Sociodemographic determinants of glycaemic control in young diabetic patients in peninsular Malaysia

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

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

Adherence to medication and glucose control in diabetic patients in Duhok, Iraq

Background: Diabetes mellitus is a chronic, progressive disorder that causes a variety of health problems. Adherence to medication is a major factor in the treatment outcome. The goal of this study is to translate and test the psychometric features of the Kurdish version of the Morisky Medication Adherence Scale (MMAS-8) among type 2 diabetic patients.

Methods: The research used a cross-sectional approach. The researchers looked at a convenient sample of diabetic Kurdish individuals. MMAS-8 was translated into Kurdish using a normal “forward–backward” technique. It was then tested on 307 type 2 diabetic outpatients in a convenience sample. Internal consistency was checked for reliability. Convergent and known group validity were used to confirm validity. For the authentic statistical analysis, the Statistical Package for Social Sciences (SPSS) version 20 was used.

Results: According to MMAS-8, 20 patients (6.5%) had a high adherence rate, 66 (21.5%) had a medium adherence rate, and 221 (72%) had a low adherence rate. There was no significant link between adherence score and gender (P = 0.055), illness duration (P = 0.251), or educational level (P = 0.12). There was a significant connection between adherence and HBA1C (P 0.001).

Conclusion: The results of this validation study show that the Kurdish version of the MMAS-8 is a reliable and valid measure of medication adherence that may now be used. non-adherent. Developing patients’ treatment adherence will improve treatment managements and control.

Real-world evaluation of sodium-glucose co-transporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors for managing type 2 diabetes mellitus: a retrospective multi-ethnic cohort study

Abstract

Purpose

Sodium-glucose co-transporter-2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP4) inhibitors are increasingly used as second-line therapies in patients with type 2 diabetes. The aim of this study was to assess the real-world effects of SGLT2 inhibitors in a multi-ethnic population in Singapore.

Methods

This retrospective cohort study examined patients diagnosed with and treated for diabetes from the Ministry of Health’s administrative database. Differences in outcomes between treatment groups were assessed using Poisson regression. Demographics, clinical characteristics, previous diagnoses and hospitalisations, and diabetes medication history were used for propensity score matching. Subgroup analyses by ethnicity were performed. Effect size was estimated using risk ratios (RRs) with 95% confidence intervals (CIs).

Results

Patients initiating SGLT2 inhibitors were more likely to achieve glycaemic control target than DPP4 inhibitor-treated patients (RR 1.09; 95% CI 1.04, 1.14). This was observed only in patients of Chinese ethnicity. A higher risk of diabetic ketoacidosis in SGLT2 inhibitor initiators was not observed. SGLT2 inhibitors were associated with reduced risk of hypoglycaemia (RR 0.69; 95% CI 0.59, 0.82) and urinary tract infection (RR 0.52; 95% CI 0.43, 0.63) but was not statistically significant for hypoglycaemia in Malay patients. Compared to DPP4 inhibitors, SGLT2 inhibitors were associated with 12% and 34% reduction in any-cause hospitalisation and all-cause mortality, respectively, potentially resulting in more than $50 million savings over 10 years.

Conclusion

SGLT2 inhibitors were associated with improvements in glycaemic control, reduced risk of complications, and was well tolerated. Ethnicity also plays a role and should be considered in future studies.

Assessment of Selected Aspects of the Quality of Life of Children with Type 1 Diabetes Mellitus in Poland

Type 1 diabetes mellitus (T1D) is, next to obesity and asthma, the most common chronic disease in children in Poland. T1D is not only a medical challenge, but it also affects all areas of a sick child's life and family functionality. New forms of therapy facilitate the daily management of the disease, but their availability is limited and partly dependent on socioeconomic status. This study aimed to assess the incidence and interrelationships between the child's health condition and the applied therapy model, and selected aspects of the child's family functionality and access to health and care services. The survey involved 206 child and youth caregivers with T1D who are members of Facebook support groups. The analysis of the obtained results revealed the existence of links between family income level and the type of insulin therapy applied. Children from families with a better financial situation (subjective and objective) were more likely to have additional medical consultations and make more frequent control visits. In families with a higher level of income, the T1D-induced restriction of child activity was less frequent. Living outside of urban centers was associated with a reduced availability of care or educational facilities adapted to take care of a child with T1D. No statistically significant correlations were observed between demographic and economic factors and the child's health status expressed by the occurrence of complications. The incidence of the latter, however, affected the child's family situation.

Depression, anxiety, stress and socio-demographic factors for poor glycaemic control in patients with type II diabetes

OBJECTIVE

This study aims to identify risks induced by depression, anxiety, stress, and socio-demographic factors associated with poor glycaemic control among type II diabetes mellitus patients in Kuala Terengganu, Malaysia.

