The status of glycemic control: A cross-sectional study of outpatients with type 2 diabetes mellitus across primary, secondary, and tertiary hospitals in the Jiangsu province of China

Efficacy and safety of cofrogliptin once every 2 weeks in Chinese patients with type 2 diabetes: A randomized, double-blind, placebo-controlled, phase 3 trial

AIM

We conducted a multicentre, randomized phase 3 trial in China to evaluate the efficacy and safety of cofrogliptin (HSK7653), a novel long-acting dipeptidyl peptidase-4 inhibitor, in patients with drug-naïve type 2 diabetes (T2D).

MATERIALS AND METHODS

Patients with inadequately controlled T2D were randomly assigned (1:1:1) to cofrogliptin 10 mg, cofrogliptin 25 mg or placebo, taken orally once every 2 weeks for a 24-week double-blind period. Eligible patients then received cofrogliptin 25 mg in a 28-week open-label extension. The primary endpoint was the change in glycated haemoglobin (HbA1c) from baseline to week 24.

RESULTS

In total, 475 patients (median age: 54.0 years) were randomized and received at least one dose of cofrogliptin 10 mg (n = 158), cofrogliptin 25 mg (n = 158) or placebo (n = 159); 401 patients entered the open-label extension. At week 24, the least-squares (LS) mean difference (95% confidence interval [CI]) in HbA1c versus placebo was -0.63% (-0.81, -0.46) with cofrogliptin 10 mg and -0.59% (-0.77, -0.42) with cofrogliptin 25 mg (both p < 0.0001). The LS mean (standard error) change in HbA1c from baseline was maintained at the end of the study in patients given open-label cofrogliptin 25 mg for an additional 28 weeks: cofrogliptin 10 mg: -0.86% (0.07); cofrogliptin 25 mg: -0.74% (0.07); placebo: -0.89% (0.07). Over the entire study, common adverse events were hyperuricaemia, hyperlipidaemia, hypertriglyceridaemia, increased lipase, upper respiratory tract infection and urinary tract infection. Hypoglycaemic events did not significantly differ between groups.

CONCLUSIONS

Cofrogliptin provided glycaemic control over 52 weeks and was generally well tolerated in patients with T2D.

CLINICAL TRIAL REGISTRATION

Registered on Clinicaltrials.gov with the registration number NCT04556851 (https://clinicaltrials.gov/study/NCT04556851).

Glycemic control during TB treatment among Filipinos: The Starting Anti-Tuberculosis Treatment Cohort Study

Poor TB treatment outcomes are observed in patients with type 2 diabetes mellitus (DM) comorbidity and glycemic control throughout treatment may play a role. The objective of this study was to investigate glycemic control longitudinally among Filipino adults undergoing TB treatment using mixed-effects linear and logistic regression. Analyses were conducted in 188 DM-TB patients out of 901 enrolled in the Starting Anti-TB Treatment (St-ATT) cohort, with a median baseline glycosylated hemoglobin (HbA1c) of 8.2% (range 4.5-13.3%). Previous versus new DM diagnosis was associated with higher mean HbA1c (worse glycemic control) during treatment, with a smaller effect amongst those with central obesity (coefficient 0.80, 95% confidence interval [CI] 0.26, 1.57, P = 0.043) than amongst those without central obesity (coefficient 3.48, 95% CI 2.16, 4.80, P<0.001). In those with a new DM diagnosis, central obesity was associated with higher blood glucose (coefficient 1.62, 95% CI 0.72, 2.53, P = 0.009). Of 177 participants with ≥2 HbA1c results, 40% had uncontrolled glycemia (≥2 HbA1c results ≥8%). Of 165 participants with ≥3 HbA1c results, 29.9% had consistently-controlled glycemia, 15.3% had initially-uncontrolled glycemia, and 18.6% had consistently-uncontrolled glycemia. Previous versus new DM diagnosis and glucose-lowering medication use versus no use were associated with having uncontrolled versus controlled glycemia (adjusted odds ratio [aOR] 2.50 95%CI 1.61, 6.05, P = 0.042; aOR 4.78 95% CI 1.61,14.23, P<0.001) and more likely to have consistently-uncontrolled versus consistently-controlled glycemia (adjusted relative risk ratio [aRRR] 5.14 95% CI 1.37, 19.20, P = 0.015; aRRR 10.24 95% CI 0.07, 0.95, P = 0.003). Relapse cases of TB were less likely than new cases to have uncontrolled (aOR 0.20 95%CI 0.06, 0.63, P = 0.031) or consistently-uncontrolled (aRRR 0.25 95%CI 0.07, 0.95, P = 0.042) versus controlled glycemia. Those with long-term DM, suggested by previous diagnosis, glucose-lowering medication use and possibly central obesity, may require additional support to manage blood glucose during TB treatment.

Estimating the health burden of foodborne gastroenteritis caused by non-typhoidal Salmonella enterica and Vibrio parahaemolyticus in Zhejiang province, China

As acute gastrointestinal (AGI) disease patients only sometimes seek medical care or submit stool samples for testing, and laboratories cannot detect or identify the pathogen, most cases of foodborne gastroenteritis still need to be identified through public health monitoring. We conducted a population survey and sentinel hospital surveillance to determine the burden of foodborne gastroenteritis caused by non-typhoidal Salmonella enterica (NTS) and Vibrio parahaemolyticus infection, from July 2018 to June 2019 in Zhejiang province, China, and a model for calculating disease burden established. Using the burden of illness pyramid model, we estimated that there were 140.3 cases of NTS infection and 136.2 cases of V. parahaemolyticus infection. We estimated annual incidence per 100,000 population in Zhejiang province as 236 (95% confidence interval [CI] 208-267) and 206 (95% CI 155-232) cases for foodborne NTS and V. parahaemolyticus gastroenteritis, respectively. The results show that AGI caused by these two pathogens constitutes a substantial burden in the Zhejiang population. The health burden of AGI estimations caused by NTS and V. parahaemolyticus in this study can serve as a strategic framework to direct policy and intervention.

The prevalence of glycemic control in patients with type 2 diabetes treated with insulin: a systematic review and meta-analysis

OBJECTIVES

To estimate the overall prevalence of glycemic control among patients with type 2 diabetes (T2D) treated with insulin.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A systematic search was performed in PubMed, EMBASE, Cochrane CENTRAL, and ProQuest Dissertation and Theses from 2000 to January 2022. Cross-sectional studies were included if they were conducted on more than 292 patients with T2D and reported the number of insulin-treated patients who were justified as achieving glycemic control. The Joanna Briggs Institute critical appraisal checklist was used to assess the quality of the included studies. Pooled estimates of the prevalence of glycemic control were calculated and reported with a 95% confidence interval (95% CI) using a random-effects model. All analyses were conducted using RStudio Version 2022.02.0, Build 443 (meta package).

RESULTS

A total of 42 studies (234,345 patients) met the inclusion criteria and were classified as having a low risk of bias. The overall estimated prevalence of glycemic control to insulin therapy among patients with T2D was 26.02% (95% CI: 23.17, 29.08). A subgroup of 34 studies that set the target HbA1c <7% showed that 23.75% (95% CI: 21.47, 26.18) of patients with T2D treated with insulin were justified as achieving good glycemic control.

CONCLUSIONS

This study provided summative evidence that glycemic control among patients with T2D treated with insulin was suboptimal and should be appropriately addressed.

Glycated haemoglobin trajectories and one-year risk of potentially avoidable hospitalisations among adult type 2 diabetes patients seeking care at specialist outpatient clinics of a tertiary hospital: a cohort study

AIM

To evaluate the association between trajectories of glycated haemoglobin (HbA1c) and potentially avoidable hospitalisations (PAH).

METHODS

We performed a cohort study in a tertiary hospital in Singapore among adult type 2 diabetes patients with ≥3HbA1c tests over two years. Then, we followed up for one year after the last HbA1c reading. Glycaemic control was analysed by (1)HbA1c trajectories through group-based trajectory modelling, and (2)mean HbA1c. PAH was defined using the Agency of Healthcare Research and Quality criteria, categorising as overall, acute, chronic, diabetes-composites.

RESULTS

A total of 14923 patients (mean age:62.9±12.8 years;55.2% men)were included. Four HbA1c trajectories were observed; low-stable(n=9854,66.0%), moderate-stable(n=3125,20.9%), high-decrease(n=1017,6.8%) and high-persistent(n=927,6.2%). Compared to the low-stable trajectory, one-year risk ratio(RR) and 95%CI, respectively for moderate-stable, high-decrease and high-persistent trajectories were as follows:(1)overall PAH:1.15(1.00-1.31),1.53(1.31-1.80),1.96(1.58-2.43);(2)diabetes PAH:1.30(1.04-1.64),1.98(1.55-2.53),2.24(1.59-3.15);(3)acute PAH:1.14(0.90-1.44),1.29(0.95-1.77),1.75(1.17-2.62); and (4)chronic PAH:1.21(1.02-1.43),1.62(1.34-1.97),2.14(1.67-2.75). Mean HbA1c was significantly associated with overall and chronic-composites of PAH whilst evidence of a non-linear relationship with diabetes-composite of PAH was noted.

