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Al Hayek A, Al Zahrani WM, Al Dawish MA. Glucometric parameter changes in patients with type 2 diabetes during ramadan fasting: A prospective comparative real-world study. Metabol Open 2024; 23:100304. [PMID: 39175933 PMCID: PMC11340621 DOI: 10.1016/j.metop.2024.100304] [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: 07/08/2024] [Revised: 07/25/2024] [Accepted: 07/25/2024] [Indexed: 08/24/2024] Open
Abstract
Background This study assessed glucometric changes in Type 2 diabetes mellitus (T2DM) patients before, during, and after Ramadan fasting using an intermittently scanned continuous glucose monitoring system (isCGMS). Methods This prospective comparative study included T2DM patients aged 30-70 years who were receiving nonintensive insulin in Riyadh, Saudi Arabia. In addition to the baseline characteristics, glycated hemoglobin (HbA1c) and ambulatory glucose profile (AGP)-derived metric data were collected at three specific points: pre-, during-, and post-Ramadan. Self-care activities during Ramadan were evaluated using the Diabetes Self-Management Questionnaire (DSMQ). Results Overall, a total of 93 T2DM patients were enrolled in the study. Their mean age ±SD age was 47.9 ± 7.5 years, and 51.6 % of them were males. Compared with pre- and post-Ramadan, there was a significant decrease in HbA1c (p < 0.001 for both periods), average glucose level (p = 0.001 and p = 0.026, respectively), glucose variability (p = 0.043 and p = 0.005, respectively), and % time above the range of 181-250 mg/dL (p < 0.001 for both periods), as well as a significant increase in % time in target (70-180 mg/dL) during Ramadan (p < 0.001 for both periods). However, the % time below 54 mg/dL was slightly greater during Ramadan than both pre- and post-Ramadan (p < 0.001 and p = 0.002, respectively). Furthermore, 32.3 % reported inadequate self-care behaviors during Ramadan. Conclusions Ramadan fasting could improve glucose levels in T2DM patients who were not on intensive insulin, with a relatively low incidence of hypoglycemia.
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Affiliation(s)
- Ayman Al Hayek
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Wael M. Al Zahrani
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed Abdulaziz Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Innab A, Kerari A. Validation of the Arabic version of the diabetes self-management questionnaire in patients with type 2 diabetes mellitus: a cross-sectional study. BMC PRIMARY CARE 2024; 25:274. [PMID: 39075401 DOI: 10.1186/s12875-024-02529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/18/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND The number of instruments available for measuring diabetes self-management activities in Arabic countries has been limited to date. To our knowledge, no multidimensional instrument suitable for measuring diabetes self-management is currently available in Arabic. This study assessed the validation of the Arabic version of the Diabetes Self-Management Questionnaire (A-DSMQ) in patients with type 2 diabetes mellitus (T2DM). METHODS This cross-sectional study was conducted from May to August 2022 at primary healthcare centers within the Riyadh region of Saudi Arabia. Four steps were followed during the translation and adaptation of the DSMQ: forward translation, consulting an expert panel, backward translation, and pilot testing on the target population. The data were collected using a convenience sample of 154 patients with T2DM. Cronbach's α coefficient, criterion validity, and known-group validity were determined. RESULTS Cronbach's α coefficient for internal consistency was 0.76. The A-DMSQ "sum scale" scores were negatively correlated with glycosylated hemoglobin (HbA1c) levels (Pearson's r = - 0.48, p < 0.01) and body mass indices (r = - 0.29, p < 0.01) and positively correlated with Self-Rated Health Scale scores (r = 0.41, p < 0.01). Mean A-DSMQ "sum scale" scores differed significantly among groups with adequate, partially adequate, and inadequate glycemic control (F = 23.193, p < 0.001). CONCLUSIONS These results indicate that the A-DSMQ is a reliable and valid tool for measuring diabetes self-management in patients with T2DM. The A-DSMQ can be used by researchers and healthcare providers interested in assessing diabetes self-management in this population. Healthcare providers should remain alert for suboptimal diabetes self-management, which may lead to significant economic costs in emergency and healthcare utilization.
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Affiliation(s)
- Adnan Innab
- Nursing Administration and Education Department, College of Nursing, King Saud University, Riyadh, 11421, Saudi Arabia.
