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Chen HF, Lee HE, Chen IT, Huang YT, Ho PS, Karim SA. Rural-urban disparities in the incidence and treatment intensity of periodontal disease among patients with diabetes. Front Public Health 2023; 11:1241150. [PMID: 37736085 PMCID: PMC10509757 DOI: 10.3389/fpubh.2023.1241150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023] Open
Abstract
Background Diabetes threatens population health, especially in rural areas. Diabetes and periodontal diseases have a bidirectional relationship. A persistence of rural-urban disparities in diabetes may indicate a rural-urban difference in periodontal disease among patients with diabetes; however, the evidence is lacking. This retrospective study aimed to investigate rural-urban discrepancies in the incidence and treatment intensity of periodontal disease among patients who were newly diagnosed with type 2 diabetes in the year 2010. Methods The present study was a retrospective cohort design, with two study samples: patients with type 2 diabetes and those who were further diagnosed with periodontal disease. The data sources included the 2010 Diabetes Mellitus Health Database at the patient level, the National Geographic Information Standardization Platform and the Department of Statistics, Ministry of Health and Welfare in Taiwan at the township level. Two dependent variables were a time-to-event outcome for periodontal disease among patients with type 2 diabetes and the treatment intensity measured for patients who were further diagnosed with periodontal disease. The key independent variables are two dummy variables, representing rural and suburban areas, with urban areas as the reference group. The Cox and Poisson regression models were applied for analyses. Results Of 68,365 qualified patients, 49% of them had periodontal disease within 10 years after patients were diagnosed with diabetes. Compared to urban patients with diabetes, rural (HR = 0.83, 95% CI: 0.75-0.91) and suburban patients (HR = 0.86, 95% CI: 0.83-0.89) had a lower incidence of periodontal disease. Among 33,612 patients with periodontal disease, rural patients received less treatment intensity of dental care (Rural: RR = 0.87, 95% CI: 0.83, 0.92; suburban: RR = 0.93, 95% CI: 0.92, 0.95) than urban patients. Conclusion Given the underutilization of dental care among rural patients with diabetes, a low incidence of periodontal disease indicates potentially undiagnosed periodontal disease, and low treatment intensity signals potentially unmet dental needs. Our findings provide a potential explanation for the persistence of rural-urban disparities in poor diabetes outcomes. Policy interventions to enhance the likelihood of identifying periodontal disease at the early stage for proper treatment would ease the burden of diabetes care and narrow rural-urban discrepancies in diabetes outcomes.
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Affiliation(s)
- Hsueh-Fen Chen
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huey-Er Lee
- Department of Dentistry, Yuan's General Hospital, Kaohsiung, Taiwan
| | - I-Te Chen
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ting Huang
- Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Shan Ho
- Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Saleema A. Karim
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmomd, VA, United States
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Das U, Kar N. Prevalence and risk factor of diabetes among the elderly people in West Bengal: evidence-based LASI 1st wave. BMC Endocr Disord 2023; 23:170. [PMID: 37568234 PMCID: PMC10416355 DOI: 10.1186/s12902-023-01421-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The complication of Diabetes is one of the important health issues among the older adult population in any region. The higher risks of diabetes prevalence among older adult people in the countries was due to social-cultural changes such as increasing urbanization, dietary changes, without physical activity, and unhealthy lifestyle behavior. The present study examines the prevalence and associated risk factors of diabetes among older adults in the state of West Bengal. METHODS The first wave of the Longitudinal Ageing Study in India 2017-18 was used to achieve the study objectives. Descriptive statistics with multinomial logistic regression models were used to carry out crude and adjusted odds ratios with 95% confidence intervals and examine the associated risk factors of diabetes prevalence among older adults. RESULTS The findings of the study indicate that the overall prevalence of diabetes among the study participants was found to be 12.4% which was significantly higher in urban areas (19%) compare to rural areas (6%). The socio-economic and bio-demographic factors like educational status, richest background family, marital status, obesity, and family history of diabetes were significantly associated with higher risks of diabetes prevalence among the older adult population in West Bengal. The risks of diabetes in the richest adult people were significantly higher than in the poorest adult people (OR = 2.78; 95% CI: 1.974-3.917). The higher risks of diabetes mellitus among the richest wealthy people are because of lifestyle behavior, smoking, and tobacco consumption respectively. CONCLUSION The study needs to policy and awareness program to reduce economic inequality and prevention of diabetes care and treatment-seeking behavior, especially for the older adult population in West Bengal.
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Affiliation(s)
- Ujjwal Das
- Dept. of Geography in, Rajiv Gandhi University, Doimukh, Arunachal Pradesh India
- Dept. of Geography, Fakir Mohan University, Balasore, Odisha India
| | - Nishamani Kar
- Dept. of Geography in, Rajiv Gandhi University, Doimukh, Arunachal Pradesh India
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Lenz B, Andrew BA, Ritter M, Karunakaran I, Gandjui NVT, Nchang LC, Surendar J, Ebob AOB, Ehrens A, Klarmann-Schulz U, Ricchiuto A, Kuehlwein JM, Fombad FF, Ngwa AM, Katcho TD, Hoerauf A, Wanji S, Hübner MP. The design and development of a study protocol to investigate Onchocerca volvulus, Loa loa and Mansonella perstans-mediated modulation of the metabolic and immunological profile in lean and obese individuals in Cameroon. PLoS One 2023; 18:e0285689. [PMID: 37267236 DOI: 10.1371/journal.pone.0285689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/10/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Life-style metabolic diseases are steadily rising, not only in developed countries, but also in low- and middle-income countries, presenting a global health problem. Metabolic disorders like type 2 diabetes and cardiovascular diseases are among the ten leading causes of death defined by the WHO in 2019. Results from animal and observational human studies suggest a connection between the decline in human helminth infections and rise of life-style-associated metabolic diseases in developing regions. This trial was designed to investigate filarial infections and their impact on metabolic diseases in Cameroon. We hypothesize that the induction of regulatory immune responses during filarial infection reduces obesity-induced low-grade inflammatory immune responses and thereby improves metabolic parameters, whereas anthelmintic treatment abolishes this protective effect. METHODS/DESIGN Participants infected with Mansonella perstans, Onchocerca volvulus and/or Loa loa being lean (BMI <25), overweight (BMI >25 and <30) or clinically obese (BMI ≥30) from Littoral regions of Cameroon will be evaluated for their parasitological, immunological, metabolic and biochemical profile before and after treatment of their parasitic infections. Anthropomorphic measurements and a detailed questionnaire will complement our analysis. The investigation will assess blood immune cell populations, serum adipokines and cytokines that could be influenced by the parasite infection and/or metabolic diseases. Further, parameters like blood glucose, homeostatic model assessment of insulin resistance (HOMA-IR), circulating lipids and circulating makers of liver function will be monitored. Parameters will be assessed before treatment, 12 and 18 months after treatment. CONCLUSION The focus of this study is to obtain a comprehensive metabolic profile of the participants in rural areas of Cameroon and to investigate the relationship between filarial immunomodulation and metabolic diseases. This study will elucidate the effect of anti-filarial treatment on the metabolic and immunological parameters that partake in the development of insulin resistance, narrowing in on a potential protective effect of filarial infections on metabolic diseases. TRIAL REGISTRATION doi.org/10.1186/ISRCTN43845142, ISRCTN43845142 February 2020 Trial title Effects of filarial parasite infection on type 2 diabetes Issue date: 27.10.22, V.1.
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Affiliation(s)
- Benjamin Lenz
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Beng Amuam Andrew
- Parasite and Vector Biology Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and the Environment, Buea, Cameroon
| | - Manuel Ritter
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Indulekha Karunakaran
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Narcisse Victor Tchamatchoua Gandjui
- Parasite and Vector Biology Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and the Environment, Buea, Cameroon
| | - Lucy Cho Nchang
- Parasite and Vector Biology Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and the Environment, Buea, Cameroon
| | - Jayagopi Surendar
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Anita Obi Bate Ebob
- Parasite and Vector Biology Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and the Environment, Buea, Cameroon
| | - Alexandra Ehrens
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Bonn, Germany
| | - Ute Klarmann-Schulz
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Bonn, Germany
| | - Arcangelo Ricchiuto
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Janina M Kuehlwein
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Bonn, Germany
| | - Fanny Fri Fombad
- Parasite and Vector Biology Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and the Environment, Buea, Cameroon
| | - Ambe Marius Ngwa
- Parasite and Vector Biology Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and the Environment, Buea, Cameroon
| | - Tatiana Djikeussi Katcho
- Parasite and Vector Biology Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and the Environment, Buea, Cameroon
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Bonn, Germany
- German-West African Centre for Global Health and Pandemic Prevention (G-WAC), Bonn, Germany
| | - Samuel Wanji
- Parasite and Vector Biology Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and the Environment, Buea, Cameroon
| | - Marc P Hübner
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Bonn, Germany
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Delrue C, Speeckaert MM. The Potential Applications of Raman Spectroscopy in Kidney Diseases. J Pers Med 2022; 12:jpm12101644. [PMID: 36294783 PMCID: PMC9604710 DOI: 10.3390/jpm12101644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/09/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022] Open
Abstract
Raman spectroscopy (RS) is a spectroscopic technique based on the inelastic interaction of incident electromagnetic radiation (from a laser beam) with a polarizable molecule, which, when scattered, carries information from molecular vibrational energy (the Raman effect). RS detects biochemical changes in biological samples at the molecular level, making it an effective analytical technique for disease diagnosis and prognosis. It outperforms conventional sample preservation techniques by requiring no chemical reagents, reducing analysis time even at low concentrations, and working in the presence of interfering agents or solvents. Because routinely utilized biomarkers for kidney disease have limitations, there is considerable interest in the potential use of RS. RS may identify and quantify urinary and blood biochemical components, with results comparable to reference methods in nephrology.
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Affiliation(s)
- Charlotte Delrue
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Marijn M. Speeckaert
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
- Correspondence: ; Tel.: +32-9-332-4509
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Gao R, Guo H, Liu Y, Pang Y, Zhang X, Lian X, Yu T, Zhu L, Li F. Effects of message framing on self-management behaviour among patients with type 2 diabetes: a randomised controlled trial protocol. BMJ Open 2022; 12:e056450. [PMID: 35768085 PMCID: PMC9240941 DOI: 10.1136/bmjopen-2021-056450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Accumulating evidence has indicated successful diabetes health education can potentially help to improve blood sugar levels in people with diabetes. However, with a rapid rise in the number of people with diabetes cases and the increasing burden on healthcare, it is often difficult for healthcare providers to find suitable time to provide health education to meet their needs. Thus, more novel and effective ways are needed to conduct education. The message frame provides a new perspective for implementation of a more effective health education in the form of changing information presentation, and the same objective content is described in either positive or negative language or outcomes. Gain framing emphasises the positive consequences of adhering to useful recommendations, while loss framing highlights the negative consequences of the non-adherence. The purpose of our research is to potentially explore the effectiveness of diabetes education based on message framing on the self-management behaviour. METHODS AND ANALYSIS A single-blind, three-arm randomised controlled trial involving 84 participants will be conducted. The participants will be assigned into three groups randomly in a 1:1:1 ratio and will receive 12-week intervention. Patients in group 1 will be provided gain framing education videos about the self-management skills for type 2 diabetes, patients in group 2 will be given education videos based on loss framing and patients in group 3 will receive education with no specific message framing. The primary outcome is self-management behaviour. The secondary outcomes will be self-efficacy, patient activation, diabetes-related knowledge and attitude, quality of life and blood glucose level. All outcomes will be measured at baseline and 12 weeks. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of School of Nursing, Jilin University (No. 2020101501). The research results will be published in peer-reviewed publications and presented in international conferences. TRIAL REGISTRATION NUMBER ChiCTR 2100045772; Pre-results.
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Affiliation(s)
- Ruitong Gao
- School of Nursing, Jilin University, Changchun, Jilin, China
- School of Health and Exercise Sciences, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Hui Guo
- Department of Endocrinology and Metabolism, Eastern Division of the First Bethune Hospital of Jilin University, Changchun, China
| | - Yandi Liu
- Department of Endocrinology and Metabolism, First Bethune Hospital of Jilin University, Changchun, China
| | - Yue Pang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Xin Zhang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Xiaoqian Lian
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Tianyue Yu
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Lanyu Zhu
- School of Nursing, Jilin University, Changchun, Jilin, China
- School of Nursing, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Feng Li
- School of Nursing, Jilin University, Changchun, Jilin, China
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Bavuma CM, Niyibizi JB, Bitunguhari L, Musafiri S, McQuillan R, Wild S. Prevalence and characteristics associated with diabetes mellitus and impaired fasting glucose among people aged 15 to 64 years in rural and urban Rwanda: secondary data analysis of World Health Organization surveillance data. Pan Afr Med J 2022; 41:115. [PMID: 35465373 PMCID: PMC8994463 DOI: 10.11604/pamj.2022.41.115.30682] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/19/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction diabetes mellitus is an increasing public health burden in developing countries. The magnitude of diabetes association with traditional risk factors for diabetes have been given less attention in rural population. This study aims to determine the prevalence of diabetes and impaired fasting glucose and to assess associated characteristics to hyperglycemia in rural and urban Rwanda. Methods this is a secondary analysis of data from a population-based cross-sectional study of 7240 people describing risk factors for non-communicable diseases using the WHO stepwise methods (STEPS). Relative frequencies of variables of interest were compared in rural and urban residence using Pearson chi-square tests. Diabetes and impaired fasting glucose were combined in a single hyperglycemia variable and odds ratios with 95% confidence intervals were used to explore associations between hyperglycemia, socio-demographic and health factors in urban and rural populations. Results the prevalence in rural and urban areas was 7.5% and 9.7% (p.005) for diabetes and 5.0% and 6.2% for impaired fasting glucose (p.079) respectively. Obesity (AOR 2.57: CI: 0.86-7.9), high total cholesterol (AOR 3.83: CI: 2.03-7.208), hypertension (AOR 1.18: CI: 0.69-2.00), increasing age were associated with hyperglycemia in urban participants but only high total cholesterol and low high density lipoproteins (HDL) cholesterol were risk factors for hyperglycemia in rural participants. Conclusion approximately one in six people in Rwanda have hyperglycemia. The magnitude of the association with traditional risk factors for diabetes differ in rural and urban settings. Different approaches to primary and secondary prevention of diabetes may be needed in rural populations.