CONCLUSION

Patients with high-decrease trajectory had a risk lower than those with persistently-high HbA1c, highlighting that a greater risk of hospitalisation conferred by poor glycaemic control is potentially reversible. Determining HbA1c trajectories could help to identify the high-risk individuals for targeted and intensive management to improve care and reduce hospitalisations.

Estimating the burden of foodborne gastroenteritis due to nontyphoidal Salmonella enterica, Shigella and Vibrio parahaemolyticus in China

To estimate the incidence of foodborne gastroenteritis caused by nontyphoidal Salmonella enterica, Shigella, and Vibrio parahaemolyticus in China, population surveys and sentinel hospital surveillance were implemented in six provinces from July 2010 to July 2011, and a multiplier calculation model for the burden of disease was constructed. The multiplier for salmonellosis and V. parahaemolyticus gastroenteritis was estimated at 4,137 [95% confidence interval (CI) 2,320–5,663], and for shigellosis at 4,356 (95% CI 2,443–5,963). Annual incidence per 100,000 population was estimated as 245 (95% CI 138–336), 67 (95% CI 38–92), and 806 (95% CI 452–1,103) for foodborne salmonellosis, shigellosis, and V. parahaemolyticus gastroenteritis, respectively, indicating that foodborne infection caused by these three pathogens constitutes an important burden to the Chinese healthcare system. Continuous implementation of active surveillance of foodborne diseases, combined with multiplier models to estimate disease burden, makes it possible for us to better understand food safety status in China.

Prevalence, awareness and control of type 2 diabetes mellitus and risk factors in Chinese elderly population

Background

Type 2 diabetes mellitus is an expanding global public health issue, especially in developing countries. This study aimed to investigate the prevalence, awareness and control rate of type 2 diabetes mellitus, and assess its risk factors in elderly Chinese individuals.

Methods

The health screening data of 376,702 individuals aged ≥ 65 years in Wuhan, China, were collected to analyse the prevalence, awareness, and control rates of diabetes. Indices, including fasting plasma glucose and other biochemical indicators, were measured for all participants using standard methods at the central laboratory. Multilevel logistic regression analysis was performed to assess the key determinants of the prevalence, awareness, and control rates of diabetes.

Results

The prevalence, awareness, and control rates of diabetes in the Chinese individuals aged ≥ 65 years were 18.80%, 77.14%, and 41.33%, respectively. There were statistically significant differences in the prevalence, awareness, and control rates by gender. Factors associated with diabetes prevalence were age, body mass index (BMI), and central obesity; while those associated with awareness and control were gender, education level, marital status, physical activity, alcohol consumption, BMI, and central obesity.

Conclusions

Diabetes is an important public health problem in the elderly in China. The awareness and control rates have improved, but overall remained poor. Therefore, effective measures to raise awareness and control the rates of diabetes should be undertaken to circumvent the growing disease burden in elderly Chinese people.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13759-9.

Prevalence and determinants of poor glycaemic control: a cross-sectional study among Moroccan type 2 diabetes patients

BACKGROUND

Diabetes remains poorly controlled in a high proportion of diabetes patients. This study examines the prevalence of poor glycaemic control and associated factors in type 2 diabetes patients in the Beni-Mellal Khenifra region in Morocco.

METHODS

A cross-sectional survey was conducted in 2017 among 1456 diabetes patients attending primary health centres. Demographic and clinical data were collected through face-to-face interviews using structured and pre-tested questionnaires. Anthropometric measurements, including body weight, height and waist circumference were taken using standardized techniques and calibrated equipment. Glycaemic control was assessed in terms of the glycated haemoglobin (HbA1c) level and poor glycaemic control was defined as HbA1c ≥7% and a level <7% reflects good glycaemic control.

RESULTS

Of the total participants, 66.3% had poor glycaemic control. Bivariate analysis showed that sex (p=0.010), education level (p=0.013), body mass index (p=0.048), duration of diabetes (p<0.0001) and type of therapeutic regimen (p<0.0001) were significantly associated with HbA1c level. However, multiple logistic regression analyses revealed that only a longer duration of diabetes (OR 1.525 [95% confidence interval {CI} 1.183-1.967], p=0.001) and receiving insulin therapy alone (OR 1.589 [95% CI 1.157-2.183], p=0.004) or a combination of oral antidiabetics with insulin (OR 2.554 [95% CI 1.786-3.653], p<0.001) were significantly associated with inadequate glycaemic control.

CONCLUSIONS

Despite the particularities of the region, the findings about glycaemic control and its cross-sectionally associated factors are in line with findings from other regions of Morocco. In this subgroup, the longer duration of diabetes and insulin treatment could constitute a cause leading to poor glycaemic control. However, inverse causality cannot be excluded.

General characteristics and reasons for the discontinuation of drug clinical trials in mainland China

Background

Although discontinuation is common in clinical trials, no study has been conducted to analyse the current situation and reasons for the suspension or discontinuation of drug clinical trials in China. This study aims to analyse the general characteristics and reasons for the discontinuation of registered clinical trials in mainland China and to identify the associated factors.

Methods

We conducted a cross-sectional observational study of discontinued trials registered in the Drug Trial Registration and Information Publication Platform before March 31, 2020. All trials with a status of terminated or stopped recorded in the platform were classified as discontinued trials and included in the analysis. The basic characteristics of the discontinued trials were recorded, reasons for trial discontinuation were recorded and divided into 4 categories as drug development strategy, trial planning, trial conduct and studied drug. Pearson’s chi-square test and fisher’s exact test were used to compare the differences in reasons for discontinuation between neoplasm trials and non-neoplasm trials, and to examine the associations of trial characteristics with different reasons related to trials discontinuation.

Results

Three hundred twelve discontinued trials were included in this study. The studied drugs were mainly chemical drugs [229 (73.4%)], and indications of the studied drugs were mainly neoplasms [77 (24.7%)]. Geographical location of the discontinued trials were mostly in northern [114 (36.5%)] and eastern [96 (30.8%)] China. Study type of the included trials was mainly bioequivalence studies [97 (31.1%)]. The most common reason for trial discontinuation was commercial or strategic decision [84 (26.9%)], followed by futility/lack of efficacy [70 (22.4%)]. The number of trial centers, sample size and whether participants had been enrolled were significantly associated with trial discontinuation (P <  0.05). Multiple center trials showed a higher rate of trial discontinuation due to trial conduct related reasons than single center trials (P <  0.05), trials with sample size > 500 showed a higher rate of trial discontinuation due to studied drug related reasons (P < 0.05), and trials enrolled participants showed a lower rate of trial discontinuation due to commercial or strategic decision and a higher rate of trial discontinuation due to studied drug related reasons than trials without enrolled participants (P < 0.05). Besides, neoplasm trials showed a higher rate of trial discontinuation due to poor recruitment and safety comparing with non-neoplasm trials (P < 0.05).

Conclusions

Trial discontinuation in China mainly occurred because of commercial or strategic decision and futility/lack of efficacy of the studied drug. Clinical trials with multiple centers and a large sample size may more likely be discontinued due to trial conduct related reasons such as good clinical practice. Discontinuation due to drug safety and lack of efficacy in multiple center trials with a large sample size deserves more attention to avoid resources wastes. Full communication with regulatory authorities such as Center for Drug Evaluation and research institutes to develop a feasible protocol is important for sponsors to avoid trial discontinuation due to protocol issues.

Evaluating the quality of care for patients with type 2 diabetes mellitus based on the HbA1c: A national survey in Iran

Objective

The present study was conducted to evaluate the quality of care for type2 diabetic patients based on the HbA1c in Iran.

Materials and methods

This cross-sectional study was conducted in 2019 among patients with type 2 diabetes in Iran. The data were collected through a three-part questionnaire including demographic information, disease-related records, and HbA1C status of patients. Multiple logistic regression was used to investigate the relationship between the outcome variable (HbA1c status) and the independent variables in Stata 12.

Results

The mean HBA1c was 8.01 ± 1.76% among 1,198 diabetic patients, and more than 66% of them had HBA1c above 7%, i.e. they had uncontrolled blood sugar levels. HBA1c has the highest average among people with more than 10 years of diabetes (8.47 ± 1.77%), self-employed people (8.36 ± 1.94%), illiterate people or those with elementary education (8.13 ± 1.76%) and people with poor economic status (8.12 ± 1.79%). Also, in the final model, people with more than 10 years of disease history had the highest prevalence of HBA1C > 7 with a chance ratio of 3.28 (P < 0.001, 95%CI: 2.37–4.53) and followed by illiterate people or those with elementary education with a chance ratio of 1.6 (P = 0.020, 95%CI: 1.08–2.39) compared to those with high school diploma or academic education.

Conclusion

The prevalence of adverse HBA1c in 66% of the studied subjects indicates an inappropriate status of diabetes control in Iran. This indicates the poor quality of services provided to the diabetics. This is a warning sign and requires appropriate interventions to improve the quality of services provided to diabetic patients.

Successful Implementation and Development of a Phase II Cardiac Rehabilitation Program: A China-Wide Cross-Sectional Study Tracking In-service Training Clinical Staff

Background: Despite the benefits of cardiac rehabilitation (CR), phase II CR remains highly unavailable; the factors influential to the successful implementation and development of phase II CR programs have not been fully explored.