| | - Ali Kerari
- Nursing Administration and Education Department, College of Nursing, King Saud University, Riyadh, 11421, Saudi Arabia
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Bekele NT, Habtewold EM, Deybasso HA, Mekuria Negussie Y. Poor self-care practices and contributing factors among adults with type 2 diabetes in Adama, Ethiopia. Sci Rep 2024; 14:13660. [PMID: 38871734 DOI: 10.1038/s41598-024-63524-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
Diabetes mellitus (DM) is a prominent global health challenge, characterized by a rising prevalence and substantial morbidity and mortality, especially evident in developing nations. Although DM can be managed with self-care practices despite its complexity and chronic nature, the persistence of poor self-care exacerbates the disease burden. There is a dearth of evidence on the level of poor self-care practices and contributing factors among patients with DM in the study area. Thus, this study assessed the proportion of poor self-care practices and contributing factors among adults with type 2 DM in Adama, Ethiopia. An institution-based cross-sectional study was conducted among 404 patients. Self-care practice was assessed by the summary of diabetes self-care activities questionnaires. Binary logistic regression was used to identify factors associated with poor self-care practices. An adjusted odds ratio with a 95% confidence interval was used to assess the strength of associations. The statistical significance was declared for a p-value < 0.05. The proportion of poor self-care practices was 54% [95% CI 49.1, 58.6]. Being divorced (AOR = 3.5; 95% CI 1.0, 12.2), having a lower level of knowledge (AOR = 1.70; 95% CI 1.0, 2.8), being on insulin (AOR = 6.3; 95% CI 1.9, 20.6), taking oral medication (AOR = 8.6; 95% CI 3.0, 24.5), being unaware of fasting blood sugar (AOR = 2.9; 95% CI 1.6, 5.2), not a member of a diabetic association (AOR = 3.6; 95% CI 1.7, 7.5), a lack of social support (AOR = 2.9; 95% CI 1.7, 4.9), and having a poor perceived benefit of self-care practices (AOR = 1.84; 95% CI 1.0, 3.2) were associated with poor self-care practices. Overall, this finding demonstrated that a significant percentage of participants (54%) had poor self-care practices. Being divorced, having a low level of knowledge about diabetes and fasting blood sugar, lacking social support, relying on oral medication, perceiving limited benefits from self-care practices, and not being a member of diabetic associations were identified as independent factors of poor self-care.
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Affiliation(s)
| | | | - Haji Aman Deybasso
- Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
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Alshahrani SA, Salem F, harbi SA, Alshahrani A, AlAhmari Y. Assessment of self-management care and glycated hemoglobin level among diabetes mellitus patients attend diabetic center in armed forces hospital in southern region, Kingdom Saudi Arabia. J Family Med Prim Care 2024; 13:2425-2431. [PMID: 39027872 PMCID: PMC11254090 DOI: 10.4103/jfmpc.jfmpc_1786_23] [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: 11/07/2023] [Revised: 12/05/2023] [Accepted: 01/08/2024] [Indexed: 07/20/2024] Open
Abstract
Background Diabetes mellitus (DM) requires patients to take on a high level of responsibility for their daily care. Thus, care for people with diabetes is moving toward patients taking an active role in their own health care. Objective To evaluate the impact of self-management care on glycemic control in individuals with DM and determine the correlation between glycated hemoglobin (A1C) levels and self-management practices. Material and Methods A cross-sectional descriptive study was conducted among diabetes patients at a diabetic center in Armed Forces Military hospitals, Southern region. A questionnaire of demographic and clinical information and self-management measured with the Diabetes Self-Management Questionnaire was used. Glycemic control was assessed using HbA1c levels. Results The study involved 255 patients with diabetes, of which 61.2% were females and 81.6% aged ≥41 years. The average diabetic self-management score was 6.49 on a scale of 10. The mean glucose self-management subscale score was 7.83 points, while the mean dietary control (DC) subscale score was 4.89. The patients had a mean physical activity (PA) subscale score of 6.31 and 8.75 for healthcare usage. Patients with higher education were significantly less likely to have poor glycemic control. Diabetes duration was significantly and positively correlated with poorer glycemic control. Mean perceived PA and DC scores were significantly associated with glycemic control. Conclusion Type 2 diabetes patients had satisfactory self-care practices. Many did not achieve the target glycemic control for diabetes.
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Affiliation(s)
- Salehah A. Alshahrani
- Family Medicine Department, Armed Forces Hospital in Southern Region, Kingdom Saudi Arabia
| | - Fatima Salem
- Endocrinology Department, Armed Forces Hospital in Southern Region, Kingdom Saudi Arabia
| | - Sana Al harbi
- Family Medicine Department, Armed Forces Hospital in Southern Region, Kingdom Saudi Arabia
| | - Ali Alshahrani
- College of Medicine, King Khalid University, Kingdom Saudi Arabia
| | - Yasser AlAhmari
- College of Medicine, King Khalid University, Kingdom Saudi Arabia
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Yaagoob E, Lee R, Stubbs M, Shuaib F, Johar R, Chan S. WhatsApp-based intervention for people with type 2 diabetes: A randomized controlled trial. Nurs Health Sci 2024; 26:e13117. [PMID: 38566413 DOI: 10.1111/nhs.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
Diabetes mellitus is a metabolic disease characterized by prolonged elevated blood glucose levels. Diabetes self-management education and support programs are widely used in western countries. The impact of social media education and support interventions such as a WhatsApp-based program and the nurses' role in supporting and implementing this self-management program unclear. Using a WhatsApp-based program, we evaluated the effects of a 6-week program in improving self-efficacy and education among people with type 2 diabetes mellitus in Saudi Arabia. Eligible participants (n = 80) were recruited with the support of nurses into a randomized controlled trial and randomly assigned into self-management intervention and control groups. The intervention group (n = 40) received the self-management program support and the usual care. The control group (n = 40) received only the usual care with nurses' support. Results from generalized estimating equation analysis showed a significant increase in self-efficacy, self-management, and education in the WhatsApp-based intervention support group compared with the control group at 6 and 12 weeks (follow-up). Implementing the program via social media improves self-efficacy. The use of social media platforms should be promoted for global diabetes management.
