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Shillah WB, Yahaya JJ, Morgan ED, Bintabara D. Predictors of microvascular complications in patients with type 2 diabetes mellitus at regional referral hospitals in the central zone, Tanzania: a cross-sectional study. Sci Rep 2024; 14:5035. [PMID: 38424145 PMCID: PMC10904798 DOI: 10.1038/s41598-024-55556-x] [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: 10/29/2023] [Accepted: 02/25/2024] [Indexed: 03/02/2024] Open
Abstract
Microvascular complications encompass a group of diseases which result from long-standing chronic effect of diabetes mellitus (DM). We aimed to determine the prevalence of microvascular complications and associated risk factors among patients with type 2 diabetes mellitus (T2DM). A cross-sectional analytical hospital-based study was conducted at Singida and Dodoma regional referral hospitals in Tanzania from December 2021 to September 2022. A total of 422 patients with T2DM were included in the analysis by determining the prevalence of microvascular complications and their predictors using multivariable logistic regression analysis. A two-tailed p value less than 0.05 was considered statistically significant. The prevalence of microvascular complications was 57.6% (n = 243) and diabetic retinopathy was the most common microvascular complication which accounted for 21.1% (n = 89). Having irregular physical activity (AOR = 7.27, 95% CI = 2.98-17.71, p < 0.001), never having physical activity (AOR = 2.38, 95% CI = 1.4-4.01, p = 0.013), being hypertensive (AOR = 5.0, 95% CI = 2.14-11.68, p = 0.030), having T2DM for more than 5 years (AOR = 2.74, 95% CI = 1.42-5.26, p = 0.025), being obese (AOR = 2.63, 95% CI = 1.22-5.68, p = 0.010), and taking anti-diabetic drugs irregularly (AOR = 1.94, 95% CI = 0.15-0.77, p < 0.001) were the predictors of microvascular complications. This study has revealed a significant proportion of microvascular complications in a cohort of patients with T2DM. Lack of regular physical activity, being obese, taking anti-diabetic drugs irregularly, presence of hypertension, and long-standing duration of the disease, were significantly associated with microvascular complications.
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Affiliation(s)
- Wilfred B Shillah
- Department of Community Medicine, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
| | - James J Yahaya
- Department of Pathology, School of Health Sciences, Soroti University, P. O. Box 211, Soroti, Uganda.
| | - Emmanuel D Morgan
- Department of Pathology, School of Health Sciences, Soroti University, P. O. Box 211, Soroti, Uganda
| | - Deogratius Bintabara
- Department of Community Medicine, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
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Sun Y, Jin D, Zhang Z, Zhang Y, Zhang Y, Kang X, Jiang L, Tong X, Lian F. Effects of antioxidants on diabetic kidney diseases: mechanistic interpretations and clinical assessment. Chin Med 2023; 18:3. [PMID: 36624538 PMCID: PMC9827645 DOI: 10.1186/s13020-022-00700-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/09/2022] [Indexed: 01/10/2023] Open
Abstract
Diabetic kidney disease (DKD) is more prevalent with an increase in diabetes mellitus. Oxidative stress is a major factor in the occurrence and progression of DKD. Defending against oxidative stress and restoring antioxidant defense might be key to preventing and treating DKD. The purpose of this article is to provide an explanation of how oxidative stress affects DKD, conduct a systematic review and meta-analysis on DKD, and examine the effect of antioxidants on the disease. An analysis of 19 randomized controlled trials showed that the use of antioxidants could reduce UAE (albumin excretion rate) in patients with DKD (SMD: - 0.31; 95% CI [- 0.47, - 0.14], I2 = 0%), UACR (urine albumin/creatinine ratio) (SMD: - 0.60; 95% CI [- 1.15, - 0.06], I2 = 89%), glycosylated hemoglobin (hbA1c) (MD: - 0.61; 95% CI [- 1.00, - 0.21], I2 = 93%) and MDA (malonaldehyde) (SMD:-1.05; 95% CI [- 1.87, - 0.23], I2 = 94%), suggesting that antioxidants seemed to have therapeutic effects in patients with DKD, especially in reducing proteinuria and hbA1c. The purpose of this study is to provide new targets and ideas for drug research and clinical treatment of DKD.