Methods: A cross-sectional survey was completed by 168 nationwide clinical staff. Parameters associated with the successful implementation and development of phase II CR and the factors associated with the quality of CR were explored by multivariable logistic regression.

Results: One hundred and eighteen of 168 respondents' institutions had successfully developed phase II CR programs, 41 of which delivered high-quality CR. Independent factors associated with successful implementation and development of CR were leadership support from hospital administrators, support from resident physicians, staff perception in CR increasing medical risk, and department type (cardiology vs. rehabilitation department). Independent factors associated with CR quality were the availability of “professional CR providers” and staff perceptions of CR improving physician–patient relationships. The medical system factors did not affect the development and quality of CR, including hospital level, funding type, academic type, general/specialized hospital, located city, medical insurance, the existence of a CR outpatient clinic and independent space, the availability of professional CR providers, staff structure, and the availability of regular training and standard procedure.

Conclusions: The development and quality of a phase II CR program may benefit from factors including support from administrators and resident physicians, adequately training more CR providers, without viewing medical system factors as a major issue.

Titratable fixed-ratio combination of insulin glargine plus lixisenatide: A simplified approach to glycemic control in type 2 diabetes mellitus

Approximately 50% of patients with type 2 diabetes mellitus (T2DM) do not achieve glycemic targets and require treatment intensification. A fixed-ratio combination of a glucagon-like peptide-1 receptor agonist (GLP-1 RA) with basal insulin, such as lixisenatide with insulin glargine (iGlarLixi), exploits the complementary mechanisms of action of each component to address hyperglycemia while mitigating potential adverse events (AEs). The iGlarLixi dose is titrated considering the effect of basal insulin on fasting plasma glucose, and the fixed-ratio combination ensures that the lixisenatide dose never exceeds 20 μg/day. We describe the characteristics of iGlarLixi therapy, based on the LixiLan clinical program, and provide guidance on the characteristics of patients likely to benefit from such treatment in routine clinical practice. In the phase III LixiLan trials, iGlarLixi resulted in significantly greater reductions in glycated hemoglobin (HbA1c), better achievement of HbA1c targets, less glycemic variability versus insulin glargine, lixisenatide or GLP-1 RA alone, and was associated with weight control, less hypoglycemia versus insulin glargine, and fewer GI AEs versus lixisenatide. Findings were consistent regardless of age, diabetes duration, and baseline HbA1c. The efficacy, safety, and convenient once-daily administration schedule of iGlarLixi make it a valuable treatment option for patients with T2DM requiring treatment intensification.

The human health burden of non-typhoidal Salmonella enterica and Vibrio parahaemolyticus foodborne gastroenteritis in Shanghai, east China

Information on the burden of disease due to foodborne pathogens in China is quite limited. To understand the incidence of foodborne gastroenteritis due to non-typhoidal Salmonella enterica and Vibrio parahaemolyticus, population survey and sentinel hospital surveillance were conducted during July 2010 to June 2011 in Shanghai, east China, and a model for calculating disease burden was established. The multiplier for gastroenteritis caused by these pathogens was estimated at 59 [95% confidence interval (CI) 30–102]. Annual incidence per 100,000 population in Shanghai was estimated as 48 (95% CI 24–83) and 183 (95% CI 93–317) cases for foodborne non-typhoidal salmonellosis and V. parahaemolyticus gastroenteritis, respectively, illustrating that bacterial gastroenteritis due to these two pathogens poses a substantial health burden. There is a significant difference between our simulated incidence and the data actually reported for foodborne diseases, indicating significant underreporting and underdiagnosis of non-typhoidal S. enterica and V. parahaemolyticus gastroenteritis in the surveillance area. The present research demonstrates basic situation of the health burden caused by major foodborne pathogens in the surveillance area. Enhanced laboratory-based sentinel hospital surveillance is one of the effective ways to monitor food safety in east China.

Organisational and individual characteristics associated with glycaemic control among patients with type 2 diabetes: cross-sectional study in China

OBJECTIVE

There is a high prevalence of poor glycaemic control among patients with type 2 diabetes (T2DM) in China. This study aimed to explore both organisational and individual characteristics associated with glycaemic control among patients with T2DM.

DESIGN

Cross-sectional survey.

SETTING

Shandong Province, China.

PARTICIPANTS

The participants were 2166 patients with T2DM and 337 healthcare providers from 36 urban communities and 36 rural villages in Shandong Province.

PRIMARY AND SECONDARY OUTCOME MEASURES

Multistage stratified sampling procedures were used to measure demand-side individual demographic, clinical and self-management characteristics, and supply-side organisational characteristics, and the status of glycaemic control. Multilevel logistic regression analysis was performed to assess key determinants of glycaemic control.

RESULTS

Only 42.8% of the patients with T2DM achieved good glycaemic control. Age, income, hypertension and self-efficacy were significantly positive predictors of optimal glycaemic control, while duration of diabetes, antidiabetic drugs and monitoring of blood glucose were significantly negative predictors of that. Private VCs (OR=0.48, 95% CI 0.29 to 0.82, p<0.01) and lack of healthcare providers (OR=0.69, 95% CI 0.53 to 0.89, p<0.01; OR=0.71, 95% CI 0.52 to 0.98, p<0.05) were significantly negative predictors of optimal glycaemic control, while diabetes knowledge level of healthcare providers (OR=1.36, 95% CI 1.02 to 1.83, p<0.05; OR=1.45, 95% CI 1.00 to 2.10, p<0.05) and kinds of antidiabetic drugs (OR=1.37, 95% CI 0.97 to 1.93, p<0.1; OR=1.46, 95% CI 1.07 to 2.00, p<0.05) were significantly positive predictors of that.

CONCLUSIONS

Glycaemic control was suboptimal among patients with T2DM in China. The determinants of failing to achieve good glycaemic control included both organisational and individual characteristics. Potential interventions that target patients, providers and the healthcare organisations should be taken to improve the glycaemic control and health outcome among patients with T2DM.

Factors associated with glycaemic control in patients with diabetes mellitus: A systematic literature review

OBJECTIVES

To perform a systematic review search and critically review the empirical evidence concerning the factors affecting glycaemic control in patients with type 1 or 2 diabetes mellitus.

BACKGROUND

Previous primary studies have investigated the factors associated with glycaemic control among patients with type 1 or 2 diabetes, but attempts to amalgamate these evidences have been methodologically limited. Hence, a robust review of the evidence is essential to explore factors that can be addressed to promote good glycaemic control in patients with diabetes.

DESIGN

Mixed-method systematic review using the Preferred Reporting Items for Systematic review and Meta-Analysis 2009 flow diagram, integrating evidence from qualitative and quantitative studies (see Supporting Information File S1).

METHODS

A systematic review of the literature published between 2006-2017 was conducted in seven electronic databases (CINAHL, MEDLINE, Scopus, EMBASE, PsycINFO, PubMed and ScienceDirect) using the search terms "diabetes mellitus," "glycemic control," "self-concept," "knowledge," "self-efficacy," "empowerment," "race," "ethnicity," "duration," "medication," "obesity" and "comorbidity."

RESULTS

A total of 1,582 articles were initially retrieved, and 24 of these articles were included in this systematic literature review. The overall empirical evidence suggested that higher socio-economic status, greater dietary knowledge, and higher self-efficacy and empowerment improve glycaemic control among patients with diabetes mellitus.

CONCLUSIONS

This review presented the factors associated with glycaemic control that may pose significant socio-economic problems to most nations worldwide and impede development nationally, regionally and even globally. Greater emphasis needs to be placed on implementing lifestyle changes on a societal level to stem the tide of the epidemic.

RELEVANCE TO CLINICAL PRACTICE

There is a need to implement self-management initiatives, that incorporate dietary knowledge, to empower patients with diabetes in their own care. Future public health policy must be geared towards increasing the capability of dealing with the rising incidence of diabetes and implementing primary prevention.

Glycemic Control in Patients with Diabetes across Primary and Tertiary Government Health Sectors in the Emirate of Dubai, United Arab Emirates: A Five-Year Pattern

Objectives

In the UAE, the comparative prevalence of diabetes is reported as 18.98%, but there are very few studies evaluating glycemic control. Attaining the optimum glycemic control has been a global challenge over the years. However, there is a trend of global improvement with the availability of newer options of antidiabetic medications, increasing numbers of physicians, and patient awareness. Our primary aim was to assess the level of glycemic control across Dubai Health Authority points of care over the past five years. Additionally, we aimed to compare the differences in glycemic control between primary and tertiary centers, between nationalities, and type I and II diabetes.

Methods

We conducted a retrospective analysis of the electronic medical records of all patients who attended primary and tertiary care centers within the Dubai Health Authority between 2012 and 2016. All patients with any type of diabetes were included in this assessment.

Results

A total of 26 447 patients were included in the study; of these, 73.8% (n = 19 508) were UAE nationals while the other nationalities accounted for 26.2% (n = 6939) of patients. The overall mean glycated hemoglobin (HbA_1c) levels from 2012 to 2016 was 7.76%. Patients attending primary care clinics had a mean HbA_1c of 7.64% compared to 7.68% for the tertiary care cohort. Out of the total population, 37.7% achieved HbA_1c < 7%. Over 40% of the patients attending primary care centers achieved HbA_1c < 7% compared to 34.9% of those who attended tertiary care centers.

