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Bayat S, Perumal-Pillay VA, Suleman F. Availability and pricing of insulin and related diagnostics in South Africa. J Pharm Policy Pract 2024; 17:2372467. [PMID: 39015751 PMCID: PMC11251433 DOI: 10.1080/20523211.2024.2372467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/10/2024] [Indexed: 07/18/2024] Open
Abstract
Background In South Africa (SA), most patients rely on the government for free healthcare. Some choose to subscribe to a medical insurance scheme. If insulin is unavailable in government or otherwise unaffordable, non-adherence may occur, which can increase complications of the disease. Methods Data on availability and pricing of insulin and related diagnostics was collected from SA pharmacies via an online survey. Co-payments levied on insulin by the biggest medical aids were extracted from formularies. Affordability of these items was then assessed. An adapted methodology from the World Health Organization/Health Action International tool was used. Results There was fairly high availability of insulin in the public sector, with the exception of long-acting insulin which respondents claimed was difficult to find; however, long-acting insulin glargine was available in most private sector pharmacies. Point-of-care (POC) blood glucose testing was free in the public sector but offered in only 31.25% of pharmacies. Patients pay a minimum of USD 40.4 (over 3 days' wages for the lowest paid government worker (LPGW)) for a months' supply of the cheapest insulin, needles and test strips. Insulin in SA was cheaper than 5 other countries, except Australia. Conclusion Overall, there is a good availability of insulin and related diagnostics in SA. Even though insulin is cheaper than other countries, it is unaffordable to the LPGW. This highlights the importance of ensuring a constant availability of insulin in the free public sector. Whilst human insulins are cheaper than newer analogue insulins and SA faces cost constraints, important variables in favour of newer insulins, such as ease-of-use, long term outcomes and value should be considered when treatment guidelines are updated. Annual POC testing should be available and offered free to all patients to detect diabetes early.
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Affiliation(s)
- Samirah Bayat
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Fatima Suleman
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Thapa A, Chibvunde S, Schwartz L, Trujillo C, Ferrari G, Drown L, Gomber A, Park PH, Matanje B, Msekandiana A, Kachimanga C, Bukhman G, Ruderman T, Adler AJ. Appropriateness and acceptability of continuous glucose monitoring in people with type 1 diabetes at rural first-level hospitals in Malawi: a qualitative study. BMJ Open 2024; 14:e075559. [PMID: 38719287 PMCID: PMC11086409 DOI: 10.1136/bmjopen-2023-075559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES The purpose of this qualitative study is to describe the acceptability and appropriateness of continuous glucose monitoring (CGM) in people living with type 1 diabetes (PLWT1D) at first-level (district) hospitals in Malawi. DESIGN We conducted semistructured qualitative interviews among PLWT1D and healthcare providers participating in the study. Standardised interview guides elicited perspectives on the appropriateness and acceptability of CGM use for PLWT1D and their providers, and provider perspectives on the effectiveness of CGM use in Malawi. Data were coded using Dedoose software and analysed using a thematic approach. SETTING First-level hospitals in Neno district, Malawi. PARTICIPANTS Participants were part of a randomised controlled trial focused on CGM at first-level hospitals in Neno district, Malawi. Pretrial and post-trial interviews were conducted for participants in the CGM and usual care arms, and one set of interviews was conducted with providers. RESULTS Eleven PLWT1D recruited for the CGM randomised controlled trial and five healthcare providers who provided care to participants with T1D were included. Nine PLWT1D were interviewed twice, two were interviewed once. Of the 11 participants with T1D, six were from the CGM arm and five were in usual care arm. Key themes emerged regarding the appropriateness and effectiveness of CGM use in lower resource setting. The four main themes were (a) patient provider relationship, (b) stigma and psychosocial support, (c) device usage and (d) clinical management. CONCLUSIONS Participants and healthcare providers reported that CGM use was appropriate and acceptable in the study setting, although the need to support it with health education sessions was highlighted. This research supports the use of CGM as a component of personalised diabetes treatment for PLWT1D in resource constraint settings. TRIAL REGISTRATION NUMBER PACTR202102832069874; Post-results.
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Affiliation(s)
- Ada Thapa
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Leah Schwartz
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Celina Trujillo
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Gina Ferrari
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Laura Drown
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Apoorva Gomber
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Paul H Park
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | - Gene Bukhman
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
- Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Alma J Adler
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Safary E, Beran D, Vetter B, Lepeska M, Abdraimova A, Dunganova A, Besançon S, Lazo-Porras M, Portocarrero Mazanett J, Pérez-León S, Maixenchs M, Nchimbi H, Ramaiya K, Munishi C, Martínez-Pérez GZ. User requirements for non-invasive and minimally invasive glucose self-monitoring devices in low-income and middle-income countries: a qualitative study in Kyrgyzstan, Mali, Peru and Tanzania. BMJ Open 2024; 14:e076685. [PMID: 38367964 PMCID: PMC10875487 DOI: 10.1136/bmjopen-2023-076685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/30/2024] [Indexed: 02/19/2024] Open
Abstract
AIMS Development of non-invasive and minimally invasive glucose monitoring devices (NI-MI-GMDs) generally takes place in high-income countries (HICs), with HIC's attributes guiding product characteristics. However, people living with diabetes (PLWD) in low-income and middle-income countries (LMICs) encounter different challenges to those in HICs. This study aimed to define requirements for NI-MI-GMDs in LMICs to inform a target product profile to guide development and selection of suitable devices. METHODS This was a multiple-methods, exploratory, qualitative study conducted in Kyrgyzstan, Mali, Peru and Tanzania. Interviews and group discussions/activities were conducted with healthcare workers (HCWs), adults living with type 1 (PLWD1) or type 2 diabetes (PLWD2), adolescents living with diabetes and caregivers. RESULTS Among 383 informants (90 HCW, 100 PLWD1, 92 PLWD2, 24 adolescents, 77 caregivers), a range of differing user requirements were reported, including preferences for area of glucose measurement, device attachment, data display, alert type and temperature sensitivity. Willingness to pay varied across countries; common requirements included ease of use, a range of guiding functions, the possibility to attach to a body part of choice and a cost lower than or equal to current glucose self-monitoring. CONCLUSIONS Ease-of-use and affordability were consistently prioritised, with broad functionality required for alarms, measurements and attachment possibilities. Perspectives of PLWD are crucial in developing a target product profile to inform characteristics of NI-MI-GMDs in LMICs. Stakeholders must consider these requirements to guide development and selection of NI-MI-GMDs at country level, so that devices are fit for purpose and encourage frequent glucose monitoring among PLWD in these settings.
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Affiliation(s)
- Elvis Safary
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva, Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | - Beatrice Vetter
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Molly Lepeska
- Health Action International, Amsterdam, The Netherlands
| | | | | | | | - Maria Lazo-Porras
- Division of Tropical and Humanitarian Medicine, University of Geneva, Geneva, Switzerland
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Silvana Pérez-León
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Happy Nchimbi
- Tanzania NCD Alliance, Dar es Salaam, Tanzania, United Republic of
| | - Kaushik Ramaiya
- Tanzania NCD Alliance, Dar es Salaam, Tanzania, United Republic of
| | - Castory Munishi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
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Yuan J, Li M, Jiang X, Lu ZK. National Volume-Based Procurement (NVBP) exclusively for insulin: towards affordable access in China and beyond. BMJ Glob Health 2024; 9:e014489. [PMID: 38232994 PMCID: PMC10806927 DOI: 10.1136/bmjgh-2023-014489] [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: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024] Open
Abstract
Universal access to insulin remains a global public health challenge mainly due to its high price. After unsuccessful healthcare reforms attempting to lower insulin prices over the past several decades, the novel pooled procurement-also known as the national volume-based procurement (NVBP)was initiated exclusively for insulin in China. The NVBP exclusively for insulin represents a unique approach to conquering the challenges in the pooled procurement many low-income and middle-income countries face. In this paper, we described how the pooled procurement mechanism was implemented for insulin in China. Forty-two insulin products from 11 companies were procured, with a median price reduction of 42.08%. The procurement price ranged from US$0.35 to US$1.63 (¥2.35-¥10.97) per defined daily dose (DDD). The median procurement price per DDD was US$$0.54 (¥3.63) for human insulins and US$0.92 (¥6.18) for analogue insulin (p<0.001), respectively. A total of 32 000 medical facilities participated in the procurement, and the pooled demand for insulin was 1.61 billion daily doses, with an estimated saving of US$2.85 billion (¥19 billion) for the first year of the procurement agreement. Insulin affordability and accessibility improved substantially. This study reveals that the NVBP exclusively for insulin could effectively reduce insulin prices and improve access to this essential medicine. Even though the pooled procurement option looks efficient, its long-term impacts on the healthcare system should be closely monitored.
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Affiliation(s)
- Jing Yuan
- Minhang Hospital, School of Pharmacy, Fudan University, Shanghai, China
| | - Minghui Li
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Xiangxiang Jiang
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Zhiqiang Kevin Lu
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
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Owusu BA, Doku DT. Towards an integrated type 1 diabetes management in low-resource settings: barriers faced by patients and their caregivers in healthcare facilities in Ghana. BMC Health Serv Res 2024; 24:21. [PMID: 38178122 PMCID: PMC10768474 DOI: 10.1186/s12913-023-10410-0] [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: 03/30/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND In Low-Middle-Income Countries (LMICs), young people living with Type 1 Diabetes Mellitus (T1DM) face structural barriers which undermine adequate T1DM management and lead to poor health outcomes. However, research on the barriers faced by young people living with T1DM have mostly focused on patient factors, neglecting concerns regarding plausible barriers that may exist at the point of healthcare service delivery. OBJECTIVE This study sought to explore barriers faced by young people living with T1DM and their caregivers at the point of healthcare service delivery. METHODS Data were drawn from a qualitative research in southern Ghana. The research was underpinned by a phenomenological study design. Data were collected from 28 young people living with T1DM, 12 caregivers, and six healthcare providers using semi-structured interview guides. The data were collected at home, hospital, and support group centres via face-to-face interviews, telephone interviews, and videoconferencing. Thematic and framework analyses were done using CAQDAS (QSR NVivo 14). RESULTS Eight key barriers were identified. These were: shortage of insulin and management logistics; healthcare provider knowledge gaps; lack of T1DM care continuity; poor healthcare provider-caregiver interactions; lack of specialists' care; sharing of physical space with adult patients; long waiting time; and outdated treatment plans. The multiple barriers identified suggest the need for an integrated model of T1DM to improve its care delivery in low-resource settings. We adapted the Chronic Care Model (CCM) to develop an Integrated Healthcare for T1DM management in low-resource settings. CONCLUSION Young people living with T1DM, and their caregivers encountered multiple healthcare barriers in both in-patient and outpatient healthcare facilities. The results highlight important intervention areas which must be addressed/improved to optimise T1DM care, as well as call for the implementation of a proposed integrated approach to T1DM care in low-resource settings.
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Affiliation(s)
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Dwivedi J, Wal P, Dash B, Ovais M, Sachan P, Verma V. Diabetic Pneumopathy- A Novel Diabetes-associated Complication: Pathophysiology, the Underlying Mechanism and Combination Medication. Endocr Metab Immune Disord Drug Targets 2024; 24:1027-1052. [PMID: 37817659 DOI: 10.2174/0118715303265960230926113201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/03/2023] [Accepted: 07/20/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND The "diabetic lung" has been identified as a possible target organ in diabetes, with abnormalities in ventilation control, bronchomotor tone, lung volume, pulmonary diffusing capacity, and neuroadrenergic bronchial innervation. OBJECTIVE This review summarizes studies related to diabetic pneumopathy, pathophysiology and a number of pulmonary disorders including type 1 and type 2 diabetes. METHODS Electronic searches were conducted on databases such as Pub Med, Wiley Online Library (WOL), Scopus, Elsevier, ScienceDirect, and Google Scholar using standard keywords "diabetes," "diabetes Pneumopathy," "Pathophysiology," "Lung diseases," "lung infection" for review articles published between 1978 to 2023 very few previous review articles based their focus on diabetic pneumopathy and its pathophysiology. RESULTS Globally, the incidence of diabetes mellitus has been rising. It is a chronic, progressive metabolic disease. The "diabetic lung" may serve as a model of accelerated ageing since diabetics' rate of respiratory function deterioration is two to three-times higher than that of normal, non-smoking people. CONCLUSION Diabetes-induced pulmonary dysfunction has not gained the attention it deserves due to a lack of proven causality and changes in cellular properties. The mechanism underlying a particular lung illness can still only be partially activated by diabetes but there is evidence that hyperglycemia is linked to pulmonary fibrosis in diabetic people.