METHODS

This cross-sectional study was performed in two Malaysian health clinics by using the Malay version of a self-administered questionnaire. This instrument contains a diabetes care profile, a 21-item version of the Depression Anxiety Stress Scales (DASS21), and a Malaysian Medication Adherence Score (MalMAS). Simple and multiple logistic regression analyses were performed.

RESULTS

A total of 338 type II diabetes mellitus patients responded (response rate 93.1%). The proportion of patients with poor glycaemic control was 76.0%. Multiple logistic regression analysis showed that 1) social support scores [Adj. OR (95% CI): 1.06 (1.03,1.10); p = 0.001]; 2) unemployment [Adj. OR (95% CI): 0.46 (0.22,0.95); p = 0.035]; 3) pensioner status [Adj. OR (95% CI): 0.28 (0.13,0.61); p = 0.001]; and 4) perception of diabetes as interfering with daily living activities [Adj. OR (95% CI): 3.18 (1.17,8.70); p = 0.024] were significant factors for poor glycaemic control.

CONCLUSIONS

Unemployment, perception of diabetes' interference with daily living activities, and social support are significantly correlated with poor glycaemic control. Further studies assessing other important clinical and psychosocial factors that may influence glycaemic control are suggested. A younger age range of participants is recommended for better outcomes and interventional implementation of findings.

Treatment Pattern and Factors Associated with Blood Pressure and Fasting Plasma Glucose Control among Patients with Type 2 Diabetes Mellitus in Police Referral Hospital in Ethiopia

BACKGROUND

The prevalence of T2DM in Ethiopia is on the rise according to certain studies. Appropriate management approaches are required to achieve desired goals of therapy in the clinical setup. This study was conducted to assess the treatment pattern and the factors associated with BP and FPG control among patients with T2DM in Federal Police Referral Hospital.

METHOD

An institution based cross sectional study was conducted from 15th October 2016 to 15th January 2017. A Systematic random sampling technique was employed in selecting the study participants. Data was collected using semi-structured interview and visiting medication records. SPSS version 20 was used for data analysis.

RESULTS

Out of a total of 414 participants who fulfilled the inclusion criteria, 361 were successfully interviewed and considered for further analysis. Target BP level was achieved in 206(57.1%) of the patients, whereas the proportion of hypertensive diabetics who attained the recommended BP target was 19.4% (n=40). Of the 361 participants who were checked about their current FPG level, only 142(39.3%) were found to be <130mg/dl. However, 87(24.1%) participants were found to control both BP and FPG levels. Gender, military status, comorbidity, type of therapy and dietary adherence showed a statistically significant association with outcome variables.

CONCLUSION

The proportion of participants with T2DM who achieved target BP, FPG or both was suboptimal. A comprehensive approach that involves targeted education on self-management strategies, individualized treatment plans, and continuous evaluation of treatment outcomes should be practiced.

Diabetes self-care and its associated factors among elderly diabetes in primary care

Objectives

Diabetes is a primarily self-manageable condition. Healthcare professionals usually offer education, treatment, and support, but patients themselves are responsible for the daily management of their condition. Increasing the effectiveness of self-management support may have a considerable impact on health care, especially for elderly people. The aim of this study was to describe diabetes self-care among elderly diabetics and to determine its associated factors.

Methods

This report describes a cross-sectional study involving 143 elderly diabetes patients in the outpatient department of the Hospital Universiti Sains Malaysia (HUSM). Self-care activities assessed in this study included dietary control, physical activity, self-monitoring of blood glucose, medication adherence, and situational related adherence behaviour, all of which were obtained using the validated Malay Elderly Diabetes Self-Care Questionnaire (MEDSCaQ).

Results

The mean (±SD) age of the subjects was 67.9 (±5.4) years old. A majority was Malay, with a mean HbA1c of 8.4 (±1.9). The mean diabetes self-care score was 26.5 (±8.0). Factors with a positive impact on diabetes self-care included being non-Malay (β = 5.275, p = 0.002), having family as care givers (β = 8.995, p = 0.004), having a higher level of family support (β = 0.159, p = 0.042), and possessing acceptable (β = 4.375, p = 0.001) or good knowledge of diabetes (β = 5.893, p = 0.004). The presence of neuropathy negatively impacted self-care, while diabetes nephropathy had a positive impact on self care (β = −4.053, p = 0.003).

Conclusions

Elderly individuals with type 2 diabetes in HUSM have a moderate score of diabetes self-care practice based on the MEDSCaQ. Determinants for good diabetes self-care include race, social support, having care-takers during periods of illness, diabetes knowledge, and diabetic microvascular complications.

