challenges and opportunities for promoting health equity in high-risk groups and expanding awareness of prediabetes in the United States.
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Affiliation(s)
- Taynara Formagini
- Department of Family Medicine, University of California San Diego, San Diego, CA, United States
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States
- University of Kansas Cancer Center, Kansas City, KS, United States
- Division of Palliative Medicine, University of Kansas School of Medicine, Kansas City, KS, United States
| | - Andrew Roberts
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States
- Aetion Inc., New York, NY, United States
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Yan Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Ryan Saelee
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Matthew James O'Brien
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Henley P, Martins T, Zamani R. Assessing Ethnic Minority Representation in Fibromyalgia Clinical Trials: A Systematic Review of Recruitment Demographics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7185. [PMID: 38131736 PMCID: PMC10742509 DOI: 10.3390/ijerph20247185] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
The under-representation of non-White participants in Western countries in clinical research has received increased attention, due to recognized physiological differences between ethnic groups, which may affect the efficacy and optimal dosage of some treatments. This review assessed ethnic diversity in pharmaceutical trials for fibromyalgia, a poorly understood chronic pain disorder. We also investigated longitudinal change to non-White participant proportions in trials and non-White participants' likelihood to discontinue with fibromyalgia research between trial stages (retention). First, we identified relevant trials conducted in the United States and Canada between 2000 and 2022, by searching PubMed, Web of Science, Scopus, and the Cochrane Library databases. In trials conducted both across the United States and Canada, and exclusively within the United States, approximately 90% of participants were White. A longitudinal analysis also found no change in the proportion of non-White participants in trials conducted across the United States and Canada between 2000 and 2022. Finally, we found no significant differences in trial retention between White and non-White participants. This review highlights the low numbers of ethnic minorities in fibromyalgia trials conducted in the United States and Canada, with no change to these proportions over the past 22 years. Furthermore, non-White participants were not more likely to discontinue with the fibromyalgia research once they were recruited.
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Affiliation(s)
| | | | - Reza Zamani
- Medical School, College of Medicine and Health, University of Exeter, Exeter EX1 2LU, UK (T.M.)
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15
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Meeks KAC, Bentley AR, Assimes TL, Franceschini N, Adeyemo AA, Rotimi CN, Doumatey AP. Mendelian randomization analyses suggest a causal role for circulating GIP and IL-1RA levels in homeostatic model assessment-derived measures of β-cell function and insulin sensitivity in Africans without type 2 diabetes. Genome Med 2023; 15:108. [PMID: 38049854 PMCID: PMC10694992 DOI: 10.1186/s13073-023-01263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND In vitro and in vivo studies have shown that certain cytokines and hormones may play a role in the development and progression of type 2 diabetes (T2D). However, studies on their role in T2D in humans are scarce. We evaluated associations between 11 circulating cytokines and hormones with T2D among a population of sub-Saharan Africans and tested for causal relationships using Mendelian randomization (MR) analyses. METHODS We used logistic regression analysis adjusted for age, sex, body mass index, and recruitment country to regress levels of 11 cytokines and hormones (adipsin, leptin, visfatin, PAI-1, GIP, GLP-1, ghrelin, resistin, IL-6, IL-10, IL-1RA) on T2D among Ghanaians, Nigerians, and Kenyans from the Africa America Diabetes Mellitus study including 2276 individuals with T2D and 2790 non-T2D individuals. Similar linear regression models were fitted with homeostatic modelling assessments of insulin sensitivity (HOMA-S) and β-cell function (HOMA-B) as dependent variables among non-T2D individuals (n = 2790). We used 35 genetic variants previously associated with at least one of these 11 cytokines and hormones among non-T2D individuals as instrumental variables in univariable and multivariable MR analyses. Statistical significance was set at 0.0045 (0.05/11 cytokines and hormones). RESULTS Circulating GIP and IL-1RA levels were associated with T2D. Nine of the 11 cytokines and hormones (exceptions GLP-1 and IL-6) were associated with HOMA-S, HOMA-B, or both among non-T2D individuals. Two-stage least squares MR analysis provided evidence for a causal effect of GIP and IL-RA on HOMA-S and HOMA-B in multivariable analyses (GIP ~ HOMA-S β = - 0.67, P-value = 1.88 × 10-6 and HOMA-B β = 0.59, P-value = 1.88 × 10-5; IL-1RA ~ HOMA-S β = - 0.51, P-value = 8.49 × 10-5 and HOMA-B β = 0.48, P-value = 5.71 × 10-4). IL-RA was partly mediated via BMI (30-34%), but GIP was not. Inverse variance weighted MR analysis provided evidence for a causal effect of adipsin on T2D (multivariable OR = 1.83, P-value = 9.79 × 10-6), though these associations were not consistent in all sensitivity analyses. CONCLUSIONS The findings of this comprehensive MR analysis indicate that circulating GIP and IL-1RA levels are causal for reduced insulin sensitivity and increased β-cell function. GIP's effect being independent of BMI suggests that circulating levels of GIP could be a promising early biomarker for T2D risk. Our MR analyses do not provide conclusive evidence for a causal role of other circulating cytokines in T2D among sub-Saharan Africans.
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Affiliation(s)
- Karlijn A C Meeks
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive Bldg 12A ste 1025, Bethesda, MD, 20892-5611, USA.
| | - Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive Bldg 12A ste 1025, Bethesda, MD, 20892-5611, USA
| | - Themistocles L Assimes
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Nora Franceschini
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Adebowale A Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive Bldg 12A ste 1025, Bethesda, MD, 20892-5611, USA
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive Bldg 12A ste 1025, Bethesda, MD, 20892-5611, USA
| | - Ayo P Doumatey
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive Bldg 12A ste 1025, Bethesda, MD, 20892-5611, USA.
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Muniyappa R, Narayanappa SBK. Disentangling Dual Threats: Premature Coronary Artery Disease and Early-Onset Type 2 Diabetes Mellitus in South Asians. J Endocr Soc 2023; 8:bvad167. [PMID: 38178904 PMCID: PMC10765382 DOI: 10.1210/jendso/bvad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 01/06/2024] Open
Abstract
South Asian individuals (SAs) face heightened risks of premature coronary artery disease (CAD) and early-onset type 2 diabetes mellitus (T2DM), with grave health, societal, and economic implications due to the region's dense population. Both conditions, influenced by cardiometabolic risk factors such as insulin resistance, hypertension, and central adiposity, manifest earlier and with unique thresholds in SAs. Epidemiological, demographic, nutritional, environmental, sociocultural, and economic transitions in SA have exacerbated the twin epidemic. The coupling of premature CAD and T2DM arises from increased obesity due to limited adipose storage, early-life undernutrition, distinct fat thresholds, reduced muscle mass, and a predisposition for hepatic fat accumulation from certain dietary choices cumulatively precipitating a decline in insulin sensitivity. As T2DM ensues, the β-cell adaptive responses are suboptimal, precipitating a transition from compensatory hyperinsulinemia to β-cell decompensation, underscoring a reduced functional β-cell reserve in SAs. This review delves into the interplay of these mechanisms and highlights a prediabetes endotype tied to elevated vascular risk. Deciphering these mechanistic interconnections promises to refine stratification paradigms, surpassing extant risk-prediction strategies.
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Affiliation(s)
- Ranganath Muniyappa
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Satish Babu K Narayanappa
- Department of Medicine, Sri Madhusudan Sai Institute of Medical Sciences and Research, Muddenahalli, Karnataka 562101, India
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Maynard MJ, Orighoye O, Apekey T, Simpson E, van Dijk M, Atherton E, Blackshaw J, Ells L. Improving adult behavioural weight management services for diverse UK Black Caribbean and Black African ethnic groups: a qualitative study of insights from potential service users and service providers. Front Public Health 2023; 11:1239668. [PMID: 38074747 PMCID: PMC10701265 DOI: 10.3389/fpubh.2023.1239668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
Background A significantly higher proportion of UK Black ethnic adults live with overweight or obesity, compared to their White British counterparts. The role of obesity in excess infection rates and mortality from COVID-19 has increased the need to understand if weight management interventions are appropriate and effective for Black ethnic groups. There is a paucity of existing research on weight management services in Black populations, and whether anticipated or experienced institutional and interpersonal racism in the healthcare and more widely affects engagement in these services. Understanding the lived experience of target populations and views of service providers delivering programmes is essential for timely service improvement. Methods A qualitative study using semi-structured interviews was conducted in June-October 2021 among 18 Black African and Black Caribbean men and women interested in losing weight and 10 weight management service providers. Results The results highlighted a positive view of life in the United Kingdom (UK), whether born in the UK or born abroad, but one which was marred by racism. Weight gain was attributed by participants to unhealthy behaviours and the environment, with improving appearance and preventing ill health key motivators for weight loss. Participants relied on self-help to address their overweight, with the role of primary care in weight management contested as a source of support. Anticipated or previously experienced racism in the health care system and more widely, accounted for some of the lack of engagement with services. Participants and service providers agreed on the lack of relevance of existing services to Black populations, including limited culturally tailored resources. Community based, ethnically matched, and flexibly delivered weight management services were suggested as ideal, and could form the basis of a set of recommendations for research and practice. Conclusion Cultural tailoring of existing services and new programmes, and cultural competency training are needed. These actions are required within systemic changes, such as interventions to address discrimination. Our qualitative insights form the basis for advancing further work and research to improve existing services to address the weight-related inequality faced by UK Black ethnic groups.