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Affiliation(s)
- Jyotsana Dwivedi
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
| | - Pranay Wal
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
| | - Biswajit Dash
- Department of Pharmaceutical Technology, ADAMAS University, West Bengal, India
| | | | - Pranjal Sachan
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
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Moro G, Fratte CD, Normanno N, Polo F, Cinti S. Point-of-Care Testing for the Detection of MicroRNAs: Towards Liquid Biopsy on a Chip. Angew Chem Int Ed Engl 2023; 62:e202309135. [PMID: 37672490 DOI: 10.1002/anie.202309135] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/08/2023]
Abstract
Point-of-care (PoC) testing is revolutionizing the healthcare sector improving patient care in daily hospital practice and allowing reaching even remote geographical areas. In the frame of cancer management, the design and validation of PoC enabling the non-invasive, rapid detection of cancer markers is urgently required to implement liquid biopsy in clinical practice. Therefore, focusing on stable blood-based markers with high-specificity, such as microRNAs, is of crucial importance. In this work, we highlight the potential impact of circulating microRNAs detection on cancer management and the crucial role of PoC testing devices, especially for low-income countries. A detailed discussion about the challenges that should be faced to promote the technological transfer and clinical use of these tools has been added, to provide the readers with a complete overview of potentialities and current limitations.
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Affiliation(s)
- Giulia Moro
- Department of Pharmacy, University of Naples Federico II, Via Montesano 9, 80131, Naples, Italy
| | - Chiara Dalle Fratte
- Department of Medical Biotechnology and Translational Medicine, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan "Statale", Via Vanvitelli 32, 20133, Milan, Italy
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori (IRCCS), Fondazione Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Federico Polo
- Department of Molecular Sciences and Nanosystems, Ca' Foscari University of Venice, Via Torino 155, 30172, Venice, Italy
- European Centre for Living Technology (ECLT), Ca' Foscari University of Venice Ca' Bottacin, 30124, Venice, Italy
| | - Stefano Cinti
- Department of Pharmacy, University of Naples Federico II, Via Montesano 9, 80131, Naples, Italy
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Han CY, Zhang J, Ye XM, Lu JP, Jin HY, Xu WW, Wang P, Zhang M. Telemedicine-assisted structured self-monitoring of blood glucose in management of T2DM results of a randomized clinical trial. BMC Med Inform Decis Mak 2023; 23:182. [PMID: 37710226 PMCID: PMC10500819 DOI: 10.1186/s12911-023-02283-4] [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: 11/10/2022] [Accepted: 09/02/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND This prospective study aimed to compare telemedicine-assisted structured self-monitoring of blood glucose(SMBG) with a traditional blood glucose meter (BGM) in adults of type 2 diabetes mellitus (T2DM). METHODS Adult participants with T2DM were assigned to an intervention group or a control group. The patients in the intervention group received a connected BGM with real-time data submission as well as individual needs-based tele-coaching to address and improve motivation and daily diabetes self-management. The patients in the control group received a traditional BGM. Changes in glycated hemoglobin(HbA1c), low blood glucose index(LBGI), and diabetes self-management behaviors were analyzed. RESULTS The study demonstrated the superiority of the telemedicine-assisted structured SMBG versus the traditional BGM for improving HbA1c. Additionally, the telemedicine-assisted SMBG reduced the risk of hypoglycemia and enhanced diabetes self-management behaviors, as differences in the LBGI and the Diabetes Self-Management Questionnaire(DSMQ) results between the groups after 6 months were found to be significant. CONCLUSIONS Telemedicine-assisted structured SMBG helps physicians and patients to achieve a specific level of glycemic control and reduce hypoglycemia. The use of coaching applications and telemedicine-assisted SMBG indicated beneficial effects for T2DM self-management, which may help limit disease progression. TRIAL REGISTRATION Chinese Clinical Trail Registry No: ChiCTR2300072356 on 12/06/2023. Retrospectively registered.
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Affiliation(s)
- Chen-Yu Han
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, No.1158 of Gongyuan Road, Qingpu District, Shanghai, 201700, China
| | - Jian Zhang
- Department of Pharmacology, Medical College of Shaoxing University, Shaoxing, 312000, China
| | - Xiao-Mei Ye
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, No.1158 of Gongyuan Road, Qingpu District, Shanghai, 201700, China
| | - Jia-Ping Lu
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, No.1158 of Gongyuan Road, Qingpu District, Shanghai, 201700, China
| | - Hai-Ying Jin
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, No.1158 of Gongyuan Road, Qingpu District, Shanghai, 201700, China
| | - Wei-Wei Xu
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, No.1158 of Gongyuan Road, Qingpu District, Shanghai, 201700, China
| | - Ping Wang
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, No.1158 of Gongyuan Road, Qingpu District, Shanghai, 201700, China
| | - Min Zhang
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, No.1158 of Gongyuan Road, Qingpu District, Shanghai, 201700, China.
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Kabakambira JD, Kong JM. Optimizing Type 2 Diabetes Management in a Medically Complex Patient: A Case Report of a Patient with Type 2 Diabetes and HIV. Diabetes Metab Syndr Obes 2023; 16:2401-2406. [PMID: 37588513 PMCID: PMC10426454 DOI: 10.2147/dmso.s415949] [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: 05/08/2023] [Accepted: 08/05/2023] [Indexed: 08/18/2023] Open
Abstract
Background The prevalence of diabetes is rapidly escalating, with projections indicating that 783 million individuals aged 20-79 years worldwide will be affected by diabetes. This rise is concurrent with a persistent prevalence of HIV in developing nations, while conventional risk factors such as sedentary lifestyle and unhealthy diet may account for this trend, HIV and its treatment have emerged as potential contributing factors. Achieving optimal diabetes control in patients with HIV necessitates a profound understanding of the intricate interplay between the two diseases and their respective treatments. Case Report We present a case involving a patient with long standing type 2 diabetes, coexisting HIV infection and hypertension. Despite receiving high doses of insulin, as advised by most diabetes guidelines, the patient's diabetes remained poorly controlled. In lieu of strictly adhering to guidelines, our primary focus was to conduct a comprehensive reevaluation of the patient's medications, prioritizing the development of streamlined and safe treatment regimens for all three of her medical conditions. Employing this strategy, we observed swift improvement in blood glucose levels, leading to successful diabetes control within one year. Conclusion This case underscores the importance of individualizing diabetes management in patients with multiple comorbidities. It highlights the significance of reassessing treatment approaches beyond standard guidelines, with a focus on tailoring therapy to suit the unique needs and complexities of each patient's medical profile. Such personalized interventions hold promise for achieving optimal diabetes control in individuals with diverse comorbidities.
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Affiliation(s)
| | - Jason M Kong
- Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
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Pylov D, Polonsky W, Imberg H, Holmer H, Hellman J, Wijkman M, Bolinder J, Heisse T, Dahlqvist S, Nyström T, Schwarz E, Hirsch I, Lind M. Treatment Satisfaction and Well-Being With CGM in People With T1D: An Analysis Based on the GOLD Randomized Trial. J Diabetes Sci Technol 2023:19322968231183974. [PMID: 37501366 DOI: 10.1177/19322968231183974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND The GOLD trial demonstrated that continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D) managed with multiple daily insulin injections (MDI) improved not only glucose control but also overall well-being and treatment satisfaction. This analysis investigated which factors contributed to improved well-being and treatment satisfaction with CGM. METHODS The GOLD trial was a randomized crossover trial comparing CGM versus self-monitored blood glucose (SMBG) over 16 months. Endpoints included well-being measured by the World Health Organization-Five Well-Being Index (WHO-5) and treatment satisfaction by the Diabetes Treatment Satisfaction Questionnaire (DTSQ) as well as glucose metrics. Multivariable R2-decomposition was used to understand which variables contributed most to treatment satisfaction. RESULTS A total of 139 participants were included. Multivariable analyses revealed that increased convenience and flexibility contributed to 60% (95% confidence interval [CI] = 50%-69%) of the improvement in treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire change version [DTSQc]) observed with CGM, whereas perceived effects on hypoglycemia and hyperglycemia only contributed to 6% (95% CI = 2%-11%) of improvements. Significant improvements in well-being (WHO-5) by CGM were observed for the following: feeling cheerful (P = .025), calm and relaxed (P = .024), being active (P = .046), and waking up fresh and rested (P = .044). HbA1c reductions and increased time in range (TIR) were associated with increased treatment satisfaction, whereas glycemic variability was not. HbA1c reduction showed also an association with increased well-being and increased TIR with less diabetes-related distress. CONCLUSIONS While CGM improves glucose control in people with T1D on MDI, increased convenience and flexibility through CGM is of even greater importance for treatment satisfaction and patient well-being. These CGM-mediated effects should be taken into account when considering CGM initiation.
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Affiliation(s)
- Daniel Pylov
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - William Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA
- University of California, San Diego, CA, USA
| | - Henrik Imberg
- Chalmers University of Technology, Gothenburg, Sweden
- University of Gothenburg, Gothenburg, Sweden
- Statistiska Konsultgruppen, Gothenburg, Sweden
| | - Helen Holmer
- Department of Internal Medicine, Centralsjukhuset, Kristianstad, Sweden
| | - Jarl Hellman
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
| | - Magnus Wijkman
- Department of Internal Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Jan Bolinder
- Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | - Sofia Dahlqvist
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
| | - Thomas Nyström
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Erik Schwarz
- Department of Internal Medicine, Faculty of Medicine & Health, Örebro University, Örebro Sweden
| | - Irl Hirsch
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Marcus Lind
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
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11
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Pulungan AB, de Beaufort C, Ratnasari AF, Puteri HA, Lewis-Watts L, Bhutta ZA. Availability and access to pediatric diabetes care: a global descriptive study. Clin Pediatr Endocrinol 2023; 32:137-146. [PMID: 37362165 PMCID: PMC10288289 DOI: 10.1297/cpe.2023-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 06/28/2023] Open
Abstract
A decade since the discovery of insulin, the increasing prevalence of type 1 diabetes mellitus (T1DM) has underscored the prevailing inequalities in the provision of essential care for T1DM worldwide. However, the details on the availability of insulin types and associated medical devices remain unclear. A cross-sectional electronic survey was distributed across a global network of pediatric societies under the umbrella of the International Pediatric Association (IPA). Access to and availability of pediatric diabetes care were investigated using standardized questions. Responses from 25 of 132 pediatric societies across six regions were included. Pediatric endocrinologists typically manage T1DM together with pediatricians or adult endocrinologists. Nonetheless, 24% of the respondents reported pediatricians to be the sole healthcare professionals. According to the respondents, the patients were either partially or completely responsible for payments of insulin (40%), A1C (24%), C-peptide (28%), and antibody testing for diagnosis (28%). Government support is generally available for insulin, but this was merely 20% for insulin pumps and 12% for continuous glucose monitors. There are considerable disparities in the access, availability, and affordability of diabetes testing, medications, and support between countries with significant out-of-pocket payments for care. Country- and region-specific improvements to national programs are necessary to achieve optimal pediatric diabetes care globally.