Cross-sectional study of patients with type 2 diabetes in OR Tambo district, South Africa

OBJECTIVES

South Africa has pledged to the sustainable development goal of promoting good health and well-being to all residents. While this is laudable, paucity of reliable epidemiological data for different regions on diabetes and treatment outcomes may further widen the inequalities of access and quality of healthcare services across the country. This study examines the sociodemographic and clinical determinants of uncontrolled type 2 diabetes mellitus (T2DM) in individuals attending primary healthcare in OR Tambo district, South Africa.

DESIGN

A cross-sectional analytical study.

SETTING

Primary healthcare setting in OR Tambo district, South Africa.

PARTICIPANTS

Patients treated for T2DM for 1 or more years (n=327).

PRIMARY OUTCOME MEASURE

Prevalence of uncontrolled T2DM.

SECONDARY OUTCOME MEASURE

Determinants of uncontrolled T2DM (glycosylated haemoglobin (HbA1c) ≥7%).

RESULTS

Out of the 327 participants, 274 had HbA1c≥7% (83.8%). Female sex (95% CI 1.3 to 4.2), overweight/obesity (95% CI 1.9 to 261.2), elevated low-density lipoprotein cholesterol (95% CI 4.4 to 23.8), sedentary habits (95% CI 7.2 to 61.3), lower monthly income (95% CI 1.3 to 6.5), longer duration of T2DM (95% CI 4.4 to 294.2) and diabetes information from non-health workers (95% CI 1.4 to 7.0) were the significant determinants of uncontrolled T2DM. There was a significant positive correlation of uncontrolled T2DM with increasing duration of T2DM, estimated glomerular filtration rate and body mass index. However, a significant negative correlation exists between monthly income and increasing HbA1c.

CONCLUSIONS

We found a significantly high prevalence (83.8%) of uncontrolled T2DM among the patients, possibly attributable to overweight/obesity, sedentary living, lower income and lack of information on diabetes. Addressing these determinants will require re-engineering of primary healthcare in the district.

Profiles and Factors Associated with Poor Glycemic Control Among Inpatients with Diabetes Mellitus Type 2 as a Primary Diagnosis in a Teaching Hospital

CONTEXT

Diabetes mellitus is a growing health problem in most countries. In Malaysia, there was an increase in prevalence over the years. This makes diabetes also a growing concern in Malaysia, which warrants strengthening of the prevention and control programme.

AIMS

This paper aims to describe the profiles of diabetes mellitus type 2 in tertiary setting and to identify the risk factors for high level of HbA1c among the study population. The findings will give a glimpse on current status of diabetes in our country and may reflect the achievement of the country in combating this disease.

SETTINGS AND DESIGN

A cross-sectional study was conducted in UKM Medical Centre.

METHODS AND MATERIAL

Medical records of patient with E11 ICD-10 code were collected using Case Report Form.

STATISTICAL ANALYSIS USED

Descriptive analysis done of mean and median while test of association were done using Spearman correlation and logistic regression.

RESULTS

The results showed that majority of inpatients of DMT2 showed mean age of 58.8 + 12.6 years and most were males (56.7%) with secondary level of education (41.7%). Median duration of disease was 12.0 + 11.0 years with median HbA1c level of 8.9 ± 4.4%. Only small proportion of patients achieved the desired level of HbA1c <6.5% (21.3%) and significant association was found with tertiary level of education [AOR = 0.10, 95%CI = 0.01-0.96] and with type of anti-diabetic therapy [AOR = 15.90, 95%CI=1;2.03-124.30].

CONCLUSIONS

In conclusion, diabetes mellitus type 2 inpatients still showed unsatisfactory glycemic control and holistic approach using health education should be advocated continuously in the future in view of education being one of the predictors for the good HbA1c outcome.

Prevalence and determinants of cardiovascular disease risk factors among the residents of urban community housing projects in Malaysia

Objectives

The objectives are to assess the prevalence and determinants of cardiovascular disease (CVD) risk factors among the residents of Community Housing Projects in metropolitan Kuala Lumpur, Malaysia.

Method

By using simple random sampling, we selected and surveyed 833 households which comprised of 3,722 individuals. Out of the 2,360 adults, 50.5% participated in blood sampling and anthropometric measurement sessions. Uni and bivariate data analysis and multivariate binary logistic regression were applied to identify demographic and socioeconomic determinants of the existence of having at least one CVD risk factor.

Results

As a Result, while obesity (54.8%), hypercholesterolemia (51.5%), and hypertension (39.3%) were the most common CVD risk factors among the low-income respondents, smoking (16.3%), diabetes mellitus (7.8%) and alcohol consumption (1.4%) were the least prevalent. Finally, the results from the multivariate binary logistic model illustrated that compared to the Malays, the Indians were 41% less likely to have at least one of the CVD risk factors (OR = 0.59; 95% CI: 0.37 - 0.93).

Conclusion

In Conclusion, the low-income individuals were at higher risk of developing CVDs. Prospective policies addressing preventive actions and increased awareness focusing on low-income communities are highly recommended and to consider age, gender, ethnic backgrounds, and occupation classes.