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Affiliation(s)
- Maria J. Maynard
- School of Health, Leeds Beckett University, Leeds, United Kingdom
- Obesity Institute, Leeds Beckett University, Leeds, United Kingdom
| | - Oritseweyinmi Orighoye
- Bradford Institute for Health Research, University of Bradford, Bradford, United Kingdom
| | - Tanefa Apekey
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Ellouise Simpson
- School of Health, Leeds Beckett University, Leeds, United Kingdom
| | - Margie van Dijk
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom
| | - Elizabeth Atherton
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom
| | - Jamie Blackshaw
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom
| | - Louisa Ells
- School of Health, Leeds Beckett University, Leeds, United Kingdom
- Obesity Institute, Leeds Beckett University, Leeds, United Kingdom
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18
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Isaksen AA, Sandbæk A, Skriver MV, Andersen GS, Bjerg L. Guideline-level monitoring, biomarker levels and pharmacological treatment in migrants and native Danes with type 2 diabetes: Population-wide analyses. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001277. [PMID: 37851595 PMCID: PMC10584163 DOI: 10.1371/journal.pgph.0001277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 08/24/2023] [Indexed: 10/20/2023]
Abstract
The prevalence of type 2 diabetes (T2D) is higher in migrants compared to native populations in many countries, but the evidence on disparities in T2D care in migrants is inconsistent. Therefore, this study aimed to examine this in Denmark. In a cross-sectional, register-based study on 254,097 individuals with T2D, 11 indicators of guideline-level care were analysed: a) monitoring: hemoglobin-A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), screening for diabetic nephropathy, retinopathy, and foot disease, b) biomarker control: HbA1c and LDL-C levels, and c) pharmacological treatment: glucose-lowering drugs (GLD), lipid-lowering drugs, angiotensin-converting enzyme-inhibitors/angiotensin receptor blockers, and antiplatelet therapy. Migrants were grouped by countries of origin: Middle East, Europe, Turkey, Former Yugoslavia, Pakistan, Sri Lanka, Somalia, Vietnam. In all migrant groups except the Europe-group, T2D was more prevalent than in native Danes (crude relative risk (RR) from 0.62 [0.61-0.64] (Europe) to 3.98 [3.82-4.14] (Sri Lanka)). In eight indicators, non-fulfillment was common (>25% among native Danes). Apart from monitoring in the Sri Lanka-group, migrants were at similar or higher risk of non-fulfillment than native Danes across all indicators of monitoring and biomarker control (RR from 0.64 [0.51-0.80] (HbA1c monitoring, Sri Lanka) to 1.78 [1.67-1.90] (LDL-C control, Somalia)), while no overall pattern was observed for pharmacological treatment (RR from 0.61 [0.46-0.80] (GLD, Sri Lanka) to 1.67 [1.34-2.09] (GLD, Somalia)). Care was poorest in migrants from Somalia, who had increased risk in all eleven indicators, and the highest risk in nine. Adjusted risks were elevated in some migrant groups, particularly in indicators of biomarker control (fully-adjusted RR from 0.84 [0.75-0.94] (LDL-C levels, Vietnam) to 1.44 [1.35-1.54] (LDL-C levels, Somalia)). In most migrant groups, T2D was more prevalent, and monitoring and biomarker control was inferior compared to native Danes. Migrants from Somalia received the poorest care overall, and had exceedingly high lipid levels.
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Affiliation(s)
- Anders Aasted Isaksen
- Department of Public Health, Aarhus University, Aarhus C, Denmark
- Steno Diabetes Center, Aarhus, Denmark
| | - Annelli Sandbæk
- Department of Public Health, Aarhus University, Aarhus C, Denmark
- Steno Diabetes Center, Aarhus, Denmark
| | | | | | - Lasse Bjerg
- Steno Diabetes Center, Aarhus, Denmark
- Department of Paediatrics, Viborg Regional Hospital, Viborg, Denmark
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19
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Pettersson S, Klompstra L, Jirwe M, Jaarsma T. Developing a Culturally Appropriate Tool to Support Self-Care in Migrants with Type 2 Diabetes - A Co-Design Study. Patient Prefer Adherence 2023; 17:2557-2567. [PMID: 37854029 PMCID: PMC10581012 DOI: 10.2147/ppa.s426908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Migrants, especially from the Middle East, experience poorer health outcomes and face greater difficulties in accessing healthcare compared to native populations and there is a need for culturally appropriate education for this vulnerable group. The purpose of this study is to describe the process of developing a culturally appropriate tool to support self-care in migrants with type 2 diabetes. Methods In this Co-design study, a tool for supporting self-care in migrants with type 2 diabetes was developed. Migrant patients with type 2 diabetes, healthcare providers and researchers participated in the process, which was based on six elements; engage, plan, explore, develop, decide and change. From February 2021 to December 2022, idea groups were conducted, and a tool was developed through brainstorming, prioritizing and prototyping. Results In total, 14 migrant patients, ten health care providers and four researchers participated in the Co-design process. The patients wished to receive information about type 2 diabetes self-care behaviour in their own languages. The healthcare providers asked for clear instructions on where to guide their patients regarding reliable information about diabetes in the patient's own language. All participants agreed that information can be presented in different formats, either: text (paper or online), audio-visual via recorded videos and/or lectures and pictures. Discussion The Co-design process led to several important insights and experiences related to the importance of diverse cultural backgrounds. When conducting a Co-design study with end-users as stakeholders, it is significant that the stakeholders have a diverse background in experiences, both as patients as well as those who deliver or implement the health service. In this study it was of great importance to include patients with diverse backgrounds regarding; gender, age, health literacy, occupation, years living in Sweden and duration of diabetes.
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Affiliation(s)
- Sara Pettersson
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| | - Leonie Klompstra
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| | - Maria Jirwe
- Red Cross University College, Department of Health Sciences, Huddinge, Sweden
| | - Tiny Jaarsma
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
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20
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Tinajero MG, Keown-Stoneman CD, Anderson L, Maguire JL, Hanley AJ, Sievenpiper JL, Johnson K, Birken C, Malik VS. Evaluation of ethnic differences in cardiometabolic risk in children. Ann Epidemiol 2023; 85:121-126.e7. [PMID: 37295761 DOI: 10.1016/j.annepidem.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE In adults, cardiometabolic conditions manifest differently by ethnicity with South Asians particularly predisposed. Whether these differences arise in childhood remains narrowly explored. To address this evidence gap, we examined whether children of different ethnicities display differences in cardiometabolic risk (CMR). METHODS A cross-sectional analysis was conducted among 5557 children (3-11 years). Multivariable linear regression models adjusted for age, sex, z-body mass index, and demographic factors were used to estimate differences in CMR outcomes between children with parents that self-reported European ancestry (reference group) and one of 13 other ethnicities (African, Arab, East Asian, Latin American, South Asian, Southeast Asian, Mixed Ethnicities, and Other). The primary outcome was a CMR score, calculated as the sum of age- and sex-standardized waist circumference, systolic blood pressure (SBP), glucose, log-triglycerides, and inverse high-density lipoprotein cholesterol (HDL-C), divided by √5. RESULTS Lower mean CMR scores were observed among children with African (β = -0.62, 95% CI: -0.92; -0.32) and East Asian (β = -0.41, 95% CI: -0.68, -0.15) ancestry compared to children with European ancestry. Children with South Asian ancestry had higher SBP (β = 2.25, 95% CI: 1.27, 3.22) and non-HDL-C (β = 0.17, 95% CI: 0.07, 0.26) than children with European ancestry. CONCLUSIONS Ethnic differences in CMR were observed in early and middle childhood.
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Affiliation(s)
- Maria G Tinajero
- University Health Network Biospecimen Services, University Health Network, Toronto, ON, Canada
| | - Charles Dg Keown-Stoneman
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Laura Anderson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jonathon L Maguire
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada
| | - Anthony J Hanley
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON,Canada
| | - John L Sievenpiper
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON,Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kassia Johnson
- Faculty of Health Sciences, McMaster University, Department of Pediatrics, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Catherine Birken
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vasanti S Malik
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
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21
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Şat S, Aydınkoç-Tuzcu K, Berger F, Barakat A, Danquah I, Schindler K, Fasching P. Diabetes and Migration. Exp Clin Endocrinol Diabetes 2023; 131:319-337. [PMID: 37315566 DOI: 10.1055/a-1946-3878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Sebahat Şat
- MVZ DaVita Rhine-Ruhr, Düsseldorf, Germany
- German Diabetes Association (DDG) Working Group on Diabetes and Migrants
| | - Kadriye Aydınkoç-Tuzcu
- German Diabetes Association (DDG) Working Group on Diabetes and Migrants
- Wilhelminenspital of the City of Vienna, 5th Medical Department of Endocrinology, Rheumatology and Acute Geriatrics, Vienna, Austria
- Austrian Diabetes Association (ÖGD) Working Group on Migration and Diabetes
| | - Faize Berger
- German Diabetes Association (DDG) Working Group on Diabetes and Migrants
| | - Alain Barakat
- German Diabetes Association (DDG) Working Group on Diabetes and Migrants
- Diabetes Center Duisburg-Mitte (DZDM), Duisburg, Germany
| | - Ina Danquah
- German Diabetes Association (DDG) Working Group on Diabetes and Migrants
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Karin Schindler
- Austrian Diabetes Association (ÖGD) Working Group on Migration and Diabetes
- Medical University of Vienna, Department of Internal Medicine III, Clinical Department of Endocrinology and Metabolism, Vienna, Austria
| | - Peter Fasching
- Wilhelminenspital of the City of Vienna, 5th Medical Department of Endocrinology, Rheumatology and Acute Geriatrics, Vienna, Austria
- Austrian Diabetes Association (ÖGD) Working Group on Migration and Diabetes
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22
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Yang J, Xia Y, Sun Y, Guo Y, Shi Z, Cristina do Vale Moreira N, Zuo H, Hussain A. Effect of lifestyle intervention on HbA1c levels in overweight and obese adults with type 2 diabetes across ethnicities: A systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2023; 199:110662. [PMID: 37028602 DOI: 10.1016/j.diabres.2023.110662] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023]
Abstract
AIMS Weight reduction is fundamental for the management and remission of diabetes. We aimed to assess ethnic differences in the effects of lifestyle weight-loss interventions on HbA1c levels in overweight or obese adults with type 2 diabetes mellitus (T2DM). METHODS We systematically searched PubMed/MEDLINE and Web of Science online databases up to 31 Dec 2022. Randomized controlled trials using lifestyle weight-loss interventions in overweight or obese adults with T2DM were selected. We performed subgroup analyses to explore the heterogeneity across different ethnicities (Asians, White/Caucasians, Black/Africans and Hispanics). A random effects model was applied to calculate weighted mean difference (WMD) with 95% confidence interval (CI). RESULTS Thirty studies including 7580 subjects from different ethnicities were identified according to the predefined inclusion and exclusion criteria. HbA1c levels were significantly reduced by lifestyle weight-loss intervention. Notably, a significantly beneficial effect on HbA1c was observed in White/Caucasians (WMD = -0.59, 95% CI: -0.90, -0.28, P < 0.001) and Asians (WMD = -0.48, 95% CI: -0.63, -0.33, P < 0.001), but not in the Black/African or Hispanic group (both P > 0.05). The findings remained essentially unchanged in the sensitivity analysis. CONCLUSIONS Lifestyle weight-loss interventions had distinct beneficial effects on HbA1c levels in different ethnic groups with T2DM, especially in Caucasians and Asians.