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Affiliation(s)
- Aman B Pulungan
- Department of Child Health, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- International Pediatric Association (IPA)
- NCD Child
- International Society for Pediatric and Adolescent Diabetes (ISPAD)
| | - Carine de Beaufort
- International Society for Pediatric and Adolescent Diabetes (ISPAD)
- Diabetes & Endocrine Care Clinique Pe ´diatrique (DECCP), Clinique Pédiatrique/Centre Hospitalier (CH) de Luxembourg, Luxembourg, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-Belval, Luxembourg
| | | | - Helena A Puteri
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Laura Lewis-Watts
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- International Pediatric Association (IPA)
- NCD Child
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
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12
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Owusu BA, Ofori-Boateng P, Forbes A, Doku DT. Knowledge of young people living with type 1 diabetes and their caregivers about its management. Nurs Open 2023; 10:2426-2438. [PMID: 36448367 PMCID: PMC10006669 DOI: 10.1002/nop2.1498] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/23/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
AIMS AND OBJECTIVE We sought to investigate knowledge and skills of type 1 diabetes (T1D) management among young people living with the disease and their caregivers. Our aim is to provide baseline evidence to inform T1D self-management education for young people living with the disease and their caregivers. BACKGROUND Both local and international guidelines recommend ongoing T1D self-management education for people living with the disease. This is because T1D often develops among young people who rarely have the competencies to adequately manage their condition. However, the extent to which young people living with T1D and their caregivers can self-manage this chronic disease in a low-resource country like Ghana is unknown. METHODS Using a phenomenological study design, semi-structured interviews were conducted with 28 young people living with type 1 diabetes, 12 caregivers and 6 healthcare providers in southern Ghana. Data were collected at homes, hospitals and support group centres of participants via face-to-face interviews, photovoice and video-conferencing. The data were analysed thematically using QSR NVivo 11. RESULTS The young people living with T1D and their caregivers demonstrated knowledge and skills in the self-monitoring of blood glucose, and the treatment of hyperglycaemia. Areas of more marginal or lack of knowledge were concerning carbohydrate counting, severe hypoglycaemia and the management of intercurrent illnesses. Young persons living with T1D and their caregivers received their management information from healthcare and non-healthcare providers. Access to diabetes self-management education influenced T1D management knowledge and practices. CONCLUSION Young people living with type 1 diabetes and their caregivers possessed limited scope of knowledge on type 1 diabetes self-management. Multiple sources of T1D knowledge were found, some of which may not be helpful to patients. The knowledge gaps identified compromises transitional independence and self-management capacity. RELEVANCE TO CLINICAL PRACTICE It is important for clinicians and organizations that provide T1D education to provide diabetes self-management education also on managing hypoglycaemia, carbohydrate counting and managing T1D during intercurrent life events among young people living with T1D. NO PATIENT OR PUBLIC CONTRIBUTION Patients and their caregivers were interviewed as research participants. They did not conceptualize, analyse, interpret or prepare the manuscript.
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Affiliation(s)
| | - Prince Ofori-Boateng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,Cape Coast Teaching Hospital, Central Region, Cape Coast, Ghana
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, London, UK
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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13
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Ruderman T, Ferrari G, Valeta F, Boti M, Kumwenda K, Park PH, Ngoga G, Ndarama E, Connolly E, Bukhman G, Adler A. Implementation of self-monitoring of blood glucose for patients with insulin-dependent diabetes at a rural non-communicable disease clinic in Neno, Malawi. S Afr Med J 2023; 113:84-90. [PMID: 36757071 DOI: 10.7196/samj.2023.v113i2.16643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) is a widely accepted standard of practice for management of insulin-dependentdiabetes, yet is largely unavailable in rural sub-Saharan Africa (SSA). This prospective cohort study is the first known report ofimplementation of SMBG in a rural, low-income country setting. OBJECTIVES To evaluate adherence and change in clinical outcomes with SMBG implementation at two rural hospitals in Neno, Malawi. METHODS Forty-eight patients with type 1 and insulin-dependent type 2 diabetes were trained to use glucometers and logbooks. Participantsmonitored preprandial glucose daily at rotating times and overnight glucose once a week. Healthcare providers were trained to evaluateglucose trends, and adjusted insulin regimens based on results. Adherence was measured as the frequency with which patients checked anddocumented blood glucose at prescribed times, while clinical changes were measured by change in glycated haemoglobin (HbA1c) over a6-month period. RESULTS Participants brought their glucometers and logbooks to the clinic 95 - 100% of the time. Adherence with measuring glucose valuesand recording them in logbooks eight times a week was high (mean (standard deviation) 69.4% (15.7) and 69.0% (16.6), respectively). MeanHbA1c decreased from 9.0% (75 mmol/mol) at enrolment to 7.8% (62 mmol/mol) at 6 months (mean difference 1.2% (95% confidenceinterval (CI) 0.6 - 2.0; p=0.0005). The difference was greater for type 1 diabetes (1.6%; 95% CI 0.6 - 2.7; p=0.0031) than for type 2 diabetes(0.9%; 95% CI 0.1 - 1.9; p=0.0630). There was no documented increase in hypoglycaemic events, and no hospitalisations or deaths occurred. CONCLUSION SMBG is feasible for patients with insulin-dependent diabetes in a rural SSA population, and may be associated with improvedHbA1c levels. Despite common misconceptions, all patients, regardless of education level, can benefit from SMBG. Further research onlong-term retention of SMBG activities and the benefits of increasing frequency of monitoring is warranted.
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Affiliation(s)
| | - G Ferrari
- NCD Synergies project, Partners in Health, Boston, Mass., USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Mass., USA.
| | - F Valeta
- Partners in Health, Neno, Malawi.
| | - M Boti
- Partners in Health, Neno, Malawi.
| | | | - P H Park
- NCD Synergies project, Partners in Health, Boston, Mass., USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Mass., USA; Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Mass., USA.
| | - G Ngoga
- NCD Synergies project, Partners in Health, Boston, Mass., USA; Noncommunicable Disease Program, Partners in Health, Rwanda; Non-Communicable Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda.
| | - E Ndarama
- Ministry of Health and Populations, Neno, Malawi.
| | - E Connolly
- Partners in Health, Neno, Malawi; Division of Pediatrics, University of Cincinnati College of Medicine, Ohio, USA; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Ohio, USA.
| | - G Bukhman
- NCD Synergies project, Partners in Health, Boston, Mass., USA; ivision of Global Health Equity, Brigham and Women's Hospital, Boston, Mass., USA; Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Mass., USA.
| | - A Adler
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Mass., USA.
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14
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Aparicio-Martínez EP, Vega-Rios A, Osuna V, Dominguez RB. Salivary Glucose Detection with Laser Induced Graphene/AgNPs Non-Enzymatic Sensor. BIOSENSORS 2023; 13:207. [PMID: 36831974 PMCID: PMC9954126 DOI: 10.3390/bios13020207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
The tailoring of novel nanomaterials for sensitive glucose detection through a non-enzymatic mechanism is currently under intensive research. Here, we present a laser-induced graphene (LIG) electrode decorated with silver nanoparticles (AgNPs) as a catalytic element for the direct electrooxidation of glucose. The AgNPs were synthesized through cyclic voltammetry using LIG as a template, resulting in a porous tridimensional assembly with anchored nanostructures. The characterization corroborated the formation of LIG/AgNPs composite with distinctive peaks attributed to Ag2O and AgO interaction with glucose. The proposed non-enzymatic sensors were successfully applied for non-enzymatic amperometric detection, exhibiting a linear range from 1 to 10 mM in the first peak (+0.7 V) and a narrow range from 1 to 2 mM with higher sensitivity of 52.2 mA/mM and improved LOD of 45 μM in the second peak (+0.55 V). The applicability of the LIG/AgNPs sensor was evaluated with spiked artificial saliva in a PoC format using a smartphone potentiostat, showing an average recovery rate of 91%. The analysis was performed in a portable, mobile, and low-cost fashion using a simulated non-invasive sample, with promising results in clinical ranges.
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Affiliation(s)
- Eider Pedro Aparicio-Martínez
- Centro de Investigación en Materiales Avanzados, SC, Miguel de Cervantes #120, Complejo Industrial Chihuahua, Chihuahua 31136, Mexico
| | - Alejandro Vega-Rios
- Centro de Investigación en Materiales Avanzados, SC, Miguel de Cervantes #120, Complejo Industrial Chihuahua, Chihuahua 31136, Mexico
| | - Velia Osuna
- CONACyT-CIMAV, SC, Miguel de Cervantes #120, Complejo Industrial Chihuahua, Chihuahua 31136, Mexico
| | - Rocio Berenice Dominguez
- CONACyT-CIMAV, SC, Miguel de Cervantes #120, Complejo Industrial Chihuahua, Chihuahua 31136, Mexico
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15
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Chahrour KM, Ooi PC, Nazeer AA, Al-Hajji LA, Jubu PR, Dee CF, Ahmadipour M, Hamzah AA. CuO/Cu/rGO nanocomposite anodic titania nanotubes for boosted non-enzymatic glucose biosensors. NEW J CHEM 2023. [DOI: 10.1039/d3nj00666b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Highly arranged porous anodic titania (TiO2) nanotube arrays (ATNT) were fruitfully fabricated by the anodization of Ti foil in an ammonium fluoride electrolyte.
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Affiliation(s)
- Khaled M. Chahrour
- Mechanical Engineering Dept., Faculty of Engineering, Karabuk University, 78050, Karabuk, Turkey
- Institute of Microengineering and Nanoelectronics (IMEN), Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia
| | - Poh Choon Ooi
- Institute of Microengineering and Nanoelectronics (IMEN), Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia
| | - Ahmed Abdel Nazeer
- Nanotechnology and Advanced Materials Program, Energy & Building Research Center, Kuwait Institute for Scientific Research (KISR), P.O. Box 24885, Safat, 13109, Kuwait
- Electrochemistry Laboratory, Physical Chemistry Department, National Research Center, Giza, Egypt
| | - Latifa A. Al-Hajji
- Nanotechnology and Advanced Materials Program, Energy & Building Research Center, Kuwait Institute for Scientific Research (KISR), P.O. Box 24885, Safat, 13109, Kuwait
| | - Peverga R. Jubu
- Department of Physics, University of Agriculture Makurdi (Now Joseph Sarwuan Tarka University Makurdi), P.M.B. 2373, Makurdi, Benue State, Nigeria
| | - Chang Fu Dee
- Institute of Microengineering and Nanoelectronics (IMEN), Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia
| | - Mohsen Ahmadipour
- Institute of Microengineering and Nanoelectronics (IMEN), Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia
| | - Azrul Azlan Hamzah
- Institute of Microengineering and Nanoelectronics (IMEN), Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia
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16
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Lim LL, Lau ES, Kong AP, Fu AW, Lau V, Jia W, Sheu WH, Sobrepena L, Yoon K, Tan AT, Chia YC, Sosale A, Saboo BD, Kesavadev J, Goh SY, Nguyen TK, Thewjitcharoen Y, Suwita R, Ma RC, Chow EY, Luk AO, Chan JC. Gender-associated cardiometabolic risk profiles and health behaviors in patients with type 2 diabetes: a cross-sectional analysis of the Joint Asia Diabetes Evaluation (JADE) program. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 32:100663. [PMID: 36785858 PMCID: PMC9918795 DOI: 10.1016/j.lanwpc.2022.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 10/31/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022]
Abstract
Background In Asia, diabetes-associated death due to cardiorenal diseases were 2-3 times higher in women than men which might be due to gender disparity in quality of care and health habits. Methods Adults with type 2 diabetes (T2D) from 11 Asian countries/areas were assessed using the same protocol (2007-2015). We compared treatment target attainment (HbA1c < 7%, blood pressure [BP] < 130/80 mmHg, risk-based LDL-cholesterol, lack of central obesity [waist circumference <90 cm in men or <80 cm in women), use of cardiorenal-protective drugs (renin-angiotensin system [RAS] inhibitors, statins), and self-reported health habits including self-monitoring blood glucose (SMBG) by gender. Analyses were stratified by countries/areas, age of natural menopause (<50 vs. ≥50 years), and comorbidities (atherosclerotic cardiovascular disease [ASCVD], heart failure, kidney impairment [eGFR < 60 mL/min/1.73 m2]). Findings Among 106,376 patients (53.2% men; median (interquartile range) diabetes duration: 6.0 (2.0-12.0) years; mean ± SD HbA1c 8.0 ± 1.9%; 27% insulin-treated), women were older and less likely to receive college education than men (28.9% vs. 48.8%). Women were less likely to smoke/drink alcohol and were physically less active than men. Women had lower BP (<130/80 mmHg: 29.4% vs. 25.7%), less general obesity (54.8% vs. 57.8%) but more central obesity than men (77.5% vs. 57.3%). Women were less likely to have ASCVD (12.8% vs. 17.0%) or heart failure (1.3% vs. 2.3%), but more likely to have kidney impairment (22.3% vs. 17.6%) and any-site cancer than men (2.5% vs. 1.6%). In most countries/areas, more men attained HbA1c <7% and risk-based LDL-cholesterol level than women. After adjusting for potential confounders including countries and centres, men had 1.63 odds ratio (95% CI 1.51, 1.74) of attaining ≥3 treatment targets than women. Interpretation Asian women with T2D had worse quality of care than men especially in middle-income countries/areas, calling for targeted implementation programs to close these care gaps. Sponsor Asia Diabetes Foundation. Funding Nil.