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Affiliation(s)
- Esmaeel Yaagoob
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Regina Lee
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michelle Stubbs
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Fatimah Shuaib
- Diabetic Education Clinic, Jizan Diabetes Center, Jazan, Saudi Arabia
| | - Raja Johar
- Diabetic Education Clinic, Jizan Diabetes Center, Jazan, Saudi Arabia
| | - Sally Chan
- President's Office, Tung Wah College, Homantin, Hong Kong
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Wang YX, Yan YJ, Lin R, Liang JX, Wang NF, Chen MF, Li H. Classifying self-management clusters of patients with mild cognitive impairment associated with diabetes: A cross-sectional study. J Clin Nurs 2024; 33:1209-1218. [PMID: 38284439 DOI: 10.1111/jocn.16993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
AIMS AND OBJECTIVES This study aims to propose a self-management clusters classification method to determine the self-management ability of elderly patients with mild cognitive impairment (MCI) associated with diabetes mellitus (DM). BACKGROUND MCI associated with DM is a common chronic disease in old adults. Self-management affects the disease progression of patients to a large extent. However, the comorbidity and patients' self-management ability are heterogeneous. DESIGN A cross-sectional study based on cluster analysis is designed in this paper. METHOD The study included 235 participants. The diabetes self-management scale is used to evaluate the self-management ability of patients. SPSS 21.0 was used to analyse the data, including descriptive statistics, agglomerative hierarchical clustering with Ward's method before k-means clustering, k-means clustering analysis, analysis of variance and chi-square test. RESULTS Three clusters of self-management styles were classified as follows: Disease neglect type, life oriented type and medical dependence type. Among all participants, the percentages of the three clusters above are 9.78%, 32.77% and 57.45%, respectively. The difference between the six dimensions of each cluster is statistically significant. CONCLUSION(S) This study classified three groups of self-management styles, and each group has its own self-management characteristics. The characteristics of the three clusters may help to provide personalized self-management strategies and delay the disease progression of MCI associated with DM patients. RELEVANCE TO CLINICAL PRACTICE Typological methods can be used to discover the characteristics of patient clusters and provide personalized care to improve the efficiency of patient self-management to delay the progress of the disease. PATIENT OR PUBLIC CONTRIBUTION In our study, we invited patients and members of the public to participate in the research survey and conducted data collection.
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Affiliation(s)
- Yun-Xian Wang
- The School of Nursing, Fujian Medical University, Fuzhou, China
- Department of nursing, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yuan-Jiao Yan
- Fujian Provincial Hospital & Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Rong Lin
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Ji-Xing Liang
- Endocrinology Department, Fujian Provincial Hospital & Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Na-Fang Wang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Ming-Feng Chen
- Neurology Department, Fujian Provincial Hospital & Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Hong Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
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Sales I, Bawazeer G, Shahba AAW, Alkofide H. The Impact of the COVID-19 Pandemic on Diabetes Self-Management in Saudi Arabia. Healthcare (Basel) 2024; 12:521. [PMID: 38470632 PMCID: PMC10930377 DOI: 10.3390/healthcare12050521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
The COVID-19 pandemic disrupted healthcare worldwide, potentially impacting disease management. The objective of this study was to assess the self-management behaviors of Saudi patients with diabetes during and after the COVID pandemic period using the Arabic version of the Diabetes Self-Management Questionnaire (DSMQ). A cross-sectional study was conducted in patients aged ≥18 years diagnosed with type 2 diabetes mellitus who had at least one ambulatory clinic visit in each of the specified time frames (Pre-COVID-19: 1 January 2019-21 March 2020; COVID-19 Time frame: 22 March 2020 to 30 April 2021) utilizing the DSMQ questionnaire, with an additional three questions specifically related to their diabetes care during the COVID pandemic. A total of 341 patients participated in the study. The study results revealed that the surveyed patients showed moderately high self-care activities post-COVID-19. Total DSMQ scores were significantly higher in patients aged >60 years versus younger groups (p < 0.05). Scores were significantly lower in patients diagnosed for 1-5 years versus longer durations (p < 0.05). Patients on insulin had higher glucose management sub-scores than oral medication users (p < 0.05). Overall, DSMQ scores were higher than the pre-pandemic Saudi population and Turkish post-pandemic findings. DSMQ results suggest that, while COVID-19 negatively impacted some self-management domains, the Saudi patients surveyed in this study upheld relatively good diabetes control during the pandemic. Further research is warranted on specific barriers to optimize diabetes care during public health crises.