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Affiliation(s)
- Jie Yang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yujia Xia
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yanan Sun
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yufei Guo
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Zumin Shi
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Qatar
| | | | - Hui Zuo
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China.
| | - Akhtar Hussain
- Faculty of Health Sciences, NORD University, Bodø, Norway; Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Brazil; International Diabetes Federation. 166 Chaussee de La Hulpe B-1170, Brussels, Belgium.
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23
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FHL2 Genetic Polymorphisms and Pro-Diabetogenic Lipid Profile in the Multiethnic HELIUS Cohort. Int J Mol Sci 2023; 24:ijms24054332. [PMID: 36901761 PMCID: PMC10001862 DOI: 10.3390/ijms24054332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Type 2 diabetes mellitus (T2D) is a prevalent disease often accompanied by the occurrence of dyslipidemia. Four and a half LIM domains 2 (FHL2) is a scaffolding protein, whose involvement in metabolic disease has recently been demonstrated. The association of human FHL2 with T2D and dyslipidemia in a multiethnic setting is unknown. Therefore, we used the large multiethnic Amsterdam-based Healthy Life in an Urban Setting (HELIUS) cohort to investigate FHL2 genetic loci and their potential role in T2D and dyslipidemia. Baseline data of 10,056 participants from the HELIUS study were available for analysis. The HELIUS study contained individuals of European Dutch, South Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan descent living in Amsterdam and were randomly sampled from the municipality register. Nineteen FHL2 polymorphisms were genotyped, and associations with lipid panels and T2D status were investigated. We observed that seven FHL2 polymorphisms associated nominally with a pro-diabetogenic lipid profile including triglyceride (TG), high-density and low-density lipoprotein-cholesterol (HDL-C and LDL-C), and total cholesterol (TC) concentrations, but not with blood glucose concentrations or T2D status in the complete HELIUS cohort upon correcting for age, gender, BMI, and ancestry. Upon stratifying for ethnicity, we observed that only two of the nominally significant associations passed multiple testing adjustments, namely, the association of rs4640402 with increased TG and rs880427 with decreased HDL-C concentrations in the Ghanaian population. Our results highlight the effect of ethnicity on pro-diabetogenic selected lipid biomarkers within the HELIUS cohort, as well as the need for more large multiethnic cohort studies.
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24
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Patel T, Umeh K, Poole H, Vaja I, Ramtoola S, Newson L. Health professionals interface with cultural conflict in the delivery of type 2 diabetes care. Psychol Health 2023; 38:230-248. [PMID: 34351821 DOI: 10.1080/08870446.2021.1960346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study explored the knowledge and experiences of health professionals (HPs) caring for South Asian patients with type 2 diabetes (T2D). DESIGN Fourteen HPs, who supported patients with T2D, were interviewed. The recruitment strategy employed purposeful and theoretical sampling methods to recruit HPs who worked across primary and secondary care settings. MAIN OUTCOME MEASURES Grounded Theory (GT) methodology and analysis generated a theoretical framework that explored HP's perceptions and experiences of providing diabetes care for South Asian patients. RESULTS A GT, presenting a core category of Cultural Conflict in T2D care, explores the influences of HP's interactions and delivery of care for South Asian patients. This analysis is informed by four categories: (1) Patient Comparisons: South Asian vs White; (2) Recognising the Heterogeneous Nature of South Asian Patients; (3) Language and Communication; (4) HPs' Training and Experience. CONCLUSIONS The findings consider how the role of social comparison, social norms, and diminished responsibility in patient self-management behaviours influence HPs' perceptions, implicit and explicit bias towards the delivery of care for South Asian patients. There was a clear call for further support and training to help HPs recognise the cultural-ethnic needs of their patients.
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Affiliation(s)
- Tasneem Patel
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Kanayo Umeh
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Helen Poole
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Ishfaq Vaja
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Shenaz Ramtoola
- Endocrinology and Metabolic Medicine, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
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25
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Improving Health and Diabetes Self-Management in Immigrants with Type 2 Diabetes Through a Co-Created Diabetes Self-Management Education and Support Intervention. J Community Health 2023; 48:141-151. [PMID: 36326989 PMCID: PMC9632564 DOI: 10.1007/s10900-022-01151-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
To examine the impact of a co-created culturally sensitive diabetes self-management education and support (DSMES) intervention on the physical and mental health of immigrants with type 2 diabetes (T2D). Pre- and post-test among people with T2D whose primary language was Urdu, Arabic or Turkish (n = 97). Participants were offered a six-week intervention based on a person-centred approach using research-based dialogue tools to facilitate learning and reflection, which was developed in co-creation with immigrants and healthcare professionals. Data were collected at baseline, post-intervention and after 6 months and analysed using paired t-tests, Wilcoxon signed-rank tests, chi-square tests and regression models when appropriate. Several clinical outcomes were improved post-intervention, including HbA1c (P < 0.001), body fat percentage (P = 0.002), self-rated general health (P = 0.05), well-being (P = 0.004) and several self-management behaviours, e.g., physical activity (P < 0.001). Most outcomes remained improved after 6 months, but the effect on HbA1c was no longer statistically significant. Some outcomes were improved only at 6 months, including waist circumference (P < 0.001) and diabetes-related emotional distress (P < 0.001). Fatigue did not change. Attendance at more programme sessions was associated with better outcomes. The DSMES intervention developed in a co-creation process was highly effective in improving the health of immigrants with T2D.
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26
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Aydınkoç-Tuzcu K, Şat S, Berger F, Barakat A, Danquah I, Schindler K, Fasching P. [Diabetes and migration (update 2023)]. Wien Klin Wochenschr 2023; 135:286-306. [PMID: 37101050 DOI: 10.1007/s00508-023-02175-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
The practice recommendation is intended to supplement the existing guidelines on diabetes mellitus and provides practical recommendations for the diagnosis, therapy and care of people with diabetes mellitus who come from different linguistic and cultural back-grounds. The article deals with the demographic datas of migration in Austria and Germany; with therapeutic advice concerning drug therapy and diabetes education for patients with migration background. In this context socio-cultural spezifics are discussed. These suggestions are seen complementary to the general treatment guidelines of the Austrian Diabetes Society and German Diabetes Society. Especially for the fast months Ramadan thera are a lot of informations. The most important point is that the patient care must highly individualized and the management plan may differ for each patient.
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Affiliation(s)
- Kadriye Aydınkoç-Tuzcu
- AG Diabetes und Migranten der DDG, Berlin, Deutschland.
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich.
- AG Migration und Diabetes der ÖDG, Wien, Deutschland.
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Montlearstraße 37, 1160, Wien, Österreich.
| | - Sebahat Şat
- MVZ DaVita Rhein-Ruhr, Düsseldorf, Deutschland
- AG Diabetes und Migranten der DDG, Berlin, Deutschland
- MVZ DaVita Nieren- und Dialysezentrum, Bismarckstraße, Düsseldorf, Deutschland
| | - Faize Berger
- AG Diabetes und Migranten der DDG, Berlin, Deutschland.
- AG Diabetes und Migranten der DDG, Deutsche Diabetes Gesellschaft (DDG), Albrechtstr. 9, 10117, Berlin, Deutschland.
| | - Alain Barakat
- AG Diabetes und Migranten der DDG, Berlin, Deutschland
- Diabetes Zentrum Duisburg-Mitte DZDM, Duisburg, Deutschland
| | - Ina Danquah
- AG Diabetes und Migranten der DDG, Berlin, Deutschland
- Heidelberger Institut für Global Health (HIGH), Medizinische Fakultät und Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - Karin Schindler
- Universitätsklinik für Innere Medizin III, Klinische Abteilung für Endokrinologie und Stoffwechsel, Medizinische Universität Wien, Wien, Österreich
- AG Migration und Diabetes der ÖDG, Wien, Deutschland
| | - Peter Fasching
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
- AG Migration und Diabetes der ÖDG, Wien, Deutschland
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27
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Salama M, Biggs BK, Creo A, Prissel R, Al Nofal A, Kumar S. Adolescents with Type 2 Diabetes: Overcoming Barriers to Effective Weight Management. Diabetes Metab Syndr Obes 2023; 16:693-711. [PMID: 36923685 PMCID: PMC10010139 DOI: 10.2147/dmso.s365829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/09/2023] [Indexed: 03/12/2023] Open
Abstract
The prevalence of type 2 diabetes (T2DM) among children and adolescents has remarkably increased in the last two decades, particularly among ethnic minorities. Management of T2DM is challenging in the adolescent population due to a constellation of factors, including biological, socioeconomic, cultural, and psychological barriers. Weight reduction is an essential component in management of T2DM as weight loss is associated with improvement in insulin sensitivity and glycemic status. A family centered and culturally appropriate approach offered by a multidisciplinary team is crucial to address the biological, psychosocial, cultural, and financial barriers to weight management in youth with T2DM. Lifestyle interventions and pharmacotherapy have shown modest efficacy in achieving weight reduction in adolescents with T2DM. Bariatric surgery is associated with excellent weight reduction and remission of T2DM in youth. Emerging therapies for weight reduction in youth include digital technologies, newer GLP-1 agonists and endoscopic procedures.
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Affiliation(s)
- Mostafa Salama
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bridget K Biggs
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Ana Creo
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rose Prissel
- Division of Endocrinology and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Correspondence: Seema Kumar, Email
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Haines MS, Leong A, Porneala BC, Zhong VW, Lewis CE, Schreiner PJ, Miller KK, Meigs JB, Carnethon MR. More appendicular lean mass relative to body mass index is associated with lower incident diabetes in middle-aged adults in the CARDIA study. Nutr Metab Cardiovasc Dis 2023; 33:105-111. [PMID: 36435699 PMCID: PMC9812900 DOI: 10.1016/j.numecd.2022.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/07/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Although lower lean mass is associated with greater diabetes prevalence in cross-sectional studies, prospective data specifically in middle-aged Black and White adults are lacking. Relative appendicular lean mass (ALM), such as ALM adjusted for body mass index (BMI), is important to consider since muscle mass is associated with overall body size. We investigated whether ALM/BMI is associated with incident type 2 diabetes in the Coronary Artery Risk Development in Young Adults study. METHODS AND RESULTS 1893 middle-aged adults (55% women) were included. ALM was measured by DXA in 2005-06. Incident type 2 diabetes was defined in 2010-11 or 2015-16 as fasting glucose ≥7 mmol/L (126 mg/dL), 2-h glucose on OGTT ≥11.1 mmol/L (200 mg/dL) (2010-11 only), HbA1C ≥48 mmol/mol (6.5%) (2010-11 only), or glucose-lowering medications. Cox regression models with sex stratification were performed. In men and women, ALM/BMI was 1.07 ± 0.14 (mean ± SD) and 0.73 ± 0.12, respectively. Seventy men (8.2%) and 71 women (6.8%) developed type 2 diabetes. Per sex-specific SD higher ALM/BMI, unadjusted diabetes risk was lower by 21% in men [HR 0.79 (0.62-0.99), p = 0.04] and 29% in women [HR 0.71 (0.55-0.91), p = 0.008]. After adjusting for age, race, smoking, education, physical activity, and waist circumference, the association was no longer significant. Adjustment for waist circumference accounted for the attenuation in men. CONCLUSION Although more appendicular lean mass relative to BMI is associated with lower incident type 2 diabetes in middle-aged men and women over 10 years, its effect may be through other metabolic risk factors such as waist circumference, which is a correlate of abdominal fat mass.