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Affiliation(s)
- Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China,Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, China
| | - Eric S.H. Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China,Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, China
| | - Alice P.S. Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Amy W.C. Fu
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, China
| | - Vanessa Lau
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, China
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Clinical Centre for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wayne H.H. Sheu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - K.H. Yoon
- Department of Endocrinology and Metabolism, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | | | - Yook-Chin Chia
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore
| | | | | | - Raymond Suwita
- Cerebrocardiovascular Diabetes Group Clinic (CDG), Jakarta, Indonesia
| | - Ronald C.W. Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Elaine Y.K. Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Andrea O.Y. Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Juliana C.N. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China,Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, China,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China,Corresponding author. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
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17
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Stene LC, Haynes A. Trending now: modelling global epidemiology of type 1 diabetes in children and adolescents. Lancet Diabetes Endocrinol 2022; 10:828-829. [PMID: 36372071 DOI: 10.1016/s2213-8587(22)00306-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Lars C Stene
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo 0213, Norway; Oslo Diabetes Research Centre, Oslo, Norway.
| | - Aveni Haynes
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
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18
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Lek N, Manivong A, Rassavong K, Phommachack D, Toomey C, Ng SM. Type 1 diabetes in Laos, 2016-2021. Pediatr Diabetes 2022; 23:620-626. [PMID: 35598163 PMCID: PMC9545879 DOI: 10.1111/pedi.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/10/2022] [Accepted: 05/15/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Before 2016, no child was known to survive type 1 diabetes (T1D) in Laos, a lower-middle income country (LMIC) in South-east Asia. In partnership with the Laos government, a non-government organization (NGO) called Action4Diabetes (A4D) has since been providing insulin, blood glucose monitoring kits, HbA1c testing, and emergency hospital expenses for Laotian children and young people (CYP) with T1D, and education for healthcare professionals. Here, we report the demographics and clinical outcomes of the CYP with T1D enrolled in A4D's Clinic Support Programme. RESEARCH DESIGN AND METHODS We collated and analyzed data on all known CYP with T1D in Laos, including gender, age and presentation at diagnosis, duration of diabetes, hospital admissions, and glycemic control during follow-up. RESULTS Fifty-three CYP (30 male; 57%) were diagnosed with T1D at a mean age of 11.3 years. Thirty CYP (57%) presented in diabetic ketoacidosis (DKA) at diagnosis. As at 16 August 2021, mean duration of T1D was 2.3 years. Forty-five CYP (85%) remained on active follow-up. Mean HbA1c for all 53 CYP was 8.7% (72 mmol/mol). Average HbA1c for the CYP in the age ranges of 1-5 years, 6-10 years, 11-15 years, 16-20 years, and 21-25 years, was 7.9% (63 mmol/mol), 8.2% (66), 8.4% (68), 9.4% (79), and 8.4% (68), respectively. CONCLUSIONS This is the first report on the status of T1D care in Laos, achieved through close partnership between the government and an NGO from 2016 to 2021. More global efforts to improve T1D care outcomes in Laos and other LMICs are urgently needed.
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Affiliation(s)
- Ngee Lek
- Department of PaediatricsKK Women's and Children's HospitalSingaporeSingapore
| | | | | | | | | | - Sze May Ng
- Southport and Ormskirk Hospital NHS TrustOrmskirkUK,Department of Women's and Children's HealthUniversity of LiverpoolLiverpoolUK
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19
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Fiedorova K, Augustynek M, Kubicek J, Kudrna P, Bibbo D. Review of present method of glucose from human blood and body fluids assessment. Biosens Bioelectron 2022; 211:114348. [DOI: 10.1016/j.bios.2022.114348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 03/22/2022] [Accepted: 05/05/2022] [Indexed: 12/15/2022]
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20
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Zafra-Tanaka JH, Beran D, Vetter B, Sampath R, Bernabe-Ortiz A. Technologies for Diabetes Self-Monitoring: A Scoping Review and Assessment Using the REASSURED Criteria. J Diabetes Sci Technol 2022; 16:962-970. [PMID: 33686875 PMCID: PMC9264435 DOI: 10.1177/1932296821997909] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Self-management is an important pillar for diabetes control and to achieve it, glucose self-monitoring devices are needed. Currently, there exist several different devices in the market and many others are being developed. However, whether these devices are suitable to be used in resource constrained settings is yet to be evaluated. AIMS To assess existing glucose monitoring tools and also those in development against the REASSURED which have been previously used to evaluate diagnostic tools for communicable diseases. METHODS We conducted a scoping review by searching PubMed for peer-review articles published in either English, Spanish or Portuguese in the last 5 years. We selected papers including information about devices used for self-monitoring and tested on humans with diabetes; then, the REASSURED criteria were used to assess them. RESULTS We found a total of 7 continuous glucose monitoring device groups, 6 non-continuous, and 6 devices in development. Accuracy varied between devices and most of them were either invasive or minimally invasive. Little to no evidence is published around robustness, affordability and delivery to those in need. However, when reviewing publicly available prices, none of the devices would be affordable for people living in low- and middle-income countries. CONCLUSIONS Available devices cannot be considered adapted for use in self-monitoring in resource constraints settings. Further studies should aim to develop less-invasive devices that do not require a large set of components. Additionally, we suggest some improvement in the REASSURED criteria such as the inclusion of patient-important outcomes to increase its appropriateness to assess non-communicable diseases devices.
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Affiliation(s)
- Jessica Hanae Zafra-Tanaka
- CRONICAS Centre of Excellence in
Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Jessica Hanae Zafra-Tanaka, MD, MSc,
CRONICAS Center of Excellence for Chronic Diseases, Universidad
Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18,
Perú.
| | - David Beran
- Division of Tropical and
Humanitarian Medicine, University of Geneva and Geneva University Hospitals,
Geneva, Switzerland
| | - Beatrice Vetter
- Foundation for Innovative New
Diagnostics, Geneva, Switzerland
| | | | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in
Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
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21
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Ye J, Deng J, Liang W, Luo H, Wen M, Liu L, Wang M, Shu Y. Time in Range Assessed by Capillary Blood Glucose in Relation to Insulin Sensitivity and β-Cell Function in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in China. J Diabetes Investig 2022; 13:1825-1833. [PMID: 35739637 DOI: 10.1111/jdi.13876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS This study investigated the association of capillary blood glucose (CBG)-assessed time in range (TIR) (3.9-10.0 mmol/L) with insulin sensitivity and islet β-cell function (BCF). MATERIALS AND METHODS We recruited 455 patients with type 2 diabetes mellitus. Seven-point glucose-profile data (pre- and 120-min post-main meals, bedtime) were collected over three consecutive days. Plasma glucose and serum insulin concentrations were measured at 0, 60, and 120 min after a 100-g standard steamed bread meal test. The homeostasis model assessment of insulin resistance (HOMA-IR) and Matsuda index were computed to evaluate insulin resistance (IR). HOMA of β-cell function (HOMA-β) and the area under the curve between insulin and blood glucose (IAUC0-120 /GAUC0-120 ) were used to estimate BCF. RESULTS TIR was positively correlated with 60- and 120-min insulin values, IAUC0-120 , the Matsuda index, HOMA-β, and IAUC0-120 /GAUC0-120 (rs : 0.154, 0.129, 0.137, 0.194, 0.341, and 0.334, respectively; P <0.05) but inversely correlated with HOMA-IR (rs : -0.239, P <0.001). After adjusting for confounders, multinomial multiple logistic regression analysis revealed that the odds ratios (ORs) of achieving the target TIR (>70%) increased by 12% (95% confidence interval [CI]: 3-21%), 7% (95% CI: 1-14%), 10% (95% CI: 5-16%), and 45% (95% CI: 25-68%) for each 10-mIU/L increase in 60- and 120-min insulin value, 10-unit increase in HOMA-β, and unit increase in IAUC0-120 /GAUC0-120 , respectively (P <0.05). Nevertheless, the OR decreased by 10% (95% CI: 1-18%) for each unit increase in HOMA-IR (P <0.05). CONCLUSIONS IR and BCF are related to CBG-assessed TIR.
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Affiliation(s)
- Jingwen Ye
- Department of Endocrinology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
| | - Jiajin Deng
- Department of Ophthalmology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
| | - Weiqiang Liang
- Department of Endocrinology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
| | - Haizhao Luo
- Department of Endocrinology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
| | - Mei Wen
- Department of Endocrinology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
| | - Lei Liu
- Department of Endocrinology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
| | - Mingzhu Wang
- Department of Endocrinology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
| | - Yi Shu
- Department of Endocrinology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
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22
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Vargas E, Aiello EM, Ben Hassine A, Ruiz-Valdepeñas Montiel V, Pinsker JE, Church MM, Laffel LM, Doyle FJ, Patti ME, Dassau E, Wang J. Concept of the "Universal Slope": Toward Substantially Shorter Decentralized Insulin Immunoassays. Anal Chem 2022; 94:9217-9225. [PMID: 35715001 DOI: 10.1021/acs.analchem.2c02178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Decentralized sensing of analytes in remote locations is today a reality. However, the number of measurable analytes remains limited, mainly due to the requirement for time-consuming successive standard additions calibration used to address matrix effects and resulting in greatly delayed results, along with more complex and costly operation. This is particularly challenging in commonly used immunoassays of key biomarkers that typically require from 60 to 90 min for quantitation based on two standard additions, hence hindering their implementation for rapid and routine diagnostic applications, such as decentralized point-of-care (POC) insulin testing. In this work we have developed and demonstrated the theoretical framework for establishing a universal slope for direct calibration-free POC insulin immunoassays in serum samples using an electrochemical biosensor (developed originally for extended calibration by standard additions). The universal slope is presented as an averaged slope constant, relying on 68 standard additions-based insulin determinations in human sera. This new quantitative analysis approach offers reliable sample measurement without successive standard additions, leading to a dramatically simplified and faster assay (30 min vs 90 min when using 2 standard additions) and greatly reduced costs, without compromising the analytical performance while significantly reducing the analyses costs. The substantial improvements associated with the new universal slope concept have been demonstrated successfully for calibration-free measurements of serum insulin in 30 samples from individuals with type 1 diabetes using meticulous statistical analysis, supporting the prospects of applying this immunoassay protocol to routine decentralized POC insulin testing.