Conclusions

Optimum glycemic target was achieved by less than 40% of patients. Glycemic control is still below the desired levels. However, there has been a trend of improvement in the last few years and we are achieving the international average targets. Further collaborative actions from clinical, educational, and strategic sectors are needed to improve our goals further.

The Status of Metabolic Control in Patients With Type 2 Diabetes Attending Dasman Diabetes Institute, Kuwait

Purpose: To evaluate metabolic control in patients with type 2 diabetes at Dasman Diabetes Institute (DDI, Kuwait), a specialist diabetes clinic and research center, and to investigate its association with patient demographics and clinical characteristics. Methods: Data from 963 patients with type 2 diabetes were retrospectively collected from the Knowledge Based Health Records maintained at DDI for patients who attended DDI during 2011-2014. The collected data included patient demographics, clinical characteristics, and anti-diabetic medications. Student's t-test was used to evaluate the differences in mean values between poor and good glycemic control groups. Categorical variables were assessed using chi-square analysis with Fisher's exact test for small data sets. Results: The patients' mean age was 53.0 ± 9.5 years with equal number of males and females. Females (34.4 ± 7.2 kg/m²) had a higher mean body mass index than males (32.1 ± 6.4 kg/m²). The mean fasting blood glucose and HbA1c levels were 9.6 ± 3.8 mmol/L and 8.5 ± 1.8%, respectively. Dyslipidemia (46%) and hypertension (40%) were the most common comorbidities, whereas nephropathy (36%) and neuropathy (35%) were the most common diabetic complications. The most commonly used anti-diabetic medication was metformin (55%). Factors significantly associated with poor glycemic control (HbA1c level ≥ 7%) included insulin use; neuropathy or foot ulcers as diabetic complications; and elevated systolic blood pressure and total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and fasting blood glucose levels. Factors significantly associated with good glycemic control included metformin use and elevated high-density lipoprotein cholesterol level. The proportion of patients with good glycemic control (HbA1c level < 7%) was 29.5%. A large proportion of the patients with poor glycemic control were only administered monotherapy drugs, and two-thirds of the patients were obese. Further, the American Diabetes Association (ADA) recommendations for blood pressure and LDL cholesterol level were met (62 and 63%, respectively) by follow-up year 4. Conclusion: The therapeutic management of type 2 diabetes in Kuwait is suboptimal. Therapeutic strategies should ensure better adherence to ADA guidelines, evaluate the high obesity rates, and adherence to lifestyle recommendations by patients, and continually promote diabetes education and self-empowerment.

Factors influencing diet barriers among outpatients with poorly-controlled type 2 diabetes: A descriptive correlational study

The aim of the present descriptive correlational study was to investigate diet barriers and their influencing factors among outpatients with poorly-controlled type 2 diabetes in Singapore. One hundred and ten patients with poorly-controlled type 2 diabetes were recruited from a tertiary hospital in Singapore. The Personal Diabetes Questionnaire and Appraisal of Diabetes Scale were used to measure the study variables. Our participants reported that the most common diet barriers were eating out, followed by food cravings. Eating problems and negative diabetes appraisal were identified as significant predictors of diet barriers. The findings laid the groundwork with preliminary findings for the development of culturally-tailored and patient-centered education programs to enhance eating behaviors and promote positive appraisal.

Association of Self-Reported Dietary and Drug Compliance with Optimal Metabolic Control in Patients with Type 2 Diabetes: Clinic-Based Single-Center Study in a Developing Country

Introduction

Influence of dietary and drug compliance of patients with diabetes on attainment of optimal metabolic (glucose and lipid) control remains underexplored in developing countries.

Materials and methods

Self-reported dietary and drug compliance score of 0–10, glycosylated hemoglobin (HbA1c), and low-density lipoprotein (LDL) levels were obtained from patients with diabetes. HbA1c <7% and LDL <100 mg/dL were used to define optimal glucose and lipid control, respectively. Proportions achieving each and both optimal parameters were estimated. Regression analysis was used to study the association of age, gender, age of onset and the duration of diabetes, self-reported dietary, and drug compliance scores with achievement of both parameters.

Results

Mean (SD) age and duration of diabetes of 207 patients were 55 (10) and 10 (03) years. Optimal glucose and LDL control were achieved by 30% and 62%, and 23% had achieved both. Regression analysis revealed significant association of self-reported high dietary compliance with achievement of both targets.

Conclusions

Findings highlight the suboptimal glucose and lipid control among patients with diabetes. Significant association of better dietary compliance with control of both parameters emphasizes the value of proper dietary adherence in achieving the optimal metabolic control among patients with diabetes.

Glycaemic control in type 2 diabetes patients and its predictors: a retrospective database study at a tertiary care diabetes centre in Ningbo, China

OBJECTIVES

The objectives of the study were to assess glycaemic control in patients with type 2 diabetes (T2DM) at a tertiary care diabetes centre in Ningbo, China and to determine factors that independently predict their glycaemic control.

DESIGN

Retrospective cross-sectional study using an existing database, the Diabetes Information Management System.

SETTING

Tertiary care diabetes centre in Ningbo, China.

PARTICIPANTS

The study included adult patients with T2DM, registered and received treatment at the diabetes centre for at least six consecutive months. The study inclusion criteria were satisfied by 1387 patients, from 1 July 2012 to 30 June 2017.

PRIMARY OUTCOME MEASURE

Glycaemic control (poor was defined as glycated haemoglobin (HbA1c)>=7% or fasting blood glucose (FBG)>7.0 mmol/L).

RESULTS

In terms of HbA1c and FBG, the 5-year period prevalence of poor glycaemic control was 50.3% and 57.3%, respectively. In terms of HbA1c and FBG, the odds of poor glycaemic control increased with the duration of T2DM (>1 to 2 years: OR 1.84, 95% CI 1.06 to 3.19; >2 to 4 years: 3.32, 1.88 to 5.85 and >4 years: 5.98, 4.09 to 8.75 and >1 to 2 years: 2.10, 1.22 to 3.62; >2 to 4 years: 2.48, 1.42 to 4.34 and >4 years: 3.34, 2.32 to 4.80) and were higher in patients residing in rural areas (1.68, 1.24 to 2.28 and 1.42, 1.06 to 1.91), with hyperlipidaemia (1.57, 1.12 to 2.19 and 1.68, 1.21 to 2.33), on diet, physical activity and oral hypoglycaemic drug (OHD) as part of their T2DM therapeutic regimen (1.80, 1.01 to 3.23 and 2.40, 1.36 to 4.26) and on diet, physical activity, OHD and insulin (2.47, 1.38 to 4.41 and 2.78, 1.58 to 4.92), respectively.

CONCLUSIONS

More than half of patients with T2DM at the diabetes centre in Ningbo, China have poor glycaemic control, and the predictors of glycaemic control were identified. The study findings could be taken into consideration in future interventional studies aimed at improving glycaemic control in these patients.

The prevalence and determinants of poor glycemic control among adults with type 2 diabetes mellitus in Saudi Arabia

BACKGROUND

Although the prevalence of type 2 diabetes mellitus (T2DM) is rising sharply in Saudi Arabia, data on glycemic control, crucial to reducing diabetes mellitus complications, remain scarce. This study therefore investigated glycemic control status and the factors influencing poor glycemic control among adult T2DM patients in Saudi Arabia.

METHODS

This cross-sectional study examined 423 T2DM patients at a diabetic center in Tabuk, Saudi Arabia between September 2016 and July 2017. Glycemic levels were measured via fasting blood glucose (FBG) levels, and "poor glycemic control" was defined as FBG >130 mg/dL. Poor glycemic control's risk factors were identified using a logistic regression.

RESULTS

In the sample, 74.9% of the patients had poor blood glycemic control. Logistic regression revealed that T2DM patients had an increased chance of poorly controlled diabetes if they had family histories of diabetes (adjusted odds ratio [AOR] =7.38, 95% CI 4.09-13.31), longer diabetic durations (AOR =2.33, 95% CI 1.14-4.78 for 5-10 years and AOR =5.19, 95% CI 2.50-10.69 for >10 years), insufficient physical exercise (AOR =19.02, 95% CI 6.23-58.06), or were overweight (AOR =3.79, 95% CI 2.00-7.18), or obese (AOR =5.35, 95% CI 2.72-12.59).

CONCLUSION

A high proportion of the sampled patients had poor glycemic control, therefore, health care professionals should manage the associated risk factors to limit disease complications and improve the health of patients with diabetes.

Design and rationale of the Cardiovascular Health and Text Messaging (CHAT) Study and the CHAT-Diabetes Mellitus (CHAT-DM) Study: two randomised controlled trials of text messaging to improve secondary prevention for coronary heart disease and diabetes

INTRODUCTION

Mobile health interventions have the potential to promote risk factor management and lifestyle modification, and are a particularly attractive approach for scaling across healthcare systems with limited resources. We are conducting two randomised trials to evaluate the efficacy of text message-based health messages in improving secondary coronary heart disease (CHD) prevention among patients with or without diabetes.