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Affiliation(s)
- Charlotte Munganyinka Bavuma
- Kigali University Teaching Hospital, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Berchmans Niyibizi
- Single Project Implementation Unit, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Leopold Bitunguhari
- Kigali University Teaching Hospital, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Sanctus Musafiri
- Kigali University Teaching Hospital, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Ruth McQuillan
- Usher Institute, University of Edinburgh, Scotland, United Kingdom
| | - Sarah Wild
- Usher Institute, University of Edinburgh, Scotland, United Kingdom
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Ko HJ, Lin YC, Chen CC, Chen MJ, Wu MS, Liu CJ, Huang CT, Yang HW, Shih SC, Yu LY, Kuo YC, Wang HY, Hu KC. Helicobacter pylori infection and increased diabetes prevalence were the risks of colorectal adenoma for adults: A systematic review and meta-analysis (PRISMA-compliant article). Medicine (Baltimore) 2021; 100:e28156. [PMID: 34918670 PMCID: PMC8677985 DOI: 10.1097/md.0000000000028156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/18/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Helicobacter pylori infection and hyperglycemia are associated with an increased risk of colorectal neoplasm, and may have a synergistic effect in combination. However, these 2 factors that affect colorectal neoplasm remain controversial. We aimed to carry out a meta-analysis to evaluate the study population diabetes prevalence rate and H pylori infection rate with colorectal adenoma risk for adults. METHODS We conducted systemic research through English databases for medical reports. We also recorded the diabetes prevalence and H pylori infection prevalence in each study. We classified these studies into 4 subgroups as their background population diabetes prevalence <6% (Group 1); between 6% and 8% (Group 2); between 8% and 10% (Group 3), and more than 10% (Group 4). The random-effects model had used to calculate pooled prevalence estimates with 95% confidence interval (CI). RESULTS Twenty-seven studies were finally eligible for meta-analysis. The random-effects model of the meta-analysis was chosen, showing pooled odds ratio (OR) equal to 1.51 (95% CI 1.39-1.63). The subgroup meta-analyses showed in Group 1 the H pylori infection associated colorectal adenoma risk OR was 1.24 (95% CI 0.86-1.78). As the diabetes rate exceed 6%, the H pylori infection became the more significant increased risk of colorectal adenoma (Group 2: OR 2.16 (95% CI 1.61-2.91); Group 3: OR 1.40 (95% CI 1.24-1.57); and Group 4: OR 1.52 (95% CI 1.46-1.57)). CONCLUSIONS The results of this meta-analysis showed elevated diabetes prevalence combined H pylori infection increasing the risks of colorectal adenoma in the adult population.
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Affiliation(s)
- Hung-Ju Ko
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Ying-Chun Lin
- Department of Anesthesia, MacKay Memorial Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University
| | - Chieh-Chang Chen
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Jen Chen
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan Healthy
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Jen Liu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Ta Huang
- Division of Endocrine, Department of Internal Medicine, DM Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Horng-Woei Yang
- Departments of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shou-Chuan Shih
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan Healthy
- MacKay Medical College, Taipei, Taiwan
| | - Lo-Yip Yu
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan Healthy
| | - Yang-Che Kuo
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan Healthy
| | - Horng-Yuan Wang
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan Healthy
| | - Kuang-Chun Hu
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan Healthy
- MacKay Medical College, Taipei, Taiwan
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Trends in the diabetes incidence and mortality in India from 1990 to 2019: a joinpoint and age-period-cohort analysis. J Diabetes Metab Disord 2021; 20:1725-1740. [PMID: 34900822 DOI: 10.1007/s40200-021-00834-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/12/2021] [Indexed: 10/20/2022]
Abstract
Introduction Globally, a metabolic disorder like Diabetes is considered as one of the largest global health issues, as it accounts for the majority of the disease burden and happens to be one of the leading causes of mortality as well as reduced life expectancy across the world. As in 2019, India is home to the second-largest number (77 million) of Diabetic adults and the number of people affected has been increasing rapidly over the years. Termed as "the diabetes capital of the world," with every fifth diabetic in the world being an Indian, there is an urgent need to address many critically significant challenges posed by Diabetes in India, like, increasing prevalence among young people in urban areas, less awareness among people, high cost of disease management, limited healthcare facilities, suboptimal diabetes control etc. In Indian context, not enough attempts have been made to observe and understand the long-term pattern of diabetes incidence and mortality. This study aims to provide deep insights into the recent trends of diabetes incidence and mortality in India from 1990 to 2019. Materials and methods This is an observational study based on the most recent data from the Global Burden of Disease (GBD) Study 2019. We extracted numbers, age-specific and age-standardized incidence and mortality rates of diabetes (from 1990 to 2019) from the Global Health Data Exchange. The average annual percentage changes in incidence and mortality were analysed by joinpoint regression analysis; the net age, period, and cohort effects on the incidence and mortality were estimated by age-period-cohort analysis. Results During the study period, age-standardized incidence and mortality rates of diabetes in India experienced an upsurge in numbers, the incidence rate increased from 199.14 to 317.02, and consequently, mortality increased from 22.30 to 27.35 per 100,000 population. The joinpoint regression analysis showed that the age-standardized incidence significantly rose by 1.63 % (95 % CI: 1.57 %, 1.69 %) in Indian males and 1.56 % in Indian females (95 % CI: 1.49 %, 1.63 %) from 1990 to 2019. On the other hand, the age-standardized mortality rates rose by 0.77 % (95 % CI: 0.24 %, 1.31 %) in Indian males and 0.57 % (95 % CI: -0.54 %, 1.70 %) in Indian females. For age-specific rates, incidence increased in most age groups, with exception of age groups 5-9, 70-74, 75-79 and 80-84 in male, and age groups 5-9, 75-79 and 80-84 in female. Mortality in male saw a decreasing trend till age group 20-24, whereas in female, the rate decreased till age group 35-39. The age effect on incidence showed no obvious changes with advancing age, but the mortality significantly increased with advancing age; period effect showed that both incidence and mortality increased with advancing time period; cohort effect on diabetes incidence and mortality decreased from earlier birth cohorts to more recent birth cohorts, while incidence showed no material changes from 1975 to 1979 to 2000-2004 birth cohort. Conclusions Mortality of diabetes decreased in younger age groups but increased in older age groups; however, Incidence increased in most age groups for both male and female. The net age or period effect showed an unfavourable trend while the net cohort effect presented a favourable trend. Aging was likely to drive a continued increase in the mortality of diabetes. Timely population-level interventions aiming for health education, lifestyle modification with special emphasis on the promotion of physical activity and healthy diet should be conducted, especially for male and earlier birth cohorts at high risk of diabetes.
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Lundeberg KR, Vidis LJ, Martin J, Randolph-Habecker J. Invaluable role of histopathology in the diagnosis of cutaneous leiomyosarcoma in insulin injection site reaction. BMJ Case Rep 2021; 14:14/11/e241333. [PMID: 34799385 PMCID: PMC8606758 DOI: 10.1136/bcr-2020-241333] [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] [Indexed: 11/16/2022] Open
Abstract
Soft tissue sarcomas (STSs) are rare and may often be misdiagnosed, resulting in delays in treatment. A 67-year-old cisgender woman with type 2 diabetes mellitus and obesity presented to her primary care physician with a mass on her left proximal arm. The clinical opinion of the attending physician was that of an insulin injection site reaction. After further evaluation from the physician, the patient was diagnosed with a lipoma without confirmatory histology. The patient continued to present with an enlarging mass, decline in health status and continued with local wound care. The patient underwent a confirmatory biopsy following which, the patient was diagnosed with leiomyosarcoma. This case report highlights the case of a person with a low or moderate income with a self-reported low health literacy living in a rural community and how STS may be misdiagnosed in medically underserved. The patient’s primary or oncology care team are not involved in the production or review of this case report.
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Affiliation(s)
- Kathleen Renee Lundeberg
- Student Physician, Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, Washington, USA
| | - Laura J Vidis
- Student Physician, Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, Washington, USA.,Department of Pathology & Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jennifer Martin
- School of Occupational Therapy, Texas Woman's University, Dallas, Texas, USA
| | - Julie Randolph-Habecker
- Department of Biomedical Sciences, Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, Washington, USA
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Bhattacharjee H, Javeri H. Commentary: Burden of diabetic retinopathy. Indian J Ophthalmol 2021; 69:3138. [PMID: 34708756 PMCID: PMC8725129 DOI: 10.4103/ijo.ijo_2644_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Zatońska K, Basiak-Rasała A, Połtyn-Zaradna K, Różańska D, Karczewski M, Wołyniec M, Szuba A. Characteristic of FINDRISC Score and Association with Diabetes Development in 6-Year Follow-Up in PURE Poland Cohort Study. Vasc Health Risk Manag 2021; 17:631-639. [PMID: 34611406 PMCID: PMC8486267 DOI: 10.2147/vhrm.s321700] [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: 05/25/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of the study was to assess if FINDRISC score was associated with diabetes development after 6 years of observation. Methods Polish cohort is a part of global PURE study. Hereby analysis presents data from baseline (2007–2010) and 6-year follow-up (2013–2016) and was conducted on 1090 participants (702 women) from urban and rural areas in Lower Silesia region (Poland) without diabetes at the baseline and with complete data throughout course of the study. Results At the baseline, women had significantly higher FINDRISC score than men (10.43 vs 8.91; p=0.000) and participants from rural areas had higher score than from urban areas (10.97 vs 9.33; p=0.000). At the baseline, 25.87% of the participants had low risk of diabetes according to FINDRISC score, 38.90% had slightly elevated risk, 16.79% moderate risk, 16.42% high risk and 2.02% very high risk. Participants, who were healthy at baseline, but developed diabetes after 6 years of observation had significantly higher FINDRISC, than those who did not (13.39 vs 9.36; p=0.000). In 6-year follow-up, diabetes was diagnosed in 2.8% of participants, who were ascertained to “low risk” according to FINDRISC score in baseline; in 9.9% of participants of “slightly elevated risk”, 17.5% of participants of “moderate risk”, 26.8% in participants of “high risk” and 50.0% of participants of “very high risk”. Conclusions Results of PURE Poland cohort study indicates that higher FINDRISC score at the baseline was associated with higher risk of diabetes development during 6 years of observation.
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Affiliation(s)
- Katarzyna Zatońska
- Department of Social Medicine, Wroclaw Medical University, Wrocław, Poland
| | | | | | - Dorota Różańska
- Department of Dietetics, Wroclaw Medical University, Wrocław, Poland
| | - Maciej Karczewski
- The Faculty of Environmental Engineering and Geodesy, Department of Mathematics, Wroclaw University of Environmental and Life Sciences, Wrocław, Poland
| | - Maria Wołyniec
- Department of Social Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Andrzej Szuba
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
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Metwally AM, Yousof H, Elkholy MM, Eletreby LA, Barakat AA, Abd El Dayem SM, Abdelrahman M, Eldeeb SM. Determinants Influencing Awareness and Healthy Practices among a Sample of Insulin-dependent Diabetic Egyptian Patients: A Rural Community-based Study. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND: The prevalence of diabetes mellitus (DM) is predicted to increase over the coming years.
AIM: The objectives of the study were to measure the level of awareness and healthy practices related to five healthy domains and assess the effect of different demographic characteristics, glycated hemoglobin (HbA1c) level, and body mass index (BMI) on these levels among diabetic patients in a rural Egyptian village.
METHODS: A cross-sectional study was done on 300 selected insulin-dependent diabetic patients resident in an Egyptian village. Data were collected using a questionnaire covering five domains: General disease awareness and management compliance practice, check-up, foot care, diet, and physical activity. HbA1c and BMI were also measured as an impact of the management adherence.
RESULTS: The study found that more than three quarters of the participants (82.0%) were uncontrolled or poorly uncontrolled (HbA1c >8) diabetics and 76.0% were either obese or morbidly obese. Total awareness and practices percentage scores were low (42.4 ± 16.8% and 40.5 ± 12.3%, respectively). The linear regression model showed that high educational level had significantly positive effects on both the total awareness and practice scores as well as their domains. The study found that female participants and those having relatives with DM had significantly higher diet awareness and practice scores (p < 0.05). Younger age had significantly higher scores on foot care and diet awareness scores, physical activity, general disease awareness, and management compliance practices domains.