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Affiliation(s)
- Eva Vargas
- Department of Nanoengineering, University of California San Diego, La Jolla, California 92093, United States
| | - Eleonora M Aiello
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, Massachusetts 02134, United States.,Sansum Diabetes Research Institute, Santa Barbara, California 93105, United States
| | - Amira Ben Hassine
- Department of Nanoengineering, University of California San Diego, La Jolla, California 92093, United States
| | | | - Jordan E Pinsker
- Sansum Diabetes Research Institute, Santa Barbara, California 93105, United States
| | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, California 93105, United States
| | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215, United States
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, Massachusetts 02134, United States.,Sansum Diabetes Research Institute, Santa Barbara, California 93105, United States
| | - Mary-Elizabeth Patti
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215, United States
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, Massachusetts 02134, United States.,Sansum Diabetes Research Institute, Santa Barbara, California 93105, United States
| | - Joseph Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, California 92093, United States
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23
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Fralick M, Jenkins AJ, Khunti K, Mbanya JC, Mohan V, Schmidt MI. Global accessibility of therapeutics for diabetes mellitus. Nat Rev Endocrinol 2022; 18:199-204. [PMID: 35039662 PMCID: PMC8762447 DOI: 10.1038/s41574-021-00621-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Michael Fralick
- Sinai Health System, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia.
- Insulin For Life Global, Sydney, New South Wales, Australia.
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK.
| | - Jean Claude Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
| | - Maria Inês Schmidt
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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24
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Shi X, Liu W, Zhang L, Xiao F, Huang P, Yan B, Zhang Y, Su W, Jiang Q, Lin M, Liu W, Li X. Sex-Specific Associations Between Low Muscle Mass and Glucose Fluctuations in Patients With Type 2 Diabetes Mellitus. Front Endocrinol (Lausanne) 2022; 13:913207. [PMID: 35909561 PMCID: PMC9326160 DOI: 10.3389/fendo.2022.913207] [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: 04/05/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Studies have shown that sex differences in lean mass, concentrations of sex hormones, and lifestyles influence cle health and glucose metabolism. We evaluated the sex-specific association between low muscle mass and glucose fluctuations in hospitalized patients with type 2 diabetes mellitus (T2DM) receiving continuous subcutaneous insulin infusion (CSII) therapy. METHODS A total of 1084 participants were included. Body composition was determined by dual-energy X-ray absorptiometry. Intraday blood glucose fluctuation was estimated by the Largest amplitude of glycemic excursions (LAGE) and standard deviation of blood glucose (SDBG). RESULTS The prevalence of low muscle mass was higher in males than in females (p<0.001). There was a significant sex-specific interaction between the status of low muscle mass and glucose fluctuations (LAGE and SDBG) (p for interaction=0.025 and 0.036 for SDBG and LAGE, respectively). Among males, low muscle mass was significantly associated with a higher LAGE and SDBG (difference in LAGE: 2.26 [95% CI: 1.01 to 3.51], p < 0.001; difference in SDBG: 0.45 [95% CI: 0.25 to 0.65], p < 0.001) after adjustment for HbA1c, diabetes duration, hyperlipidemia, diabetic peripheral neuropathy, diabetic nephropathy, and cardiovascular disease. These associations remained significant after further adjustment for age and C-peptide. Among females, low muscle mass was not associated with LAGE or SDBG after adjustment for all covariates. CONCLUSION The prevalence of low muscle mass was higher in males than in females. Low muscle mass was significantly associated with higher LAGE and SDBG among males, but not females.
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Affiliation(s)
- Xiulin Shi
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The School of Clinical Medicine, Fujian Medical University, Fouzhou, China
| | - Wenjuan Liu
- Department of Endocrine, Zhangzhou Hospital of Traditional Chinese Medicine, Zhangzhou, China
| | - Lulu Zhang
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Fangsen Xiao
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Peiying Huang
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Bing Yan
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yiping Zhang
- The School of Clinical Medicine, Fujian Medical University, Fouzhou, China
| | - Weijuan Su
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Qiuhui Jiang
- The School of Clinical Medicine, Fujian Medical University, Fouzhou, China
| | - Mingzhu Lin
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wei Liu
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- *Correspondence: Xuejun Li, ; Wei Liu,
| | - Xuejun Li
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The School of Clinical Medicine, Fujian Medical University, Fouzhou, China
- *Correspondence: Xuejun Li, ; Wei Liu,
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25
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Chan JCN, Lim LL, Wareham NJ, Shaw JE, Orchard TJ, Zhang P, Lau ESH, Eliasson B, Kong APS, Ezzati M, Aguilar-Salinas CA, McGill M, Levitt NS, Ning G, So WY, Adams J, Bracco P, Forouhi NG, Gregory GA, Guo J, Hua X, Klatman EL, Magliano DJ, Ng BP, Ogilvie D, Panter J, Pavkov M, Shao H, Unwin N, White M, Wou C, Ma RCW, Schmidt MI, Ramachandran A, Seino Y, Bennett PH, Oldenburg B, Gagliardino JJ, Luk AOY, Clarke PM, Ogle GD, Davies MJ, Holman RR, Gregg EW. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet 2021; 396:2019-2082. [PMID: 33189186 DOI: 10.1016/s0140-6736(20)32374-6] [Citation(s) in RCA: 303] [Impact Index Per Article: 101.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/06/2020] [Accepted: 11/05/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China.
| | - Lee-Ling Lim
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nicholas J Wareham
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, La Trobe University, Melbourne, VIC, Australia
| | - Trevor J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, KS, USA
| | - Ping Zhang
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric S H Lau
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Björn Eliasson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Endocrinology and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alice P S Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Medical Research Council Centre for Environment and Health, Imperial College London, London, UK; WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
| | - Carlos A Aguilar-Salinas
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Margaret McGill
- Diabetes Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Medicine and Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Guang Ning
- Shanghai Clinical Center for Endocrine and Metabolic Disease, Department of Endocrinology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China; Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Wing-Yee So
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jean Adams
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Paula Bracco
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Gabriel A Gregory
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jingchuan Guo
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, KS, USA
| | - Xinyang Hua
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Emma L Klatman
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Boon-Peng Ng
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA; College of Nursing and Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - David Ogilvie
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jenna Panter
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Meda Pavkov
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hui Shao
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nigel Unwin
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Martin White
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Constance Wou
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Maria I Schmidt
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India
| | - Yutaka Seino
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, Japan; Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe, Japan
| | - Peter H Bennett
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Brian Oldenburg
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; WHO Collaborating Centre on Implementation Research for Prevention and Control of NCDs, University of Melbourne, Melbourne, VIC, Australia
| | - Juan José Gagliardino
- Centro de Endocrinología Experimental y Aplicada, UNLP-CONICET-CICPBA, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Graham D Ogle
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Rury R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Edward W Gregg
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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Bhutta ZA, Salam RA, Gomber A, Lewis-Watts L, Narang T, Mbanya JC, Alleyne G. A century past the discovery of insulin: global progress and challenges for type 1 diabetes among children and adolescents in low-income and middle-income countries. Lancet 2021; 398:1837-1850. [PMID: 34774146 DOI: 10.1016/s0140-6736(21)02247-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 12/11/2022]
Abstract
Type 1 diabetes is on the rise globally; however, the burden of mortality remains disproportionate in low-income and middle-income countries (LMICs). As 2021 marks 100 years since the discovery of insulin, we revisit progress, global burden of type 1 diabetes trends, and understanding of the pathogenesis and management practices related to the disease. Despite much progress, inequities in access and availability of insulin formulations persist and are reflected in differences in survival and morbidity patterns related to the disease. Some of these inequities have also been exacerbated by health-system challenges during the COVID-19 pandemic. There is a clear opportunity to improve access to insulin and related essential technologies for improved management of type 1 diabetes in LMICs, especially as a part of universal health coverage. These improvements will require concerted action and investments in human resources, community engagement, and education for the timely diagnosis and management of type 1 diabetes, as well as adequate health-care financing. Further research in LMICs, especially those in Africa, is needed to improve our understanding of the burden, risk factors, and implementation strategies for managing type 1 diabetes.
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Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.
| | | | - Apoorva Gomber
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Laura Lewis-Watts
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Tanya Narang
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - George Alleyne
- Pan American Health Organization and Regional Office of the World Health Organization, Washington DC, USA
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27
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Fujita A, Masuda T, Nishitani S, Akimoto AM, Yoshida R, Sakata T. Slow-phase-transition Behavior of Thermoresponsive Polymer Brushes Constrained at Substrate Observed by In Situ Electrical Monitoring Using Poly(N-isopropylacrylamide)-grafted Gate Field-effect Transistor. CHEM LETT 2021. [DOI: 10.1246/cl.210373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Akane Fujita
- Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Tsukuru Masuda
- Department of Bioengineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Shoichi Nishitani
- Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Aya Mizutani Akimoto
- Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Ryo Yoshida
- Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Toshiya Sakata
- Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
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29
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Noncontact Optical Measurement of Aqueous Humor Glucose Levels and Correlation with Serum Glucose Levels in Rabbit. BIOSENSORS 2021; 11:bios11100387. [PMID: 34677343 PMCID: PMC8533889 DOI: 10.3390/bios11100387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
The noninvasive measurement of serum glucose levels has been investigated for the monitoring of blood sugar control in diabetes. In our study, we aimed to develop a novel noncontact glucometer (NCGM) utilizing an optical approach to measure the intraocular aqueous humor glucose levels in the anterior chamber of rabbit eyes. The NCGM consists of a hybrid optical system that simultaneously measures near-infrared absorption and the polarized rotatory distribution of glucose molecules in the aqueous humor. In vitro optical measurements demonstrated that NCGM measurements had high precision and repeatability for different glucose levels, including 50 mg/dL (14.36%), 100 mg/dL (−4.05%), 200 mg/dL (−5.99%), 300 mg/dL (4.86%), 400 mg/dL (−2.84%), 500 mg/dL (−0.11%), and 600 mg/dL (4.48%). In the rabbit experiments, we found a high correlation between aqueous glucose levels and serum glucose levels, with a mean difference of 8 mg/dL. According to the testing results, the in vivo NCGM measurement of aqueous humor glucose levels also displayed a high correlation with serum glucose levels, with a mean difference of 29.2 mg/dL. In conclusion, aqueous humor glucose levels were accurately measured using the NCGM, and the results correlated with serum glucose levels.
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30
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A Pilot Trial to Evaluate the Accuracy of a Novel Non-Invasive Glucose Meter. SENSORS 2021; 21:s21206704. [PMID: 34695917 PMCID: PMC8538169 DOI: 10.3390/s21206704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022]
Abstract
The non-invasive self-monitoring of blood glucose (SMBG) has been the subject of intense investigation over recent decades. We conducted a pilot study designed to examine a novel non-invasive glucometer, the HGR GWave, utilizing radiofrequency (RF) sensing. Blood glucose levels assessed by this HGR prototype were compared to measurements performed by a hexokinase core laboratory assay during an oral glucose tolerance test (oGTT) for 5 subjects with type 2 diabetes. The HGR glucose meter readings were also compared to two Abbot Freestyle® glucose meters, which were also used for calibration. The accuracy of the results was evaluated through the calculation of relative absolute difference (RAD), specified percentage differences between 43 reference glucose measurements, and using comparator measurements. The median RAD was −4.787. We detected 79.04%, 92.99% and 97.64% of HGR readings within ±10%, ±15% and ±20% of the reference glucose measurements. The HGR readings had a high correlation with reference lab glucose measurements with R2 = 0.924 (95% CI 0.929–0.979; p < 0.0001). When compared to the Freestyle® glucose meters 94.3% and 100% of the readings were within ±5% and ±10%, with R2 = 0.975 (0.975–0.994; p < 0.0001). The HGR prototype glucose meter was found to be accurate in detecting real-time blood glucose during an oGTT in this small pilot study. A study with a broader range of blood glucose levels is needed to further assess its accuracy and its suitability for clinical use.