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Affiliation(s)
- Yuting Sun
- grid.464297.aGuang’anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing, 100053 China
| | - De Jin
- grid.469513.c0000 0004 1764 518XHangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Ziwei Zhang
- grid.440665.50000 0004 1757 641XCollege of Chinese Medicine, Changchun University of Chinese Medicine, ChangchunJilin, 130117 China
| | - Yuehong Zhang
- grid.464297.aGuang’anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing, 100053 China
| | - Yuqing Zhang
- grid.464297.aGuang’anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing, 100053 China
| | - Xiaomin Kang
- grid.464297.aGuang’anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing, 100053 China
| | - Linlin Jiang
- grid.464297.aGuang’anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing, 100053 China
| | - Xiaolin Tong
- grid.464297.aInstitute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fengmei Lian
- grid.464297.aGuang’anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing, 100053 China
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Beaubien-Souligny W, Leclerc S, Verdin N, Ramzanali R, Fox DE. Bridging Gaps in Diabetic Nephropathy Care: A Narrative Review Guided by the Lived Experiences of Patient Partners. Can J Kidney Health Dis 2022; 9:20543581221127940. [PMID: 36246342 PMCID: PMC9558862 DOI: 10.1177/20543581221127940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE OF REVIEW Diabetes affects almost a 10th of the Canadian population, and diabetic nephropathy is one of its main complications. It remains a leading cause of kidney failure despite the availability of effective treatments. SOURCES OF INFORMATION The sources of information are iterative discussions between health care professionals and patient partners and literature collected through the search of multiple databases. METHODS Major pitfalls related to optimal diabetic nephropathy care were identified through discussions between patient partners and clinician researchers. We identified underlying factors that were common between pitfalls. We then conducted a narrative review of strategies to overcome them, with a focus on Canadian initiatives. KEY FINDINGS We identified 5 pitfalls along the diabetic nephropathy trajectory, including a delay in diabetes diagnosis, suboptimal glycemic control, delay in the detection of kidney involvement, suboptimal kidney protection, and deficient management of advanced chronic kidney disease. Several innovative care models and approaches have been proposed to address these pitfalls; however, they are not consistently applied. To improve diabetic nephropathy care in Canada, we recommend focusing initiatives on improving awareness of diabetic nephropathy, improving access to timely evidence-based care, fostering inclusive patient-centered care environment, and generating new evidence that supports complex disease management. It is imperative that patients and their families are included at the center of these initiatives. LIMITATIONS This review was limited to research published in peer-reviewed journals. We did not perform a systematic review of the literature; we included articles that were relevant to the major pitfalls identified by our patient partners. Study quality was also not formally assessed. The combination of these factors limits the scope of our conclusions.
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Affiliation(s)
- William Beaubien-Souligny
- Division of Nephrology, Centre
Hospitalier de l’Université de Montréal, QC, Canada,Department of Medicine, University of
Montreal, QC, Canada
| | - Simon Leclerc
- Division of Nephrology, Department of
Medicine, The Research Institute of the McGill University Health Centre, Montreal,
QC, Canada,Division of Nephrology, Hôpital
Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Nancy Verdin
- The Kidney Foundation of Canada,
London, ON, Canada
| | - Rizwana Ramzanali
- Patient and Community Engagement
Research Program, University of Calgary, AB, Canada
| | - Danielle E. Fox
- Department of Community Health
Sciences, University of Calgary, AB, Canada,Danielle E. Fox, Department of Community
Health Sciences, University of Calgary, TRW 3D44A, 3280 Hospital Drive
Northwest, Calgary, AB T2N 4Z6, Canada.
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Saiyed NS, Yagoub U, Al Qahtani B, Al Zahrani AM, Al Hariri I, Syed MJ, Elmardi ME, Tufail MA, Manajreh M. Risk Factors of Microvascular Complications Among Type 2 Diabetic Patients Using Cox Proportional Hazards Models: A Cohort Study in Tabuk Saudi Arabia. J Multidiscip Healthc 2022; 15:1619-1632. [PMID: 35923155 PMCID: PMC9342245 DOI: 10.2147/jmdh.s367241] [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] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The burden of type 2 diabetes (T2D) is high in Saudi Arabia, but data related to its complications are limited. This study aimed to determine the incidence of microvascular complications caused by T2D and evaluate the impact of the associated risk factors. Patients and Methods This retrospective cohort study was conducted at two military hospitals in Tabuk, Saudi Arabia. Data on the socio-demographics, glycaemic profile, blood lipid indices, duration of T2D, and associated microvascular complications were collected from electronic health records and medical files. Descriptive statistics and Cox proportional hazards models were used for data analysis. Results This study included 1563 T2D patients. The incidence of microvascular complications was 34.3% (95% confidence interval [CI], 32.0-36.6). Retinopathy was the most common complication (incidence=20.0%; 95% CI, 18.0-22.0%), while nephropathy was the least common complication (incidence=12.2%; 95% CI, 10.6-13.8%). Advanced age (≥65 years) showed the highest risk of retinopathy (Hazard ratios [HR], 2.86; 95% CI, 2.56-3.21), neuropathy (HR, 2.70; 95% CI, 2.40-3.05), and nephropathy (HR, 2.37; 95% CI, 2.12-2.64) compared with their counterparts. After adjusting for potential confounders, the study found that the significant risk factors for microvascular complications were longer duration (≥10 years) of T2D (HR, 5.3; 95% CI, 5.1-5.6), uncontrolled hypertension (HR, 3.9; 95% CI, 3.3-4.2), poor glycaemic control (HR, 4.6; 95% CI, 4.3-5.1), obesity (HR, 2.3; 95% CI, 2.2-2.6), and dyslipidaemia (HR, 1.6; 95% CI, 1.2-2.0). Conclusion Given the high burden of microvascular complications in military healthcare facilities in Tabuk, Saudi Arabia, a context-specific accessible public health program focusing on the promotion of a healthy lifestyle, physical activity, and consumption of a healthy diet, as well as the early diagnosis and management of diabetes, needs to be developed and implemented.