CONCLUSION: The studied awareness and practice domains were inadequate. Their improvement is cornerstones to impact glycemic control of diabetics and control their health risks, especially in rural communities.
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13
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Metwally AM, Yousof H, Elkholy MM, Eletreby LA, Barakat AA, Abd El Dayem SM, Abdelrahman M, Eldeeb SM. Determinants Influencing Awareness and Healthy Practices among a Sample of Insulin-dependent Diabetic Egyptian Patients: A Rural Community-based Study. Open Access Maced J Med Sci 2021; 9:500-508. [DOI: https:/doi.org/10.3889/oamjms.2021.6017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND: The prevalence of diabetes mellitus (DM) is predicted to increase over the coming years.
AIM: The objectives of the study were to measure the level of awareness and healthy practices related to five healthy domains and assess the effect of different demographic characteristics, glycated hemoglobin (HbA1c) level, and body mass index (BMI) on these levels among diabetic patients in a rural Egyptian village.
METHODS: A cross-sectional study was done on 300 selected insulin-dependent diabetic patients resident in an Egyptian village. Data were collected using a questionnaire covering five domains: General disease awareness and management compliance practice, check-up, foot care, diet, and physical activity. HbA1c and BMI were also measured as an impact of the management adherence.
RESULTS: The study found that more than three quarters of the participants (82.0%) were uncontrolled or poorly uncontrolled (HbA1c >8) diabetics and 76.0% were either obese or morbidly obese. Total awareness and practices percentage scores were low (42.4 ± 16.8% and 40.5 ± 12.3%, respectively). The linear regression model showed that high educational level had significantly positive effects on both the total awareness and practice scores as well as their domains. The study found that female participants and those having relatives with DM had significantly higher diet awareness and practice scores (p < 0.05). Younger age had significantly higher scores on foot care and diet awareness scores, physical activity, general disease awareness, and management compliance practices domains.
CONCLUSION: The studied awareness and practice domains were inadequate. Their improvement is cornerstones to impact glycemic control of diabetics and control their health risks, especially in rural communities.
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Verma AK, Goyal Y, Bhatt D, Dev K, Alsahli MA, Rahmani AH, Almatroudi A. A Compendium of Perspectives on Diabetes: A Challenge for Sustainable Health in the Modern Era. Diabetes Metab Syndr Obes 2021; 14:2775-2787. [PMID: 34168477 PMCID: PMC8216699 DOI: 10.2147/dmso.s304751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
Diabetes is a chronic illness. Hyperglycemia is the characteristic of this disorder. Diabetes is a global crisis which affects the economy and health of all nations. Over the last decades, the number of individuals living with diabetes has significantly increased worldwide. Asia is a key epicenter of the emerging diabetes epidemic, with China and India the two nations having the highest number of diabetic people. Economic development, modernization, unhealthy diet, population aging, and sedentary lifestyles are the major factors responsible for the increasing diabetes epidemic. Diabetes is associated with several complications, and cardiovascular disease is the most important cause of morbidity and mortality among people with diabetes. These life-threatening problems can be prevented or delayed by proper management of diabetes. Lifestyle modification is an important factor to decrease the diabetes risk. The frequency of diabetic complications will rise if there is a lack of cost-effective and sustainable interventions. Hence, prevention of diabetes and its complications such as diabetic retinopathy and cardiovascular disease should be a crucial part of all future health-related public policies among all nations. This review summarizes current epidemiological aspects of diabetes in the world along with its complications, preventive measures, and treatment.
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Affiliation(s)
- Amit K Verma
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Yamini Goyal
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Deepti Bhatt
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Kapil Dev
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Mohammed A Alsahli
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
| | - Arshad Husain Rahmani
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
| | - Ahmad Almatroudi
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
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Hou L, Li X, Liu L, Wei H, Xiong F, Du H, Yang Y, Zhang H, Zhang Q, Yao H, Fu J, Yan X, Cui L, Liu G, Li T, Chen S, Li P, Xin Y, Liang X, Yu B, Dong Z, Chen R, Ma H, Cheng X, Luo F, Gong C, Song W, Chen X, Zhang Z, Peng X, Li G, Liang L, Maimaiti M, Cheung PT, Luo X. A Multicenter Survey of Type I Diabetes Mellitus in Chinese Children. Front Endocrinol (Lausanne) 2021; 12:583114. [PMID: 34211433 PMCID: PMC8239384 DOI: 10.3389/fendo.2021.583114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 05/17/2021] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To investigate the features and treatment status of children with type 1 diabetes mellitus (T1DM) in China. METHODS We recruited patients <14 years of age with T1DM from 33 medical centers in 25 major cities of China between January 2012 and March 2015. All patients completed a questionnaire that was conducted by their pediatric endocrinologists at all centers. RESULTS A total of 1,603 children (755 males and 848 females) with T1DM participated in this survey. Of these, 834 (52.03%) of the patients exhibited diabetic ketoacidosis (DKA) at onset, while 769 patients (47.97%) did not exhibit DKA (non-DKA) at onset. There was a higher proportion of females (55.71%) in the cohort of patients exhibiting DKA at onset than in the non-DKA cohort (49.33%). The mean age of patients exhibiting DKA at presentation was 7.12 ± 0.14 years; this was significantly younger than that in non-DKA group (7.79 ± 0.15 years; P < 0.005). The frequency of DKA in 3 years old, 3-7 years old, and 7 years old or more was 77.21%, 26.17%, and 37.62%, respectively. Upon initial diagnosis, 29.4%, 15.2% and 11.8% of patients showed positivity for glutamic acid decarboxylase antibody (GADA), Insulin autoantibodies (IAA), or islet cell antibody (ICA), respectively. During six months follow-up, 244 patients (15.21%) reported receiving insulin pump therapy, and more than 60% of patients monitored their blood glucose levels less than 35 times per week. Although the majority of patients had no problems with obtaining insulin, 4.74% of the children surveyed were not able to receive insulin due to financial reasons, a shortage of insulin preparations, or the failure of the parents or guardians to acquire the appropriate medicine. CONCLUSION DKA is more common in very young children. Treatment and follow-up of T1DM in China still face very serious challenges.
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Affiliation(s)
- Ling Hou
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuzhen Li
- Department of Genetics and Endocrinology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Li Liu
- Department of Genetics and Endocrinology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hanyang Wei
- Department of Endocrinology and Genetic, Henan Provincial Children’s Hospital, Zhengzhou, China
| | - Feng Xiong
- Department of Endocrine and Genetic Metabolism Disease, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Hongwei Du
- Department of Pediatrics, The First Affiliated Hospital, Jilin University, Changchun, China
| | - Yu Yang
- Department of Endocrinology, Metabolism, and Genetics, Children’s Hospital of Nanchang University & Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Huifeng Zhang
- Department of Pediatrics, The Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qin Zhang
- Department of Endocrinology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Hui Yao
- Department of Endocrinology, Wuhan Children’s Hospital, Wuhan, China
| | - Junfen Fu
- Department of Endocrinology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoli Yan
- Department of Pediatrics Endocrinology, Xi’an Children’s Hospital, Xi’an, China
| | - Lanwei Cui
- Department of Pediatrics, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Geli Liu
- Department of Pediatrics, General Hospital of Tianjin Medical University, Tianjin, China
| | - Tang Li
- Department of Pediatrics, Qingdao Women and Children’s Hospital, Qingdao University, Qingdao, China
| | - Shaoke Chen
- Department of Pediatrics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Pin Li
- Department of Endocrinology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Xin
- Department of Pediatrics Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiangrong Liang
- Department of Endocrinology, Qilu Children’s Hospital, Shandong University, Jinan, China
| | - Baosheng Yu
- Department of Pediatrics, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zhiya Dong
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ruimin Chen
- Department of Endocrinology, Fuzhou Children’s Hospital, Fuzhou, China
| | - Huamei Ma
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xinran Cheng
- Department of Endocrinology and Metabolism, Chengdu Women’s and Children’s Central Hospital, Chengdu, China
| | - Feihong Luo
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Chunxiu Gong
- Endocrinology, Genetics, and Metabolism, Beijing Diabetes Center for Children and Adolescents, Medical Genetics Department, Beijing Children’s Hospital, Beijing, China
| | - Wenhui Song
- Department of Pediatric Endocrinology, Shanxi Provincial Children’s Hospital, Taiyuan, China
| | - Xiaobo Chen
- Department of Endocrinology, Children’s Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Zhixin Zhang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Xiangyun Peng
- Department of Endocrinology, Hunan Provincial Children’s Hospital, Changsha, China
| | - Guimei Li
- Department of Pediatrics, Shandong Provincial Hospital, Jinan, China
| | - Liyang Liang
- Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mireguli Maimaiti
- Department of Pediatrics, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Pik To Cheung
- Paediatric Endocrinology, Genetics, and Metabolism, Virtus Medical Group and The University of Hong Kong, Hong Kong SAR, China
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xiaoping Luo,
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Sarker A, Das R, Ether S, Saif-Ur-Rahman KM. Non-pharmacological interventions for the prevention of type 2 diabetes mellitus in low and middle-income countries: protocol for a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2020; 9:288. [PMID: 33298172 PMCID: PMC7727251 DOI: 10.1186/s13643-020-01550-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/30/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The disease burden caused by type 2 diabetes mellitus is a prime public health concern. The prevalence and rate of deaths from diabetes mellitus in low- and middle-income countries (LMICs) are higher than the high-income countries. Increased physical activity and a balanced diet are essential and successful measures to prevent the onset of diabetes mellitus. This systematic review aims to explore the available non-pharmacological approaches for the prevention of type 2 diabetes mellitus in LMICs. METHODS AND ANALYSIS Six online databases will be explored to get related randomized controlled trials (RCTs) published in English from inception to September 2020, and two coders will independently screen, identify studies, extract data, and assess the risk of bias in each article. The searched articles will be included by applying specific inclusion and exclusion criteria. Joanna Briggs Institute's tool for RCTs will be used for appraising the trials critically. Narrative synthesis and pooled effect of the interventions will be demonstrated. A meta-analysis will be conducted using the random-effects model if assumptions are fulfilled. DISCUSSION This review is an attempt to explore the available non-pharmacological approaches for the prevention of type 2 diabetes mellitus in LMICs. Findings from the review will highlight effective non-pharmacological measures for the prevention of type 2 diabetes mellitus to guide policy for future strategies. SYSTEMATIC REVIEW REGISTRATION The review protocol has been registered ( CRD42020191507 ).
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Affiliation(s)
- Anupam Sarker
- Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | - Rina Das
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Saraban Ether
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - K M Saif-Ur-Rahman
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.
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Ganie MA, Sahar T, Rashid A, Baba MS, Ahmad N, Bhat H, Wani IA, Shah ZA. Prevalence of diabetes and prediabetes in tribal population of Kashmir: Lessons for the future. Diabetes Res Clin Pract 2020; 169:108457. [PMID: 32979420 DOI: 10.1016/j.diabres.2020.108457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/03/2020] [Accepted: 09/15/2020] [Indexed: 11/25/2022]
Abstract
AIMS Considering a surge in the incidence of Diabetes mellitus (DM) across all ethnic groups and lack of any representative data from the tribal communities of Jammu and Kashmir, the present study aimed to assess the prevalence of DM and prediabetes in them. METHODS Subjects were recruited from five districts of Kashmir valley using multistage cluster sampling by probability proportional to size (PPS) technique. Data collection included recording of socio-demographic, medical facts, assessment of anthropometric parameters and biochemical evaluation HbA1c and random blood glucose measurements as per the American Diabetes Association (ADA) criteria were used for diagnosis of DM. RESULTS A total of 6808 subjects were recruited in this study including 2872 (42%) men and 3936 (58%) women with mean age of 39.60 ± 20.19 years and 35.17 ± 16.70 years, respectively. Around 8.60% subjects were obese, 38.9% were found to be hypertensive, 73% had dyslipidemia and 3.75% had metabolic syndrome. About 1.26% (0.5% males and 0.9% females) had DM and 11.64% had prediabetes based on HbA1c cut offs. Increasing age, body mass index and family history portend significant risk factors while smoking and sedentary lifestyle increased the risk marginally. CONCLUSIONS Although the prevalence of DM among tribals of Kashmir valley is lower than general population, the higher prediabetes to DM ratio may indicate a future trend of increasing DM prevalence in this disadvantageous subpopulation.