METHODS AND ANALYSIS

The Cardiovascular Health And Text Messaging (CHAT) Study and the CHAT-Diabetes Mellitus (CHAT-DM) Study are multicentre, single-blind, randomised controlled trials of text messaging versus standard treatment with 6 months of follow-up conducted in 37 hospitals throughout 17 provinces in China. The intervention group receives six text messages per week which target blood pressure control, medication adherence, physical activity, smoking cessation (when appropriate), glucose monitoring and lifestyle recommendations including diet (in CHAT-DM). The text messages were developed based on behavioural change techniques, using models such as the information-motivation-behavioural skills model, goal setting and provision of social support. A total sample size of 800 patients would be adequate for CHAT Study and sample size of 500 patients would be adequate for the CHAT-DM Study. In CHAT, the primary outcome is the change in systolic blood pressure (SBP) at 6 months. Secondary outcomes include a change in proportion of patients achieving a SBP <140 mm Hg, low-density lipoprotein cholesterol (LDL-C), physical activity, medication adherence, body mass index (BMI) and smoking cessation. In CHAT-DM, the primary outcome is the change in glycaemic haemoglobin (HbA_1C) at 6 months. Secondary outcomes include a change in the proportion of patients achieving HbA_1C<7%, fasting blood glucose, SBP, LDL-C, BMI, physical activity and medication adherence.

ETHICS AND DISSEMINATION

The central ethics committee at the China National Center for Cardiovascular Disease and the Yale University Institutional Review Board approved the CHAT and CHAT-DM studies. Results will be disseminated via usual scientific forums including peer-reviewed publications.

TRIAL REGISTRATION NUMBER

CHAT (NCT02888769) and CHAT-DM (NCT02883842); Pre-results.

Effectiveness and clinical inertia in patients with antidiabetic therapy

AIMS

To establish the effectiveness of antidiabetic therapy and the frequency of clinical inertia in the management of type 2 diabetes mellitus in Colombia.

METHODS

A cross-sectional study with follow-up of patients who had been treated for at least 1 year and were receiving medical consultation for antidiabetic treatment. Effectiveness was established when haemoglobin-A1c levels were <7% and when clinical inertia was reached, which was defined as no therapeutic modifications despite not achieving management controls. Sociodemographic, clinical and pharmacological variables were evaluated, and multivariate analyses were performed.

RESULTS

In total, 363 patients with type 2 diabetes mellitus were evaluated, with a mean age of 62.0±12.2 years. A total of 1,016 consultations were evaluated, and the therapy was effective at the end of the follow-up in 57.9% of cases. Clinical inertia was found in 56.8% of patients who did not have metabolic control. The most frequently prescribed medications were metformin (84.0%), glibenclamide (23.4%) and insulin glargine (20.7%). Moreover, 57.6% of the patients were treated with two or more antidiabetic medications. Having metabolic control in the first consult of the follow-up was a protective factor against clinical inertia in the subsequent consultations (OR: 0.08; 95%CI: 0.04-0.15; P<.001).

CONCLUSIONS

The effectiveness of treatment for patients with type 2 diabetes mellitus has increased in Colombia, and for the first time, clinical inertia was identifiable and quantifiable and found in similar proportions to other countries. Clinical inertia is a relevant condition given that it interferes with the possibility of controlling this pathology.

Structured self-monitoring of blood glucose regimens improve glycemic control in poorly controlled Chinese patients on insulin therapy: Results from COMPASS

BACKGROUND

The use of self-monitoring of blood glucose (SMBG) among patients with insulin-treated, type 2 diabetes (T2DM) in China is suboptimal. Herein we evaluated the effectiveness of structured SMBG for improving glycemic control and increasing the frequency of SMBG.

METHODS

Insulin-treated (>3 months) T2DM patients aged ≥18 years with HbA1c >8.0 % (64 mmol/mol) were recruited to the study. They received SMBG materials and were advised on a structured SMBG regimen for their insulin therapy. Patients were trained to self-adjust insulin dosage according to SMBG readings and were seen by physicians at Months 3 and 6. Endpoints included changes in HbA1c, SMBG frequency, and hypoglycemia frequency.

RESULTS

The study enrolled 820 patients, with mean (± SD) age 55.1 ± 9.8 years, body mass index 24.9 ± 3.6 kg/m² , HbA1c 9.7 ± 1.6 % (83 mmol/mol), and diabetes duration 9.8 ± 7.1 years, with median insulin therapy of 30.3 (3.0-274.1) months, from 19 Chinese clinics. By Month 3, 99.9 % of patients performed daily SMBG. At Months 3 and 6, HbA1c had decreased from baseline (-1.81 % and -1.73 %, respective; P < 0.0001 for both), with reduced hypoglycemia. In addition, 36.2 % and 39.9 % of patients achieved HbA1c <7.0 % (53 mmol/mol) at Months 3 and 6, respectively. The largest HbA1c improvements were for patients with a shorter duration of diabetes and insulin therapy.

CONCLUSIONS

A structured SMBG regimen, with training on interpretation of and responses to SMBG readings, increased SMBG frequency and improved HbA1c and the management of insulin-treated T2DM.

Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †

Diabetic foot is a severe public health issue, yet rare studies investigated its global epidemiology. Here we performed a systematic review and meta-analysis through searching PubMed, EMBASE, ISI Web of science, and Cochrane database. We found that that global diabetic foot ulcer prevalence was 6.3% (95%CI: 5.4-7.3%), which was higher in males (4.5%, 95%CI: 3.7-5.2%) than in females (3.5%, 95%CI: 2.8-4.2%), and higher in type 2 diabetic patients (6.4%, 95%CI: 4.6-8.1%) than in type 1 diabetics (5.5%, 95%CI: 3.2-7.7%). North America had the highest prevalence (13.0%, 95%CI: 10.0-15.9%), Oceania had the lowest (3.0%, 95% CI: 0.9-5.0%), and the prevalence in Asia, Europe, and Africa were 5.5% (95%CI: 4.6-6.4%), 5.1% (95%CI: 4.1-6.0%), and 7.2% (95%CI: 5.1-9.3%), respectively. Australia has the lowest (1.5%, 95%CI: 0.7-2.4%) and Belgium has the highest prevalence (16.6%, 95%CI: 10.7-22.4%), followed by Canada (14.8%, 95%CI: 9.4-20.1%) and USA (13.0%, 95%CI: 8.3-17.7%). The patients with diabetic foot ulcer were older, had a lower body mass index, longer diabetic duration, and had more hypertension, diabetic retinopathy, and smoking history than patients without diabetic foot ulceration. Our results provide suggestions for policy makers in deciding preventing strategy of diabetic foot ulceration in the future. Key messages Global prevalence of diabetic foot is 6.3% (95%CI: 5.4-7.3%), and the prevalence in North America, Asia, Europe, Africa and Oceania was 13.0% (95%CI: 10.0-15.9%), 5.5% (95%CI: 4.6-6.4%), 5.1% (95%CI: 4.1-6.0%), 7.2% (95%CI: 5.1-9.3%), and 3.0% (95% CI: 0.9-5.0%). Diabetic foot was more prevalent in males than in females, and more prevalent in type 2 diabetic foot patients than in type 1 diabetic foot patients. The patients with diabetic foot were older, had a lower body mass index, longer diabetic duration, and had more hypertension, diabetic retinopathy, and smoking history than patients without diabetic foot.

Assessing the disparity in spatial access to hospital care in ethnic minority region in Sichuan Province, China

BACKGROUND

There is a great disparity in spatial accessibility to hospital care between ethnic minority and non-minority regions in China. Being one of the basic social demands, spatial access to hospital care in minority regions draws increasing attention in China in recent years. We performed this study to have a better understanding of spatial access to hospital care in ethnic minority region in China, and to guide the allocation of government investment in the future.

METHODS

Sichuan Province, southwest of China was selected as a sample to examine the difference in hospital access between ethnic minority and non-minority region in China. We applied the shortest path analysis and the enhanced two-step floating catchment area (E2SFCA) method under ArcGIS 9.3 environment.

RESULTS

In Sichuan, healthcare access in ethnic minority region is worse than in non-minority region in terms of time to hospital and the value of spatial accessibility. There is relatively greater inequality in access to doctors and health professionals than in access to hospital beds. In ethnic minority region, the balance between primary, secondary, and tertiary hospitals, as well as between public and private hospitals, is less even, compared with the non-minority region. The disparity within ethnic minority region is larger than in non-minority region.

CONCLUSIONS

The combination of shortest path analysis and E2SFCA method is superior to the traditional county ratio method in assessing spatial access to healthcare. Compared to the non-minority region, ethnic minority region rely more heavily on government investment to provide healthcare. In ethnic minority region, the current distribution of primary, secondary and tertiary hospitals is inappropriate, and there is an urgent shortage of healthcare personnel. We therefore recommend that the government use preferential policies to encourage more social capital investment in ethnic minority region, use government investment as a supplement to build a more equitable healthcare market, encourage doctors to work in such regions, and push forward road construction in rural area.