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Niwaha AJ, Rodgers LR, Greiner R, Balungi PA, Mwebaze R, McDonald TJ, Hattersley AT, Shields BM, Nyirenda MJ, Jones AG. HbA1c performs well in monitoring glucose control even in populations with high prevalence of medical conditions that may alter its reliability: the OPTIMAL observational multicenter study. BMJ Open Diabetes Res Care 2021; 9:9/1/e002350. [PMID: 34535465 PMCID: PMC8451306 DOI: 10.1136/bmjdrc-2021-002350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/22/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The utility of HbA1c (glycosylated hemoglobin) to estimate glycemic control in populations of African and other low-resource countries has been questioned because of high prevalence of other medical conditions that may affect its reliability. Using continuous glucose monitoring (CGM), we aimed to determine the comparative performance of HbA1c, fasting plasma glucose (FPG) (within 5 hours of a meal) and random non-fasting glucose (RPG) in assessing glycemic burden. RESEARCH DESIGN AND METHODS We assessed the performance of HbA1c, FPG and RPG in comparison to CGM mean glucose in 192 Ugandan participants with type 2 diabetes. Analysis was undertaken in all participants, and in subgroups with and without medical conditions reported to affect HbA1c reliability. We then assessed the performance of FPG and RPG, and optimal thresholds, in comparison to HbA1c in participants without medical conditions thought to alter HbA1c reliability. RESULTS 32.8% (63/192) of participants had medical conditions that may affect HbA1c reliability: anemia 9.4% (18/192), sickle cell trait and/or hemoglobin C (HbC) 22.4% (43/192), or renal impairment 6.3% (12/192). Despite high prevalence of medical conditions thought to affect HbA1c reliability, HbA1c had the strongest correlation with CGM measured glucose in day-to-day living (0.88, 95% CI 0.84 to 0.91), followed by FPG (0.82, 95% CI 0.76 to 0.86) and RPG (0.76, 95% CI 0.69 to 0.81). Among participants without conditions thought to affect HbA1c reliability, FPG and RPG had a similar diagnostic performance in identifying poor glycemic control defined by a range of HbA1c thresholds. FPG of ≥7.1 mmol/L and RPG of ≥10.5 mmol/L correctly identified 78.2% and 78.8%, respectively, of patients with an HbA1c of ≥7.0%. CONCLUSIONS HbA1c is the optimal test for monitoring glucose control even in low-income and middle-income countries where medical conditions that may alter its reliability are prevalent; FPG and RPG are valuable alternatives where HbA1c is not available.
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Affiliation(s)
- Anxious J Niwaha
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
- NCD Theme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Lauren R Rodgers
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Rosamund Greiner
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Priscilla A Balungi
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
- NCD Theme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Raymond Mwebaze
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
| | - Timothy J McDonald
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Beverley M Shields
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Moffat J Nyirenda
- NCD Theme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- NCD Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Angus G Jones
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
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Bernabé-Ortiz A, Zafra-Tanaka JH, Moscoso-Porras M, Sampath R, Vetter B, Miranda JJ, Beran D. Diagnostics and monitoring tools for noncommunicable diseases: a missing component in the global response. Global Health 2021; 17:26. [PMID: 33750391 PMCID: PMC7941936 DOI: 10.1186/s12992-021-00676-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/25/2021] [Indexed: 11/15/2022] Open
Abstract
A key component of any health system is the capacity to accurately diagnose individuals. One of the six building blocks of a health system as defined by the World Health Organization (WHO) includes diagnostic tools. The WHO’s Noncommunicable Disease Global Action Plan includes addressing the lack of diagnostics for noncommunicable diseases, through multi-stakeholder collaborations to develop new technologies that are affordable, safe, effective and quality controlled, and improving laboratory and diagnostic capacity and human resources. Many challenges exist beyond price and availability for the current tools included in the Package of Essential Noncommunicable Disease Interventions (PEN) for cardiovascular disease, diabetes and chronic respiratory diseases. These include temperature stability, adaptability to various settings (e.g. at high altitude), need for training in order to perform and interpret the test, the need for maintenance and calibration, and for Blood Glucose Meters non-compatible meters and test strips. To date the issues surrounding access to diagnostic and monitoring tools for noncommunicable diseases have not been addressed in much detail. The aim of this Commentary is to present the current landscape and challenges with regards to guidance from the WHO on diagnostic tools using the WHO REASSURED criteria, which define a set of key characteristics for diagnostic tests and tools. These criteria have been used for communicable diseases, but so far have not been used for noncommunicable diseases. Diagnostic tools have played an important role in addressing many communicable diseases, such as HIV, TB and neglected tropical diseases. Clearly more attention with regards to diagnostics for noncommunicable diseases as a key component of the health system is needed.
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Affiliation(s)
- Antonio Bernabé-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jessica H Zafra-Tanaka
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Miguel Moscoso-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Beatrice Vetter
- Foundation for Innovative and New Diagnostics, Geneva, Switzerland
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,The George Institute for Global Health, UNSW, Sydney, Australia
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland.
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Saiyed M, Hasnani D, Alonso GT, Richmond E, Besançon S, Cotterill A, Ngwu U, Mazza C, Rottembourg D, Lanzinger S. Worldwide differences in childhood type 1 diabetes: The SWEET experience. Pediatr Diabetes 2021; 22:207-214. [PMID: 33038056 DOI: 10.1111/pedi.13137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/22/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To study worldwide differences in childhood diabetes, comparing relevant indicators among five regions within the SWEET initiative. SUBJECTS We investigated 26 726 individuals with type 1 diabetes (T1D) from 54 centers in the European region; 7768 individuals from 30 centers in the Asia/Middle East/Africa region; 2642 people from five centers in Australia/New Zealand; 10 839 individuals from seven centers in North America, and 1114 patients from five centers in South America. METHODS The SWEET database was analyzed based on the following inclusion criteria: T1D, time period 2015-2019, and age < 21 years, with analysis of the most recent documented year of therapy. For the statistical analysis, we used multivariable linear and logistic regression models to adjust for age (<6 years, 6- < 12 years, 12- < 18 years, 18- < 21 years), gender, and duration of diabetes (<2 years, 2- < 5 years, 5- < 10 years, ≥10 years). RESULTS Adjusted HbA1c means ranged from 7.8% (95%-confidence interval: 7.6-8.1) in Europe to 9.5% (9.2-9.8) in Asia/Middle East/Africa. Mean daily insulin dose ranged from 0.8 units/kg in Europe (0.7-0.8) and Australia/New Zealand (0.6-0.9) to 1.0 unit/kg 0.9-1.1) in Asia/Middle East/Africa. Percentage of pump use was highest in North America (80.7% [79.8-81.6]) and lowest in South America (4.2% [3.2-5.6]). Significant differences between the five regions were also observed with regards to body mass index SD scores, frequency of blood glucose monitoring and presence of severe hypoglycaemia. CONCLUSIONS We found significant heterogeneity in diabetes care and outcomes across the five regions. The aim of optimal care for each child remains a challenge.
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Affiliation(s)
- Mahira Saiyed
- Diacare- Diabetes Care & Hormone Clinic, Ahmedabad, India
| | | | - G Todd Alonso
- Barbara Davis Center for Diabetes, Denver, Colorado, USA
| | - Erick Richmond
- National Children's Hospital, Hospital CIMA, San Jose, Costa Rica
| | - Stéphane Besançon
- Service d'endocrinologie et diabétologie, NGO Santé Diabète, Hopital du Mali, Bamako, Mali
| | - Andrew Cotterill
- Queensland Paediatric Endocrinology, Brisbane, Queensland, Australia
| | | | - Carmen Mazza
- Unit of Nutrition Hospital Juan P. Garrahan, Buenos Aires, Argentina
| | | | - Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Wu K, Chugh VK, di Girolamo A, Liu J, Saha R, Su D, Krishna VD, Nair A, Davies W, Wang YA, Cheeran MCJ, Wang JP. A Portable Magnetic Particle Spectrometer for Future Rapid and Wash-Free Bioassays. ACS APPLIED MATERIALS & INTERFACES 2021; 13:7966-7976. [PMID: 33566573 PMCID: PMC9053107 DOI: 10.1021/acsami.0c21040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Nowadays, there is an increasing demand for more accessible routine diagnostics for patients with respect to high accuracy, ease of use, and low cost. However, the quantitative and high accuracy bioassays in large hospitals and laboratories usually require trained technicians and equipment that is both bulky and expensive. In addition, the multistep bioassays and long turnaround time could severely affect the disease surveillance and control especially in pandemics such as influenza and COVID-19. In view of this, a portable, quantitative bioassay device will be valuable in regions with scarce medical resources and help relieve burden on local healthcare systems. Herein, we introduce the MagiCoil diagnostic device, an inexpensive, portable, quantitative, and rapid bioassay platform based on the magnetic particle spectrometer (MPS) technique. MPS detects the dynamic magnetic responses of magnetic nanoparticles (MNPs) and uses the harmonics from oscillating MNPs as metrics for sensitive and quantitative bioassays. This device does not require trained technicians to operate and employs a fully automatic, one-step, and wash-free assay with a user friendly smartphone interface. Using a streptavidin-biotin binding system as a model, we show that the detection limit of the current portable device for streptavidin is 64 nM (equal to 5.12 pmole). In addition, this MPS technique is very versatile and allows for the detection of different diseases just by changing the surface modifications on MNPs. Although MPS-based bioassays show high sensitivities as reported in many literatures, at the current stage, this portable device faces insufficient sensitivity and needs further improvements. It is foreseen that this kind of portable device can transform the multistep, laboratory-based bioassays to one-step field testing in nonclinical settings such as schools, homes, offices, etc.
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Affiliation(s)
| | | | - Arturo di Girolamo
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Jinming Liu
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Renata Saha
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Diqing Su
- Department of Chemical Engineering and Material Science, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Venkatramana D. Krishna
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, Minnesota 55108, United States
| | - Abilash Nair
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Will Davies
- Department of Computer Science, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | | | - Maxim C-J Cheeran
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, Minnesota 55108, United States
| | - Jian-Ping Wang
- Department of Electrical and Computer Engineering and Department of Chemical Engineering and Material Science, University of Minnesota, Minneapolis, Minnesota 55455, United States
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Nocturnal Hypoglycaemia in Patients with Diabetes Mellitus: Database Analysis of a Cohort Using Telemedicine Support for Self-Monitoring of Blood Glucose over a 10-Year-Long Period. MEDICINA-LITHUANIA 2021; 57:medicina57020167. [PMID: 33672913 PMCID: PMC7918473 DOI: 10.3390/medicina57020167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 01/09/2023]
Abstract
Background and Objectives: In patients with diabetes mellitus, hypoglycaemic episodes, especially during night hours, carry a significant risk. Data about the occurrence of nocturnal hypoglycaemia in real-world settings are of clinical importance. The aim of our study was to evaluate the occurrence of nocturnal hypoglycaemia among patients with diabetes using self-monitoring of blood glucose (SMBG) with telemedicine support. Materials and Methods: We retrospectively analysed the central database of an internet-based supportive system between 2010 and 2020 when 8190 SMBG users uploaded nearly 10 million capillary blood glucose values. Nocturnal hypoglycaemia was defined as capillary blood glucose < 3.0 mmol/L measured between 00:00 and 05:59 h. Results: The database contained 914,146 nocturnal blood glucose values from 7298 users; 24,623 (2.7%) glucose values were below the hypoglycaemic threshold and 2363 patients (32.4%) had at least one hypoglycaemic glucose value. Nocturnal hypoglycaemia was more often found in patients with type 1 vs. type 2 diabetes (n = 1890 (80.0%) vs. n = 387 (16.4%), respectively). Hypoglycaemic blood glucose values were most frequently observed in the age group of 10.0–19.9 years (n = 481 (20.4%)). Patients with nocturnal hypoglycaemia were mostly on insulin treatment (1854 (78.5%) patients with 20,727 (84.1%) hypoglycaemic glucose values). Only 356 patients (15.1%) with nocturnal hypoglycaemia performed a retest within 120 min. Within a one-day-long (1440 min) timeframe, the elapsed median time until a retest, yielding a safe blood glucose value (>3.9 mml/L), was 273 min (interquartile range: 157–300 min). Conclusions: Nocturnal hypoglycaemia should be considered as a persisting challenge to antihyperglycaemic treatment in patients living with diabetes. Continuous efforts are needed to improve both antihyperglycaemic treatment and patient education for preventing nocturnal hypoglycaemia, and to act adequately if hypoglycaemic values are detected.