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Affiliation(s)
- Mohd Ashraf Ganie
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India.
| | - Tajali Sahar
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Aafia Rashid
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Mohd Saleem Baba
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Nisar Ahmad
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Hilal Bhat
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Imtiyaz Ahmad Wani
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Zafar Amin Shah
- Department of Immunology and Molecular Medicine, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
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Vasan SK, Antonisamy B, Gowri M, Selliah HY, Geethanjali FS, Jebasingh FS, Paul TV, Thomas N, Karpe F, Johnson M, Osmond C, Fall CHD. Prevalence, incidence and predictors of cardiovascular risk factors: longitudinal data from rural and urban South India and comparison with global data. BMJ Open Diabetes Res Care 2020; 8:8/1/e001782. [PMID: 33093130 PMCID: PMC7583064 DOI: 10.1136/bmjdrc-2020-001782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION India has high mortality rates from cardiovascular disease (CVD). Understanding the trends and identifying modifiable determinants of CVD risk factors will guide preventive strategies and policy making. RESEARCH DESIGN AND METHODS CVD risk factors (obesity, central obesity, and type 2 diabetes (T2D), hypertension, hypercholesterolemia and hypertriglyceridemia) prevalence and incidence were estimated in 962 (male 519) non-migrant adults from Vellore, South India, studied in: (1) 1998-2002 (mean age 28.2 years) and (2) 2013-2014 (mean age 41.7 years). Prevalence was compared with the Non-Communicable Disease Risk Collaboration (global) data. Incidence was compared with another Indian cohort from New Delhi Birth Cohort (NDBC). Regression analysis was used to test baseline predictors of incident CVD risk factors. RESULTS The prevalence at 28 and 42 years was 17% (95% CI 14% to 19%) and 51% (95% CI 48% to 55%) for overweight/obesity, 19% (95% CI 17% to 22%) and 59% (95% CI 56% to 62%) for central obesity, 3% (95% CI 2% to 4%) and 16% (95% CI 14% to 19%) for T2D, 2% (95% CI 1% to 3%) and 19% (95% CI 17% to 22%) for hypertension and 15% (95% CI 13% to 18%) and 30% (95% CI 27% to 33%) for hypertriglyceridemia. The prevalence of T2D at baseline and follow-up and hypertension at follow-up was comparable with or exceeded that in high-income countries despite lower obesity rates. The incidence of most risk factors was lower in Vellore than in the NDBC. Waist circumference strongly predicted incident T2D, hypertension and hypertriglyceridemia. CONCLUSIONS A high prevalence of CVD risk factors was evident at a young age among Indians compared with high and upper middle income countries, with rural rates catching up with urban estimates. Adiposity predicted higher incident CVD risk, but the prevalence of hypertension and T2D was higher given a relatively low obesity prevalence. Preventive efforts should target both rural and urban India and should start young.
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Affiliation(s)
- Senthil K Vasan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, Hampshire, UK
| | - Belavendra Antonisamy
- Department of Biostatistics, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Hepsy Y Selliah
- Department of Biostatistics, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Finney S Geethanjali
- Department of Clinical Biochemistry, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Felix S Jebasingh
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Thomas V Paul
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Matthew Johnson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, Hampshire, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, Hampshire, UK
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, Hampshire, UK
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Personal, Social, and Environmental Mediators Associated With Increased Recreational Physical Activity in Women and Girls in the Kingdom of Tonga. J Phys Act Health 2020; 17:1100-1108. [PMID: 32937601 DOI: 10.1123/jpah.2019-0630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/19/2020] [Accepted: 08/06/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this paper was to identify personal, social, and environmental mediators of recreational physical activity (PA) in a 6-month netball-based intervention for women and girls in Tonga. METHODS Tonga Netball's "low-engagement village program" was implemented in 10 villages and aimed to increase the recreational PA levels in women and girls through a comprehensive, structured community-level netball program addressing key barriers to participation. In a mixed-methods approach, these mediating barriers were identified through qualitative interviews based on the socioecological model. Quantitative measures for mediators and recreational PA were then developed, and data from 301 women and girls were collected. Standard mediation analyses methods were then applied. RESULTS Program participation appeared to significantly increase PA levels. Statistically significant personal mediators were body issues, preferring competitions, and clothing. Social mediators were support from sports council, community leaders, friends, and church. Environmental mediators were travel time and access to balls, bibs, and umpires. CONCLUSION A comprehensive community-level program addressing key participation barriers can increase recreational PA among women and girls in Tonga. Triangulating these results with mediation analyses of variables on the causal pathway can strengthen our understanding of causation and inform funding prioritization for critical program components in similar contexts.
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Changes in diabetes prevalence and corresponding risk factors - findings from 3- and 6-year follow-up of PURE Poland cohort study. BMC Public Health 2020; 20:843. [PMID: 32493306 PMCID: PMC7268673 DOI: 10.1186/s12889-020-08970-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/21/2020] [Indexed: 01/04/2023] Open
Abstract
Background Diabetes mellitus (DM) is one of the greatest challenges for public health worldwide. The aim of the study was the analysis of diabetes development in participants with normoglycemia and Impaired Fasting Glucose (IFG) in 3-year and 6-year follow-up of PURE Poland cohort study. Methods The analysis was conducted in Polish cohort enrolled into Prospective Urban and Rural Epidemiology (PURE) Study. The following study presents results of 1330 participants that have partaken both in the baseline study, in 3-year and in the 6-year follow up. The analysis of the impact of risk factors on diabetes development was performed using multivariate Cox frailty analysis. Population Attributable Risk (PAR) was computed individually for every risk factor. Results Diabetes prevalence increased from 17.7% at baseline to 23.98% in 3-year- and 28.27% in 6-year follow-up. The risk of diabetes was higher in participants with obesity [HR = 5.7, 95%Cl 2,56-12,82], overweight [HR = 3.4, 95%Cl 1,56-7,54] and IFG [HR = 2.7, 95%Cl 1,87-3,85]. The risk of diabetes development was almost 2-fold higher in men than in women [HR = 1.826; 95%CI =1,24 - 2,69]. In 6 years, diabetes developed in 23.8% of participants with IFG and 7.9% of participants with normoglycemia. According to PAR, overweight and obesity accounted for 80.8%, hypertension for 67.6% and IFG for 38.3% of diabetes cases in our population. Conclusions Our study reveals alarming increase in prevalence of diabetes during 6 years of observation. In our population, most diabetes cases can be attributed to overweight, obesity, hypertension and IFG. Findings add strong rationale to implement targeted preventive measures in population of high risk.
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Haque M, Islam T, Rahman NAA, McKimm J, Abdullah A, Dhingra S. Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries. Risk Manag Healthc Policy 2020; 13:409-426. [PMID: 32547272 PMCID: PMC7244358 DOI: 10.2147/rmhp.s239074] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/24/2020] [Indexed: 12/31/2022] Open
Abstract
The prevalence of long-term (chronic) non-communicable diseases (NCDs) is increasing globally due to an ageing global population, urbanization, changes in lifestyles, and inequitable access to healthcare. Although previously more common in high- and upper-middle-income countries, lower-middle-income countries (LMICs) are more affected, with NCDs in LMICs currently accounting for 85–90% of premature deaths among 30–69 years old. NCDs have both high morbidity and mortality and high treatment costs, not only for the diseases themselves but also for their complications. Primary health care (PHC) services are a vital component in the prevention and control of long-term NCDs, particularly in LMICs, where the health infrastructure and hospital services may be under strain. Drawing from published studies, this review analyses how PHC services can be utilized and strengthened to help prevent and control long-term NCDs in LMICs. The review finds that a PHC service approach, which deals with health in a comprehensive way, including the promotion, prevention, and control of diseases, can be useful in both high and low resource settings. Further, a PHC based approach also provides opportunities for communities to better access appropriate healthcare, which ensures more significant equity, efficiency, effectiveness, safety, and timeliness, empowers service users, and helps healthcare providers to achieve better health outcomes at lower costs. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/33l6gK1RNFo
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Affiliation(s)
- Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
| | - Tariqul Islam
- UChicago Research Bangladesh, Dhaka 1230, Bangladesh
| | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, 25200, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Swansea University, Swansea, Wales SA2 8PP, UK
| | - Adnan Abdullah
- Unit of Occupational Medicine, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
| | - Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Mount Hope, Trinidad & Tobago
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Wang X, Liu D, Du M, Hao R, Zheng H, Yan C. The role of text messaging intervention in Inner Mongolia among patients with type 2 diabetes mellitus: a randomized controlled trial. BMC Med Inform Decis Mak 2020; 20:90. [PMID: 32410608 PMCID: PMC7222448 DOI: 10.1186/s12911-020-01129-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 05/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Short messages service (SMS) provides a practical medium for delivering content to address patients to adherence to self-management. The aim of study was to design some patient-centered health education messages, evaluate the feasibility of messages, and explore the effect of this model. Methods The messages were designed by a panel of experts, and SMS Quality Evaluation Questionnaire was used to evaluate their quality. A two-arm randomized controlled trial was conducted to evaluate the effectiveness of this management model. Participants were randomly divided into an intervention group (IG) who received evaluated messages and a control group (CG) who received regular education. The primary outcomes were changes in plasma glucose and control rates, and the secondary outcomes were improvements in diet control, physical activities, weight control, etc. Results A total of 42 messages covering five main domains: health awareness, diet control, physical activities, living habits and weight control were designed, and the average scores of the messages were 8.0 (SD 0.7), 8.5 (SD 0.6), 7.9 (SD 1.0), 8.0 (SD 0.7), and 8.4 (SD 0.9), respectively. In the SMS intervention, 171 patients with an average age of 55.1 years were involved, including 86 in the CG and 85 in the IG. At 12 months, compared with the control group (CG), the decrease of fasting plasma glucose (FPG) (1.5 vs. 0.4, P = 0.011) and control rate (49.4% vs. 33.3%, P = 0.034), the postprandial glucose (PPG) (5.8 vs. 4.2, P = 0.009) and control rate (57.8% vs. 33.7%, P = 0.002) were better in the intervention group (IG). In terms of self-management, improvements in weight control (49.3% vs. 28.2%, P = 0.031), vegetables consumption (87.3% vs. 29.0%, P < 0.001), fruits consumption (27.5% vs. 7.4%, P = 0.022), and physical activities (84.7% vs. 70.0%, P = 0.036) were better in the IG than in the CG. Conclusions The overall quality of the messages was high. It was effective and feasible to carry out an SMS intervention to improve the behavioral habits of patients with chronic diseases in remote and undeveloped areas. Trial registration Clinicaltrials.gov, ChiCTR1900023445. Registered May 28, 2019--Retrospectively registered.
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Affiliation(s)
- Xuemei Wang
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Dan Liu
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, China.,Department of Medicine, Hetao College, Bayan Nur, China
| | - Maolin Du
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, China.
| | - Ruiqi Hao
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Huiqiu Zheng
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Chaoli Yan
- Department of Endocrinology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Asril NM, Tabuchi K, Tsunematsu M, Kobayashi T, Kakehashi M. Predicting Healthy Lifestyle Behaviours Among Patients With Type 2 Diabetes in Rural Bali, Indonesia. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2020; 13:1179551420915856. [PMID: 32341670 PMCID: PMC7171987 DOI: 10.1177/1179551420915856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 03/06/2020] [Indexed: 12/13/2022]
Abstract
Background Type 2 diabetes is a lifelong metabolic disease closely related to unhealthy lifestyle behaviours. This study aimed to identify factors explaining the healthy lifestyle behaviours of patients with type 2 diabetes in rural Indonesia. The extended health belief model, demographic characteristics, clinical lifestyle factors and diabetes knowledge were investigated to provide a complete description of these behaviours. Method A sample of 203 patients with type 2 diabetes representing a cross-section of the population were recruited from community health centres in the rural areas of Bali province. The data were collected through questionnaires. Descriptive statistics and a hierarchical regression test were employed. Results This study showed demographic characteristics, clinical and lifestyle factors, diabetes knowledge and the extended health belief model accounted for 71.8% of the variance in healthy lifestyle behaviours of patients with type 2 diabetes in rural Indonesia. The significant demographic factors were age, education level, employment status and traditional beliefs. The significant clinical and lifestyle factors were alcohol use, diabetic medicine and duration of symptoms. Finally, the significant extended health belief model factors were perceived severity, susceptibility, barriers, family support, bonding social capital and chance locus of control. Conclusions The extended health belief model forms an adequate model for predicting healthy lifestyle behaviours among patients with diabetes in rural Indonesia. The contribution of this model should be strengthened in developing the diabetes management.
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Affiliation(s)
- Nice Maylani Asril
- Department of Health Informatics, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.,Faculty of Education, Ganesha University of Education, Bali, Indonesia
| | - Keiji Tabuchi
- Department of Health Promotion and Development Science, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Miwako Tsunematsu
- Department of Health Informatics, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Toshio Kobayashi
- Department of General Internal Medicine, Ishii Memorial Hospital, Yamaguchi, Japan
| | - Masayuki Kakehashi
- Department of Health Informatics, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
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Tay W, Kaur B, Quek R, Lim J, Henry CJ. Current Developments in Digital Quantitative Volume Estimation for the Optimisation of Dietary Assessment. Nutrients 2020; 12:E1167. [PMID: 32331262 PMCID: PMC7231293 DOI: 10.3390/nu12041167] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 12/23/2022] Open
Abstract
Obesity is a global health problem with wide-reaching economic and social implications. Nutrition surveillance systems are essential to understanding and addressing poor dietary practices. However, diets are incredibly diverse across populations and an accurate diagnosis of individualized nutritional issues is challenging. Current tools used in dietary assessment are cumbersome for users, and are only able to provide approximations of dietary information. Given the need for technological innovation, this paper reviews various novel digital methods for food volume estimation and explores the potential for adopting such technology in the Southeast Asian context. We discuss the current approaches to dietary assessment, as well as the potential opportunities that digital health can offer to the field. Recent advances in optics, computer vision and deep learning show promise in advancing the field of quantitative dietary assessment. The ease of access to the internet and the availability of smartphones with integrated cameras have expanded the toolsets available, and there is potential for automated food volume estimation to be developed and integrated as part of a digital dietary assessment tool. Such a tool may enable public health institutions to be able to gather an effective nutritional insight and combat the rising rates of obesity in the region.