Evidence for validity of a national physician and patient-reported, cross-sectional survey in China and UK: the Disease Specific Programme

OBJECTIVE

Diabetes represents a significant challenge for Chinese healthcare providers. Healthcare decision-making is generally based on many data sources, including randomised controlled and real-world studies; however, good-quality data from Chinese diabetes patients are scarce. We performed an initial validation to assess the representativeness of one source of real-world data-the Diabetes Adelphi Disease Specific Programme (DSP) in China.

SETTING

China, UK.

PARTICIPANTS

The Chinese DSP included 2060 patients with previously diagnosed type 2 diabetes mellitus (T2DM) sampled by 200 physicians. The reference Chinese population comprised 238 639 patients with previously diagnosed T2DM. The UK DSP contained 1481 patients with T2DM sampled by 125 physicians; the reference UK population comprised 289 patients with diabetes.

PRIMARY AND SECONDARY OUTCOMES

The primary outcome was comparison of unweighted China DSP and reference data for sex, body mass index (BMI), blood pressure (BP), patients achieving glycosylated haemoglobin (HbA1c)<7%, total cholesterol, coronary heart disease and dyslipidaemia. The secondary outcome was comparison of weighted UK DSP and reference data for BMI, BP, mean HbA1c, total cholesterol, smoking and insulin status.

RESULTS

Comparison of unweighted China DSP and reference data revealed statistical equivalence for BMI, systolic BP, proportion of patients achieving HbA1c <7%, total cholesterol, coronary heart disease and dyslipidaemia. Sex, age, diabetes duration, diastolic BP and mean HbA1c level were not equivalent, although differences were generally small. Weighting of data did not substantially affect the results. A similar pattern was observed for UK data.

CONCLUSIONS

This study provides evidence that the methodology used for the China and UK parts of the Diabetes DSP produces representative samples that are comparable with other independent sources of patient treatment outcomes data, which may ultimately inform public health decision-making. Although this method could be used in other countries, the current validation applies to UK and China. Further research is required for other countries.

Association between socioeconomic status and metabolic control and diabetes complications: a cross-sectional nationwide study in Chinese adults with type 2 diabetes mellitus

Background

Low socioeconomic status (SES) is associated with adverse cardiovascular risk factor patterns and poor outcomes in patients with diabetes. The aim of this study was to determine whether SES is associated with the control of blood glucose, blood pressure, blood cholesterol (3Bs), and diabetic complications in Chinese adults with type 2 diabetes.

Methods

Data regarding patients’ demographics, social economics, diabetes complications, and cardiovascular risk profiles were analyzed for 25,454 patients. The outcomes of interest were the proportions of patients with HbA1c <7.0 %, blood pressure <140/80 mmHg, total serum cholesterol <4.5 mmol/L, and diabetes complications. Multivariable logistic regression was used for analysis.

Results

Of the 25,454 patients, the least educated patients (1695, 6.7 %) had the highest chances of developing cardiovascular diseases (p = 0.048), cerebrovascular diseases (p < 0.001), and retinopathy (p < 0.001). The patients with lowest household income (10,039, 40.8 %) had the highest prevalence of retinopathy (p < 0.001) and neuropathy (p < 0.001). The most educated patients were more likely than the least educated patients to achieve HbA1c <7.0 % [adjusted odds ratio (OR) 1.38; 95 % confidence interval (95 % CI) 1.22–1.56] and 3B goals (adjusted OR 1.30; 95 % CI 1.11–1.53). The patients with highest household income were more likely to achieve BP < 140/80 mmHg (adjusted OR 1.16; 95 % CI 1.07–1.27), but less likely to reach HbA1c < 7.0 % (adjusted OR 0.90; 95 % CI 0.83–0.98) than those lowest income patients.

Conclusions

Low SES was associated with poor metabolic control and more diabetes complications in adult patients in China. Individual diabetes management based on the SES of patients is encouraged.

Electronic supplementary material

The online version of this article (doi:10.1186/s12933-016-0376-7) contains supplementary material, which is available to authorized users.

A comparative study of the quality of care and glycemic control among ambulatory type 2 diabetes mellitus clients, at a Tertiary Referral Hospital and a Regional Hospital in Central Kenya

Background

Peripheral public health facilities remain the most frequented by the majority of the population in Kenya; yet remain sub-optimally equipped and not optimized for non-communicable diseases care.

Design and methodology

We undertook a descriptive, cross sectional study among ambulatory type 2 diabetes mellitus clients, attending Kenyatta National Referral Hospital (KNH), and Thika District Hospital (TDH) in Central Kenya. Systematic random sampling was used. HbA1c was assessed for glycemic control and the following, as markers of quality of care: direct client costs, clinic appointment interval and frequency of self monitoring test, affordability and satisfaction with care.

Results

We enrolled 200 clients, (Kenyatta National Hospital 120; Thika District Hospital 80); Majority of the patients 66.5 % were females, the mean age was 57.8 years; and 58 % of the patients had basic primary education. 67.5 % had diabetes for less than 10 years and 40 % were on insulin therapy. The proportion (95 % CI) with good glycemic was 17 % (12.0–22.5 respectively) in the two facilities [Kenyatta National Hospital 18.3 % (11.5–25.6); Thika District Hospital 15 % (CI 7.4–23.7); P = 0.539]. However, in Thika District Hospital clients were more likely to have a clinic driven routine urinalysis and weight, they were also accorded shorter clinic appointment intervals; incurred half to three quarter lower direct costs, and reported greater affordability and satisfactions with care.

Conclusion

In conclusion, we demonstrate that in Thika district hospital, glycemic control and diabetic care is suboptimal; but comparable to that of Kenyatta National Referral hospital. Opportunities for improvement of care abound at peripheral health facilities.

Specialist-led diabetes registries and predictors of poor glycemic control in type 2 diabetes: Insights into the functionally refractory patient from the LMC Diabetes Registry database

BACKGROUND

The aim of the present study was to explore features associated with glycemic control in type 2 diabetes (T2D) patients undergoing care by specialist clinics.

METHODS

Literature searches identified diabetes registries whose databases recorded outcomes of specialist care. The LMC Diabetes Registry database (n = 58 280; LMC) was queried to identify patients with T2D who had been seen in a defined 14-month period. Logistic regression modeling was used to identify predictors of glycemic control in these patients. Poor glycemic control was defined as HbA1c ≥9.0% (75 mmol/mol) despite specialist care for ≥1 year.

RESULTS

Few published registry-based studies have discussed glycemic control and outcomes of specialist care for T2D. Among 10 590 LMC patients with T2D, mean HbA1c was 7.6% (60 mmol/mol), with 38% of patients meeting the Canadian Diabetes Association target of ≤7.0% (53 mmol/mol). Overall, 15% showed poor glycemic control with persistent HbA1c ≥9.0% (75 mmol/mol); among insulin-treated patients (n = 3856), 28% met this criterion. Patient characteristics independently associated with poor glycemic control included early age of onset, the number of diabetes education program visits, the number of oral therapies, and insulin use.

CONCLUSIONS

Type 2 diabetes patients with poor glycemic control are found disproportionately in referral specialist care clinics. These functionally refractory patients demonstrate features that may assist in predicting their potential outcome, and may represent a group with specific barriers to care. Specialist patient registries, such as the LMC Diabetes Registry, may provide critical information regarding this cohort.

Glycaemic Control and Associated Self-Management Behaviours in Diabetic Outpatients: A Hospital Based Observation Study in Lusaka, Zambia

BACKGROUND

The control of diabetes mellitus depends on several factors that also include individual lifestyles. We assessed glycaemic control status and self-management behaviours that may influence glycaemic control among diabetic outpatients.

METHODS

This cross-sectional study among 198 consenting randomly selected patients was conducted at the University Teaching Hospital diabetic clinic between September and December 2013 in Lusaka, Zambia. A structured interview schedule was used to collect data on demographic characteristics, self-management behaviours, and laboratory measurements. Binary logistic regression analysis using IBM SPSS for Windows version 20.0 was carried out to predict behaviours that were associated with glycaemic control status.

RESULTS

The proportion of patients that had good glycaemic control status (HbA1c≤ 48 mmol/mol) was 38.7% compared to 61.3% that had poor glycaemic control status (HbA1c≥ 49 mmol/mol). Adherence to antidiabetic treatment and fasting plasma glucose predicted glycaemic control status of the patients. However, self-blood glucose monitoring, self-blood glucose monitoring means and exercise did not predict glycaemic control status of the patients.

CONCLUSION

We find evidence of poor glycaemic control status among most diabetic patients suggesting that health promotion messages need to take into account both individual and community factors to promote behaviours likely to reduce nonadherence.

Efficacy and safety of saxagliptin in older participants in the SAVOR-TIMI 53 trial

OBJECTIVE

To examine the safety and cardiovascular (CV) effects of saxagliptin in the predefined elderly (≥65 years) and very elderly (≥75 years) subpopulations of the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus-Thrombolysis in Myocardial Infarction 53 (SAVOR-TIMI 53) trial.

RESEARCH DESIGN AND METHODS

Individuals ≥40 years (n = 16,492; elderly, n = 8,561; very elderly, n = 2,330) with HbA1c ≥6.5% (47.5 mmol/mol) and ≤12.0% (107.7 mmol/mol) were randomized (1:1) to saxagliptin (5 or 2.5 mg daily) or placebo in a double-blind trial for a median follow-up of 2.1 years.