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Affiliation(s)
- Ibrahim Sales
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (G.B.); (H.A.)
| | - Ghada Bawazeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (G.B.); (H.A.)
| | | | - Hadeel Alkofide
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (G.B.); (H.A.)
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Alsaidan AA, Thirunavukkarasu A, Alhassan HH, Bin Ahmed IA, Alnasiri AS, Alhirsan WM, Alazmi NNM, Alkhlaf AK, Alderbas JM, Alkhaldi MA. Evaluation of Self-Management Behaviors and Its Correlation with the Metabolic Syndrome among the Type 2 Diabetes Mellitus Patients of Northern Saudi Arabia. J Clin Med 2023; 13:118. [PMID: 38202125 PMCID: PMC10779580 DOI: 10.3390/jcm13010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/16/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Self-management behavior among diabetes patients is essential to monitor blood sugar levels, make necessary lifestyle changes, and help patients reduce their risk of complications from diabetes. We assessed the prevalence of metabolic syndrome (MS) and its association with self-management behavior and sociodemographic characteristics among 310 patients with type 2 diabetes mellitus (T2DM) attending different diabetes care centers in northern Saudi Arabia. We evaluated the self-management behaviors of patients with T2DM using a validated Arabic version of the Summary of Diabetes Self-Care Activities Scale. Regarding MS, we applied the National Cholesterol Education Program (NCEP) Adult Treatment Plan-3 (ATP-3) guidelines. A logistic regression analysis was used to identify the predictors of MS. We found that more than one-third (36.5%) of patients had MS according to the NCEP ATP-3 criteria. The prevalence of MS was significantly associated with unsatisfactory self-management behaviors. Regarding sociodemographic predictors for MS, we found a significant association between gender (ref: female: Adjusted OR (AOR) = 1.89, 95%CI = 1.17-2.95, p = 0.007) and body mass index (ref.: normal range: AOR = 2.98, 95%CI = 1.31-5.07, p = 0.003). Our findings suggest a tailor-made multifaceted intervention to improve the self-management behaviors of T2DM patients, which, in turn, can reduce MS.
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Affiliation(s)
- Aseel Awad Alsaidan
- Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia;
| | - Ashokkumar Thirunavukkarasu
- Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia;
| | - Hassan H. Alhassan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka 72388, Saudi Arabia;
| | - Ibrahim Abdullah Bin Ahmed
- Department of Family Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia;
| | - Anas Salem Alnasiri
- King Abdulaziz Specialist Hospital, Ministry of Health, Sakaka 72345, Saudi Arabia;
| | - Wejdan Madallah Alhirsan
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (W.M.A.); (N.N.M.A.); (A.K.A.); (M.A.A.)
| | - Nouf Nashmi M. Alazmi
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (W.M.A.); (N.N.M.A.); (A.K.A.); (M.A.A.)
| | - Abdalaziz Khaled Alkhlaf
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (W.M.A.); (N.N.M.A.); (A.K.A.); (M.A.A.)
| | - Jumanah Mohammed Alderbas
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (W.M.A.); (N.N.M.A.); (A.K.A.); (M.A.A.)
| | - Motaz Abdulsalam Alkhaldi
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (W.M.A.); (N.N.M.A.); (A.K.A.); (M.A.A.)
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Simegn W, Mohammed SA, Moges G. Adherence to Self - Care Practice Among Type 2 Diabetes Mellitus Patients Using the Theory of Planned Behavior and Health Belief Model at Comprehensive Specialized Hospitals of Amhara Region, Ethiopia: Mixed Method. Patient Prefer Adherence 2023; 17:3367-3389. [PMID: 38106363 PMCID: PMC10725631 DOI: 10.2147/ppa.s428533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023] Open
Abstract
Background Diabetes mellitus is one of the major public health problems that requires appropriate self-care practices to reduce complications. The current study assessed adherence to self-care practices and associated factors using the theory of planned behavior and the health belief model among type 2 diabetes mellitus patients. Methods A facility-based, sequential explanatory mixed-method was undertaken at comprehensive specialized hospitals in the Amhara region of Ethiopia. A single population proportion formula was used to calculate sample size. Proportional allocation to the three study settings and systematic random sampling techniques were used to select 846 study participants. Logistic regression analysis was used to identify associated factors. Variables with a P-value less than 0.05 were declared statistically significant. For the qualitative study, purposive sampling was used to select sixteen key informants, and thematic analysis was performed. Results About 42.4% of the study participants had good adherence to self-care practices. Being a member of a diabetes association (AOR = 2.57, 95% CI: 1.51, 4.38), having a home glucometer (AOR = 2.52, 95% CI: 1.59, 4.02), having good glycemic control (AOR = 4.07, 95% CI: 2.53, 6.53), having low perceived barriers (AOR = 8.65, 95% CI: 4.65, 16.07), and having middle perceived barriers (AOR = 3.26, 95% CI: 1.88, 5.66) were significantly associated with good adherence to self-care practice. On the other hand, poor wealth index (AOR = 0.27, 95% CI: 0.16, 0.46), poor behavioral control (AOR = 0.59, 95% CI: 0.36, 0.97), poor behavioral intention (AOR = 0.36, 95% CI: 0.21, 0.64), low perceived benefits (AOR = 0.20, 95% CI: 0.08, 0.51), and middle perceived benefits (AOR = 0.57, 95% CI: 0.31, 0.83) were significantly associated with poor adherence to self-care practice. The key informants explored the influence of patients' beliefs, self-efficacy, social support, and barriers on their self-care practices. Conclusion Less than half of type 2 diabetes mellitus patients had good adherence to self-care practices. This was more evident for patients who are members of a diabetes association, having a high wealth index, having a home glucometer, good behavioral control, good behavioral intentions, high perceived benefit, and poor perceived barriers. Appropriate intervention should be designed based on the aforementioned factors.