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Affiliation(s)
- Melanie S Haines
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Aaron Leong
- Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Bianca C Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Victor W Zhong
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama, Birmingham, AL, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - James B Meigs
- Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
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Agyemang C, van der Linden EL, Antwi-Berko D, Nkansah Darko S, Twumasi-Ankrah S, Meeks K, van den Born BJH, Henneman P, Owusu-Dabo E, Beune E. Cohort profile: Research on Obesity and Diabetes among African Migrants in Europe and Africa Prospective (RODAM-Pros) cohort study. BMJ Open 2022; 12:e067906. [PMID: 36521887 PMCID: PMC9756160 DOI: 10.1136/bmjopen-2022-067906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The Research on Obesity and Diabetes among African Migrants (RODAM) prospective (RODAM-Pros) cohort study was established to identify key changes in environmental exposures and epigenetic modifications driving the high burden of cardiovascular disease (CVD) risk among sub-Saharan African migrants. PARTICIPANTS All the participants in the RODAM cross-sectional study that completed the baseline assessment (n=5114) were eligible for the follow-up of which 2165 participants (n=638 from rural-Ghana, n=608 from urban-Ghana, and n=919 Ghanaian migrants in Amsterdam, the Netherlands) were included in the RODAM-Pros cohort study. Additionally, we included a subsample of European-Dutch (n=2098) to enable a comparison to be made between Ghanaian migrants living in the Netherlands and the European-Dutch host population. FINDINGS TO DATE Follow-up data have been collected on demographics, socioeconomic status, medical history, psychosocial environment, lifestyle factors, nutrition, anthropometrics, blood pressure, fasting blood, urine and stool samples. Biochemical analyses included glucose metabolism, lipid profile, electrolytes and renal function, liver metabolism and inflammation. In a subsample, we assessed DNA methylation patterns using Infinium 850K DNA Methylation BeadChip. Baseline results indicated that migrants have higher prevalence of CVD risk factors than non-migrants. Epigenome-wide association studies suggest important differences in DNA methylation between migrants and non-migrants. The follow-up study will shed further light on key-specific environmental exposures and epigenetic modifications contributing to the high burden of CVD risk among sub-Saharan African migrants. FUTURE PLANS Follow-up is planned at 5-year intervals, baseline completed in 2015 and first follow-up completed in 2021.
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Affiliation(s)
- Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Eva L van der Linden
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Daniel Antwi-Berko
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Samuel Nkansah Darko
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Sampson Twumasi-Ankrah
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Karlijn Meeks
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Bert-Jan H van den Born
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Peter Henneman
- Department of Human Genetics, Genome Diagnostics laboratory Amsterdam, Reproduction & Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Erik Beune
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Sagastume D, Siero I, Mertens E, Peñalvo JL. Cardiometabolic Profile and Outcomes in Migrant Populations: A Review of Comparative Evidence from Migrants in Europe in Relation to Their Country of Origin. Curr Cardiol Rep 2022; 24:1799-1810. [PMID: 36348148 DOI: 10.1007/s11886-022-01802-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The potential effect of migration on increasing cardiometabolic risk factors remains partially understood. We aim to synthesize the evidence comparing the burden of diabetes and adiposity of migrating populations in Europe, with that of their country of origin. METHODS We conducted a scoping literature review. We searched PubMed for studies investigating the effect of migration on diabetes or adiposity outcomes among migrants in countries from the European Union or the United Kingdom compared to the population in the country of origin. Studies were qualitatively synthesized in evidence tables and the demographic characteristics, study design, risk factors investigated, and outcomes were quantitatively summarized using measures of central tendency. FINDINGS Of 1175 abstracts retrieved, 28 studies were eligible. Most of the studies included migrating populations residing in Western (50%), Northern (39%), and Southern Europe (11%) originating from countries in Africa (46%), Asia (29%), or European overseas (25%) regions of which 85% were classified as low-middle-income countries. Most of the studies (93%) had a cross-sectional design. The median number of individuals in the country of origin was greater [917; IQR: 231-1378] than in the receiving country [249; 150-883]. Thirty-five percent of the studies investigated migration as an independent risk factor, whereas 28% contextualized migration into lifestyle changes. The majority of the studies (57%) reported both diabetes and adiposity outcomes. Within the limited evidence available, controversial results were found as some studies showed poorer outcomes for the migrating populations, while others showed the opposite. CONCLUSION Studies assessing the impact of migration by comparing migrating populations and the population of origin on diabetes and adiposity outcomes have gained interest. So far, the available evidence is highly heterogeneous to inform public health strategies in the receiving countries. We recommend further research including a more robust methodology and in-depth characterization of the migrant populations.
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Affiliation(s)
- Diana Sagastume
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Irene Siero
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Elly Mertens
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - José L Peñalvo
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
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van der Velden AIM, van den Berg BM, van den Born BJ, Galenkamp H, Ijpelaar DHT, Rabelink TJ. Ethnic differences in urinary monocyte chemoattractant protein-1 and heparanase-1 levels in individuals with type 2 diabetes: the HELIUS study. BMJ Open Diabetes Res Care 2022; 10:10/6/e003003. [PMID: 36564084 PMCID: PMC9791388 DOI: 10.1136/bmjdrc-2022-003003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/05/2022] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION We aimed to investigate ethnic differences in two urinary inflammatory markers in participants with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS We included 55 Dutch, 127 South-Asian Surinamese, 92 African Surinamese, 62 Ghanaian, 74 Turkish and 88 Moroccan origin participants with T2DM from the HEalthy LIfe in an Urban Setting study. Using linear regression analyses, we investigated differences in urinary monocyte chemoattractant protein-1 (MCP-1) and heparanase-1 (HPSE-1) levels across ethnic minorities compared with Dutch. Associations between the urinary markers and albuminuria (albumin:creatinine ratio (ACR)) was investigated per ethnicity. RESULTS Urinary MCP-1 levels were higher in the Moroccan participants (0.15 log ng/mmol, 95% CI 0.05 to 0.26) compared with Dutch after multiple adjustments. Urinary HPSE-1 levels were lower in the African Surinamese and Ghanaian participants compared with the Dutch, with a difference of -0.16 log mU/mmol (95% CI -0.29 to -0.02) in African Surinamese and -0.16 log mU/mmol (95% CI -0.31 to -0.00) in Ghanaian after multiple adjustments. In all ethnic groups except the Dutch and Ghanaian participants, MCP-1 was associated with ACR. This association remained strongest after multiple adjustment in South-Asian and African Surinamese participants, with an increase in log ACR of 1.03% (95% CI 0.58 to 1.47) and 1.23% (95% CI 0.52 to 1.94) if log MCP-1 increased 1%. Only in the Dutch participants, an association between HPSE-1 and ACR was found, with increase in log ACR of 0.40% (95% CI 0.04 to 0.76) if log HPSE-1 increased 1%. CONCLUSIONS We found ethnic differences in urinary MCP-1 and HPSE-1 levels, in a multi-ethnic cohort of participants with T2DM. In addition, we found ethnic differences in the association of MCP-1 and HPSE-1 levels with albuminuria. These findings suggest differences in renal inflammation across ethnic groups.
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Affiliation(s)
- Anouk I M van der Velden
- Department of Internal Medicine (Nephrology) and Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Bernard M van den Berg
- Department of Internal Medicine (Nephrology) and Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - B J van den Born
- Internal Medicine, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Public and Occupational Health, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
| | - Daphne H T Ijpelaar
- Department of Internal Medicine (Nephrology) and Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine and Nephrology, Groene Hart Hospital, Gouda, The Netherlands
| | - Ton J Rabelink
- Department of Internal Medicine (Nephrology) and Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands
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32
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Ohanyan H, Portengen L, Kaplani O, Huss A, Hoek G, Beulens JWJ, Lakerveld J, Vermeulen R. Associations between the urban exposome and type 2 diabetes: Results from penalised regression by least absolute shrinkage and selection operator and random forest models. ENVIRONMENT INTERNATIONAL 2022; 170:107592. [PMID: 36306550 DOI: 10.1016/j.envint.2022.107592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/23/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) is thought to be influenced by environmental stressors such as air pollution and noise. Although environmental factors are interrelated, studies considering the exposome are lacking. We simultaneously assessed a variety of exposures in their association with prevalent T2D by applying penalised regression Least Absolute Shrinkage and Selection Operator (LASSO), Random Forest (RF), and Artificial Neural Networks (ANN) approaches. We contrasted the findings with single-exposure models including consistently associated risk factors reported by previous studies. METHODS Baseline data (n = 14,829) of the Occupational and Environmental Health Cohort study (AMIGO) were enriched with 85 exposome factors (air pollution, noise, built environment, neighbourhood socio-economic factors etc.) using the home addresses of participants. Questionnaires were used to identify participants with T2D (n = 676(4.6 %)). Models in all applied statistical approaches were adjusted for individual-level socio-demographic variables. RESULTS Lower average home values, higher share of non-Western immigrants and higher surface temperatures were related to higher risk of T2D in the multivariable models (LASSO, RF). Selected variables differed between the two multi-variable approaches, especially for weaker predictors. Some established risk factors (air pollutants) appeared in univariate analysis but were not among the most important factors in multivariable analysis. Other established factors (green space) did not appear in univariate, but appeared in multivariable analysis (RF). Average estimates of the prediction error (logLoss) from nested cross-validation showed that the LASSO outperformed both RF and ANN approaches. CONCLUSIONS Neighbourhood socio-economic and socio-demographic characteristics and surface temperature were consistently associated with the risk of T2D. For other physical-chemical factors associations differed per analytical approach.