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Ngassa Piotie P, Wood P, Webb EM, Hugo JF, Rheeder P. Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings. Ther Adv Endocrinol Metab 2021; 12:20420188211054688. [PMID: 34733467 PMCID: PMC8558786 DOI: 10.1177/20420188211054688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In South Africa, initiating insulin for people with type 2 diabetes and subsequent titration is a major challenge for the resource-constrained healthcare system. Inadequate support systems in primary care, including not being able to access blood glucose monitors and test strips for self-monitoring of blood glucose, results in patients with type 2 diabetes being referred to higher levels of care. In primary care, initiation of insulin may be delayed due to a shortage of healthcare workers. The delayed initiation of insulin is also exacerbated by the reported resistance of both healthcare providers and people with type 2 diabetes to start insulin. In South Africa, telehealth provides an opportunity to overcome these challenges and manage insulin therapy in primary care. METHODS We describe the development of a digital health intervention including the framework used, the theoretical approach and subsequent implementation strategies. RESULTS This intervention is an innovative, nurse-driven and app-enabled intervention called 'the Tshwane Insulin Project intervention'. The Tshwane Insulin Project intervention was designed and evaluated using the framework recommended by the Medical Research Council for complex interventions. The Tshwane Insulin Project intervention was developed in four sequential phases: planning, design, implementation and evaluation. The Tshwane Insulin Project intervention followed the Integrated Chronic Disease Management framework to facilitate implementation and acceptability. The Tshwane Insulin Project comprises a facility-level intervention, where nurses evaluate patients and initiate insulin, an individual-level intervention where community healthcare workers visit patients at their homes to follow-up and provide educational information, while using telehealth to enable physician-directed insulin titration if needed, and a community-level intervention aimed at empowering community healthcare workers to support people living with diabetes and raise awareness of diabetes. CONCLUSION The technological advancements in digital health and telemedicine present an opportunity to improve diabetes care in resource-limited countries. This work can inform those intending to develop and implement complex interventions in primary healthcare in developing countries.
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Affiliation(s)
| | - Paola Wood
- Division of Biokinetics, Department of Physiology, Faculty of Health Sciences, University of Pretoria, Hatfield, South Africa
| | - Elizabeth M. Webb
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Johannes F.M. Hugo
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa; UP COPC Research Unit, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Paul Rheeder
- Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
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Odeh R, Gharaibeh L, Daher A, Kussad S, Alassaf A. Caring for a child with type 1 diabetes during COVID-19 lockdown in a developing country: Challenges and parents' perspectives on the use of telemedicine. Diabetes Res Clin Pract 2020; 168:108393. [PMID: 32858098 PMCID: PMC7446666 DOI: 10.1016/j.diabres.2020.108393] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/08/2020] [Accepted: 08/20/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM Jordan implemented abrupt and extreme lockdown measures to prevent the spread of COVID-19. This study aims to evaluate the effect of these measures on paediatric patients with type 1 diabetes in terms of acute metabolic complications and shortages in insulin and glucose measuring supplies. It also evaluates the caregivers' perceptions of the use of telemedicine during the lockdown. METHODS This is a questionnaire-based cross-sectional study. It was completed using Google forms and patients/caregivers were asked to consent if they agreed to answer. RESULTS 235 patients/families participated in the study. The mean age of the patients was 10.8 years ± 3.9 years (N = 229). Twenty-four children (10.2%) needed to visit the emergency department during the lockdown period which lasted for 10 weeks. Of these, eight (3.4%) were hospitalized due to acute metabolic complications. Families (58.3%) faced insulin shortages and 14% had to ration insulin, i.e., decrease the dose, during the lockdown. Glucose monitoring strips were rationed by 43.4% of families leading to more frequent low/high glucose readings in 75.5% of children of these families. Telemedicine using phones and social media applications was utilized for communication with healthcare professionals and continuing medical care. Most of the participants (85.5%) described it as a smooth and positive experience. CONCLUSIONS The extreme lockdown due to COVID-19 pandemic caused insulin and glucose measuring equipment shortages in children with diabetes in Jordan. However, the use of telemedicine for providing guidance and support was perceived positively by the families.
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Affiliation(s)
- Rasha Odeh
- Department of Paediatrics, School of Medicine, University of Jordan, Jordan.
| | - Lobna Gharaibeh
- Faculty of Pharmacy, AI-Ahliyya, Amman University, Amman, Jordan; Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, AI-Ahliyya Amman University, Amman, Jordan
| | - Amirah Daher
- Department of Paediatrics, School of Medicine, University of Jordan, Jordan
| | - Sara Kussad
- Department of Paediatrics, School of Medicine, University of Jordan, Jordan
| | - Abeer Alassaf
- Department of Paediatrics, School of Medicine, University of Jordan, Jordan
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Point of Care Diagnostics in Resource-Limited Settings: A Review of the Present and Future of PoC in Its Most Needed Environment. BIOSENSORS-BASEL 2020; 10:bios10100133. [PMID: 32987809 PMCID: PMC7598644 DOI: 10.3390/bios10100133] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022]
Abstract
Point of care (PoC) diagnostics are at the focus of government initiatives, NGOs and fundamental research alike. In high-income countries, the hope is to streamline the diagnostic procedure, minimize costs and make healthcare processes more efficient and faster, which, in some cases, can be more a matter of convenience than necessity. However, in resource-limited settings such as low-income countries, PoC-diagnostics might be the only viable route, when the next laboratory is hours away. Therefore, it is especially important to focus research into novel diagnostics for these countries in order to alleviate suffering due to infectious disease. In this review, the current research describing the use of PoC diagnostics in resource-limited settings and the potential bottlenecks along the value chain that prevent their widespread application is summarized. To this end, we will look at literature that investigates different parts of the value chain, such as fundamental research and market economics, as well as actual use at healthcare providers. We aim to create an integrated picture of potential PoC barriers, from the first start of research at universities to patient treatment in the field. Results from the literature will be discussed with the aim to bring all important steps and aspects together in order to illustrate how effectively PoC is being used in low-income countries. In addition, we discuss what is needed to improve the situation further, in order to use this technology to its fullest advantage and avoid “leaks in the pipeline”, when a promising device fails to take the next step of the valorization pathway and is abandoned.
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Klatman EL, Ogle GD. Access to insulin delivery devices and glycated haemoglobin in lower-income countries. World J Diabetes 2020; 11:358-369. [PMID: 32864048 PMCID: PMC7438184 DOI: 10.4239/wjd.v11.i8.358] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/03/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Young people with type 1 diabetes in low-and-middle income countries face many challenges in accessing care, with various essential supplies needed for survival and long-term health.
AIM To study insulin delivery devices and glycated haemoglobin (HbA1c) testing.
METHODS A survey was conducted in 2019 of leading diabetes centres in 41 countries supported by the Life for a Child Program. The survey covered numerous aspects concerning availability and costs at all levels of the health system, local usage patterns and attitudes, obstacles, and other aspects.
RESULTS Thirty-seven countries returned the survey (90.2% response rate). Key findings included: Syringe use was most common (83.1%), followed by insulin pens (16.7%) and pumps (0.2%). 48.6% of public health systems did not provide syringes, even with a co-payment. Use of suboptimal syringe/needle combinations was common. Needles were generally reused in almost all countries (94.3%, n = 35). Aside from donated supplies, there was variable access to HbA1c testing within public health facilities, and, when available, patients often had to cover the cost. Provision was further compromised by numerous problems including stock-outs, and challenges with understanding the test, equipment maintenance, and refrigeration.
CONCLUSION Large gaps exist for adequate access to appropriate insulin delivery devices and HbA1c testing. Public health systems in low-and-middle income countries should increase affordable provision. There are also needs for specific health professional training and diabetes education; elimination of customs duties and taxes; development of inexpensive, robust HbA1c testing methods that do not require refrigeration of testing supplies; differential pricing schemes; and other solutions.
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Rathmann W, Charbonnel B, Gomes MB, Hammar N, Khunti K, Kosiborod M, Kuss O, Shestakova MV, Watada H, Shimomura I, Tang F, Cid-Ruzafa J, Chen H, Fenici P, Surmont F, Ji L. Socioeconomic factors associated with hypoglycaemia in patients starting second-line glucose-lowering therapy: The DISCOVER study. Diabetes Res Clin Pract 2020; 165:108250. [PMID: 32531326 DOI: 10.1016/j.diabres.2020.108250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/15/2020] [Accepted: 06/04/2020] [Indexed: 11/25/2022]
Abstract
AIMS Using data from DISCOVER (NCT02322762; NCT02226822), a 3-year, global, observational study programme of patients with type 2 diabetes initiating second-line glucose-lowering therapy, we assessed socioeconomic factors associated with hypoglycaemic events and fear of hypoglycaemia. METHODS Data were collected at baseline (second-line therapy initiation) and 6, 12 and 24 months. Factors associated with experiencing a hypoglycaemic event at baseline or during follow-up were determined using a hierarchical logistic regression model and an interval-censored survival analysis, respectively. Fear of hypoglycaemia was assessed using the hypoglycaemia fear survey-II (HFS-II). RESULTS The overall proportion of patients reporting hypoglycaemic events during follow-up was 7.3%; this was higher in middle-income countries than in high-income countries (8.4% vs 5.8%, p < 0.001). Factors associated with an increased risk of hypoglycaemia during follow-up included living in a country with a low gross national income, use of glucose-monitoring equipment and second-line treatment with insulin, meglitinides or sulphonylureas (versus metformin). Experiencing hypoglycaemia was associated with increased HFS-II worry and overall scores. CONCLUSIONS Our results highlight the global inequity in the treatment of type 2 diabetes. Increased risk of hypoglycaemia in middle-income countries may be explained by limited treatment options and may be underestimated because of limited access to glucose-monitoring equipment.
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Affiliation(s)
- Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.
| | | | | | - Niklas Hammar
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; AstraZeneca Gothenburg, Mölndal, Sweden
| | | | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; University of Missouri, Kansas City, MO, USA; The George Institute for Global Health and University of New South Wales, Sydney, Australia
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | | | | | | | - Fengming Tang
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | | | | | | | | | - Linong Ji
- Peking University People's Hospital, Beijing, China
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Zhang Y, Dai J, Han X, Zhao Y, Zhang H, Liu X, Li W, Ling H, Zhou X, Ying C. Glycemic variability indices determined by self-monitoring of blood glucose are associated with β-cell function in Chinese patients with type 2 diabetes. Diabetes Res Clin Pract 2020; 164:108152. [PMID: 32360707 DOI: 10.1016/j.diabres.2020.108152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 04/05/2020] [Accepted: 04/14/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Glycemic control plays an important role in diabetes management, and self-monitoring of blood glucose (SMBG) is critical to achieving good glycemic control. However, there are few studies about the relationship between SMBG-estimated glycemic indices and β-cell function. Here we investigated the association between glucose variation indices estimated by SMBG and β-cell function among Chinese patients with type 2 diabetes mellitus (T2DM). METHODS In this cross‑sectional study, 397 patients with T2DM were recruited from February 2015 to October 2016. β-cell function was monitored using the Homeostasis Model Assessment 2 (HOMA2)-%β index. The parameters evaluated by SMBG were the mean blood glucose (MBG), standard deviation of MBG (SDBG), largest amplitude of glycemic excursions (LAGE), and postprandial glucose excursion (PPGE). RESULTS HOMA2-%β was negatively correlated with SDBG, LAGE, PPGE, and MBG (r = -0.350, -0.346, -0.178, and -0.631, respectively; all p < 0.01). After adjusting for confounding characteristics (diabetic duration, triglyceride, total cholesterol, fasting C-peptide, HOMA2-insulin resistance index, hypoglycemia, and diabetic treatments) and glycated hemoglobin A1c on a continuous scale, odds ratios of SDBG, LAGE, PPGE, and MBG between the patients in the lowest and highest HOMA2-%β quartiles were 2.02 (1.14-3.57), 1.24 (1.04-1.49), 1.13 (0.86-1.51), and 2.26 (1.70-3.00). HOMA2-%β was independently associated with SDBG, LAGE, and MBG. CONCLUSIONS Increased SDBG and LAGE assessed by SMBG are associated with β-cell dysfunction in Chinese patients with T2DM.