A pilot study: the development of a culturally tailored Malaysian Diabetes Education Module (MY-DEMO) based on the Health Belief Model

BACKGROUND

Diabetes education and self-care remains the cornerstone of diabetes management. There are many structured diabetes modules available in the United Kingdom, Europe and United States of America. Contrastingly, few structured and validated diabetes modules are available in Malaysia. This pilot study aims to develop and validate diabetes education material suitable and tailored for a multicultural society like Malaysia.

METHODS

The theoretical framework of this module was founded from the Health Belief Model (HBM). The participants were assessed using 6-item pre- and post-test questionnaires that measured some of the known HBM constructs namely cues to action, perceived severity and perceived benefit. Data was analysed using PASW Statistics 18.0.

RESULTS

The pre- and post-test questionnaires were administered to 88 participants (31 males). In general, there was a significant increase in the total score in post-test (97.34 ± 6.13%) compared to pre-test (92.80 ± 12.83%) (p < 0.05) and a significant increase in excellent score (>85%) at post-test (84.1%) compared to pre-test (70.5%) (p < 0.05). There was an improvement in post-test score in 4 of 6 items tested. The remaining 2 items which measured the perceived severity and cues to action had poorer post-test score.

CONCLUSIONS

The preliminary results from this pilot study suggest contextualised content material embedded within MY DEMO maybe suitable for integration with the existing diabetes education programmes. This was the first known validated diabetes education programme available in the Malay language.

Socioeconomic status. The relationship with health and autoimmune diseases

Socioeconomic status (SES) is a hierarchical social classification associated with different outcomes in health and disease. The most important factors influencing SES are income, educational level, occupational class, social class, and ancestry. These factors are closely related to each other as they present certain dependent interactions. Since there is a need to improve the understanding of the concept of SES and the ways it affects health and disease, we review herein the tools currently available to evaluate SES and its relationship with health and autoimmune diseases.

Factors associated with good glycemic control among patients with type 2 diabetes mellitus

AIMS/INTRODUCTION

The aim of the present study was to determine the status of glycemic control and identify factors associated with good glycemic control among diabetic patients treated at primary health clinics.

MATERIALS AND METHODS

A systematic random sample of 557 patients was selected from seven clinics in the Hulu Langat District. Data were collected from patients' medication records, glycemic control tests and structured questionnaires. Logistic regression analysis was carried out to predict factors associated with good glycemic control.

RESULTS

Variables associated with good glycemic control included age (odds ratio 1.033; 95% confidence interval 1.008-1.059) and duration of diabetes mellitus (odds ratio 0.948; 95% confidence interval 0.909-0.989). Compared with the patients who were receiving a combination of insulin and oral antidiabetics, those receiving monotherapy (odds ratio 4.797; 95% confidence interval 1.992-11.552) and a combination of oral antidiabetics (odds ratio 2.334; 95% confidence interval 1.018-5.353) were more likely to have good glycemic control. In the present study, the proportion of patients with good glycemic control was lower than that in other published studies. Older patients with a shorter duration of diabetes who were receiving monotherapy showed better glycemic control.

CONCLUSIONS

Although self-management behavior did not appear to influence glycemic control, diabetic patients should be consistently advised to restrict sugar intake, exercise, stop smoking and adhere to medication instructions. Greater effort by healthcare providers in the primary health clinics is warranted to help a greater number of patients achieve good glycemic control.

Acculturation and glycemic control of Asian Indian adults with type 2 diabetes

The prevalence of type 2 diabetes is disproportionately high among Asian Indians (AI), one of the fastest growing immigrant groups in the United States (US). Poorly controlled diabetes associated with inadequate self-management increases complications and thus medical costs. Acculturation may be an important determinant of diabetes self-management and hence control. This study examined the association between the degree of acculturation and glycemic control as measured by Hemoglobin A1c in AI adults with type 2 diabetes. A mixed method (quantitative and qualitative) study was conducted among 30 AI adults with type 2 diabetes. Acculturation assessment using the Suinn-Lew Asian Self-identity Instrument was followed by socio-demographic questions, self-reported anthropometric measures, and open ended diabetes self-care questions. A two-step multiple regression analysis and content analysis of verbatim interview transcriptions were conducted. Interactions of acculturation with body mass index (interaction b = 1.11; p = 0.01), annual household income (interaction b = 7.19; p = .01), and diabetes duration (interaction b = .30; p = .02) significantly predicted higher HbA1c levels (R(2) change = .368; F change = 4.21; p = .02). From the qualitative interviews, the following were regarded as US specific facilitators for glycemic control: excellent health care system and facilities, availability of healthy food choices and self-monitoring devices, medical insurance benefits, good quality medications, and improved health awareness. Cultural orientation might be important for patient tailored interventions targeting AI with type 2 diabetes. Therefore, interventions targeted at Asian Indians with diabetes should include culture specific adaptations to nutrition education and support.