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Affiliation(s)
- Wudneh Simegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Ahmed Mohammed
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Getachew Moges
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Khan M, Agarwal M, Usman K, Mishra P. Prevalence of Self-care Practices among Type 2 Diabetes Mellitus Patients and its Effect on Glycemic Control: A Cross-sectional Study in Secondary and Tertiary Health-care Centers in Lucknow. Int J Appl Basic Med Res 2023; 13:246-254. [PMID: 38229723 PMCID: PMC10789459 DOI: 10.4103/ijabmr.ijabmr_212_23] [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: 05/08/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 01/18/2024] Open
Abstract
Background Globally, prevalence of diabetes is 10.5%, and in 2019, approximately 463 million adults were living with diabetes by 2045; this will increase to 700 million (10.9%). India is a diabetic capital of world, prevalence of diabetes in India is 8.3%. Aim This study aimed to assess self-care practices (SCPs) among type 2 diabetes mellitus (T2DM) patients, its predictors, and effect of SCP on glycemic control. Materials and Methods A cross-sectional hospital-based study was conducted among 300 known T2DM patients in the age group of 18-60 years attending noncommunicable diseases clinic at Secondary and Tertiary Care Hospitals of Lucknow, Uttar Pradesh, selected using two-stage purposive sampling method. Data were collected using a predesigned and pretested semi-structured questionnaire. Data were collected from consenting respondents on the sociodemographic profile (about their residence, gender, marital status, type of family, educational status, family income, employment status, etc.). SCP was assessed using Summary of Diabetes Self-Care Activities. Data were analyzed using SPSS. Results Among 300 patients with a mean age 50 ± 8.9 years, the prevalence of good SCPs was 37%. Out of 189 T2DM patients with poor SCPs, 66.4% had uncontrolled blood sugar level (285.4 ± 67 mg/dL). Out of 73 T2DM patients with poor SCPs, 65.7% had uncontrolled glycated hemoglobin level (8.4% ± 2%), and this was statistically significant. Conclusion The practice of self-care was found to be suboptimal among patients with T2DM in the study.
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Affiliation(s)
- Maviya Khan
- Department of Community Medicine and Public Health, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Monika Agarwal
- Department of Community Medicine and Public Health, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Kauser Usman
- Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
- Department of Geriatric Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Ye J, Wu Y, Yang S, Zhu D, Chen F, Chen J, Ji X, Hou K. The global, regional and national burden of type 2 diabetes mellitus in the past, present and future: a systematic analysis of the Global Burden of Disease Study 2019. Front Endocrinol (Lausanne) 2023; 14:1192629. [PMID: 37522116 PMCID: PMC10376703 DOI: 10.3389/fendo.2023.1192629] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Aim To report the global, regional, and national burden of type 2 diabetes mellitus (T2DM) in 2019, assess its trends in the past, and forecast its trends in the future. Methods The main data source was the Global Burden of Disease 2019 database. We assessed the changes in T2DM burden from 1990 to 2019 with joinpoint regression analysis. Age-period-cohort analysis was used to forecast the T2DM incidence and mortality rate from 2020 to 2034. Results The burden of T2DM has increased from 1990 to 2019 generally. The low-middle socio-demographic index (SDI) region had the highest increase in age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (ASDR) due to T2DM. Nationally, the increase in ASIR (r=0.151, p=0.046) and the decrease in ASMR (r=0.355, p<0.001) were positively correlated with SDIs. In 2019, the global ASIR, ASPR, ASMR, ASDR due to T2DM were 259.9 (95% UI 240.3-281.4), 5282.9 (95% UI 4853.6-5752.1), 18.5 (95% UI 17.2-19.7), and 801.5 (95% UI 55477000-79005200) per 100,000 population, respectively. Additionally, the ASIR (r=0.153, p=0.030) and ASPR (r=0.159, p=0.024) of T2DM were positively correlated with SDIs, while ASMR (r=-0.226, p=0.001) and ASDR (r=-0.171, p=0.015) due to T2DM were negatively correlated with SDIs. The ASIR was estimated to increase to 284.42, and ASMR was estimated to increase to 19.1 from 2030 to 2034, per 100,000 population. Conclusion Globally, the burden of T2DM has increased in the past and was forecast to continue increasing. Greater investment in T2DM prevention is needed.