RESULTS

The hazard ratio (HR) for the comparison of saxagliptin versus placebo for the primary end point (composite of CV mortality, myocardial infarction, or ischemic stroke) was 0.92 for elderly patients vs. 1.15 for patients <65 years (P = 0.06) and 0.95 for very elderly patients. The HRs for the secondary composite end points in the entire cohort, elderly cohort, and very elderly cohort were similar. Although saxagliptin increased the risk of hospitalization for heart failure in the overall saxagliptin population, there was no age-based treatment interaction (P = 0.76 for elderly patients vs. those <65 years; P = 0.34 for very elderly patients vs. those <75 years). Among saxagliptin-treated individuals with baseline HbA1c ≥7.6% (59.6 mmol/mol), the mean change from baseline HbA1c at 2 years was -0.69%, -0.64%, -0.66%, and -0.66% for those ≥65, <65, ≥75, and <75 years old, respectively. The incidence of overall adverse events (AEs) and serious AEs was similar between saxagliptin and placebo in all cohorts; however, hypoglycemic events were higher for saxagliptin versus placebo regardless of age.

CONCLUSIONS

The SAVOR-TIMI 53 trial supports the overall CV safety of saxagliptin in a robust number of elderly and very elderly participants, although the risk of heart failure hospitalization was increased irrespective of age category. AEs and serious AEs as well as glycemic efficacy of saxagliptin in elderly patients are similar to those found in younger patients.

Glycemic Control in Chinese Patients with Type 2 Diabetes Mellitus Receiving Oral Antihyperglycemic Medication-Only or Insulin-Only Treatment: A Cross-Sectional Survey

INTRODUCTION

The primary aim of this analysis was to explore whether glycemic control (glycated hemoglobin [HbA1c] <7%) and the incidence of hypoglycemia are different between Chinese patients with type 2 diabetes mellitus (T2DM) receiving oral antihyperglycemic medication (OAM)-only or insulin-only regimens.

METHODS

Physicians in nine Chinese cities completed surveys (Adelphi Real World Diabetes Disease Specific Programme) from October 2011 to March 2012. Key information collected included patients' demographic and clinical characteristics, HbA1c levels, and hypoglycemia incidence. Patients receiving OAM-only (n = 1077) or insulin-only (n = 292) regimens for ≥6 months who had most recent HbA1c results available and measured within 3 months of survey completion were included. The primary and secondary outcomes were glycemic control and the incidence of hypoglycemia. Primary (multivariate logistic regression analysis with adjustment for potential confounders) and sensitivity analyses (propensity score matching method) were performed.

RESULTS

A higher proportion of patients in the insulin-only group achieved glycemic control than patients in the OAM-only group (41.8% vs 35.9%). Insulin-only treatment was associated with significantly (P = 0.013) better glycemic control than OAM-only treatment (odds ratio [95% confidence interval]: 1.48 [1.09, 2.01]). A higher proportion of patients in the insulin-only group experienced hypoglycemia (overall) than patients in the OAM-only group (33.3% vs 14.4%). Insulin-only treatment was associated with significantly (P < 0.001) increased overall hypoglycemia compared with OAM-only treatment (odds ratio [95% confidence interval]: 2.38 [1.72, 3.29]). Sensitivity analysis results were consistent with the primary analysis results.

CONCLUSIONS

The results of this analysis provide important real-world information on glycemic control and hypoglycemia in Chinese patients with T2DM, which may be useful for guiding evidenced-based management. Notably, Chinese patients with T2DM receiving OAM-only had poorer glycemic control compared with those receiving insulin-only therapy, although patients receiving OAM-only were less likely to experience hypoglycemic events.

Predictors of poor glycaemic control in older patients with type 2 diabetes mellitus

INTRODUCTION

We assessed the predictors of poor glycaemic control among older patients with type 2 diabetes mellitus (T2DM) in Malaysia.

METHODS

This cross-sectional study used the data of 21,336 patients aged ≥ 60 years with T2DM from the Adult Diabetes Control and Management Registry 2008-2009.

RESULTS

Predictors of poor glycaemic control were: age groups 60-69 years (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.66-2.33) and 70-79 years (OR 1.43, 95% CI 1.20-1.71); Malay (OR 1.53, 95% CI 1.41-1.66) and Indian (OR 1.32, 95% CI 1.19-1.46) ethnicities; T2DM durations of 5-10 years (OR 1.46, 95% CI 1.35-1.58) and > 10 years (OR 1.75, 95% CI 1.59-1.91); the use of oral antidiabetic agents only (OR 5.86, 95% CI 3.32-10.34), insulin only (OR 17.93, 95% CI 9.91-32.43), and oral antidiabetic agents and insulin (OR 29.42, 95% CI 16.47-52.53); and elevated blood pressure (OR 1.10, 95% CI 1.01-1.20), low-density lipoprotein cholesterol (OR 1.48, 95% CI 1.38-1.59) and triglycerides (OR 1.61, 95% CI 1.51-1.73). Hypertension (OR 0.71, 95% CI 0.64-0.80), hypertension and dyslipidaemia (OR 0.68, 95% CI 0.61-0.75), pre-obesity (OR 0.89, 95% CI 0.82-0.98) and obesity (OR 0.76, 95% CI 0.70-0.84) were less likely to be associated with poor glycaemic control.

CONCLUSION

Young-old and middle-old age groups (i.e. < 80 years), Malay and Indian ethnicities, longer T2DM duration, the use of pharmacological agents, and elevated blood pressure and lipid levels were associated with poor glycaemic control. The presence of comorbidities, pre-obesity and obesity were less likely to be associated with poor glycaemic control.

Tight glycemic control and cardiovascular effects in type 2 diabetic patients

Diabetes Mellitus (DM) with poor glycemic control is one of the leading causes for cardiovascular mortality in diabetic patients. Tight glycemic control with glycosylated haemoglobin of <7 gms% is recommended as a routine and < 6.5 gms% is recommended for young and newly diagnosed diabetics. Treatment goal aims at achieving near normal blood glucose level, and directed at management of other co morbid conditions such as obesity, hypertension and dyslipidemia. Oral hypoglycemic agents are the preferred drugs, alone or in combination. Preference for glitazones is declining due to the increasing evidences of associated adverse events. Gliptins appear as promising agents with lesser tendency to cause hypoglycemia, but their long term safety and efficacy is yet to be established. We emphasize the role of preventive measures in prediabetics and in established DM, treatment should be individualized and customized to minimize hypoglycemic effects and to retain quality of life.

Quality of diabetes care in low- and middle-income Asian and Middle Eastern countries (1993-2012): 20-year systematic review

OBJECTIVE

To assess the extent to which people with diabetes in low- and middle-income countries (LMIC) of Asia and the Middle East met evidence-based care recommendations through a systematic review of published literature.

METHODS

Electronic searches of Medline and Embase were carried out for studies assessing quality of care among people with diabetes in Asia and the Middle East between 1993 and 2012. Benchmarking against American Diabetes Association guidelines, we reported level and proportions meeting recommended risk factor control (glycated hemoglobin [HbA1c], blood pressure, and low density lipoprotein-cholesterol [LDL]) and preventive care processes across different settings.

RESULTS

One hundred and fifteen publications met eligibility for inclusion (91 reported risk factor control, 7 reported preventive processes, and 17 reported both). Only China, Thailand, Malaysia and Philippines had nationally representative data. Mean HbA1c (6.5-11% or 48-97 mmol/mol), SBP (120-152 mm Hg), and LDL (2.4-3.8 mmol/l) varied greatly. Despite variation in availability of data, studies consistently showed that recommended care goals were not being achieved.

CONCLUSIONS

The practice of auditing and benchmarking against evidence-based guidelines appears to be uncommon in Asia and the Middle East and there was heterogeneity of reporting across studies, populations, and methods used. The available data showed inadequate care.

The ABC of diabetes. How many patients are able to achieve the goal laid down by American Diabetes Association?

BACKGROUND

To study the number of patients with Type 2 Diabetes Mellitus who achieve the glycemic, blood pressure and LDL-Cholesterol targets as per American Diabetes Association, Standard of Care for Management of Diabetes.

METHODS

Hundred patients of Type 2 Diabetes mellitus were recruited from December 2008 to January 2009 from an Endocrinology OPD of tertiary care hospital and followed up for six months. Glycosylated hemoglobin (HbA1c), blood pressure (BP) and LDL-Cholesterol (LDL) were estimated at baseline and prevalence of those at target (HbA1c <7%, BP < 130/80 mm Hg, LDL < 100 mg/dl) was documented and repeated at three and six months to monitor improvement in the number of patients at target and trend in improvement of individual parameters.

RESULTS

The percentage of patients at target at baseline and six months for HbA1c was (45% vs. 55% p = 0.101), BP < 130/80 mm Hg (27% vs. 25%) and LDL <100 mg/dl (37% vs. 40% p = 0.386). All three parameters were at target in one patient and three patients at six months period. Mean values at baseline and six months of HbA1c 7.46% (95% CI 7.17-7.75) vs 7.21% (95% CI 6.9-7.52), Systolic BP 138 mm Hg (95% CI 135-141), Diastolic BP 86 mm Hg (95% CI 84-86) and LDL 114 mg/dl (95%CI 107-121) vs. 110 mg/dl (95%CI 105-116) did not show significant improvement (p for trend).