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Affiliation(s)
- Nasrin S Saiyed
- Research Department, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Umar Yagoub
- Research Department, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Bandar Al Qahtani
- Academic Affairs Department, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | | | - Ibrahim Al Hariri
- Family Medicine Department, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Meerab Javed Syed
- Internal Medicine Department, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | | | | | - Marwan Manajreh
- Research Department, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
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Arjunan P, D'Souza MS. Efficacy of nurse-led cardiac rehabilitation on health care behaviours in adults with chronic heart failure: An experimental design. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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D'Souza MS, Mirza NA. Towards Equitable Health Care Access: Community Participatory Research Exploring Unmet Health Care Needs of Homeless Individuals. Can J Nurs Res 2021; 54:451-463. [PMID: 34387510 PMCID: PMC9605994 DOI: 10.1177/08445621211032136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Community and health services often overlook health care needs of persons experiencing homelessness, which leads to deterioration in health and increased utilization of emergency services. Since homeless people are underrepresented in health service research, little is known about their unmet health care needs, particularly in smaller cities where resources are limited. This community-based participatory research explored the experiences of small-city homeless service users (HSUs) with unmet health care needs and community service providers (CSPs) who work with them to determine barriers to health care access affecting them. Structured interviews were conducted with 65 HSUs and 15 CSPs in interior British Columbia, Canada. These interviews were audio-recorded, and the retrieved data were analyzed thematically. The three themes uncovered included: a lack of access to health care and risk of stigma, a lack of trust and fear of discrimination, and a need for community navigation and social support. The findings indicate that HSUs do not receive equitable care and face challenges in accessing appropriate and timely foot care, which contributes to increased foot-related emergency visits, loss of trust in the health care system, and disabilities due to worsening foot conditions. Various social determinants of health also impact HSUs, such as low socioeconomic status, lack of housing, decreased social support, unhealthy behaviors, and inequitable access to health services. By collaborating with HSUs, community and health services need to develop innovative outreach programs that provide better community resources as the first step toward equitable access to health care.
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Affiliation(s)
| | - Noeman Ahmad Mirza
- Faculty of Nursing, 8637University of Windsor, Toldo Health Education Centre, Windsor, ON, Canada
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Al Salmi I, Kamble P, Lazarus ER, D'Souza MS, Al Maimani Y, Hannawi S. Kidney Disease-Specific Quality of Life among Patients on Hemodialysis. Int J Nephrol 2021; 2021:8876559. [PMID: 33880190 PMCID: PMC8049780 DOI: 10.1155/2021/8876559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Quality of life (QoL) of hemodialysis patients can be examined in two aspects: kidney-specific quality of life and general quality of life. OBJECTIVE To determine the QoL among patients undergoing hemodialysis, to assess patients' QoL on hemodialysis, and to determine the factors associated with QoL among hemodialysis patients in Oman. METHOD A cross-sectional study was carried out with 205 patients to measure the QoL across various demographic and clinical variables in Oman. The Arabic version of the KDQOL-SFtool was used to collect data from patients undergoing hemodialysis to give QoL quantitative measures. RESULTS The physical-QoL was 45.7 (95% CI, 44.3, 47.0), which is less than half that of a healthy human. The emotional-QoL is 53.33 (95% CI, 51.1, 55.5), slightly more than half in a healthy human-QoL. The difference between physical and emotional-QoL scores is -7.66 (95% CI, -10.3, -5.1), showing that physical QoL is significantly less than emotional-QoL. The overall general QoL score was 49.5 (95% CI, 47.8, 51.2), half the QoL score of a healthy human. Younger patients are also more likely to experience emotional problems compared with older patients. Patients with 5-8 mg/l levels of serum creatinine have lower emotional wellbeing. People on low incomes experienced social difficulties, while the maximum burden was found in physical activities and minimum social function. CONCLUSION Both physical (45.7) and emotional (53.3) QoL scores in dialysis patients are nearly half those of an average human. Hence, there is a poor QoL among dialysis patients like other studies, and therefore, further improvement of renal rehabilitation in dialysis patients is warranted to improve patients' QoL.