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Affiliation(s)
- Yusheng Zhang
- The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Jiao Dai
- The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Xiao Han
- The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Yue Zhao
- The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Hui Zhang
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Xuan Liu
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Wei Li
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Hongwei Ling
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Xiaoyan Zhou
- Laboratory of Morphology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, PR China
| | - Changjiang Ying
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China.
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The impact of limited and strategic blood glucose monitoring on metabolic control in a type 1 diabetes clinic in Central India. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00817-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Sakata T, Nishitani S, Kajisa T. Molecularly imprinted polymer-based bioelectrical interfaces with intrinsic molecular charges. RSC Adv 2020; 10:16999-17013. [PMID: 35521456 PMCID: PMC9053408 DOI: 10.1039/d0ra02793f] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/23/2020] [Indexed: 11/25/2022] Open
Abstract
For enzyme-/antibody-free and label-free biosensing, a molecularly imprinted polymer (MIP)-based membrane with phenylboronic acid (PBA) molecules, which induces the change in the density of molecular charges based on the small biomolecule–PBA diol binding, has been demonstrated to be suitable for the bioelectrical interface of biologically coupled gate field-effect transistor (bio-FET) sensors. MIP-coated gate FET sensors selectively detect various small biomolecules such as glucose, dopamine, sialic acid, and oligosaccharides without using labeled materials. In particular, the well-controlled MIP film by surface-initiated atom transfer radical polymerization (SI-ATRP) contributes to the quantitative analysis of small biomolecule sensing, resulting in potentiometric Langmuir isotherm adsorption analysis by which the parameters such as the binding affinity between small biomolecules and MIP cavities are evaluated. Also, the output electrical signal of even a random MIP-coated gate FET sensor is quantitatively analyzed using the bi-Langmuir adsorption isotherm equation, showing the adsorption mechanism of small biomolecules onto the template-specific MIP membrane. Thus, a platform based on the MIP bioelectrical interface for the bio-FET sensor is suitable for an enzyme-/antibody-free and label-free biosensing system in the fields of clinical diagnostics, drug discovery, the food industry, and environmental research. A molecularly imprinted polymer (MIP)-based membrane with phenylboronic acid (PBA) molecules, which induces the change in the density of molecular charges, is suitable for the bioelectrical interface of field-effect transistor (FET) sensors.![]()
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Affiliation(s)
- Toshiya Sakata
- Department of Materials Engineering, School of Engineering, The University of Tokyo 7-3-1 Hongo, Bunkyo-ku Tokyo 113-8656 Japan +81-3-5841-1842 +81-3-5841-1842
| | - Shoichi Nishitani
- Department of Materials Engineering, School of Engineering, The University of Tokyo 7-3-1 Hongo, Bunkyo-ku Tokyo 113-8656 Japan +81-3-5841-1842 +81-3-5841-1842
| | - Taira Kajisa
- Institute of Post-LED Photonics, Tokushima University 2-1, Minamijosanjima-cho Tokushima 770-8506 Japan
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Klatman EL, McKee M, Ogle GD. Documenting and visualising progress towards Universal Health Coverage of insulin and blood glucose test strips for people with diabetes. Diabetes Res Clin Pract 2019; 157:107859. [PMID: 31545980 DOI: 10.1016/j.diabres.2019.107859] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/05/2019] [Accepted: 09/13/2019] [Indexed: 12/14/2022]
Abstract
AIMS Global governments have committed to achieve Universal Health Coverage (UHC), ensuring access to quality and affordable healthcare for all. This is fundamental for those with type 1 diabetes mellitus, who require daily access to both insulin and blood glucose test strips to survive. This group risks being left behind by global initiatives that fail to consider these particular needs. METHODS A questionnaire was distributed to key informants in 37 less-resourced countries. Seven high-income countries were also included for comparison. We drew on a WHO framework developed to assess progress towards UHC to create scales on three dimensions: population covered, services provided and direct costs. A fourth dimension, availability, was added. Results were grouped into six patterns and visually displayed with radar graphs. RESULTS 65% of the less-resourced national health systems provided insulin, with medians of 67% for service provision (equating to Human Regular and NPH), 55% direct costs covered, and 75% availability. Test strips were only provided in 14% of the less-resourced systems, with medians 42% (less than two strips per day), 76%, and 88% respectively. Six patterns of provision were identified. Progress correlated with income level, yet some low-income countries are achieving provision for insulin and test strips for those enrolled in health insurance schemes. CONCLUSION No less-resourced country had even near-complete coverage for insulin, and coverage was worse for test strips. This study demonstrates the utility of this framework which could be developed as a means of tracking progress in meeting the needs of people with diabetes.
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Affiliation(s)
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Graham David Ogle
- Life for a Child Program, Glebe, Sydney, Australia; Diabetes NSW & ACT, Glebe, Sydney, Australia.
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45
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Patterson CC, Karuranga S, Salpea P, Saeedi P, Dahlquist G, Soltesz G, Ogle GD. Worldwide estimates of incidence, prevalence and mortality of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 2019; 157:107842. [PMID: 31518658 DOI: 10.1016/j.diabres.2019.107842] [Citation(s) in RCA: 283] [Impact Index Per Article: 56.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 09/06/2019] [Indexed: 01/09/2023]
Abstract
AIMS This article describes the methods, results and limitations of the International Diabetes Federation (IDF) Diabetes Atlas 9th edition estimates of worldwide numbers of cases of type 1 diabetes in children and adolescents. METHODS Most information in the published literature is in the form of incidence rates derived from registers of newly-diagnosed cases. After systematic review of the published literature and recent conference abstracts, identified studies were quality graded. If no study was available, extrapolation was used to assign a country the rate from an adjacent country with similar characteristics. Estimates of incident cases were obtained by applying incidence rates to United Nations 2019 population estimates. Estimates of prevalent cases were derived from incidence rates after making allowance for higher mortality rates in less-developed countries. RESULTS Incidence rates were available for 45% of countries (ranging from 6% in the sub-Saharan Africa region to 77% in the European region). Worldwide annual incidence estimates were 98,200 (128,900) new cases in the under 15 year (under 20 year) age-groups. Corresponding prevalence estimates were 600,900 (1,110,100) existing cases. Compared with estimates in earlier Atlas editions, numbers have increased in most IDF regions, reflecting incidence rate increases, but prevalence estimates have decreased in sub-Saharan Africa because allowance has been made for increased mortality in those with diabetes. CONCLUSIONS Worldwide estimates of numbers of children and adolescents with type 1 diabetes continue to increase.
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Affiliation(s)
- Christopher C Patterson
- UKCRC Centre of Excellence for Public Health Northern Ireland, Queen's University Belfast, United Kingdom; Centre for Public Health, Queen's University Belfast, United Kingdom.
| | | | | | - Pouya Saeedi
- International Diabetes Federation, Brussels, Belgium
| | - Gisela Dahlquist
- Department of Clinical Science, University of Umea, Umea, Sweden
| | - Gyula Soltesz
- Department of Pediatrics, Pecs University, Pecs, Hungary
| | - Graham D Ogle
- Life for a Child Program, Diabetes NSW, Sydney, Australia
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Mota-Oropeza ME, Bartley HE, Hernández-Pérez ND, Lara AG, Vázquez-López NA, Flores MF, Velázquez MM, Castañeda-Saldivar MJ, Middlehurst AC, Jenkins AJ, Ogle GD. Providing quality care for children and adolescents with diabetes from lower-income families in Mexico. J Pediatr Endocrinol Metab 2019; 32:1139-1146. [PMID: 31483761 DOI: 10.1515/jpem-2019-0363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 11/15/2022]
Abstract
Background The objective of this study was to determine the demographic and clinical features of youth supported by member associations of the Federación Mexicana de Diabetes and the Life for a Child Program (LFAC). Methods An analysis of 2017 Annual Clinical Data Sheets of 306 subjects from five Mexican centers was performed. Results Type 1 diabetes (T1D) was diagnosed in 292 subjects; 54.6% were female, with six diagnosed aged <6 months (genetic tests not yet conducted). Type 2 diabetes (T2D) or other types were diagnosed in 11 and three subjects, respectively. T1D diagnosis age ranged 0.0-22.6 years with a peak at 8 years. The mean ± standard deviation (SD) diabetes duration was 5.3 ± 3.5 years (range 0.0-21.0 years), with a mean ± SD subject age at check-up of 13.3 ± 4.3 years. Of the T1D subjects, 1.0%, 6.7%, 13.7% and 78.6% were receiving 1, 2, 3 and ≥4 insulin injections/day with a mean ± SD daily dose of 0.92 ± 0.34 U/kg. The median number of blood glucose tests/week was 40. The mean/median hemoglobin A1c (HbA1c) levels for those with duration ≥6 months were 8.7/8.4% (72/68 mmol/mol) and were higher in adolescents vs. children. Elevated body mass index SD, triglycerides (≥150 mg/dL) and non-high-density lipoprotein (HDL)-cholesterol (≥130 mg/dL) were common: 7.6%, 11.0% and 12.7% (n = 288, 218 and 180, respectively). Serum creatinine levels were normal in all tested subjects (n = 194). Conclusions Youth with diabetes in less-resourced families in Mexico are achieving reasonable glycemia. Most T1D patients use a basal bolus insulin regimen and test blood glucose several times daily. Some subjects have adverse vascular risk factor profiles. Further attention is needed to prevent chronic complications. Monogenic diabetes is very likely in some youth, and genetic testing is indicated.
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Affiliation(s)
| | - Hannah Elizabeth Bartley
- Life for a Child Program, Diabetes NSW & ACT, Glebe, NSW, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | | | - Arely Gutiérrez Lara
- Asociaciόn Mexicana de Diabetes en Nuevo León, A.C., Monterrey, Nuevo León, Mexico
| | | | - Maria Francisa Flores
- Asociaciόn Mexicana de Diabetes en el Estado de Guerrero, A.C., Acapulco, Guerrero, Mexico
| | | | | | | | | | - Graham David Ogle
- Life for a Child Program, Diabetes NSW & ACT, Glebe, NSW, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
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miR-149-5p protects against high glucose-induced pancreatic beta cell apoptosis via targeting the BH3-only protein BIM. Exp Mol Pathol 2019; 110:104279. [PMID: 31260649 DOI: 10.1016/j.yexmp.2019.104279] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 12/27/2022]
Abstract
Diabetes mellitus (DM) is characterized by the elevated blood glucose levels and is regarded as one of the most threatening diseases worldwide. The dysfunction of pancreatic beta cells is a key contributor for the pathophysiology of DM. There is growing evidence showing the role of microRNAs (miRNAs) in the regulation of pancreatic beta cell functions. In the present study, we determined the expression of miR-149-5p in pancreatic beta cells under high-glucose (HG) stimulation and explored the underlying mechanism of miR-149-5p-mediated functions of pancreatic beta cells. The results showed the down-regulation of miR-149-5p in the pancreatic beta cell line (MIN6 cells) under HG stimulation. Overexpression of miR-149-5p protected against HG-induced cell apoptosis and impairment of insulin secretion, and attenuated HG-induced an increase in reactive oxygen species (ROS) production in MIN6 cells; while inhibition of miR-149-5p suppressed cell viability, induced cell apoptosis, inhibited insulin secretion and enhanced ROS production in MIN6 cells. Further mechanistic studies revealed that miR-149-5p targeted the BH3-only protein BIM 3' untranslated region and suppressed BIM expression in MIN6 cells. The rescue experimental assays showed that enforced expression of BIM attenuated the miR-149-5p-mediated effects in HG-stimulated pancreatic beta cells. In conclusion, the present study for the first time elucidated the biological functions of miR-149-5p in regulating pancreatic beta cell functions. The data from the present study provided evidence showing that miR-149-5p protected against HG-induced pancreatic beta cell apoptosis partly via suppressing BIM expression. The therapeutic potential of miR-149-5p in the treatment of DM still requires further detailed investigations.
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