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Affiliation(s)
- Wesley Tay
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117599, Singapore; (W.T.); (B.K.); (R.Q.); (J.L.)
| | - Bhupinder Kaur
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117599, Singapore; (W.T.); (B.K.); (R.Q.); (J.L.)
| | - Rina Quek
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117599, Singapore; (W.T.); (B.K.); (R.Q.); (J.L.)
| | - Joseph Lim
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117599, Singapore; (W.T.); (B.K.); (R.Q.); (J.L.)
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117599, Singapore; (W.T.); (B.K.); (R.Q.); (J.L.)
- Department of Biochemistry, Yong Loo Lin School of Medicine, Singapore 117596, Singapore
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Flores-Guerrero JL, Muñoz-Morales A, Narea-Jimenez F, Perez-Fuentes R, Torres-Rasgado E, Ruiz-Vivanco G, Gonzalez-Viveros N, Castro-Ramos J. Novel Assessment of Urinary Albumin Excretion in Type 2 Diabetes Patients by Raman Spectroscopy. Diagnostics (Basel) 2020; 10:diagnostics10030141. [PMID: 32138353 PMCID: PMC7151048 DOI: 10.3390/diagnostics10030141] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/25/2019] [Accepted: 12/24/2019] [Indexed: 11/16/2022] Open
Abstract
Urinary albumin excretion remains the key biomarker to detect renal complications in type 2 diabetes. As diabetes epidemy increases, particularly in low-income countries, efficient and low-cost methods to measure urinary albumin are needed. In this pilot study, we evaluated the performance of Raman spectroscopy in the assessment of urinary albumin in patients with type 2 diabetes. The spectral Raman analysis of albumin was performed using artificial urine, at five concentrations of albumin and 24 h collection urine samples from ten patients with Type 2 Diabetes. The spectra were obtained after removing the background fluorescence and fitting Gaussian curves to spectral regions containing features of such metabolites. In the samples from patients with type 2 diabetes, we identified the presence of albumin in the peaks of the spectrum located at 663.07, 993.43, 1021.43, 1235.28, 1429.91 and 1633.91 cm−1. In artificial urine, there was an increase in the intensity of the Raman signal at 1450 cm−1, which corresponds to the increment of the concentrations of albumin. The highest concentration of albumin was located at 1630 cm−1. The capability of Raman spectroscopy for detection of small concentrations of urinary albumin suggests the feasibility of this method for the screening of type 2 diabetes renal complications.
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Affiliation(s)
- Jose L. Flores-Guerrero
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Correspondence: ; Tel.:+ 31-50-36-10137
| | - Aaron Muñoz-Morales
- Department of Physics, Faculty of Experimental Sciences and Technology, Center of Medical and Biotechnology Research, University of Carabobo, Valencia 2005, Venezuela;
| | - Freddy Narea-Jimenez
- Optics coordination, Biomedical Optics Group, National Institute of Astrophysics, Optics and Electronics, INAOE, Puebla 72840, Mexico; (F.N.-J.); (N.G.-V.); (J.C.-R.)
| | - Ricardo Perez-Fuentes
- Department of Chronic Disease Physiopathology, East Center of Biomedical Research, Mexican Social Security Institute, CIBIOR, Puebla 74360, Mexico; (R.P.-F.); (G.R.-V.)
| | - Enrique Torres-Rasgado
- Faculty of Medicine, Meritorious Autonomous University of Puebla, BUAP, Puebla 72589, Mexico;
| | - Guadalupe Ruiz-Vivanco
- Department of Chronic Disease Physiopathology, East Center of Biomedical Research, Mexican Social Security Institute, CIBIOR, Puebla 74360, Mexico; (R.P.-F.); (G.R.-V.)
| | - Naara Gonzalez-Viveros
- Optics coordination, Biomedical Optics Group, National Institute of Astrophysics, Optics and Electronics, INAOE, Puebla 72840, Mexico; (F.N.-J.); (N.G.-V.); (J.C.-R.)
| | - Jorge Castro-Ramos
- Optics coordination, Biomedical Optics Group, National Institute of Astrophysics, Optics and Electronics, INAOE, Puebla 72840, Mexico; (F.N.-J.); (N.G.-V.); (J.C.-R.)
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Acet T, Ozcan K, Zengin G. An assessment of phenolic profiles, fatty acid compositions, and biological activities of two Helichrysum species: H. plicatum and H. chionophilum. J Food Biochem 2019; 44:e13128. [PMID: 31868928 DOI: 10.1111/jfbc.13128] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/12/2019] [Accepted: 12/02/2019] [Indexed: 02/06/2023]
Abstract
In the present study, we aimed to search and compare the biological activities of the ethanol (EtOH), methanol (MeOH), and ethylacetate (EtOAc) solvent extracts of the flower, stem, and root parts of two Helichrysum plants (H. chionophilum (Hc) and H. plicatum subsp. plicatum (Hp)). The antioxidant properties were determined by using (2,2-diphenyl-1-picrylhydrazyl) (DPPH) and ABTS (2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) assays. The enzyme inhibitory effects of the extracts were investigated on butyrylcholinesterase (BChE), acetylcholinesterase (AChE), α-glucosidase, and α-amylase. Palmitic acid (C 16:0) was also determined as major fatty acids in the tested oils (31.21%-67.68%). In both plants, it was found that the EtOAc extracts of the flowers had a strong antioxidant and enzyme inhibitory effect. In conclusion, the results obtained in the present study showed that H. chionophilum and H. plicatum can be seen as a promising source for the natural bioactive compounds that can be used in therapeutic applications. PRACTICAL APPLICATIONS: The members of the genus Helichrysum have been widely taken for therapeutic purposes in traditional medicine as well as food. In this context, we investigated the chemical characterization and biological activities of two Helichrysum species extracts (H. chionophilum and H. plicatum subsp. plicatum). Antioxidant capacity, enzyme inhibition and anti-microbial effects were tested for biological activities. Chemical characterization was identified by high performance liquid chromatography (HPLC) (for phenolic) and gas chromatography-flame ioanization detector (GC-FID) (for fatty acids). Based on our findings, the species may be valuable for designing novel food products.
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Affiliation(s)
- Tuba Acet
- Department of Genetic and Bioengineering, Faculty of Engineering and Natural Sciences, Gumushane University, Gumushane, Turkey
| | - Kadriye Ozcan
- Department of Genetic and Bioengineering, Engineering Faculty, Giresun University, Giresun, Turkey
| | - Gokhan Zengin
- Deparment of Biology, Science Faculty, Selcuk University, Campus, Konya, Turkey
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Tesfaye B, Alebel A, Gebrie A, Zegeye A, Tesema Leshargie C, Ferede A, Abera H, Alam K. Diabetes Mellitus and Its Association with Hypertension in Ethiopia: A Systematic Review and Meta-Analysis. Diabetes Res Clin Pract 2019; 156:107838. [PMID: 31520712 DOI: 10.1016/j.diabres.2019.107838] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/20/2019] [Accepted: 08/30/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is a growing public health concern globally, including Ethiopia. Although numerous studies have been published from different parts of Ethiopia, no attempt is made so far to estimate the burden of DM at the national level. This study aims to estimate the pooled prevalence of DM and its association with hypertension in Ethiopia. METHODS A systematic search was conducted in major databases. Two authors extracted the necessary data and analysis was conducted using STATA version 14. Heterogeneity across the studies was evaluated by Cochran's Q test and I2 statistics. RESULTS Eighteen studies with a total of 45,284 participants were included in this review. The pooled prevalence of DM was 4.99% (95% CI: 3.86%, 6.11%). Hypertension was significantly associated with DM (OR: 8.32; 95% CI: 3.05, 22.71). CONCLUSION The burden of DM in Ethiopia is considerable, and the association between diabetes and hypertension is significant. Based on the evidence, this review recommends establishing the coordinated national programs that counteract the increasing burden of DM in the country is very essential. In addition, Early hypertension screening should be done in diabetic patients to control co-morbidity and further complications.
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Affiliation(s)
- Bekele Tesfaye
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
| | - Animut Alebel
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Alemu Gebrie
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Abriham Zegeye
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Cheru Tesema Leshargie
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Aster Ferede
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Habtamu Abera
- Department of Nursing, Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Khorshed Alam
- School of Commerce and Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD 4350, Australia
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Owolabi EO, Goon DT. The use of text messaging for improving adherence to anti-diabetic regimen and glycaemic control in low-resource settings of South Africa: A study protocol for a randomised controlled trial. Contemp Clin Trials Commun 2019; 15:100418. [PMID: 31372574 PMCID: PMC6661274 DOI: 10.1016/j.conctc.2019.100418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/11/2019] [Accepted: 07/18/2019] [Indexed: 12/03/2022] Open
Abstract
Background Despite the various innovations and treatment modalities, diabetes treatment outcomes remain sub-optimal globally and in South Africa. This places significant strain on the healthcare system. Text messaging is a cost-effective measure for promoting health. Yet, its effectiveness in improving diabetes treatment outcomes has not been documented in South Africa, especially in the resource-restrained settings. This study aims as determining the effectiveness, feasibility and acceptability of text messaging in improving diabetes outcomes in low-resource settings of the Eastern Cape Province of South Africa. Methods and analysis This is a multi-centre, two-arm, parallel, randomised controlled trial which will compare the use of text messaging in addition to diabetes standard care to standard care alone in promoting diabetes outcomes for six months. The study will be conducted at six primary healthcare centres in two selected districts in Eastern Cape, South Africa. The study requires 216 participants if an attrition rate of 20% is anticipated. Data will be collected at baseline and six months. Randomisation will follow baseline data collection using simple randomisation, with an allocation ratio of 1:1, after removing any identifying information. The primary outcome measure is a change in mean morning random blood sugar. Secondary outcomes include change in diabetes knowledge, medication adherence, self-management, health-related quality of life, mean blood pressure, weight and clinic attendance. Data will be obtained through self-reporting using validated measures, review of clinical records and objective measurements. Data collection and measurements will follow standard procedure. Data analysis will be based on the principle of Intention-to-treat. Trial registration This trial was registered in the Pan African Clinical Trial Registry, trial number: PACTR201810599931422.
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Affiliation(s)
- Eyitayo Omolara Owolabi
- Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Daniel Ter Goon
- Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
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Aminuddin HB, Jiao N, Jiang Y, Hong J, Wang W. Effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, health-related quality of life and clinical outcomes in patients with type 2 diabetes: A systematic review and meta-analysis. Int J Nurs Stud 2019; 116:103286. [PMID: 30827741 DOI: 10.1016/j.ijnurstu.2019.02.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To review the evidence and determine the effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, health-related quality of life, glycated hemoglobin, body mass index (BMI), and blood pressure (BP) levels of adults with type 2 diabetes mellitus . METHODS A systematic search of five databases (PubMed, Embase, Cochrane, CINAHL and Scopus) was conducted. Studies published in English from January 2007 to January 2018 were considered. Only randomized controlled trials (RCTs) of smartphone-based self-management interventions for patients with type 2 diabetes mellitus that reported any of the study outcomes were included. Two reviewers independently screened the studies, extracted data and assessed the quality of the studies. Meta-analyses were conducted for the different study outcomes. RESULTS A total of 26 articles, consisting of 22 studies with 2645 participants, were included in the review. The results from meta-analysis on the studies revealed that as compared to control group, participants received smartphone-based self-management intervention had better self-efficacy with large effect size of 0.98 (P < 0.001), self-care activities with effect size of 0.90 (P < 0.001), health related quality of life with effect size of 0.26 (p=0.01), and lower glycated hemoglobin (pooled MD=-0.55; p<0.001). Subgroup analyses were also conducted for self-efficacy as significant heterogeneity was present among the studies. The effects on BMI and BP were not statistically significant. CONCLUSIONS Smartphone-based self-management interventions appear to have beneficial effects on self-efficacy, self-care activities and health-relevant outcomes for patients with type 2 diabetes mellitus. However, more research with good study design is needed to evaluate the effectiveness of smartphone-based self-care interventions for T2DM.
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Affiliation(s)
- Haziqah Binte Aminuddin
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Nana Jiao
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Gujral UP, Mohan V, Pradeepa R, Deepa M, Anjana RM, Narayan KM. Ethnic differences in the prevalence of diabetes in underweight and normal weight individuals: The CARRS and NHANES studies. Diabetes Res Clin Pract 2018; 146:34-40. [PMID: 30244052 PMCID: PMC6295265 DOI: 10.1016/j.diabres.2018.09.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/13/2018] [Indexed: 12/13/2022]
Abstract
AIMS Type 2 diabetes in lean individuals has recently come to attention. We assessed type 2 diabetes prevalence and the associated risk factors in underweight and normal weight individuals in two ethnic populations. METHODS We conducted cross-sectional analyses, using representative samples of 4930 Asian Indians from the CARRS-Chennai Study and 2868 Whites from the NHANES Survey. Diabetes was defined as use of glucose lowering medication, fasting glucose ≥126 mg/dl, or 2 h glucose ≥200 mg/dl. Body mass index (BMI) was classified using WHO standard criteria. RESULTS Prevalence of type 2 diabetes by BMI varied by ethnicity and sex. In men, type 2 diabetes prevalence was 5.4% and 23.5% in underweight and normal weight Asian Indians and 0.0% and 6.1% in underweight and normal weight Whites. In women, the prevalence was 5.6% and 13.6% in underweight and normal weight Asian Indians and 2.3% and 2.8% in underweight and normal weight Whites. Adjustment for waist circumference, insulin resistance, and insulin secretion did not explain the increased prevalence in Asian Indians. CONCLUSIONS These findings suggest significant ethnic differences in type 2 diabetes prevalence without overweight or obesity. Future studies should examine the pathophysiology of type 2 diabetes development in lean individuals.