Does ethnicity contribute to the control of cardiovascular risk factors among patients with type 2 diabetes?

This study aimed to examine the control of cardiovascular risk factors among the ethnic groups with type 2 diabetes in Malaysia. The authors analyzed the data of 70 092 adults from the Malaysian diabetes registry database. Malays had the worst achievement of target for most of the risk factors. Indians had poor achievement of control for waist circumference (odds ratio [OR] = 0.6, 95% confidence interval [CI] = 0.6-0.7) and high-density lipoprotein cholesterol (OR = 0.5, 95% CI = 0.4-0.5). As compared with the Malays, the Chinese had a better achievement of target control for the risk factors, including the following: body mass index (OR = 1.3, 95% CI = 1.2-1.4), blood pressure (OR = 1.3, 95% CI = 1.3-1.4), total cholesterol (OR = 1.7, 95% CI = 1.6-1.8), low-density lipoprotein cholesterol (OR = 1.7, 95% CI = 1.6-1.8), glycated hemoglobin A1c (OR = 1.4, 95% CI = 1.3-1.4) and fasting blood glucose (OR = 1.4, 95% CI = 1.3-1.5). Ethnicity, sociocultural factors, and psychobehavioral factors should be addressed in designing and management strategies for the control of cardiovascular risk factors among type 2 diabetes patients.

Social determinants of health on glycemic control in pediatric type 1 diabetes

OBJECTIVE

To evaluate the relationship between the social determinants of health (SDH) and glycemic control in a large pediatric type 1 diabetes (T1D) population.

STUDY DESIGN

Deprivation Indices (DI) were used to ascertain population-level measures of socioeconomic status, family structure, and ethnicity in patients with T1D followed at The Hospital for Sick Children August 2010-2011 (n = 854). DI quintile scores were determined for individual patients based on de-identified postal codes, and linked to mean patient A1Cs as a measure of glycemic control. We compared mean A1C between the most and least deprived DI quintiles. Associations were estimated controlling for age and sex, and repeated for insulin pump use.

RESULTS

The T1D population evaluated in this study was most concentrated in the least and most deprived quintiles of the Material DI. A1C levels were highest in patients with the greatest degree of deprivation (fifth vs first quintile) on the Material DI (9.2% vs 8.3%, P < .0001), Social DI (9.1% vs 8.3%, P < .0001), and Ethnic Concentration Index (8.9% vs 8.4%, P = .03). These relationships between measures of the SDH and A1C were not evident for patients on insulin pumps. On regression analysis, higher A1C was predicted by older age, female sex, not using pump therapy, and being in the most deprived quintile for Material and Social Deprivation, but not Ethnic Concentration.

CONCLUSIONS

Measures of the SDH comprising Material and Social Deprivation were significantly associated with suboptimal glycemic control in our pediatric T1D cohort. Use of insulin pump therapy also predicted A1C and may have a moderating effect on these relationships.

Alternanthera sessilis Red Ethyl Acetate Fraction Exhibits Antidiabetic Potential on Obese Type 2 Diabetic Rats

The antidiabetic potential of Alternanthera sessilis Red was investigated using the obese type 2 diabetic rats induced by high fat diet and streptozotocin. Three fractions (hexane, ethyl acetate, and water) were obtained from the crude ethanol extract of Alternanthera sessilis Red. Alternanthera sessilis Red ethyl acetate fraction (ASEAF) was found to possess the most potent antihyperglycemic effect through oral glucose tolerance test. The ASEAF was subsequently given to the diabetic rats for two weeks. It was found that two-week administration of ASEAF reduces the fasting blood glucose level, triglyceride level, and free fatty acid level of the rats. ASEAF-treated diabetic rats showed higher pancreatic insulin content and pancreatic total superoxide dismutase activity compared to the untreated diabetic rats. Also, the insulin sensitivity indexes suggested that ASEAF ameliorates the insulin resistant state of the diabetic rats. In conclusion, ASEAF could be developed into a potential antidiabetic agent for the management of type 2 diabetes.

Self-care practice and glycaemic control amongst adults with diabetes at the Jimma University Specialized Hospital in south-west Ethiopia: A cross-sectional study

Background

The main goal in diabetes care is to improve the patient's quality of life, to maintain satisfactory metabolic control and to retain minimal complications caused by diabetes mellitus (DM). Thus, this study has assessed self-care practice and glycaemic control amongst adults with diabetes mellitus.

Setting

A facility-based study amongst the diabetic follow-up clinic at Jimma University Specialized Hospital in Ethiopia.