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Affiliation(s)
- Haykanush Ohanyan
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Utrecht, the Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, the Netherlands; Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, Noord-Holland, the Netherlands; Upstream Team, www.upstreamteam.nl. Amsterdam UMC, VU University Amsterdam, Amsterdam, Noord-Holland, the Netherlands.
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Utrecht, the Netherlands
| | - Oriana Kaplani
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Utrecht, the Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Utrecht, the Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, the Netherlands; Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, Noord-Holland, the Netherlands; Upstream Team, www.upstreamteam.nl. Amsterdam UMC, VU University Amsterdam, Amsterdam, Noord-Holland, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, the Netherlands; Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, Noord-Holland, the Netherlands; Upstream Team, www.upstreamteam.nl. Amsterdam UMC, VU University Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Muilwijk M, Loh M, Mahmood S, Palaniswamy S, Siddiqui S, Silva W, Frost GS, Gage HM, Jarvelin MR, Rannan-Eliya RP, Ahmad S, Jha S, Kasturiratne A, Katulanda P, Khawaja KI, Kooner JS, Wickremasinghe AR, van Valkengoed IGM, Chambers JC. The iHealth-T2D study: a cluster randomised trial for the prevention of type 2 diabetes amongst South Asians with central obesity and prediabetes-a statistical analysis plan. Trials 2022; 23:755. [PMID: 36068618 PMCID: PMC9450360 DOI: 10.1186/s13063-022-06667-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND South Asians are at high risk of type 2 diabetes (T2D). Lifestyle modification is effective at preventing T2D amongst South Asians, but the approaches to screening and intervention are limited by high costs, poor scalability and thus low impact on T2D burden. An intensive family-based lifestyle modification programme for the prevention of T2D was developed. The aim of the iHealth-T2D trial is to compare the effectiveness of this programme with usual care. METHODS The iHealth-T2D trial is designed as a cluster randomised controlled trial (RCT) conducted at 120 sites across India, Pakistan, Sri Lanka and the UK. A total of 3682 South Asian men and women with age between 40 and 70 years without T2D but at elevated risk for T2D [defined by central obesity (waist circumference ≥ 95 cm in Sri Lanka or ≥ 100 cm in India, Pakistan and the UK) and/or prediabetes (HbA1c ≥ 6.0%)] were included in the trial. Here, we describe in detail the statistical analysis plan (SAP), which was finalised before outcomes were available to the investigators. The primary outcome will be evaluated after 3 years of follow-up after enrolment to the study and is defined as T2D incidence in the intervention arm compared to usual care. Secondary outcomes are evaluated both after 1 and 3 years of follow-up and include biochemical measurements, anthropometric measurements, behavioural components and treatment compliance. DISCUSSION The iHealth-T2D trial will provide evidence of whether an intensive family-based lifestyle modification programme for South Asians who are at high risk for T2D is effective in the prevention of T2D. The data from the trial will be analysed according to this pre-specified SAP. ETHICS AND DISSEMINATION The trial was approved by the international review board of each participating study site. Study findings will be disseminated through peer-reviewed publications and in conference presentations. TRIAL REGISTRATION EudraCT 2016-001,350-18 . Registered on 14 April 2016. CLINICALTRIALS gov NCT02949739 . Registered on 31 October 2016.
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Affiliation(s)
- Mirthe Muilwijk
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Public Health, Health Behaviours & Cardiovascular Diseases, Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands.
| | - Marie Loh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Sara Mahmood
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Services Institute of Medical Sciences, Services Hospital, Ghaus Ul Azam, Jail Road 54700, Lahore, Pakistan
| | - Saranya Palaniswamy
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Samreen Siddiqui
- Max Healthcare, Institute of Endocrinology, Diabetes and Metabolism, Max Super Speciality Hospital, 2, Press Enclave Road, Skaet, New Delhi, 110017, India
| | - Wnurinham Silva
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Gary S Frost
- Faculty of Medicine, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 ONN, UK
| | - Heather M Gage
- Department of Clinical and Experimental Medicine, Surrey Health Economics Centre, University of Surrey, Leggett Building, Daphne Jackson Road, Guildford, Surrey, GU2 7WG, UK
| | - Marjo-Riitta Jarvelin
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Unit of Primary Care, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, Middlesex, UK
| | | | - Sajjad Ahmad
- Punjab Institute of Cardiology, Punjab Institute of Cardiology, Jail Road, Shadman, Lahore, Punjab, Pakistan
| | - Sujeet Jha
- Max Healthcare, Institute of Endocrinology, Diabetes and Metabolism, Max Super Speciality Hospital, 2, Press Enclave Road, Skaet, New Delhi, 110017, India
| | - Anuradhani Kasturiratne
- Faculty of Medicine, University of Kelaniya, Thalagolla Road, PO Box 06, Ragama, 11010, Sri Lanka
| | - Prasad Katulanda
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo, 00800, Sri Lanka
| | - Khadija I Khawaja
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Services Institute of Medical Sciences, Services Hospital, Ghaus Ul Azam, Jail Road 54700, Lahore, Pakistan
| | - Jaspal S Kooner
- London Northwest University Healthcare NHS Trust, Uxbridge Road, Southall, UB1 3HW, Middlesex, UK
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 ONN, UK
| | - Ananda R Wickremasinghe
- Faculty of Medicine, University of Kelaniya, Thalagolla Road, PO Box 06, Ragama, 11010, Sri Lanka
| | - Irene G M van Valkengoed
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health, Health Behaviours & Cardiovascular Diseases, Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - John C Chambers
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
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Le S, Zhang Y, Voutilainen A, Tan X, Laukkanen J, Wang C, Cheng S. Differences in cardiometabolic risk profiles between Chinese and Finnish older adults with glucose impairment and central obesity. J Endocrinol Invest 2022; 45:1427-1437. [PMID: 35325446 PMCID: PMC9184414 DOI: 10.1007/s40618-022-01777-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/23/2022] [Indexed: 12/06/2022]
Abstract
BACKGROUND Obesity and ethnicity play important roles in cardiovascular complications in patients with type 2 diabetes mellitus (T2DM). This study aimed to compare cardiometabolic risk profiles between Chinese and Finnish older adults of central obesity with prediabetes or T2DM. METHODS Study subjects were 60-74 years old and originated from two population samples. The Finnish subjects came from the Kuopio Ischemic Heart Disease (KIHD) study (n = 1089), and the Chinese subjects came from the Shanghai High-risk Diabetic Screen (SHiDS) study (n = 818). The KIHD and SHiDS studies used similar questionnaires to determine participants' baseline characteristics regarding the history of medication use and diseases and lifestyle factors. All study subjects participated in glucose tolerance tests and anthropometry assessments, including waist circumference measurements. RESULTS Among study subjects of central obesity with prediabetes (n = 298), fasting and 2-h glucose, and fasting insulin and insulin resistance were significantly higher in Chinese than in Finnish (p < 0.0001-0.016). In addition, triglyceride (TG) level was higher and the low-density lipoprotein cholesterol (LDL) and LDL to high-density lipoprotein cholesterol (HDL) ratio were lower in Chinese than in Finnish (p < 0.0001-0.003). Among subjects of central obesity with T2DM (n = 251), Chinese subjects had significantly less proportions of antihypertensive, glycaemic control medication, and statin users as well as lower level of physical activity (p < 0.0001 for all), while higher blood pressure (p = 0.002 for systolic blood pressure and p < 0.0001 for diastolic blood pressure), TG levels (p < 0.05) and HDL (p = 0.002) than the Finnish counterparts. There were no differences in β-cell function (HOMA-β) between Chinese and Finnish both in prediabetes and T2DM. CONCLUSIONS Our results indicated that Chinese and Finnish older adults of central obesity with prediabetes and T2DM had similar β-cell function. However, Chinese individuals with prediabetes are prone to insulin resistance. Meanwhile, lipid metabolism dysfunction is also different between Chinese and Finnish. Chinese older adults of central obesity with prediabetes showed higher TG, but Finnish showed higher LDL and LDL/HDL. Strategic for T2DM prevention and treatment should be ethnically specific.
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Affiliation(s)
- S Le
- Exercise Translational Medicine Center, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, 200240, Shanghai, China
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, 200240, China
- Department of Physical Therapy, Taihe Hospital, Hubei University of Medicine, Shiyan, 442099, China
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014, Jyväskylä, Finland
| | - Y Zhang
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, The Metabolic Disease Biobank, Shanghai, 200233, China
| | - A Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
| | - X Tan
- Exercise Translational Medicine Center, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, 200240, Shanghai, China
- Department of Neuroscience, Uppsala University, BMC, Box 593, 75124, Uppsala, Sweden
| | - J Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014, Jyväskylä, Finland.
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland.
- Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, 70211, Kuopio, Finland.
| | - C Wang
- Department of Endocrinology and Metabolism, School of Medicine, Shanghai Fourth People's Hospital Affiliated to Tongji University, Tongji University, 1279 Sanmen Road, Shanghai, 200434, China.
| | - S Cheng
- Exercise Translational Medicine Center, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, 200240, Shanghai, China.
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, 200240, China.
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014, Jyväskylä, Finland.
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Ellahi B, Aitken A, Dikmen D, Seyhan-Erdoğan B, Makda M, Razaq R. Acceptability, Usability and Weight Loss Outcomes in a Randomized Cross-Over Study of Commercially Available Portion Size Tools in an Overweight South Asian Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137714. [PMID: 35805371 PMCID: PMC9266172 DOI: 10.3390/ijerph19137714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 01/09/2023]
Abstract
South Asian women living in the UK are particularly at high risk of obesity-related complications, such as type 2 diabetes and cardiovascular disease. Exposure to large portion sizes is a risk factor for obesity. Specifically designed tableware helps individuals to manage weight by controlling food portion sizes. Thirty-one (n = 31) overweight or obese South Asian adult women participated in a randomised cross-over trial aimed to assess the efficacy, acceptance, and weight change of two guided/calibrated commercially available portion control tools (Utensil set and Crockery Set) used in free-living conditions. Data on acceptance, perceived changes in portion size, frequency, and meal type was collected using paper questionnaires and 3-day diet diaries. Scores describing acceptance, ease of use, and perceived effectiveness were derived from five-point Likert scales from which binary indicators (high/low) were analysed for significance using multivariate variance analysis for repeated measurements. A reduction in BMI was observed at each point of measurement (p = 0.007). For overall tool use, the crockery set scored higher in all areas of acceptance, ease of use, and perceived efficacy for all comparisons. Self-selected portion sizes increased for salads and decreased for cooking oil and breakfast cereals with both tools. Further research to scale up and evaluate similar weight management interventions for this group is warranted.