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Affiliation(s)
- Unjali P Gujral
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Road NE, Room 7040 N Emory University, Atlanta, GA, USA.
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, IDF Centre of Education, Chennai, India.
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, IDF Centre of Education, Chennai, India
| | - Mohan Deepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, IDF Centre of Education, Chennai, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, IDF Centre of Education, Chennai, India.
| | - K M Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Road NE, Room 7040 N Emory University, Atlanta, GA, USA; Nutrition and Health Sciences Program, Emory University, 1518 Clifton Road, Room 7000, Atlanta, GA, USA; Department of Medicine, School of Medicine, 201 Dowman Drive Emory University, Atlanta, GA, USA.
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The Indices of Nitric Oxide System in Rats with Carrageenan-Induced Enterocolitis Combined with Diabetes Mellitus. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2018. [DOI: 10.2478/rjdnmd-2018-0033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Abstract
Background and aims: Diabetes mellitus (DM) represents a considerable public health issue, being one of the major causes of morbidity and mortality in the modern societies. Chronic hyperglycemia is accompanied by significant physiological, biochemical, and histological changes, e.g. development of oxidative stress that affects the motor activity of the intestine. This study aimed to evaluate the indices of nitric oxide (NO) system in blood serum and colon tissue supernatant of rats with carrageenan-induced enterocolitis combined with streptozotocin-induced diabetes.
Material and methods: The total NOS activity was determined by monitoring the rate of conversion of L-arginine into citrulline. The total quantity of NO metabolites was assessed by evaluating their amount, which included nitrite ions that were initially present in the sample (NO2
−) and nitrate ions reducted to nitrites (NO3
−).
Results: We found a significant increase in total NOS activity in colon tissue of all experimental groups vs. control animals (54.8, 30.6 and 79.2 % respectively). The total content of NO metabolites in colon tissue of all experimental groups also significantly increased (2.8, 1.9 and 3.4 times respectively) compared to the control animals.
Conclusions: We observed activation of nitroxydergic process in blood serum and colon tissue of rats with carrageenan-induced enterocolitis. Nitroxydergic processes markedly intensified in rats with carrageenan-induced enterocolitis combined with diabetes mellitus.
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Pearson-Stuttard J, Zhou B, Kontis V, Bentham J, Gunter MJ, Ezzati M. Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment. Lancet Diabetes Endocrinol 2018; 6:e6-e15. [PMID: 29803268 PMCID: PMC5982644 DOI: 10.1016/s2213-8587(18)30150-5] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diabetes and high body-mass index (BMI) are associated with increased risk of several cancers, and are increasing in prevalence in most countries. We estimated the cancer incidence attributable to diabetes and high BMI as individual risk factors and in combination, by country and sex. METHODS We estimated population attributable fractions for 12 cancers by age and sex for 175 countries in 2012. We defined high BMI as a BMI greater than or equal to 25 kg/m2. We used comprehensive prevalence estimates of diabetes and BMI categories in 2002, assuming a 10-year lag between exposure to diabetes or high BMI and incidence of cancer, combined with relative risks from published estimates, to quantify contribution of diabetes and high BMI to site-specific cancers, individually and combined as independent risk factors and in a conservative scenario in which we assumed full overlap of risk of diabetes and high BMI. We then used GLOBOCAN cancer incidence data to estimate the number of cancer cases attributable to the two risk factors. We also estimated the number of cancer cases in 2012 that were attributable to increases in the prevalence of diabetes and high BMI from 1980 to 2002. All analyses were done at individual country level and grouped by region for reporting. FINDINGS We estimated that 5·7% of all incident cancers in 2012 were attributable to the combined effects of diabetes and high BMI as independent risk factors, corresponding to 804 100 new cases. 187 600 (24·5%) of 766 000 cases of liver cancer and 121 700 (38·4%) of 317 000 cases of endometrial cancer were attributable to these risk factors. In the conservative scenario, about 4·5% (629 000 new cases) of all incident cancers assessed were attributable to diabetes and high BMI combined. Individually, high BMI (544 300 cases) was responsible for almost twice as many cancer cases as diabetes (293 300 cases). 25·8% of diabetes-related cancers (equating to 75 600 new cases) and 31·9% of high BMI-related cancers (174 040 new cases) were attributable to increases in the prevalence of these risk factors from 1980 to 2002. INTERPRETATION A substantial number of cancer cases are attributable to diabetes and high BMI. As the prevalence of these cancer risk factors increases, clinical and public health efforts should focus on identifying optimal preventive and screening measures for whole populations and individual patients. FUNDING NIHR and Wellcome Trust.
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Affiliation(s)
- Jonathan Pearson-Stuttard
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - Bin Zhou
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Vasilis Kontis
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - James Bentham
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; School of Mathematics, Statistics and Actuarial Science (SMSAS), University of Kent, Canterbury, UK
| | - Marc J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Majid Ezzati
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
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Pearson-Stuttard J, Zhou B, Kontis V, Bentham J, Gunter MJ, Ezzati M. Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment. Lancet Diabetes Endocrinol 2018; 6:95-104. [PMID: 29195904 PMCID: PMC5805864 DOI: 10.1016/s2213-8587(17)30366-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Diabetes and high body-mass index (BMI) are associated with increased risk of several cancers, and are increasing in prevalence in most countries. We estimated the cancer incidence attributable to diabetes and high BMI as individual risk factors and in combination, by country and sex. METHODS We estimated population attributable fractions for 12 cancers by age and sex for 175 countries in 2012. We defined high BMI as a BMI greater than or equal to 25 kg/m2. We used comprehensive prevalence estimates of diabetes and BMI categories in 2002, assuming a 10-year lag between exposure to diabetes or high BMI and incidence of cancer, combined with relative risks from published estimates, to quantify contribution of diabetes and high BMI to site-specific cancers, individually and combined as independent risk factors and in a conservative scenario in which we assumed full overlap of risk of diabetes and high BMI. We then used GLOBOCAN cancer incidence data to estimate the number of cancer cases attributable to the two risk factors. We also estimated the number of cancer cases in 2012 that were attributable to increases in the prevalence of diabetes and high BMI from 1980 to 2002. All analyses were done at individual country level and grouped by region for reporting. FINDINGS We estimated that 5·6% of all incident cancers in 2012 were attributable to the combined effects of diabetes and high BMI as independent risk factors, corresponding to 792 600 new cases. 187 600 (24·5%) of 766 000 cases of liver cancer and 121 700 (38·4%) of 317 000 cases of endometrial cancer were attributable to these risk factors. In the conservative scenario, about 4·5% (626 900 new cases) of all incident cancers assessed were attributable to diabetes and high BMI combined. Individually, high BMI (544 300 cases) was responsible for twice as many cancer cases as diabetes (280 100 cases). 26·1% of diabetes-related cancers (equating to 77 000 new cases) and 31·9% of high BMI-related cancers (174 040 new cases) were attributable to increases in the prevalence of these risk factors from 1980 to 2002. INTERPRETATION A substantial number of cancer cases are attributable to diabetes and high BMI. As the prevalence of these cancer risk factors increases, clinical and public health efforts should focus on identifying optimal preventive and screening measures for whole populations and individual patients. FUNDING NIHR and Wellcome Trust.
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Affiliation(s)
- Jonathan Pearson-Stuttard
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - Bin Zhou
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Vasilis Kontis
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - James Bentham
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; School of Mathematics, Statistics and Actuarial Science (SMSAS), University of Kent, Canterbury, UK
| | - Marc J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Majid Ezzati
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
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Aekplakorn W, Chariyalertsak S, Kessomboon P, Assanangkornchai S, Taneepanichskul S, Putwatana P. Prevalence of Diabetes and Relationship with Socioeconomic Status in the Thai Population: National Health Examination Survey, 2004-2014. J Diabetes Res 2018; 2018:1654530. [PMID: 29687009 PMCID: PMC5852889 DOI: 10.1155/2018/1654530] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 01/09/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To determine the prevalence and trend of diabetes, related glycemic control, and influential socioeconomic (SES) factors in the Thai population aged ≥20 years during 2004-2014. METHODS Data from the Thai National Health Examination Survey 2004, 2009, and 2014 were used. Age-adjusted prevalence was calculated, and the associations of education levels with prevalence of diabetes and glycemic control were examined using logistic regression. RESULTS Age-adjusted prevalence of diabetes increased from 7.7% in 2004 to 7.8% in 2009 and 9.9% in 2014 (8.9% among men and 10.8% among women). Proportions of undiagnosed diabetes were slightly decreased but remained high in 2014 (51.2% for men and 41.3% for women). Diabetes prevalence was higher among those with primary education in both sexes; however, undiagnosed diabetes was higher among women with secondary and university educations. The percentages of those treated and controlled slightly improved among men (45.9%) but not among women (36.4%). Unmet glycemic control was also higher among women with secondary education levels and among men with university-level educations. CONCLUSIONS Epidemic diabetes continues to grow in the Thai population, particularly in individuals with lower educational attainment. Measures to detect new cases and strengthen glycemic control should be scaled up.
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Affiliation(s)
- Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Rama VI Rd., Ratchathewi, Bangkok, Thailand
| | | | | | | | | | - Panwadee Putwatana
- Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Unnikrishnan R, Pradeepa R, Joshi SR, Mohan V. Type 2 Diabetes: Demystifying the Global Epidemic. Diabetes 2017; 66:1432-1442. [PMID: 28533294 DOI: 10.2337/db16-0766] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 12/29/2016] [Indexed: 01/07/2023]
Abstract
Type 2 diabetes (T2D) has attained the status of a global pandemic, spreading from affluent industrialized nations to the emerging economies of Asia, Latin America, and Africa. There is significant global variation in susceptibility to T2D, with Pacific Islanders, Asian Indians, and Native Americans being considerably more prone to develop the disorder. Although genetic factors may play a part, the rapidity with which diabetes prevalence has risen among these populations reflects the far-ranging and rapid socioeconomic changes to which they have been exposed over the past few decades. Traditionally, obesity and its correlate, insulin resistance, have been considered the major mediators of T2D risk; however, recent evidence shows that early loss of β-cell function plays an important role in the pathogenesis of T2D, especially in nonobese individuals such as South Asians. Knowledge of the modifiable risk factors of T2D is important, as it forms the basis for designing cost-effective preventive and therapeutic strategies to slow the epidemic in populations at increased risk. Lessons learned from randomized prevention trials need to be implemented with appropriate cultural adaptations, accompanied by empowerment of the community, if the diabetes epidemic is to be slowed or halted.
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Affiliation(s)
- Ranjit Unnikrishnan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes and WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, Chennai, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes and WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, Chennai, India
| | | | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes and WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, Chennai, India
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Tripathy JP, Thakur JS, Jeet G, Chawla S, Jain S, Pal A, Prasad R, Saran R. Prevalence and risk factors of diabetes in a large community-based study in North India: results from a STEPS survey in Punjab, India. Diabetol Metab Syndr 2017; 9:8. [PMID: 28127405 PMCID: PMC5259959 DOI: 10.1186/s13098-017-0207-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 01/13/2017] [Indexed: 11/10/2022] Open
Abstract
AIMS India is the diabetes capital with home to 69.1 million people with DM, the second highest number of cases after China. Recent epidemiological evidence indicates a rising DM epidemic across all classes, both affluent and the poor in India. This article reports on the prevalence of diabetes and pre-diabetes in the North Indian state of Punjab as part of a large household NCD Risk Factor Survey. METHODS A household NCD STEPS survey was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals. All the subjects were administered the WHO STEPS questionnaire, anthropometric and blood pressure measurements. Every alternate respondent in the sample (n = 2499) was assayed for blood parameters. RESULTS Overall prevalence of DM among the study participants was found out to be 8.3% (95% CI 7.3-9.4%) whereas prevalence of prediabetes was 6.3% (5.4-7.3%). Age group (45-69 years), marital status, hypertension, obesity and family history of DM were found to be the risk factors significantly associated with DM. Out of all persons with DM, only 18% were known case of DM or on treatment, among whom only about one-third had controlled blood glucose status. CONCLUSIONS The study reported high prevalence of diabetes, especially of undiagnosed cases amongst the adult population, most of whom have uncontrolled blood sugar levels. This indicates the need for systematic screening and awareness program to identify the undiagnosed cases in the community and offer early treatment and regular follow up.