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Affiliation(s)
- Issa Al Salmi
- The Royal Hospital, 23 July Street, P. O. Box 1331, Code 111, Muscat, Oman
| | - Pramod Kamble
- Senior Specialist Nephrologist, Royal Hospital Ministry of Health, Muscat, Oman
| | | | | | - Yaqoob Al Maimani
- Senior Nephrologist & Superintendent, Bowsher Dialysis Unit, Muscat, Oman
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Wang H, Yuan M, Zou X. Efficacy and safety of Ginkgo biloba for patients with early diabetic nephropathy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21959. [PMID: 32871945 PMCID: PMC7458229 DOI: 10.1097/md.0000000000021959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Diabetic nephropathy (DN) is not only an important microvascular complication of diabetes but also the main cause of end-stage renal disease. Ginkgo biloba has a variety of biological activities and has been widely used in China to treat kidney diseases such as DN. This article aimed to evaluate the efficacy and safety of G biloba in patients affected with DN in the early stage. METHODS This protocol follows the preferred reporting items for systematic review and meta-analysis protocols and the recommendations of the Cochrane Collaboration Handbook. Seven electronic databases will be searched from inception to July 31, 2020. Two investigators will independently identify relevant randomized controlled trials, fetch data, and assess the risk of bias with tools provided by Cochrane. A comprehensive meta-analysis will be conducted with the Cochrane Collaboration software (Review Manager 5.3) for eligible and appropriate studies. Further, the evidence will be assessed with the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS The results will be published in academic peer-reviewed journals, and the evidence gathered by this project will be dedicated to assessing the efficacy and safety of G biloba for DN patients in the early stage. CONCLUSION This systematic review and meta-analysis will synthesize the available evidence to demonstrate the efficacy of G biloba in delaying the progression of patients with early DN. TRIAL REGISTRATION NUMBER PROSPERO CRD42020166805.
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Affiliation(s)
- Hongyun Wang
- Clinical College of Traditional Chinese Medicine, Hubei University of Chinese Medicine
| | - Meilin Yuan
- Clinical College of Traditional Chinese Medicine, Hubei University of Chinese Medicine
| | - Xinrong Zou
- Department of Nephrology, Hubei Provincial Hospital of Traditional Chinese Medicine
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, Hubei Province, China
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Xie F, Lei J, Ran M, Li Y, Deng L, Feng J, Zhong Y, Li J. Attenuation of Diabetic Nephropathy in Diabetic Mice by Fasudil through Regulation of Macrophage Polarization. J Diabetes Res 2020; 2020:4126913. [PMID: 32685556 PMCID: PMC7345603 DOI: 10.1155/2020/4126913] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/11/2020] [Accepted: 06/11/2020] [Indexed: 12/24/2022] Open
Abstract
Inflammation and fibrosis induced by hyperglycemia are considered to play a critical role in the pathogenesis of diabetic nephropathy. As macrophage polarization may determine the severity and progression of inflammation, regulation of macrophage polarization may be an effective method to treat diabetic complications. Fasudil, a potent Rho-kinase inhibitor, reportedly exhibits anti-inflammatory activity. However, whether fasudil reduces hyperglycemia-induced diabetic nephropathy via regulation of macrophage polarization remains unclear. In this study, we investigate the effect of fasudil on diabetic nephropathy in streptozotocin-induced type 1 diabetic mice. Our data showed that fasudil significantly decreased urinary protein and serum creatinine in diabetic mice, whereas it had no effect on the body weight and blood glucose. We also found increased M1-type macrophages and related proinflammatory cytokines, adverse fibrosis in renal tissue of diabetic mice. Interestingly, treatment of diabetic mice with fasudil increased the number of M2-type macrophages and related anti-inflammatory cytokines, which attenuated renal injury in diabetic mice. Taken together, the results of this study suggest that fasudil could slow the progression of diabetic nephropathy. The possible mechanism might be associated with its induction of M2 macrophage polarization and the reduction of M1 macrophage polarization and inflammation.
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Affiliation(s)
- Fajiang Xie
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Cardiology, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Jiesen Lei
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Maoxia Ran
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Cardiology, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Yan Li
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Li Deng
- Department of Rheumatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jian Feng
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yi Zhong
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jiafu Li
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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