Methods

A cross-sectional study was conducted from 01 April to 30 April 30 2010. A total of 343 diabetic patients were selected using a systematic sampling method. The data were collected by structured questionnaires and a medical card review; anthropometric measurement was done by trained nurses.

Results

The study showed that 53% of the respondents had diabetes related knowledge. The study also found that 64% of the respondents were physically less active, and 17% of the respondents were walking on foot for less than 30 minutes per a day. Only 18.1% of the respondents were able to control their Fasting Blood Sugar (FBS) to level below 126 mg/dL.

Conclusion

The present study illustrates that the level of knowledge about diabetes and self-care practices amongst diabetic patients were meager. In addition, it showed that respondents’ level of physical activity, their educational status, and the dose of oral hypoglycaemic agents taken by the respondents significantly affected glycaemic control.

Associations between socioeconomic status and major complications in type 1 diabetes: the Pittsburgh epidemiology of diabetes complication (EDC) Study

PURPOSE

To understand the effect of socioeconomic status (SES) on the risk of complications in type 1 diabetes (T1D), we explored the relationship between SES and major diabetes complications in a prospective, observational T1D cohort study.

METHODS

Complete data were available for 317 T1D persons within 4 years of age 28 (ages 24-32) in the Pittsburgh Epidemiology of Diabetes Complications Study. Age 28 was selected to maximize income, education, and occupation potential and to minimize the effect of advanced diabetes complications on SES.

RESULTS

The incidences over 1 to 20 years' follow-up of end-stage renal disease and coronary artery disease were two to three times greater for T1D individuals without, compared with those with a college degree (p < .05 for both), whereas the incidence of autonomic neuropathy was significantly greater for low-income and/or nonprofessional participants (p < .05 for both). HbA(1c) was inversely associated only with income level. In sex- and diabetes duration-adjusted Cox models, lower education predicted end-stage renal disease (hazard ratio [HR], 2.9; 95% confidence interval [95% CI], 1.1-7.7) and coronary artery disease (HR, 2.5, 95% CI, 1.3-4.9), whereas lower income predicted autonomic neuropathy (HR, 1.7; 95% CI, 1.0-2.9) and lower-extremity arterial disease (HR, 3.7; 95% CI, 1.1-11.9).

CONCLUSIONS

These associations, partially mediated by clinical risk factors, suggest that lower SES T1D individuals may have poorer self-management and, thus, greater complications from diabetes.

Association of socioeconomic status with mortality in type 1 diabetes: the Pittsburgh epidemiology of diabetes complications study

PURPOSE

Socioeconomic status (SES) as a risk factor for mortality in type 1 diabetes (T1D) has not been adequately studied prospectively.

METHODS

Complete clinical and SES (income, education, occupation) data were available for 317 T1D participants in the Pittsburgh Epidemiology of Diabetes Complications Study within 4 years of age 28 (chosen to maximize income, education, and occupational potential, and to minimize the SES effect of advanced diabetes complications). Vital status was determined as of 1/1/2008.

RESULTS

Over a median 16 years of follow-up, 34 (10.7%) deaths occurred (standardized mortality ratios [SMRs] = 4.1, 95% confidence interval [CI]: 2.7-5.5). SMRs did not differ from the general population for those in the highest education and income groups, whereas in those with low SES, SMRs were increased. Mortality rates were three times lower for individuals with a college degree versus without a college degree (p = 0.004) and nearly four times lower for the highest income versus lower income groups (p = 0.04). In Cox models adjusting for diabetes duration and sex, education was the only SES measure predictive of mortality (hazard ratio [HR] = 3.0, 95% CI: 1.2-7.8), but lost significance after adjusting for HbA(1c), non-HDL cholesterol, hypertension, and microalbuminuria (HR = 2.1, 95% CI: 0.8-5.6).

CONCLUSIONS

The strong association of education with mortality in T1D is partially mediated by better glycemic, lipid, and blood pressure control.

Self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control

OBJECTIVE

To investigate the self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control.

METHODS

Using a one-to-one interviewing approach, data were collected from 126 diabetic adults from four settings. A 75-item questionnaire was used to assess diabetes-related knowledge and self-care practices regarding, diet, medication, physical activity and self-monitoring of blood glucose (SMBG).

RESULTS

Most subjects had received advice on the importance of self-care in the management of their diabetes and recognised its importance. Sixty-seven subjects (53%) scored below 50% in their diabetes-related knowledge. Subjects who consumed more meals per day (80%), or who did not include their regular sweetened food intakes in their daily meal plan (80%), or who were inactive in daily life (54%), had higher mean fasting blood glucose levels (p=0.04). Subjects with medication non-adherence (46%) also tended to have higher fasting blood glucose levels. Only 15% of the subjects practiced SMBG. Predictors of knowledge deficit and poor self-care were low level of education (p = <0.01), older subjects (p=0.04) and Type 2 diabetes subjects on oral anti-hyperglycaemic medication (p = <0.01).