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Affiliation(s)
- Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India
| | - J. S. Thakur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gursimer Jeet
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sohan Chawla
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arnab Pal
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajendra Prasad
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajiv Saran
- Department of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI USA
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Du GL, Su YX, Yao H, Zhu J, Ma Q, Tuerdi A, He XD, Wang L, Wang ZQ, Xiao S, Wang SX, Su LP. Metabolic Risk Factors of Type 2 Diabetes Mellitus and Correlated Glycemic Control/Complications: A Cross-Sectional Study between Rural and Urban Uygur Residents in Xinjiang Uygur Autonomous Region. PLoS One 2016; 11:e0162611. [PMID: 27622506 PMCID: PMC5021360 DOI: 10.1371/journal.pone.0162611] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/25/2016] [Indexed: 12/28/2022] Open
Abstract
Background Diabetes is a major global public health problem driven by a high prevalence of metabolic risk factors. Objective To describe the differences of metabolic risk factors of type 2 diabetes, as well as glycemic control and complicated diabetic complications between rural and urban Uygur residents in Xinjiang Uygur Autonomous Region of China. Methods This comparative cross-sectional study, conducted among 2879 urban and 918 rural participants in Xinjiang, China, assessed the metabolic risk factors of diabetes and related complications differences between urban and rural settlements. Results Compared to rural areas, urban participants had higher education level and more average income, little physical activity, less triglycerides and higher HDL-c (p < 0.05 respectively). Differences in metabolic risk factors by urban/rural residence included overweight or obesity, triglycerides (≥1.71mmol/l), HDL-c (< 1.04 mmol/l), alcohol intake, and physical inactivity (p < 0.01 respectively). There was significant difference regarding the prevalence of HbA1c >8% (48.1% versus 54.5%, p = 0.019) between rural and urban diabetic participants. No significant difference in the prevalence of type 2 diabetic complications between urban and rural participants (74.9% versus 72.2%; p = 0.263) was detected. Compared to rural participants, the most prevalent modifiable risk factors associated with diabetic complications in urban participants were obesity (BMI ≥ 28 Kg/m2), HDL-c (< 1.04 mmol/l), physical inactivity and irregular eating habits (p = 0.035, p = 0.001, p < 0.001, and p = 0.013, respectively). Conclusions Urban settlers were significantly more likely to have metabolic risk factors highlighting the need for public health efforts to improve health outcomes for these vulnerable populations. Diabetes related complications risk factors were prevalent amongst rural and urban diabetes settlers.
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Affiliation(s)
- Guo-li Du
- Department of Endocrinology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yin-xia Su
- The Key Laboratory of Xinjiang Metabolic Disease, Clinical Medical Research Institute, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hua Yao
- The Key Laboratory of Xinjiang Metabolic Disease, Clinical Medical Research Institute, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- * E-mail:
| | - Jun Zhu
- Department of Endocrinology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qi Ma
- The Key Laboratory of Xinjiang Metabolic Disease, Clinical Medical Research Institute, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ablikm Tuerdi
- Department of Endocrinology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiao-dong He
- Department of Endocrinology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Li Wang
- The Key Laboratory of Xinjiang Metabolic Disease, Clinical Medical Research Institute, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhi-qiang Wang
- Department of Occupational and Environmental Health, Xinjiang Medical University, Urumqi, China
| | - Shan Xiao
- Department of Endocrinology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Shu-xia Wang
- Department of Health Check Centre, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Li-ping Su
- Department of Pathology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Gujral U, Mohan V, Pradeepa R, Deepa M, Anjana R, Mehta N, Gregg E, Narayan K. Ethnic Variations in Diabetes and Prediabetes Prevalence and the roles of Insulin Resistance and β-cell Function: The CARRS and NHANES Studies. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2016; 4:19-27. [PMID: 27042403 PMCID: PMC4811044 DOI: 10.1016/j.jcte.2016.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We compared the hyperglycemia prevalence in Asian Indians to other ethnic groups. The prevalence of diabetes was higher in Indians compared to other ethnic groups. The prevalence of prediabetes was lower in Indians compared to other ethnic groups. These differences may be driven by impaired β-cell function.
Aims It is unclear how the prevalence of diabetes in Asian Indians in urban India compares to that of race/ethnic groups in the US that may have different underlying susceptibilities. Therefore, we examined ethnic variations in the prevalence of type 2 diabetes, iIFG, iIGT, IFG + IGT, and the associated risk factors in Asian Indians in Chennai, India, and Whites, Blacks, and Hispanics in the United States. Methods Cross-sectional analyses, using representative samples of 4867 Asian Indians aged 20–74 years from Chennai, India, in the Centre for Cardiometabolic Risk Reduction in South-Asia study (CARRS) (2010–2011) and 6512 US Whites, Blacks, and Hispanics aged 20–74 years from the National Health and Nutrition Examination Survey (NHANES) (2007–2012). Results The age-adjusted prevalence of type 2 diabetes was highest in Asian Indians (men: 28.4, 95% CI: 25.9, 31.0; women: 30.6, 95% CI, 27.5, 33.9) and lowest in Caucasians (men: 12.2, 95% CI, 10.3, 14.4, women: 9.5, 95% CI, 7.9, 11.5). Asian Indians had the lowest prediabetes prevalence (men: 19.0, 95% CI, 17.2, 20.8; women: 27.2, 95% CI, 22.8, 32.1) and Caucasians had the highest (men; 46.5, 95% CI, 43.5, 49.6, women: 34.4, 95% CI, 31.7, 37.3). However, there were differences in prediabetes prevalence by gender and prediabetes state. The inclusion of HOMA-β in standardized polytomous logistic regression models resulted in a greater odds of diabetes in Blacks and Hispanics compared to Asian Indians. Conclusions The high prevalence of diabetes in Asian Indians may be due to innate susceptibilities for β-cell dysfunction in this high risk population.
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Affiliation(s)
- U.P. Gujral
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nutrition and Health Sciences Program, Graduate Division of Biomedical and Biological Sciences, Laney Graduate School, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329, USA
- Corresponding author. Tel.: +1 626 589 8512; fax: +1 404 727 6123.
| | - V. Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, IDF Centre of Education, Chennai, India
| | - R. Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, IDF Centre of Education, Chennai, India
| | - M. Deepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, IDF Centre of Education, Chennai, India
| | - R.M. Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, IDF Centre of Education, Chennai, India
| | - N.K. Mehta
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - E.W. Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - K.M. Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nutrition and Health Sciences Program, Graduate Division of Biomedical and Biological Sciences, Laney Graduate School, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329, USA
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
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Gregg EW, Sattar N, Ali MK. The changing face of diabetes complications. Lancet Diabetes Endocrinol 2016; 4:537-47. [PMID: 27156051 DOI: 10.1016/s2213-8587(16)30010-9] [Citation(s) in RCA: 332] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 12/16/2022]
Abstract
The global increase in type 2 diabetes prevalence is well documented, but international trends in complications of type 2 diabetes are less clear. The available data suggest large reductions in classic complications of type 2 diabetes in high-income countries over the past 20 years, predominantly reductions in myocardial infarction, stroke, amputations, and mortality. These trends might be accompanied by less obvious, but still important, changes in the character of morbidity in people with diabetes. In the USA, for example, substantial reductions in macrovascular complications in adults aged 65 years or older mean that a large proportion of total complications now occur among adults aged 45-64 years instead, rates of renal disease could persist more than other complications, and obesity-related type 2 diabetes could have increasing effect in youth and adults under 45 years of age. Additionally, the combination of decreasing mortality and increasing diabetes prevalence has increased the overall mean years lived with diabetes and could lead to a diversification of diabetes morbidity, including continued high rates of renal disease, ageing-related disability, and cancers. Unfortunately, data on trends in diabetes-related complications are limited to only about a dozen countries, most of which are high income, leaving the changing character for countries of low and middle income ambiguous.
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Affiliation(s)
- Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mohammed K Ali
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Excess cost burden of diabetes in Southern India: a clinic-based, comparative cost-of-illness study. GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS 2016; 1:e8. [PMID: 29868200 PMCID: PMC5870439 DOI: 10.1017/gheg.2016.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/29/2015] [Accepted: 02/05/2016] [Indexed: 11/06/2022]
Abstract
Background There are few data on excess direct and indirect costs of diabetes in India and limited data on rural costs of diabetes. We aimed to further explore these aspects of diabetes burdens using a clinic-based, comparative cost-of-illness study. Methods Persons with diabetes (n = 606) were recruited from government, private, and rural clinics and compared to persons without diabetes matched for age, sex, and socioeconomic status (n = 356). We used interviewer-administered questionnaires to estimate direct costs (outpatient, inpatient, medication, laboratory, and procedures) and indirect costs [absence from (absenteeism) or low productivity at (presenteeism) work]. Excess costs were calculated as the difference between costs reported by persons with and without diabetes and compared across settings. Regression analyses were used to separately identify factors associated with total direct and indirect costs. Results Annual excess direct costs were highest amongst private clinic attendees (INR 19 552, US$425) and lowest amongst government clinic attendees (INR 1204, US$26.17). Private clinic attendees had the lowest excess absenteeism (2.36 work days/year) and highest presenteeism (0.06 work days/year) due to diabetes. Government clinic attendees reported the highest absenteeism (7.48 work days/year) and lowest presenteeism (-0.31 work days/year). Ten additional years of diabetes duration was associated with 11% higher direct costs (p < 0.001). Older age (p = 0.02) and longer duration of diabetes (p < 0.001) were associated with higher total lost work days. Conclusions Excess health expenditures and lost productivity amongst individuals with diabetes are substantial and different across care settings. Innovative solutions are needed to cope with diabetes and its associated cost burdens in India.
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Ko B, Lim J, Kim YZ, Park HS. Trends in type 2 diabetes prevalence according to income levels in Korea (1998-2012). Diabetes Res Clin Pract 2016; 115:137-9. [PMID: 26830075 DOI: 10.1016/j.diabres.2016.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/05/2015] [Accepted: 01/08/2016] [Indexed: 11/30/2022]
Abstract
There was no significant association between diabetes prevalence and income levels for either sex in 1998. However, the high income level in men and the low income level in women positively related to the odds of diabetes in 2011-2012. Preventive strategies for diabetes should consider the gender-specific economic discrepancy.
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Affiliation(s)
- B Ko
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 100-742, South Korea
| | - J Lim
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea
| | - Y Z Kim
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea
| | - H S Park
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea.
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Abstract
Diabetes is among the biggest of the 21st-century global health challenges. In the U.S. and other high-income countries, thanks to investments in science, dedication to implementing these findings, and measurement of quality of care, there have been improvements in diabetes management and declines in rate of diabetes complications and mortality. This good news, however, is overshadowed by the ever-increasing absolute numbers of people with diabetes and its complications and the unprecedented growth of diabetes in low- and middle-income countries of the world. To comprehensively win the war against diabetes requires 1) concerted attention to prevention and 2) expansion of global research to better inform population-level policies to curb diabetes but also to better understand individual- and population-level variations in pathophysiology and phenotypes globally so that prevention and treatment can be tailored. For example, preliminary data show that thin people in low- and middle-income countries such as India commonly experience type 2 diabetes. Global studies comparing these thin Asian Indians with other high-risk groups such as Pima Indians, a population with a high mean BMI, suggest that type 2 diabetes may not be a single pathophysiological entity. Pima Indians may represent the well-studied phenotype of poor insulin action (type 2A), whereas Asian Indians represent the grossly understudied phenotype of poor insulin secretion (type 2B). This has major implications for diagnosis, prevention, and treatment and highlights the mismatch between where diabetes burdens occur (i.e., low- and middle-income countries) and where research happens (i.e., high-income countries). Correcting this imbalance will advance our knowledge and arsenal to win the global war against diabetes.
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Affiliation(s)
- K M Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, and Department of Medicine, School of Medicine, Emory University, Atlanta, GA
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Abstract
BACKGROUND One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. METHODS We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence-defined as fasting plasma glucose of 7.0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs-in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. FINDINGS We used data from 751 studies including 4,372,000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4.3% (95% credible interval 2.4-7.0) in 1980 to 9.0% (7.2-11.1) in 2014 in men, and from 5.0% (2.9-7.9) to 7.9% (6.4-9.7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28.5% due to the rise in prevalence, 39.7% due to population growth and ageing, and 31.8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. INTERPRETATION Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries. FUNDING Wellcome Trust.
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Piette JD, Marinec N, Janda K, Morgan E, Schantz K, Yujra ACA, Pinto B, Soto JMH, Janevic M, Aikens JE. Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country. Telemed J E Health 2016; 22:261-8. [PMID: 26352854 PMCID: PMC4968278 DOI: 10.1089/tmj.2015.0099] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients' engagement in mobile health (m-health) interventions using interactive voice response (IVR) calls is less in low- and middle-income countries (LMICs) than in industrialized ones. We conducted a study to determine whether automated telephone feedback to informal caregivers ("CarePartners") increased engagement in m-health support among diabetes and hypertension patients in Bolivia. MATERIALS AND METHODS Patients with diabetes and/or hypertension were identified through ambulatory clinics affiliated with four hospitals. All patients enrolled with a CarePartner. Patients were randomized to weekly IVR calls including self-management questions and self-care education either alone ("standard m-health") or with automated feedback about health and self-care needs sent to their CarePartner after each IVR call ("m-health+CP"). RESULTS The 72 participants included 39 with diabetes and 53 with hypertension, of whom 19 had ≤6 years of education. After 1,225 patient-weeks of attempted IVR assessments, the call completion rate was higher among patients randomized to m-health+CP compared with standard m-health (62.0% versus 44.9%; p < 0.047). CarePartner feedback more than tripled call completion rates among indigenous patients and patients with low literacy (p < 0.001 for both). M-health+CP patients were more likely to report excellent health via IVR (adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI], 1.07, 6.32) and less likely to report days in bed due to illness (AOR = 0.42; 95% CI, 0.19, 0.91). CONCLUSIONS In this study we found that caregiver feedback increased engagement in m-health and may improve patients' health status relative to standard approaches. M-health+CP represents a scalable strategy for increasing the reach of self-management support in LMICs.