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Affiliation(s)
- Basma Ellahi
- Faculty of Health and Social Care, University of Chester, Parkgate Road, Chester CH14BJ, UK; (A.A.); (M.M.); (R.R.)
- Correspondence: ; Tel.: +44-1244-512177; Fax: +44-1244-510000
| | - Amanda Aitken
- Faculty of Health and Social Care, University of Chester, Parkgate Road, Chester CH14BJ, UK; (A.A.); (M.M.); (R.R.)
| | - Derya Dikmen
- Department of Nutrition and Dietetics, Hacettepe University, Ankara 06230, Turkey; (D.D.); (B.S.-E.)
| | - Bilge Seyhan-Erdoğan
- Department of Nutrition and Dietetics, Hacettepe University, Ankara 06230, Turkey; (D.D.); (B.S.-E.)
| | - Munibah Makda
- Faculty of Health and Social Care, University of Chester, Parkgate Road, Chester CH14BJ, UK; (A.A.); (M.M.); (R.R.)
| | - Rifat Razaq
- Faculty of Health and Social Care, University of Chester, Parkgate Road, Chester CH14BJ, UK; (A.A.); (M.M.); (R.R.)
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van Olden CC, Muilwijk M, Stronks K, van den Born BJ, Moll van Charante EP, Nicolau M, Zwinderma AH, Nieuwdorp M, Groen AK, van Valkengoed IGM. Differences in the prevalence of intermediate hyperglycaemia and the associated incidence of type 2 diabetes mellitus by ethnicity: The HELIUS study. Diabetes Res Clin Pract 2022; 187:109859. [PMID: 35367312 DOI: 10.1016/j.diabres.2022.109859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/14/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
AIMS We aimed to describe differences in the prevalence of intermediate hyperglycaemia (IH) between six ethnic groups. Moreover, to investigate differences in the association of the classifications of IH with the incidence of T2DM between ethnic groups. METHODS We included 3759 Dutch, 2826 African Surinamese, 1646 Ghanaian, 2571 Turkish, 2691 Moroccan and 1970 South Asian Surinamese origin participants of the HELIUS study. IH was measured by fasting plasma glucose (FPG) and HbA1c. We calculated age-, BMI and physical-activity-adjusted prevalence of IH by sex, and calculated age and sex-adjusted hazard ratios (HR)for the association between IH and T2DM in each ethnic group. RESULTS The prevalence of IH was higher among ethnic minority groups (68.6-41.7%) than the Dutch majority (34.9%). The prevalence of IH categories varied across subgroups. Combined increased FPG and HbA1c was most prevalent in South-Asian Surinamese men (27.6%, 95 %CI: 24.5-30.9%), and in Dutch women (4.2%, 95 %CI: 3.4-5.1%). The HRs for T2DM for each IH-classification did not differ significantly between ethnic groups. HRs were highest for the combined classification, e.g., HR = 8.1, 95 %CI: 2.5-26.6 in the Dutch. CONCLUSION We found a higher prevalence of IH in ethnic minority versus majority groups, but did not find evidence for a differential association of IH with incident T2DM.
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Affiliation(s)
- C C van Olden
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands.
| | - M Muilwijk
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - K Stronks
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - B J van den Born
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - E P Moll van Charante
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - M Nicolau
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - A H Zwinderma
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - M Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - A K Groen
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - I G M van Valkengoed
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
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Cheng Z, Li Y, Young JL, Cheng N, Yang C, Papandonatos GD, Kelsey KT, Wise JP, Shi K, Zheng T, Liu S, Bai Y. Long-term association of serum selenium levels and the diabetes risk: Findings from a case-control study nested in the prospective Jinchang Cohort. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 818:151848. [PMID: 34822883 PMCID: PMC8909917 DOI: 10.1016/j.scitotenv.2021.151848] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 05/07/2023]
Abstract
An increasing body of evidence implicates high levels of selenium intake in the development of diabetes, although prospective studies remain sparse. We conducted a nested case-control study of 622 diabetes incident cases and 622-age, sex, and follow-up time-matched controls in the prospective Jinchang cohort of 48,001 participants with a median of 5.8 years of follow-up. Inductively coupled plasma mass spectrometry (ICP-MS) was used to measure all 622 case-control pairs' baseline serum levels of selenium (Se), which were then categorized into quartiles based on the frequency distribution among the controls. Multivariable adjusted conditional logistic regression and restricted cubic splines (RCS) models were applied to evaluate independent odds ratios (OR) as estimates for relative risks (RR) of diabetes according to quartiles (Q) of selenium levels. Compared to the lowest quartile (Q1 as reference), significantly greater diabetes risks (with 95% confidence interval) were observed in Q3 (OR = 1.62, 1.17-2.35) and Q4 (OR = 1.79, 1.21-2.64). Sub-analyses showed these increased risks of diabetes by serum levels of Se. appeared to differ by sex, age, BMI status, history of hypertension, and dyslipidemia. Further, application of RSC models showed that serum Se levels between 95 and 120 μg/L were significantly and positively associated with diabetes risk whereas no apparent relation exists when Se levels were under 95 μg/L in this cohort population.
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Affiliation(s)
- Zhiyuan Cheng
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Street, Shenzhen 518055, China
| | - Yuanyuan Li
- Key Laboratory of Environment and Health, Ministries of Education and Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Street, Wuhan, Hubei, 430030, China
| | - Jamie L Young
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville, KY 40202, USA
| | - Ning Cheng
- School of Basic Medical Science, Lanzhou University, 199 Donggang West Street, Lanzhou, Gansu 730000, China
| | - Chenhui Yang
- Key Laboratory of Environment and Health, Ministries of Education and Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Street, Wuhan, Hubei, 430030, China
| | - George D Papandonatos
- Department of Biostatistics, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02901, USA
| | - Karl T Kelsey
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02901, USA
| | - John Pierce Wise
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville, KY 40202, USA; Wise Laboratory of Environmental and Genetic Toxicology, University of Louisville, 500 S. Preston St., 55A, Room 1422, Louisville, KY 40202, USA
| | - Kunchong Shi
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02901, USA
| | - Tongzhang Zheng
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02901, USA
| | - Simin Liu
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02901, USA
| | - Yana Bai
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, 199 Donggang West Street, Lanzhou, Gansu 730000, China.
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Luxenburg O, Myers V, Ziv A, Novikov I, Gimpelevitch I, Saban M, Brammli-Greenberg S, Wilf-Miron R. Factors Affecting the Patient Journey in Scheduling a Specialist Appointment in a Public Healthcare System. J Patient Exp 2022; 9:23743735221092547. [PMID: 35434290 PMCID: PMC9006356 DOI: 10.1177/23743735221092547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A questionnaire was developed to evaluate the journey experienced by patients from identifying a need to see a community specialist in Israel's public healthcare system, through scheduling an appointment and attending. A telephone survey was conducted with a nationally representative group of 3751 adults, in 2019 to 2020. Fifty-seven percent needed to see a specialist in the last 6 months; among those, 82%, visited a specialist. Among the 3% who did not make an appointment, in 41 of 52 (79%) cases this was due to long waiting time. Younger and more educated patients were more likely to try to get an earlier appointment. Timeliness (55%) and wanting a specific physician (43%) were major considerations in scheduling. Reported need was greater in females, Jewish versus Arab respondents, more educated and those with chronic illness. Those who did not make an appointment sought private care, emergency treatment, or went untreated. Although a large percentage of respondents did eventually get an appointment, vulnerable patients may have more difficulty navigating the system. Following the patient journey can provide insights to help design services better suited to patients’ needs.
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Affiliation(s)
- Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Vicki Myers
- Health Technology Assessment and Policy Unit, Gertner Institute of Epidemiology & Health Policy Research, Sheba Medical Center, Tel HaShomer, Israel
| | - Arnona Ziv
- Information & Computerization Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Ilya Novikov
- Biostatistics & Biomathematics Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Irena Gimpelevitch
- Biostatistics & Biomathematics Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Mor Saban
- Health Technology Assessment and Policy Unit, Gertner Institute of Epidemiology & Health Policy Research, Sheba Medical Center, Tel HaShomer, Israel
| | - Shuli Brammli-Greenberg
- Information & Computerization Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
- School of Public Health, Hebrew University, Jerusalem, Israel
| | - Rachel Wilf-Miron
- Health Technology Assessment and Policy Unit, Gertner Institute of Epidemiology & Health Policy Research, Sheba Medical Center, Tel HaShomer, Israel
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Ismail SU, Asamane EA, Osei-Kwasi HA, Boateng D. Socioeconomic Determinants of Cardiovascular Diseases, Obesity, and Diabetes among Migrants in the United Kingdom: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053070. [PMID: 35270763 PMCID: PMC8910256 DOI: 10.3390/ijerph19053070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 02/04/2023]
Abstract
There has been little agreement on the role that socioeconomic factors play in the aetiology of cardiovascular diseases (CVDs), obesity, and diabetes among migrants in the United Kingdom (UK). We systematically reviewed the existing evidence on this association to contribute to filling this gap in the literature. Two reviewers were involved at each stage of the review process to ensure validity. We comprehensively searched through several electronic databases and grey literature sources to identify potentially eligible papers for our review. We extracted data from our finally included studies and appraised the methodological rigour of our studies. A narrative synthesis approach was used to synthesise and interpret the extracted data. We sieved through 2485 records identified from our search and finally obtained 10 studies that met our inclusion criteria. The findings of this review show that there is a trend towards an association between socioeconomic factors and CVDs, diabetes, and obesity among migrants in the UK. However, the picture was more complex when specific socioeconomic variables and migrant subgroups were analysed. The evidence for this association is inconclusive and its causal relationship remains speculative. There is, therefore, the need for further research to understand the exact association between socioeconomic factors and CVD, diabetes, and obesity among migrants in the UK.