CONCLUSION

There were diabetes-related knowledge deficits and inadequate self-care practices among the majority of diabetic patients with sub-optimal glycaemic control.

PRACTICE IMPLICATIONS

This study should contribute to the development of effective education strategies to promote health for adults with sub-optimal diabetes control.

Early manifestation of macrovasculopathy in newly diagnosed never treated type II diabetic patients with no traditional CVD risk factors

Type II diabetes patients have increased risk of macrovascular complications compared with the general population. Arterial stiffness is considered as an independent predictor of macrovascular events. This study investigated arterial stiffness in newly diagnosed never treated diabetes and impaired glucose tolerance (IGT) patients without any traditional cardiovascular diseases (CVD) risk factors. After preliminary screening of 1620 individuals, 30 diabetic and 30 IGT patients were recruited and compared with age- and sex-matched 30 normoglycaemic subjects. The subjects were newly diagnosed, never treated, normotensive, non-obese, non-hyperlipidaemic and non-smoker. Haemodynamic variables, pulse wave velocity (PWV) and augmentation index (AI) were measured. The PWV was significantly higher in diabetic patients (10.37+/-2.64m/s vs. 8.70+/-1.29m/s; p=0.035) and was of borderline significant in IGT subjects (9.54+/-1.56m/s vs.8.70+/-1.29m/s, p=0.078) compared to normoglycaemic individuals. Augmentation index was higher of borderline significant in diabetic (134.53+/-17.32% vs. 129.17+/-11.18%, p=0.055) and IGT patients (132.02+/-16.11% vs. 129.17+/-11.18%, p=0.059) compared to normoglycaemic individuals. The study demonstrated that newly diagnosed never treated diabetic patients without any CV complications had early manifestation of macrovascular diseases as evident by increased arterial stiffness. The findings also revealed early manifestations of preclinical vasculopathy and potentially increased risk for development of macrovascular diseases at an early age in diabetic patients.

Ethnic differences in glycaemic control in adult Type 2 diabetic patients in primary care: a 3-year follow-up study

OBJECTIVE

To evaluate ethnic differences and characteristics related to glycaemic control in patients with Type 2 diabetes in primary care.

RESEARCH DESIGN AND METHODS

Prospective cohort study; 500 adult patients with Type 2 diabetes, who were not on insulin therapy, were followed up annually for 3 years. HbA(1c) at baseline and 3-year changes and subsequent insulin therapy were related to baseline characteristics.

RESULTS

Malay patients had significantly higher HbA(1c) (mean 8.7% +/- sd 1.66) compared with Chinese (8.2 +/- sd 1.67) and Indian (8.2 +/- sd 1.55) (P = 0.032) at baseline, and consistently for all years of HbA(1c) assessment (P = 0.017). At baseline, Malay patients were significantly more obese than Chinese or Indians (P < 0.001); fewer of them received structured shared-care intervention (P = 0.001), but they had a significantly higher glucose control educational score (P < 0.05). Multivariable analyses showed that HbA(1c) at baseline was significantly related to age (P = 0.001), BMI (P = 0.031) and ethnicity (P = 0.002). HbA(1c) declined significantly over 3 years in the whole population and in all ethnic groups. Significantly greater HbA(1c) declines were associated with higher baseline HbA(1c), structured shared-care intervention and non-insulin therapy. Correcting for differences on these factors, the decline in HbA(1c) in Malays was significantly less than in the Chinese. Insulin therapy was associated with higher baseline HbA(1c) and higher BMI.

CONCLUSIONS

Malay ethnicity was associated with persistently poor glycaemic control. Sociocultural and behavioural factors should be addressed in improving care for patients with poorly controlled diabetes.

Prevention of renal failure: the Malaysian experience

Prevention of renal failure: The Malaysian experience. Renal replacement therapy in Malaysia has shown exponential growth since 1990. The dialysis acceptance rate for 2003 was 80 per million population, prevalence 391 per million population. There are now more than 10,000 patients on dialysis. This growth is proportional to the growth in gross domestic product (GDP). Improvement in nephrology and urology services with widespread availability of ultrasonography and renal pathology has improved care of renal patients. Proper management of renal stone disease, lupus nephritis, and acute renal failure has decreased these as causes of end-stage renal disease (ESRD) in younger age groups. Older patients are being accepted for dialysis, and 51% of new patients on dialysis were diabetic in 2003. The prevalence of diabetes is rising in the country (presently 7%); glycemic control of such patients is suboptimal. Thirty-three percent of adult Malaysians are hypertensive and blood pressure control is poor (6%). There is a national coordinating committee to oversee the control of diabetes and hypertension in the country. Primary care clinics have been provided with kits to detect microalbuminuria, and ACE inhibitors for the treatment of hypertension and diabetic nephropathy. Prevention of renal failure workshops targeted at primary care doctors have been launched, opportunistic screening at health clinics is being carried out, and public education targeting high-risk groups is ongoing. The challenge in Malaysia is to stem the rising tide of diabetic ESRD.