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Affiliation(s)
- Junjun Ye
- Department of Endocrine and Metabolic Diseases, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Yixi Wu
- Department of Endocrine and Metabolic Diseases, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Shuhui Yang
- Department of Endocrine and Metabolic Diseases, Shantou Central Hospital, Shantou, Guangdong, China
| | - Dan Zhu
- Department of Endocrine and Metabolic Diseases, Shantou Central Hospital, Shantou, Guangdong, China
| | - Fengwu Chen
- Department of Endocrine and Metabolic Diseases, Shantou Central Hospital, Shantou, Guangdong, China
| | - Jingxian Chen
- Shantou University Medical College, Shantou, Guangdong, China
- Department of Endocrine and Metabolic Diseases, Longhu Hospital, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xiaoxia Ji
- Department of Endocrine and Metabolic Diseases, Shantou Central Hospital, Shantou, Guangdong, China
| | - Kaijian Hou
- Department of Endocrine and Metabolic Diseases, Longhu Hospital, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- School of Public Health, Shantou University, Shantou, China
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12
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Khan WJ, Arsalan M, Javed Khan W. Diabetes Self-Care Activities and Their Relationship With Glycemic Control in Patients Visiting Hayatabad Medical Complex, Peshawar. Cureus 2023; 15:e42741. [PMID: 37654937 PMCID: PMC10467515 DOI: 10.7759/cureus.42741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
Background A significant portion of the Pakistani population is affected by diabetes, which has emerged as a global healthcare concern. Objective This study aimed to assess the correlation between glycemic control in diabetes patients and their engagement in diabetes self-care activities (DSCA). Methodology Cross-sectional research was conducted at Hayatabad Medical Complex in Peshawar between June 2019 and May 2020. A total of 280 carefully selected patients with type 2 diabetes mellitus (T2DM) were included. Data collection involved an interviewer-administered questionnaire encompassing sociodemographic information, diabetes-related data, and the summary of the Diabetes Self-Care Activities (SDSCA) scale. Descriptive statistics and Pearson's chi-square test were employed for data analysis. Results The study observed that the majority of participants (40.36%) were females, and the age range of the participants was between 42 and 53 years (68.22%). According to the study, 55.00% of participants had a normal body mass index (BMI), and 71.08% of participants had diabetes in their family. Regarding glycemic control, 55.71% of individuals exhibited good control based on fasting blood sugar (FBS) levels while 74.64% showed poor control according to hemoglobin A1C (HbA1c) values. HbA1c was substantially linked with a general diet (healthy eating plan), physical activities, and adherence to medication ((odds ratios (OR): 3.12), (95% confidence interval (CI): 1.02 - 8.78), (P value: 0.031)); ((OR: 2.19, 95%), (CI:1.18 - 3.79), (P value: 0.003)); ((OR: 2.85), (95% CI: 1.22 - 6.59), P value: 0.021)). Conclusion The findings indicated that health professionals need to create health education programs on DSCA in order to increase DSCA adherence in people with T2DM while maintaining glycemic control.
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Affiliation(s)
- Wagmah Javed Khan
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Muhammad Arsalan
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Wardah Javed Khan
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
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13
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Chen HM, Su BY. Factors Related to the Continuity of Care and Self-Management of Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Taiwan. Healthcare (Basel) 2022; 10:2088. [PMID: 36292535 PMCID: PMC9602078 DOI: 10.3390/healthcare10102088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Most diabetic patients suffer from chronic diseases affecting their self-management status. This study aims to explore the relationship between the CoC and the self-management of patients with Type 2 Diabetes Mellitus (T2DM) and analyze the predictive factors affecting their self-management. METHODS Structured questionnaires were used for data collection. Convenient sampling was adopted to recruit inpatients diagnosed with T2DM in the endocrine ward of a medical hospital in central Taiwan. RESULTS A total of 160 patients were recruited. The average age of the patients is 66.60 ± 14.57 years old. Among the four dimensions of the self-management scale, the average score of the problem-solving dimension was the highest, and that of the self-monitoring of blood glucose was the lowest. The analysis results showed that the overall regression model could explain 20.7% of the total variance in self-management. CONCLUSIONS Healthcare providers should attach importance to the CoC of T2DM patients and encourage patients to maintain good interaction with healthcare providers during their hospitalization. It is recommended to strengthen CoC for patients with diabetes who are single or with low educational levels in clinical practice to enhance their blood glucose control and improve diabetes self-management.