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Affiliation(s)
- Sanda Umar Ismail
- School of Health and Social Wellbeing, University of the West of England, Bristol BS16 1QY, UK
- Correspondence:
| | - Evans Atiah Asamane
- Institute of Applied Health, University of Birmingham, Birmingham B15 2SQ, UK;
| | | | - Daniel Boateng
- University Medical Center Utrecht, Utrecht University, 3508 TC Utrecht, The Netherlands;
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi 00000, Ghana
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40
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The acceptability and effect of a culturally-tailored dance intervention to promote physical activity in women of South Asian origin at risk of diabetes in the Netherlands—A mixed-methods feasibility study. PLoS One 2022; 17:e0264191. [PMID: 35213598 PMCID: PMC8880860 DOI: 10.1371/journal.pone.0264191] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 02/04/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Populations of South Asian (SA) origin are at high risk of type 2 diabetes (T2D) and related complications. Analysis of T2D prevention interventions for these populations show that limited attention has been given to facilitating increased physical activity (PA) in a culturally appropriate manner. The aim of this feasibility study was to identify whether culturally tailored dance is acceptable to women of SA origin, and whether it may have an effect on PA and PA-related social cognitive determinants. Methods A community-based culturally tailored dance intervention choreographed to Bollywood music was evaluated among 26 women of SA origin in the Netherlands for 10 weeks, 2 times per week. This feasibility study was conducted as a before-after, mixed-methods study, combining data from focus groups, individual interviews, questionnaires and accelerometers. Results The majority of participants were in the age of 50–59 years and at moderate-to-high T2D risk. There was high attendance (73%), low drop out (12%) and high satisfaction scores for various program components. Key reasons for participation were the cultural appropriateness, in particular the combination of historically and emotionally embedded Indian music and dance, and the non-competitive nature of the intervention. On average, in each of the 19 one-hour sessions, participants spent 30.8 minutes in objectively assessed light intensity PA, 14.1 minutes in moderate intensity PA and 0.3 minutes in vigorous PA, and took 2,100 steps during a session. At follow-up, total moderate-to-vigorous PA increased by 7.8 minutes per day (95%CI: 3.1, 12.5) and daily steps increased by 784 (95%CI: 173, 1394), with a concomitant reduction in light PA of 12 minutes per day (95%CI: -21.9, -2.2). Positive shifts in some PA-behavioral social cognitive determinants and no negative side-effects were observed. Conclusions Bollywood Dance appears to be a feasible, culturally acceptable and potentially effective approach to increase PA in SA women in the Netherlands. A pilot cluster RCT is needed to confirm these initial findings on effectiveness.
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41
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Diabetes und Migration. DIABETOLOGE 2022. [DOI: 10.1007/s11428-022-00865-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bradley SA, Spring KJ, Beran RG, Chatzis D, Killingsworth MC, Bhaskar SMM. Role of diabetes in stroke: Recent advances in pathophysiology and clinical management. Diabetes Metab Res Rev 2022; 38:e3495. [PMID: 34530485 DOI: 10.1002/dmrr.3495] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 02/05/2023]
Abstract
The increasing prevalence of diabetes and stroke is a major global public health concern. Specifically, acute stroke patients, with pre-existing diabetes, pose a clinical challenge. It is established that diabetes is associated with a worse prognosis after acute stroke and the various biological factors that mediate poor recovery profiles in diabetic patients is unknown. The level of association and impact of diabetes, in the setting of reperfusion therapy, is yet to be determined. This article presents a comprehensive overview of the current knowledge of the role of diabetes in stroke, therapeutic strategies for primary and secondary prevention of cardiovascular disease and/or stroke in diabetes, and various therapeutic considerations that may apply during pre-stroke, acute, sub-acute and post-stroke stages. The early diagnosis of diabetes as a comorbidity for stroke, as well as tailored post-stroke management of diabetes, is pivotal to our efforts to limit the burden. Increasing awareness and involvement of neurologists in the management of diabetes and other cardiovascular risk factors is desirable towards improving stroke prevention and efficacy of reperfusion therapy in acute stroke patients with diabetes.
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Affiliation(s)
- Sian A Bradley
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Kevin J Spring
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Medical Oncology Group, Liverpool Clinical School, Western Sydney University & Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Roy G Beran
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, New South Wales, Australia
- Medical School, Griffith University, Southport, Queensland, Australia
- Sechenov Moscow First State University, Moscow, Russia
| | | | - Murray C Killingsworth
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Department of Anatomical Pathology, Correlatively Microscopy Facility, NSW Health Pathctology, Sydney, New South Wales, Australia
| | - Sonu M M Bhaskar
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, New South Wales, Australia
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Chen M, Moran LJ, Harrison CL, Ukke GG, Sood S, Bennett CJ, Bahri Khomami M, Absetz P, Teede H, Lim S. Ethnic differences in response to lifestyle intervention for the prevention of type 2 diabetes in adults: A systematic review and meta-analysis. Obes Rev 2022; 23:e13340. [PMID: 34528393 DOI: 10.1111/obr.13340] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022]
Abstract
The risk of type 2 diabetes mellitus (T2DM) varies by ethnicity, but ethnic differences in response to diabetes prevention interventions remain unclear. This systematic review and meta-analysis assessed ethnic differences in the effects of lifestyle interventions on T2DM incidence, glycemic outcomes (fasting glucose, 2-h glucose, HbA1c ), anthropometric measures (weight, BMI, waist circumference), and lifestyle behaviors (physical activity, energy intake, energy from fat, fiber intake). MEDLINE, EMBASE, and other databases were searched (to June 15, 2020) for randomized and non-randomized controlled trials on lifestyle interventions (diet and/or physical activity) in adults at risk of T2DM. Ethnicity was categorized into European, South Asian, East and Southeast Asian, Middle Eastern, Latin American, and African groups. Forty-four studies were included in meta-analyses. Overall, lifestyle interventions resulted in significant improvement in T2DM incidence, glycemic outcomes, anthropometric measures, physical activity, and energy intake (all P < 0.01). Significant subgroup differences by ethnicity were found for 2-h glucose, weight, BMI, and waist circumference (all P < 0.05) but not for T2DM incidence, fasting glucose, HbA1c , and physical activity (all P > 0.05). Few studies in non-European groups reported dietary intake. Lifestyle interventions in different ethnic groups may have similar effects in reducing incidence of T2DM although this needs to be confirmed in further studies.
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Affiliation(s)
- Mingling Chen
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Gebresilasea Gendisha Ukke
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Surbhi Sood
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Christie J Bennett
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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Agyemang C, van der Linden EL, Bennet L. Type 2 diabetes burden among migrants in Europe: unravelling the causal pathways. Diabetologia 2021; 64:2665-2675. [PMID: 34657183 PMCID: PMC8563673 DOI: 10.1007/s00125-021-05586-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/17/2021] [Indexed: 12/16/2022]
Abstract
European populations are ethnically and culturally diverse due to international migration. Evidence indicates large ethnic inequalities in the prevalence of type 2 diabetes. This review discusses the burden of type 2 diabetes and its related complications, and the potential explanatory mechanisms among migrants in Europe. The current available data suggest that the rate of type 2 diabetes is higher in all migrant groups and that they develop this disease at an earlier age than the host European populations. The level of diabetes awareness among migrant populations is high, but glycaemic control remains suboptimal compared with Europeans. The culturally adapted lifestyle modification intervention trials to prevent type 2 diabetes mainly focus on South Asian adults in Europe. Diabetes-related microvascular and macrovascular complications remain a major burden among migrant populations in Europe. Earlier studies found higher mortality rates among migrants, but recent studies seem to suggest a shifting trend in favour of first-generation migrants. However, the extent of the burden of type 2 diabetes varies across migrant groups and European countries. Despite the higher burden of type 2 diabetes among migrants, the key underlying factors are not well understood mainly due to limited investment in basic science research and development of prospective cohort studies. We hypothesise that the underlying risk factors for the high burden of type 2 diabetes and its related complications in migrants are multifaceted and include pre-migration factors, post-migration factors and genetic predispositions. Given the multi-ethnic nature of the current European population, there is a clear need for investment in research among migrant populations to gain insight into factors driving the high burden of type 2 diabetes and related complications to facilitate prevention and treatment efforts in Europe.
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Affiliation(s)
- Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
| | - Eva L van der Linden
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Louise Bennet
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Clinical Research and Trial Centre, Lund University Hospital, Lund, Sweden
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Breuing J, Joisten C, Neuhaus AL, Heß S, Kusche L, Haas F, Spiller M, Pieper D. Communication strategies in the prevention of type 2 diabetes and gestational diabetes in vulnerable groups: a scoping review. Syst Rev 2021; 10:301. [PMID: 34819163 PMCID: PMC8611985 DOI: 10.1186/s13643-021-01846-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/22/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The global prevalence of diabetes is nearly 9%, with an upward trend in type 2 diabetes mellitus (T2DM) and gestational diabetes (GDM). Although evidence shows that vulnerable groups are affected disproportionally, these groups are difficult to reach in terms of preventive measures. Currently, there is no gold standard regarding communication strategies and/or public awareness campaigns. METHODS We conducted a scoping review in September 2019. Two reviewers independently screened the results of the electronic literature search in several databases, including Medline, EMBASE, and PsycINFO. Extracted data were charted, categorized, and summarized. RESULTS All of the included articles (n=24) targeted T2DM; none targeted GDM. We identified the following five different vulnerable groups within the identified studies: migrants (n=9), ethnic groups such as African Americans (n=8), people with low socioeconomic status (n=3), older people (n=1), and people in need of care (n=1). Three categories of communication strategies were identified as follows: adapted diabetes prevention programs (n=21), community health workers (n=5), and technical approaches (n=9). CONCLUSION We found different approaches for preventive interventions for T2DM. Some of these approaches were already adapted to known barriers. Communication strategies should be adapted to barriers and facilitating factors to increase participation and motivation.