Reliability and validity of the Chinese version of the Worry Scale

This article presents the findings on the development and validation of a Chinese version of the Worry Scale (WS), a measure of worry about hypoglycemia. A previously developed 16-item WS was back-translated and applied to 117 Chinese diabetic patients living in Hong Kong. An iterative process of factor and item analyses identified a unidimensional 10-item Chinese WS (WS-10), which accounted for 57.15% of the total variance. Cronbach's alpha was 0.91. Strong correlation was demonstrated between the WS-10 and WS with 16 items (r = 0.97, p = 0.000). Comparing the level of worry about hypoglycemia between Type 1 and Type 2 diabetic patients established a contrast-group validity of the WS-10 (p = 0.002). Criterion validity was established by correlating the WS-10 with the respondents' glycosylated hemoglobin (r = -0.29, p = 0.002). Test-retest reliability using intraclass correlation (ICC) was established, ICC(1, 1) = 0.68. As the clinical administration of this scale takes less than 5 min, the Chinese WS-10 offers a useful instrument to identify patients with high levels of worry about hypoglycemia for clinical and education interventions. It also provides public health nurses with a reliable and valid prepost measure of intervention effectiveness. The Chinese WS-10 will facilitate further research about the effects of worry concerning hypoglycemia on self-care behaviors with the Chinese populations.

Etiology and outcome of childhood and adolescent diabetes mellitus in North India

The etiology of childhood onset diabetes mellitus (DM) varies between regions and races, and its long-term outcome is affected by social and economic factors. There are scant data on the etiology of childhood DM and outcome of multidisciplinary team management from developing countries. We retrospectively analyzed case records of 160 predominantly middle socio-economic group patients with onset of DM < or =18 years of age for etiology and features at presentation. In addition, we prospectively studied acute and chronic complications and metabolic control in a subset of 67 patients. Type 1 DM comprised 81%, type 2 DM 8%, and fibrocalculous pancreatic DM 9% of patients. Mean HbA1c was 8.0+/-1.5%. Retinopathy was present in 22% and nephropathy in 18% of those with DM duration > or =5 years (mean age 21.2+/-6.8 years, mean duration 10.2+/-4.6 years). The frequency of ketoacidosis and severe hypoglycemia was 5.0 and 3.3 episodes per 100 patient years. Mortality was 7% over 823 person years of follow up. We conclude that fairly good metabolic control is achievable in a middle socio-economic population in India, with the assistance of a diabetes education program. The frequency of microvascular complications is comparable to that in the literature. However, mortality remains unacceptably high.

Ethnicity and glycaemic control are major determinants of diabetic dyslipidaemia in Malaysia

AIMS

To define the prevalence of dyslipidaemia in young diabetic patients in Peninsular Malaysia and the contributory factors of dyslipidaemia in these subjects.

METHODS

This is a cross-sectional study involving 848 young diabetic patients from seven different centres, with representation from the three main ethnic groups. Clinical history and physical examination was done and blood taken for HbA1c, fasting glucose, total cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol and triglycerides.

RESULTS

The overall lipids were suboptimal, worse in Type 2 diabetes mellitus (DM) patients compared with Type 1 DM patients. Of the Type 2 patients, 73.2% had total cholesterol > 5.20 mmol/l, 90.9% had LDL-cholesterol > 2.60 mmol/l, 52.6% had HDL-cholesterol < 1.15 mmol/l and 27.3% had serum triglycerides > 2.30 mmol/l. There were ethnic differences in the lipid levels with the Malays having the highest total cholesterol (mean 6.19 mmol/l), and the highest LDL-cholesterol (mean 4.16 mmol/l), while the Chinese had the highest HDL-cholesterol (geometric mean 1.24 mmol/l). Ethnicity was an important determinant of total, LDL- and HDL-cholesterol in Type 2 DM, and LDL- and HDL-cholesterol and triglycerides in Type 1 DM. Glycaemic control was an important determinant of total, LDL-cholesterol and triglycerides in both Type 1 and Type 2 DM. Waist-hip ratio (WHR) was an important determinant of HDL-cholesterol and triglycerides in both types of DM. Gender was an important determinant of HDL-cholesterol in Type 2 DM, but not in Type 1 DM. Socioeconomic factors and diabetes care facilities did not have any effect on the dyslipidaemia.

CONCLUSIONS

The prevalence of dyslipidaemia was high especially in Type 2 DM patients. Ethnicity, glycaemic control, WHR, and gender were important determinants of dyslipidaemia in young diabetic patients. Diabet. Med. 18, 501-508 (2001)