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Affiliation(s)
- Hsiao-Mei Chen
- Department of Nursing, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Nursing, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Bei-Yi Su
- Department of Psychology, Chung Shan Medical University, Taichung 40201, Taiwan
- Clinical Psychological Room, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
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14
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Thongduang K, Boonchieng W, Chautrakarn S, Ong-Artborirak P. The Influence of Family Caregiver Knowledge and Behavior on Elderly Diabetic Patients' Quality of Life in Northern Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10216. [PMID: 36011847 PMCID: PMC9407734 DOI: 10.3390/ijerph191610216] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
The quality of life (QoL) of elderly diabetic patients may be affected by caregiver factors, but this has received little empirical support. The objective of this cross-sectional study is to determine the influence of family caregivers’ diabetes knowledge and behavior on the QoL among elderly patients with diabetes mellitus (DM). The participants included 354 elderly patients with Type 2 DM and their family caregivers, who were recruited through multistage sampling from five districts in Chiang Mai, Thailand. Face-to-face interviews with DM patients were conducted using the Thai Simplified Diabetes Knowledge Scale (T-SDKS), the Thai version of the Diabetes Self-Management Questionnaire (DSMQ) for self-care behaviors, and the Thai version of the World Health Organization Quality of Life for Older People (WHOQOL-OLD) scale. For caregivers, their diabetes knowledge was measured by T-SDKS and patient-care or supportive behaviors were developed based on DSMQ. The results showed a moderate level of QoL among elderly diabetic patients. According to simple linear regression analysis, the QoL score among elderly DM patients was positively associated with their diabetes knowledge (B = 1.25), self-care behaviors (B = 3.00), caregivers’ knowledge (B = 0.97), and supportive behavior from caregivers (B = 2.92) at a significance level of p < 0.01. In the multivariable model, patients’ self-care behaviors (B = 1.58, p = 0.001), caregivers’ knowledge (B = 0.58, p = 0.001), and patient-care behaviors (B = 1.38, p = 0.004) were significantly associated with QoL among DM patients when controlling for patient factors, including age, body mass index (BMI), education, and living arrangements, which accounted for 27.0% of the variance. This indicates that caregivers’ adequate diabetes knowledge and appropriate supportive behaviors may impact the QoL of elderly diabetic patients. Health care providers should prioritize motivating and empowering family caregivers to pay more attention to the patient for the success goal.
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Affiliation(s)
| | - Waraporn Boonchieng
- Faculty of Public Health, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence in Community Health Informatics, Chiang Mai University, Chiang Mai 50200, Thailand
| | | | - Parichat Ong-Artborirak
- Faculty of Public Health, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence in Community Health Informatics, Chiang Mai University, Chiang Mai 50200, Thailand
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15
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El-Radad HM, Sayed Ahmed HA, Eldahshan NA. The relationship between self-care activities, social support, and glycemic control in primary healthcare patients with type 2 diabetes. Diabetol Int 2022; 14:65-75. [PMID: 35966954 PMCID: PMC9362383 DOI: 10.1007/s13340-022-00598-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/20/2022] [Indexed: 02/01/2023]
Abstract
Objective Egyptian studies in assessing the relationship between diabetes self-care, social support, and glycemic control in primary healthcare (PHC) are limited. Therefore, this study aimed to assess this relationship, and to evaluate the associated factors of diabetes self-care, social support, and glycemic control in Egyptian PHC patients with type 2 diabetes (T2DM). Methods A cross-sectional study was conducted on 320 T2DM patients at four PHC settings in Port Said city, affiliated with the General Authority of Healthcare. A semi-structured questionnaire was used to collect data, including demographic characteristics, socioeconomic status scale, disease profile, the Arabic versions of the Summary of Diabetes Self-Care Activities, and the received social support scales. Data were collected from January 2020 to June 2020. Results Diabetes self-care activities, and self-monitoring of blood glucose had a very weak negative correlations with glycated hemoglobin (HbA1c) levels (rho = - 0.125, p = 0.025, rho = - 0.112, p = 0.044, respectively). Receiving social support on following a meal correlated positively and very weakly with HbA1c levels (rho = 0.145, p = 0.010). Hardly positive correlation was found between receiving emotional support on feelings about diabetes, and following a specific diet (rho = 0.169, p = 0.002). Diabetes self-care activities were positively associated with higher education levels, and elevated BMI. Received social support was negatively associated with having coronary artery disease, and marital status e.g. divorced and widow. Increased age, and female gender were the predictors of good glycemic control. Conclusion Diabetes self-care activities were linked with reduced HBA1c levels. Further studies are needed to evaluate the buffering effect of social support on glycemic outcomes in PHC patients with T2DM.