CONCLUSION

Standards of care for HbA1c, blood pressure and LDL remains to be achieved in majority of the diabetic patients.

Glycaemic control in diabetic patients in Zambia

INTRODUCTION

The glycaemic control status of diabetic patients affects the management of their disorder. We examined the glycaemic control and clinical factors that may influence the achievement of the glycaemic control targets among diabetic out-patients.

METHODS

This was a hospital based cross-sectional study carried out at the University Teaching Hospital diabetic clinic in Lusaka, Zambia. A simple random sample of 198 consenting participants was selected from diabetic out-patients between September and December 2013. A structured interview schedule was used to capture socio-demographic data as well as needed clinical data from clients' medical records and laboratory results. Multivariate binary logistic regression analysis was carried out to examine factors that may be associated with the glycaemic control status of these diabetic patients.

RESULTS

Overall (n = 198), mean (SD) age was 53.19 ± 13.32 years. Majority (61.3%) of the patients had poor glycaemic control status (HbA1c ≥ 49 mmol/mol). Insulin treatment (OR 0.13, 95% CI: 0.01 - 1.41), systolic blood pressure (OR 1.04, CI: 1.00 - 1.08) and fasting plasma glucose (previous; OR 0.81, CI: 0.72 - 0.90 and current; OR 0.85, CI: 0.78 - 0.93) were statistically significantly associated with glycaemic control. The poor glycaemic control observed in this study is similar to that reported in other published studies.

CONCLUSION

We found evidence of poor glycaemic control in the study population suggesting need to explore the reasons for this. Association of Insulin, systolic blood pressure and fasting plasma glucose with glycaemic control further suggests the efficiency of traditional basic monitoring parameters which should be exploited in sharpening primary preventive strategies especially those that support lifestyle modification. Such efforts should also be integrated in all information, education and communication strategies that target but not limited to hospital based patients too.

Age of diabetes diagnosis and diabetes duration associate with glycated haemoglobin

An earlier age of diagnosis (r=-0.28, p<0.0001) and longer duration of type 2 diabetes (r=0.26, p<0.0001) were each found to correlate with higher HbA1c level, on analysis of a diabetes centre database in people under regular shared care. When combined, these biological variables strongly associate with the current HbA1c level.

Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: a qualitative study

BACKGROUND

Self-monitoring of blood glucose (SMBG) helps to improve glycemic control and empowerment of people with diabetes. It is particularly useful for people with diabetes who are using insulin as it facilitates insulin titration and detection of hypoglycemia. Despite this, the uptake of SMBG remains low in many countries, including Malaysia.

PURPOSE

This study aimed to explore the barriers and facilitators to SMBG, in people with type 2 diabetes using insulin.

PATIENTS AND METHODS

Qualitative methodology was employed to explore participants' experience with SMBG. Semistructured, individual in-depth interviews were conducted on people with type 2 diabetes using insulin who had practiced SMBG, in the primary care clinic of a teaching hospital in Malaysia. Participants were purposively sampled from different age groups, ethnicity, education level, and level of glycemic control (as reflected by the glycated hemoglobin [HbA1c]), to achieve maximum variation in sampling. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked, and analyzed using a thematic approach.

RESULTS

A total of 15 participants were interviewed, and thematic saturation was reached. The factors that influenced SMBG were mainly related to cost, participants' emotion, and the SMBG process. The barriers identified included: frustration related to high blood glucose reading; perception that SMBG was only for insulin titration; stigma; fear of needles and pain; cost of test strips and needles; inconvenience; unconducive workplace; and lack of motivation, knowledge, and self-efficacy. The facilitators were: experiencing hypoglycemic symptoms; desire to see the effects of dietary changes; desire to please the physician; and family motivation.

CONCLUSION

Participants' perceptions of the purpose of SMBG, the emotions associated with SMBG, and the complexity, pain, and cost related to SMBG as well as personal and family motivation are the key factors that health care providers must consider when advising people with diabetes on SMBG.

Comparison of metformin and repaglinide monotherapy in the treatment of new onset type 2 diabetes mellitus in China

OBJECTIVE

This study was designed to compare the effects of metformin and repaglinide on the fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) in newly diagnosed type 2 diabetes in China.

METHODS

A total of 107 newly diagnosed type 2 diabetic patients (46 women and 61 men) participated in the study. All patients received 3-month treatment of metformin or repaglinide. Fasting blood glucose and HbA1c were determined at baseline and at the end of the 3-month of treatment.

RESULTS

FPG and HbA1c decreased in both metformin and repaglinide groups after 3 months treatment (P < 0.01). The reduction of HbA1c was significantly greater in the repaglinide group (P < 0.01). Metformin decreases fasting insulin concentration and HOMA-IR (P < 0.01), and repaglinide improves HOMA-β(P < 0.01). Triglycerides (TG) were reduced in both groups (P < 0.01 in metformin group; P < 0.05 in repaglinide group), but total cholesterol (TC) and low-density lipoprotein (LDL) were decreased only after metformin treatment (P < 0.05).

CONCLUSIONS

Both repaglinide and metformin were effective in glycaemic control in new onset patients with type 2 diabetes in China. Repaglinide had no effect on insulin sensitivity, but it improved β-cell function.

Glycemic control among patients in China with type 2 diabetes mellitus receiving oral drugs or injectables

BACKGROUND

The prevalence of type 2 diabetes mellitus (T2DM) is increasing rapidly among Chinese adults, and limited data are available on T2DM management and the status of glycemic control in China. We assessed the efficacy of oral antidiabetes drugs (OADs), glucagon-like peptide-1 (GLP-1) receptor agonists, and insulin for treatment of T2DM across multiple regions in China.

METHODS

This was a multicenter, cross-sectional survey of outpatients conducted in 606 hospitals across China. Data from all the patients were collected between April and June, 2011.

RESULTS

A total of 238,639 patients were included in the survey. Eligible patients were treated with either OADs alone (n=157,212 [65.88%]), OADs plus insulin (n=80,973 [33.93%]), or OADs plus GLP-1 receptor agonists (n=454 [0.19%]). The OAD monotherapy, OAD + insulin, and OAD + GLP-1 receptor agonist groups had mean glycosylated hemoglobin (HbA1c) levels (±SD) of 7.67% (±1.58%), 8.21% (±1.91%), and 7.80% (±1.76%), respectively. Among those three groups, 34.63%, 26.21%, and 36.12% met the goal of HbA1c <7.0%, respectively. Mean HbA1c and achievement of A1c <7.0% was related to the duration of T2DM.

CONCLUSIONS

Less than one third of the patients had achieved the goal of HbA1c <7.0%. Glycemic control decreased and insulin use increased with the duration of diabetes.

Younger adult type 2 diabetic patients have poorer glycaemic control: a cross-sectional study in a primary care setting in Singapore

BACKGROUND

The aim was to study the glycaemic control of type 2 diabetic patients, and to identify factors associated with unacceptable glycaemic control (defined as HbA1c >8.0%).

METHODS

Analysis of data collected in a cross-sectional survey of type 2 diabetic patients in eight SingHealth Polyclinics in January 2009. HbA1c value was measured on the day of the survey, while information on patient and diabetic characteristics was obtained through a questionnaire. Odds ratio of having unacceptable glycaemic control was estimated for selected variables using multiple logistic regression models.

RESULTS

A total of 688 patients were included in the analysis. The mean (± standard deviation) and median (range) HbA1c levels were 7.6% (± 1.35) and 7.3% (5.0% to 14.0%), respectively. 25.4% of the patients had an unacceptable HbA1c level of >8.0% and the odds of this were higher (p < 0.05) in patients with the following characteristics: younger age, longer diabetes duration, presence of insulin treatment, and poorer compliance to medication.

CONCLUSION

Younger adult patients were found to have poorer glycaemic control, and hence targeted educational and behaviour modification programmes would be required to effectively manage this group of patients.

Relation between glucose levels, high-sensitivity C-reactive protein (hs-CRP), body mass index (BMI) and serum and dietary retinol in elderly in population-based study

The aim of this study was to evaluate the relationships between fasting glucose levels, hs-CRP, BMI and serum retinol and diet in elderly people. For this study, a cross-sectional, epidemiological, population-based format was adopted. One hundred and sixty-three individuals between 60 and 90 years of age participated; the participants were from different socioeconomic and health backgrounds, except for the individuals diagnosed with diabetes. Most subjects had serum concentrations in the reference ranges for all variables. There was not a significant relationship between fasting glucose and serum retinol or diet. There was a significant correlation between hs-CRP and BMI (r=0.22, p=0.0082) and hs-CRP and total calorie intake (p=0.0091), which reinforces the notion that an increased intake of calories results in being overweight and/or obese. Considering the importance of vitamin A in various physiological processes, more studies on these relationships are necessary to establish a recommendation of vitamin A for the treatment and prevention of changes in fasting glucose and obesity in the elderly population.