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Affiliation(s)
- Jessica Breuing
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Strasse 200, Building 38, 51109 Cologne, Germany
| | - Christine Joisten
- Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Annika Lena Neuhaus
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Strasse 200, Building 38, 51109 Cologne, Germany
| | - Simone Heß
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Strasse 200, Building 38, 51109 Cologne, Germany
| | - Lena Kusche
- Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Fabiola Haas
- Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Mark Spiller
- Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Strasse 200, Building 38, 51109 Cologne, Germany
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Davidson EM, Krasuska M, Jenum AK, Gill JMR, Beune E, Stronks K, van Valkengoed IGM, Diaz E, Sheikh A. Developing a realist informed framework for cultural adaptation of lifestyle interventions for the prevention of type 2 diabetes in South Asian populations in Europe. Diabet Med 2021; 38:e14584. [PMID: 33838051 DOI: 10.1111/dme.14584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/14/2021] [Accepted: 04/08/2021] [Indexed: 01/04/2023]
Abstract
AIMS Selected lifestyle interventions proven effective for White-European populations have been culturally adapted for South Asian populations living in Europe, who are at higher risk of type 2 diabetes. However, a limited theoretical basis underpins how cultural adaptations are believed to augment intervention effectiveness. We undertook a realist review to synthesise existing literature on culturally adapted type 2 diabetes prevention interventions, to develop a framework that shows 'how' cultural adaptation works, for 'whom' and in 'what contexts'. METHODS We followed the stepped methodological approach of realist review. Our work concluded a European-wide project (EuroDHYAN), and core studies were identified from the preceding EuroDHYAN reviews. Data were extracted, coded into themes and synthesised to create 'Context-Mechanism-Outcome' configurations and to generate a refined explanatory framework. RESULTS We identified eight core intervention papers. From this evidence, and supporting literature, we examined the 'Team' domain of cultural adaptation and identified a mechanism of shared cultural identity which we theorised as contributing to strong team-participant relationships. We also identified four key contexts which influenced intervention outcomes: 'research setting' and 'heterogeneous populations' (intrinsic to the intervention) and 'broader environment' and 'socio-cultural stress' (extrinsic barriers). CONCLUSIONS This work instigates research into the mechanisms of cultural adaptation which, if pursued, will allow a more nuanced understanding of how to apply adaptations, and for whom. In practice we recommend greater consideration of heterogeneous and intersecting population characteristics; how intervention design can safeguard sustainability; and how the four key contexts identified influence how, and whether, these interventions work.
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Affiliation(s)
| | | | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Erik Beune
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Karien Stronks
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Irene G M van Valkengoed
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Esperanza Diaz
- Department for Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Muilwijk M, Loh M, Siddiqui S, Mahmood S, Palaniswamy S, Shahzad K, Athauda LK, Jayawardena R, Batool T, Burney S, Glover M, Bamunuarachchi V, Panda M, Madawanarachchi M, Rai B, Sattar I, Silva W, Waghdhare S, Jarvelin MR, Rannan-Eliya RP, Wijemunige N, Gage HM, Valabhji J, Frost GS, Wickremasinghe R, Kasturiratne A, Khawaja KI, Ahmad S, van Valkengoed IG, Katulanda P, Jha S, Kooner JS, Chambers JC. Effects of a lifestyle intervention programme after 1 year of follow-up among South Asians at high risk of type 2 diabetes: a cluster randomised controlled trial. BMJ Glob Health 2021; 6:e006479. [PMID: 34725039 PMCID: PMC8562508 DOI: 10.1136/bmjgh-2021-006479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/30/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION South Asians are at high risk of type 2 diabetes (T2D). We assessed whether intensive family-based lifestyle intervention leads to significant weight loss, improved glycaemia and blood pressure in adults at elevated risk for T2D. METHODS This cluster randomised controlled trial (iHealth-T2D) was conducted at 120 locations across India, Pakistan, Sri Lanka and the UK. We included 3684 South Asian men and women, aged 40-70 years, without T2D but with raised haemoglobin A1c (HbA1c) and/or waist circumference. Participants were randomly allocated either to the family-based lifestyle intervention or control group by location clusters. Participants in the intervention received 9 visits and 13 telephone contacts by community health workers over 1-year period, and the control group received usual care. Reductions in weight (aim >7% reduction), waist circumference (aim ≥5 cm reduction), blood pressure and HbA1C at 12 months of follow-up were assessed. Our linear mixed-effects regression analysis was based on intention-to-treat principle and adjusted for age, sex and baseline values. RESULTS There were 1846 participants in the control and 1838 in the intervention group. Between baseline and 12 months, mean weight of participants in the intervention group reduced by 1.8 kg compared with 0.4 kg in the control group (adjusted mean difference -1.10 kg (95% CI -1.70 to -1.06), p<0.001). The adjusted mean difference for waist circumference was -1.9 cm (95% CI -2.5; to 1.3), p<0.001). No overall difference was observed for blood pressure or HbA1c. People who attended multiple intervention sessions had a dose-dependent effect on waist circumference, blood pressure and HbA1c, but not on weight. CONCLUSION An intensive family-based lifestyle intervention adopting low-resource strategies led to effective reduction in weight and waist circumference at 12 months, which has potential long-term benefits for preventing T2D. A higher number of attended sessions increased the effect on waist circumference, blood pressure and HbA1c. TRIAL REGISTRATION NUMBER EudraCT: 2016-001350-18; ClinicalTrials.gov: NCT02949739.
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Affiliation(s)
- Mirthe Muilwijk
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Marie Loh
- Lee Kon Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Samreen Siddiqui
- Institute of Endocrinology Diabetes and Metabolism, Max Healthcare, New Delhi, Delhi, India
| | - Sara Mahmood
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Saranya Palaniswamy
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | | | - Lathika K Athauda
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Western, Sri Lanka
| | - Tayyaba Batool
- Department of Endocrinology and Metabolism, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Saira Burney
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Matthew Glover
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Vodathi Bamunuarachchi
- Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Western, Sri Lanka
| | - Manju Panda
- Institute of Endocrinology Diabetes and Metabolism, Max Healthcare, New Delhi, Delhi, India
| | - Madawa Madawanarachchi
- Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Western, Sri Lanka
| | - Baldeesh Rai
- School of Public Health, Imperial College London, London, UK
| | - Iqra Sattar
- Punjab Institute of Cardiology, Lahore, Punjab, Pakistan
| | - Wnurinham Silva
- School of Public Health, Imperial College London, London, UK
| | - Swati Waghdhare
- Institute of Endocrinology Diabetes and Metabolism, Max Healthcare, New Delhi, Delhi, India
| | - Marjo-Riitta Jarvelin
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- School of Public Health, Imperial College London, London, UK
- Department of Life Sciences, College of Health and Life Sciences, Brunel University, London, UK
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | | | | | - Heather M Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - Jonathan Valabhji
- Department of Diabetes and Endocrinology, Imperial College London, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Gary S Frost
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Anuradhani Kasturiratne
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Khadija I Khawaja
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Sajjad Ahmad
- Punjab Institute of Cardiology, Lahore, Punjab, Pakistan
| | - Irene Gm van Valkengoed
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Prasad Katulanda
- Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka
| | - Sujeet Jha
- Institute of Endocrinology Diabetes and Metabolism, Max Healthcare, New Delhi, Delhi, India
| | - Jaspal S Kooner
- London North West University Healthcare NHS Trust, Harrow, London, UK
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - John C Chambers
- Lee Kon Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
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Şat S, Aydınkoç-Tuzcu K, Berger F, Barakat A, Schindler K, Fasching P. Diabetes und Migration. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1507-2545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sebahat Şat
- MVZ DaVita Rhein-Ruhr, Düsseldorf
- AG Diabetes und Migranten der DDG
| | - Kadriye Aydınkoç-Tuzcu
- AG Diabetes und Migranten der DDG
- Wilhelminenspital der Stadt Wien, 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wien
- AG Migration und Diabetes der ÖDG
| | | | - Alain Barakat
- AG Diabetes und Migranten der DDG
- Diabetes Zentrum Duisburg-Mitte DZDM
| | - Karin Schindler
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Endokrinologie und Stoffwechsel, Wien
- AG Migration und Diabetes der ÖDG
| | - Peter Fasching
- Wilhelminenspital der Stadt Wien, 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wien
- AG Migration und Diabetes der ÖDG
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Analyzing Type 2 Diabetes Associations with the Gut Microbiome in Individuals from Two Ethnic Backgrounds Living in the Same Geographic Area. Nutrients 2021; 13:nu13093289. [PMID: 34579166 PMCID: PMC8468640 DOI: 10.3390/nu13093289] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/08/2021] [Accepted: 09/17/2021] [Indexed: 12/19/2022] Open
Abstract
It is currently unknown whether associations between gut microbiota composition and type 2 diabetes (T2D) differ according to the ethnic background of individuals. Thus, we studied these associations in participants from two ethnicities characterized by a high T2D prevalence and living in the same geographical area, using the Healthy Life In Urban Settings (HELIUS) study. We included 111 and 128 T2D participants on metformin (Met-T2D), 78 and 49 treatment-naïve T2D (TN-T2D) participants, as well as a 1:1 matched group of healthy controls from, respectively, African Surinamese and South-Asian Surinamese descent. Fecal microbiome profiles were obtained through 16S rRNA gene sequencing. Univariate and machine learning analyses were used to explore the associations between T2D and the composition and function of the gut microbiome in both ethnicities, comparing Met-T2D and TN-T2D participants to their respective healthy control. We found a lower α-diversity for South-Asian Surinamese TN-T2D participants but no significant associations between TN-T2D status and the abundance of bacterial taxa or functional pathways. In African Surinamese participants, we did not find any association between TN-T2D status and the gut microbiome. With respect to Met-T2D participants, we identified several bacterial taxa and functional pathways with a significantly altered abundance in both ethnicities. More alterations were observed in South-Asian Surinamese. Some altered taxa and pathways observed in both ethnicities were previously related to metformin use. This included a strong negative association between the abundance of Romboutsia and Met-T2D status. Other bacterial taxa were consistent with previous observations in T2D, including reduced butyrate producers such as Anaerostipes hadrus. Hence, our results highlighted both shared and unique gut microbial biomarkers of Met-T2D in individuals from different ethnicities but living in the same geographical area. Future research using higher-resolution shotgun sequencing is needed to clarify the role of ethnicity in the association between T2D and gut microbiota composition.
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Tinajero MG, Malik VS. An Update on the Epidemiology of Type 2 Diabetes: A Global Perspective. Endocrinol Metab Clin North Am 2021; 50:337-355. [PMID: 34399949 DOI: 10.1016/j.ecl.2021.05.013] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Type 2 diabetes (T2D) is a public health burden associated with immense health care and societal costs, early death, and morbidity. Largely because of epidemiologic changes, including nutrition transitions, urbanization, and sedentary lifestyles, T2D is increasing in every region of the world, particularly in low-income and middle-income countries. This article highlights global trends in T2D and discusses the role of genes, early-life exposures, and lifestyle risk factors in the cause of T2D, with an emphasis on populations in current hotspots of the epidemic. It also considers potential impacts of the coronavirus disease 2019 pandemic and T2D prevention policies and action.
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Affiliation(s)
- Maria G Tinajero
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, 5th Floor, Toronto, ON M5S 1A8, Canada
| | - Vasanti S Malik
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, 5th Floor, Toronto, ON M5S 1A8, Canada; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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