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Affiliation(s)
| | - Hazem A. Sayed Ahmed
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Nahed Amen Eldahshan
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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16
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Letta S, Aga F, Assebe Yadeta T, Geda B, Dessie Y. Self-care practices and correlates among patients with type 2 diabetes in Eastern Ethiopia: A hospital-based cross-sectional study. SAGE Open Med 2022; 10:20503121221107337. [PMID: 35784669 PMCID: PMC9244934 DOI: 10.1177/20503121221107337] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/25/2022] [Indexed: 11/15/2022] Open
Abstract
Objective: This study investigated the level and correlates of self-care practices among patients with type 2 diabetes on follow-up in two public hospitals in Harar, Eastern Ethiopia. Methods: We conducted a hospital-based cross-sectional study on adult patients with type 2 diabetes, surveying diabetes self-care practices using a 15-item Summary of Diabetes Self-Care Activities. Responses ranged from 0 to 7 days, and a composite score was computed representing the mean days of diabetes self-care practices. A generalized Poisson regression model with robust variance was used. The association between the diabetes self-care practices and correlates was examined using the incidence rate ratio with a 95% confidence level. The statistical significance was set at a p value of ⩽0.05. Results: This study included 879 patients with type 2 diabetes. The overall mean (standard deviation) diabetes self-care practices were 3.7 ± 1.1 days out of the recommended 7 days, indicating low self-care practices. After controlling for other variables, tertiary educational level (incidence rate ratio = 1.06; 95% confidence interval: 1.01, 1.12), adequate diabetes knowledge (incidence rate ratio = 1.04; 95% confidence interval: 1.00, 1.08), moderate (incidence rate ratio = 1.07; 95% confidence interval: 1.02, 1.11) and high perceived self-efficacy (incidence rate ratio = 1.14; 95% confidence interval: 1.09, 1.13) (incidence rate ratio = 1.07; 95% confidence interval: 1.02, 1.11), high to marginal food security (incidence rate ratio = 1.13; 95% confidence interval: 1.03, 1.24), and receiving dietary advice (incidence rate ratio = 1.11; 95% confidence interval: 0.06, 1.15) were positively correlated with diabetes self-care practices. A history of hospitalization, on the other hand, was found to be inversely correlated with diabetes self-care practices (incidence rate ratio = 0.94; 95% confidence interval: 0.88, 0.99). Conclusion: The study indicated that adherence of patients with type 2 diabetes to the recommended self-care practices was considerably low. Therefore, tailored diabetes self-management education to enhance self-efficacy and diabetes self-care practices must be in place. This can be achieved through the system or individual-based integrated intervention efforts.
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Affiliation(s)
- Shiferaw Letta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fekadu Aga
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- Department of Nursing, College of Health Sciences, Madda Walabu University, Shashamene, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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17
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Zhu R, Zhou S, Xia L, Bao X. Incidence, Morbidity and years Lived With Disability due to Type 2 Diabetes Mellitus in 204 Countries and Territories: Trends From 1990 to 2019. Front Endocrinol (Lausanne) 2022; 13:905538. [PMID: 35898461 PMCID: PMC9309695 DOI: 10.3389/fendo.2022.905538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We aimed to examine the descriptive epidemiology and trends in the burden of type 2 diabetes mellitus (T2DM). METHODS Data were extracted from the Global Burden of Disease 2019 dataset. Estimated annual percentage changes (EAPCs) were calculated to assess the trends in incidence rate, mortality and disability-adjusted life-years (DALYs) associated with T2DM. Measures were stratified by sex, region, country, age and social development index (SDI) value. RESULTS The global age-standardized incidence rate of T2DM increased from 1990 to 2019, with an EAPC of 1.25 (95% CI, 1.19 to 1.31). In 2019, the highest age-standardized incidence rate of T2DM was observed in high-SDI regions, and the largest increase in this rate from 1990 to 2019 was also in high-SDI regions (EAPC, 1.74;95% CI, 1.57 to 1.90). At the regional level, Central Asia (EAPC, 2.53;95% CI, 2.45 to 2.61) had the largest increase in the age-standardized incidence rate of T2DM from 1990 to 2019. At the national level, Luxembourg (EAPC, 4.51;95% CI, 4.37 to 4.65) and Uzbekistan (EAPC, 3.63; 95% CI, 3.44 to 3.82) had the largest increases in the age-standardized incidence rate of T2DM from 1990 to 2019. The global age-standardized death and DALY rates increased from 1990 to 2019, with EAPCs of 0.26 (95% CI, 0.16 to 0.37) and 0.81 (95% CI, 0.77 to 0.85), respectively. The age-standardized death and DALY rates showed the largest increases in Central Asia, South Asia and Southern Sub-Saharan Africa. CONCLUSIONS Globally, the age-standardized incidence, death and DALY rates increased from 1990 to 2019. Central Asia, South Asia and Southern Sub-Saharan Africa were found to have the greatest burden of T2DM. Future strategies should focus on these high-risk regions and other high-risk populations.
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Affiliation(s)
- Rongrong Zhu
- Department of Pharmacy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Shan Zhou
- Department of Endocrinology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Liang Xia
- Department of Gynecology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Xiaoming Bao
- Department of Cardiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
- *Correspondence: Xiaoming Bao,
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