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Affiliation(s)
- John D. Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kathryn Janda
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Emily Morgan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Karolina Schantz
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Mary Janevic
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - James E. Aikens
- School of Medicine, University of Michigan, Ann Arbor, Michigan
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Little M, Humphries S, Patel K, Dodd W, Dewey C. Factors associated with glucose tolerance, pre-diabetes, and type 2 diabetes in a rural community of south India: a cross-sectional study. Diabetol Metab Syndr 2016; 8:21. [PMID: 26958082 PMCID: PMC4782344 DOI: 10.1186/s13098-016-0135-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/17/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND India's national rural prevalence of type 2 diabetes has quadrupled in the past 25 years. Despite the growing rural burden, few studies have examined putative risk factors and their relationship with glucose intolerance and diabetes in rural areas. We undertook a cross-sectional study to determine the prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes in a rural area of south India. In addition, we determined which factors were associated with type 2 diabetes. METHODS We sampled 2 % of the adult population from 17 villages using a randomized household-level sampling technique. Each participant undertook a questionnaire that included basic descriptive information and an assessment of socioeconomic status, physical activity, and dietary intake. Height, weight, waist and hip circumference, and blood pressure measurements were taken. An oral glucose tolerance test was used to determine diabetes status. We used stepwise logistic model building techniques to determine associations between several putative factors and type 2 diabetes. RESULTS 753 participants were included in the study. The age- and sex-standardized prevalence of IFG was 3.9 %, IGT was 5.6 %, and type 2 diabetes was 10.8 %. Factors associated with type 2 diabetes after adjusting for confounders included physical activity [OR 0.81], rurality [OR 0.76], polyunsaturated fat intake [OR 0.94], body mass index [OR 1.85], waist to hip ratio [OR 1.62], and tobacco consumption [OR 2.82]. CONCLUSION Our study contributes to the growing body of research suggesting that diabetes is a significant concern in rural south India. Associated risk factors should be considered as potential targets for reducing health burdens in India.
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Affiliation(s)
- Matthew Little
- />Department of Population Medicine, University of Guelph, Guelph, ON Canada
| | - Sally Humphries
- />Department of Sociology and Anthropology, University of Guelph, Guelph, ON Canada
| | - Kirit Patel
- />Department of International Development Studies, Menno Simons College, University of Winnipeg, Winnipeg, MB Canada
| | - Warren Dodd
- />Department of Population Medicine, University of Guelph, Guelph, ON Canada
| | - Cate Dewey
- />Department of Population Medicine, University of Guelph, Guelph, ON Canada
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Nanditha A, Ma RCW, Ramachandran A, Snehalatha C, Chan JCN, Chia KS, Shaw JE, Zimmet PZ. Diabetes in Asia and the Pacific: Implications for the Global Epidemic. Diabetes Care 2016; 39:472-85. [PMID: 26908931 DOI: 10.2337/dc15-1536] [Citation(s) in RCA: 295] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The last three decades have witnessed an epidemic rise in the number of people with diabetes, especially type 2 diabetes, and particularly in developing countries, where more than 80% of the people with diabetes live. The rise of type 2 diabetes in South Asia is estimated to be more than 150% between 2000 and 2035. Although aging, urbanization, and associated lifestyle changes are the major determinants for the rapid increase, an adverse intrauterine environment and the resulting epigenetic changes could also contribute in many developing countries. The International Diabetes Federation estimated that there were 382 million people with diabetes in 2013, a number surpassing its earlier predictions. More than 60% of the people with diabetes live in Asia, with almost one-half in China and India combined. The Western Pacific, the world's most populous region, has more than 138.2 million people with diabetes, and the number may rise to 201.8 million by 2035. The scenario poses huge social and economic problems to most nations in the region and could impede national and, indeed, global development. More action is required to understand the drivers of the epidemic to provide a rationale for prevention strategies to address the rising global public health "tsunami." Unless drastic steps are taken through national prevention programs to curb the escalating trends in all of the countries, the social, economic, and health care challenges are likely to be insurmountable.
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Affiliation(s)
| | - Ronald C W Ma
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | | | - Juliana C N Chan
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Paul Z Zimmet
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Venkat Narayan KM, Rhodes EC. Addressing noncommunicable diseases in primary care: the case of type 2 diabetes. J R Coll Physicians Edinb 2016; 46:272-277. [DOI: 10.4997/jrcpe.2016.414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Mirbolouk M, Hajebrahimi MA, Akbarpour S, Tohidi M, Azizi F, Hadaegh F. Different glucose tolerance status and incident cardiovascular disease and all-cause mortality among elderly Iranians. Geriatr Gerontol Int 2015; 16:1263-1271. [PMID: 26463623 DOI: 10.1111/ggi.12633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2015] [Indexed: 11/27/2022]
Abstract
AIMS To determine the effect of different glucose categories on incident cardiovascular disease (CVD) and all-cause mortality in a population-based cohort. METHODS A total of 834 individuals aged 65 years and older without a history of CVD at baseline were stratified according to 2-h post-load glucose fasting glucose test into six categories including: (i) normal fasting glucose/normal glucose tolerance; (ii) prediabetes, (iii) isolated fasting hyperglycemia (IFH); (iv) isolated post-challenge hyperglycemia (IPH); (v) IPH and IFH; and (vi) known diabetes mellitus. The prognostic significance of these groups on CVD and total mortality were examined by Cox proportional hazard ratios in a multivariate adjusted model. RESULTS Over 9 years of follow up, 186 incidents of CVD and 218 deaths occurred (72 CVD mortality).Of the population, 45.2%, 30.7%, 1.2%, 6.1% 4.7%, and 11.9% were normal fasting glucose/normal glucose tolerance, prediabetes IFH, IPH, IFH and IPH, and known diabetes mellitus, respectively. Multivariate adjusted hazard ratios for CVD were 1.13 (95% CI 0.78-1.64), 1.03 (95% CI 0.25-4.22), 1.17 (95% CI 0.65-2.11), 2.52 (95% CI 1.43-4.42) and 2.39 (95% CI 1.55-3.69), and for CVD mortality were 0.59 (95% CI 0.27-1.30), 2.02 (95% CI 0.27-15.15), 1.26 (95% CI 0.51-3.16), 3.57 (95% CI 1.64-7.75), and 4.70 (95% CI 2.54-8.69) for prediabetes, IFH, IPH, IFH and IPH, and known diabetes mellitus phenotypes, respectively. Corresponding hazard ratios for all-cause mortality in multivariate model adjusted for prevalent CVD were 1.07 (95% CI 0.73-1.57), 0.59 (95% CI 0.08-4.30), 0.92 (95% CI 0.5-1.70), 2.31 (95% CI 1.33-4.01) and 3.88 (95% CI 2.70-5.55), respectively. CONCLUSION Among the elderly population with newly diagnosed diabetes, only the combined IFH and IPH phenotype, but not IFH or IPH alone, was a significant predictor of CVD and mortality events. Prediabetes was not associated with any risk. Geriatr Gerontol Int 2016; 16: 1263-1271.
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Affiliation(s)
- Mohammadhassan Mirbolouk
- Prevention of Metabolic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Hajebrahimi
- Prevention of Metabolic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Akbarpour
- Prevention of Metabolic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gujral UP, Narayan KMV, Pradeepa RG, Deepa M, Ali MK, Anjana RM, Kandula NR, Mohan V, Kanaya AM. Comparing Type 2 Diabetes, Prediabetes, and Their Associated Risk Factors in Asian Indians in India and in the U.S.: The CARRS and MASALA Studies. Diabetes Care 2015; 38:1312-8. [PMID: 25877810 PMCID: PMC4477335 DOI: 10.2337/dc15-0032] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/24/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the prevalence of diabetes and prediabetes and the associated risk factors in two Asian Indian populations living in different environments. RESEARCH DESIGN AND METHODS We performed cross-sectional analyses, using representative samples of 2,305 Asian Indians aged 40-84 years living in Chennai, India, from the Centre for cArdiometabolic Risk Reduction in South-Asia study (CARRS) (2010-2011), and 757 Asian Indians aged 40-84 years living in the greater San Francisco and Chicago areas from the U.S. Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (2010-2013). Diabetes was defined as self-reported use of glucose-lowering medication, fasting glucose ≥126 mg/dL, or 2-h glucose ≥200 mg/dL. Prediabetes was defined as fasting glucose 100-125 mg/dL and/or 2-h glucose 140-199 mg/dL. RESULTS Age-adjusted diabetes prevalence was higher in India (38% [95% CI 36-40]) than in the U.S. (24% [95% CI 21-27]). Age-adjusted prediabetes prevalence was lower in India (24% [95% CI 22-26]) than in the U.S. (33% [95% CI 30-36]). After adjustment for age, sex, waist circumference, and systolic blood pressure, living in the U.S. was associated with an increased odds for prediabetes (odds ratio 1.2 [95% CI 0.9-1.5]) and a decreased odds for diabetes (odds ratio 0.5 [95% CI 0.4-0.6]). CONCLUSIONS These findings indicate possible changes in the relationship between migration and diabetes risk and highlight the growing burden of disease in urban India. Additionally, these results call for longitudinal studies to better identify the gene-environment-lifestyle exposures that underlie the elevated risk for type 2 diabetes development in Asian Indians.
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Affiliation(s)
- Unjali P Gujral
- Nutrition and Health Sciences Program, Graduate Division of Biomedical and Biological Sciences, Laney Graduate School, Emory University, Atlanta, GA
| | - K M Venkat Narayan
- Nutrition and Health Sciences Program, Graduate Division of Biomedical and Biological Sciences, Laney Graduate School, Emory University, Atlanta, GA Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA Department of Medicine, School of Medicine, Emory University, Atlanta, GA
| | - R Ghua Pradeepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, International Diabetes Federation Centre of Education, Chennai, India
| | - Mohan Deepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, International Diabetes Federation Centre of Education, Chennai, India
| | - Mohammed K Ali
- Nutrition and Health Sciences Program, Graduate Division of Biomedical and Biological Sciences, Laney Graduate School, Emory University, Atlanta, GA Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Ranjit M Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, International Diabetes Federation Centre of Education, Chennai, India
| | - Namratha R Kandula
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, International Diabetes Federation Centre of Education, Chennai, India
| | - Alka M Kanaya
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA
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Amin F, Fatima SS, Islam N, Gilani AH. Prevalence of obesity and overweight, its clinical markers and associated factors in a high risk South-Asian population. BMC OBESITY 2015. [PMID: 26217531 PMCID: PMC4510896 DOI: 10.1186/s40608-015-0044-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Obesity is a global epidemic, which is a risk factor for cardiovascular diseases and metabolic abnormalities. It is measured by body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), body fat (BF) distribution and abdominal fat mass, each having its own merits and limitations. Variability in body composition between ethnic groups in South-Asians is significant and may not be truly reflected by BMI alone, which may result in misclassification. This study therefore, aims to determine the frequency of obesity, body fat composition and distribution, in a high risk population of an urban slum of Karachi, Pakistan. This survey included 451 participants selected by systematic sampling who were administered pre-tested questionnaires on socio-demographics, diet and physical activity. Chi-square was used to determine the association between categorical variables and multiple linear regression was used for quantitative variables. A P value of less than 0.05 was considered significant. Results Classified by BMI, 29% study subjects were overweight and 21% obese (58.7% with central obesity). Body fat percent (BF%) classified 81% as overweight. Females were more obese (P 0.03) with higher prevalence of central obesity (P <0.001) and WHR (P 0.003) but with a lower muscle mass (P 0.001). Activity score and muscle mass showed inverse linear association with BF% whereas, WC, weight, BMI and WHR had a positive linear association with BF%. The relationship between BMI and BF% was quadratic with a weaker association at lower BMI. Adjusting for socio-demographic variables, BF%, weight, diastolic blood pressure (DBP), BMI and score on the diet questionnaire had a positive linear association with WC, while WC, WHR and BP had a positive linear association with BF%. BF%, muscle content and WC had a positive linear association with BMI. Conclusion Considering lower cut-offs for South-Asians BMI and WC, this study showed a high prevalence of obesity among a sub-urban population of Karachi, which was even higher when BF% was measured. Considering the rising prevalence of non-communicable diseases, BF%, WC, WHR and BMI measurements are convenient and feasible means of identifying population at risk and hence addressing it through public awareness and early detection. Electronic supplementary material The online version of this article (doi:10.1186/s40608-015-0044-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Faridah Amin
- Natural Product Research Unit, Department of Biological and Biomedical Sciences, The Aga Khan University Medical College, Karachi, 74800 Pakistan
| | - Syeda Sadia Fatima
- Department of Biological and Biomedical Sciences, The Aga Khan University Medical College, Karachi, 74800 Pakistan
| | - Najmul Islam
- Department of Medicine, The Aga Khan University Medical College, Karachi, 74800 Pakistan
| | - Anwar H Gilani
- Natural Product Research Unit, Department of Biological and Biomedical Sciences, The Aga Khan University Medical College, Karachi, 74800 Pakistan ; College of Health Sciences, Mekelle University, PO Box 1871, Mekelle, Ethiopia
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