The prevalence of pre-diabetes and diabetes and their associated factors in Northeast China: a cross-sectional study

Prevalence of prediabetes and risk of CVD mortality in individuals with prediabetes alone or plus hypertension in Northeast China: insight from a population based cohort study

BACKGROUND

To evaluate the current prevalence of prediabetes in northeast China, and further determine the association between prediabetes alone or coexistent with hypertension and cardiovascular disease (CVD) mortality.

METHODS

In the prospective study, 15,557 participants without diabetes among aged ≥40 years in northeast China, were followed for a median of 5.5 years. Following the American Diabetes Association, prediabetes was defined as fasting plasma glucose (FPG) range of 5.6-6.9 mmol/L or glycated hemoglobin (HbA1c) range of 5.7-6.4% in people without diabetes.

RESULTS

The prevalence of prediabetes was 44.3% among population aged ≥40 years in northeast China. Prediabetes alone did not promote risk of CVD mortality. However, when the subgroups were stratified by hypertension, the CVD mortality risk in prediabetes plus hypertension subjects increased significantly compared with population without prediabetes and hypertension. Multivariate-adjusted hazard ratios for CVD mortality in prediabetes subgroups plus hypertension were 2.28 (95% CI: 1.50, 3.47) for those diagnosed by FPG < 5.6 mmol/L & HbA1c 5.7-6.4%, 2.18 (95% CI: 1.53, 3.10) for those diagnosed by FPG 5.6-6.0 mmol/L & HbA1c < 6.5% and 2.35 (95% CI: 1.65, 3.35) for those diagnosed by FPG 6.1-6.9 & HbA1c < 6.5% compared with the reference group. Moreover, the percentage of hypertension in prediabetes subjects was high (60.4%), but the awareness, treatment and control rates were far from satisfactory (45.3, 35.1 and 4.8%, respectively).

CONCLUSIONS

The prevalence of prediabetes remains high in northeast China, and the CVD mortality was elevated significantly in prediabetes coexistent with hypertension. Considering the high percentage and low control rate of hypertension in prediabetes, strategies focused on HbA1c screening, FPG lowering and blood pressure management should be emphasized in northeast China.

Knowledge, attitude, and practice toward non-nutritive sweeteners among the population with reduced sugar intake requirement

Introduction

This study aimed to explore the knowledge, attitude, and practice (KAP) toward non-nutritive sweeteners among a population with reduced sugar intake requirements.

Methods

This cross-sectional study used self-developed questionnaires to collect demographic characteristics and KAP towards non-nutritive sweeteners among respondents with reduced sugar intake requirements, i.e., overweight or obese individuals and patients with pre-diabetes or diabetes.

Results

A total of 639 valid questionnaires were collected, and 51.64% of participants were male. The KAP scores were 7.63 ± 3.58 (range: 0-11), 34.28 ± 7.47 (range: 12-60), and 15.48 ± 3.97 (range: 7-35), respectively. Pearson's correlation analysis showed that knowledge score was positively correlated with attitude (r = 0.229, p < 0.001) and practice score (r = 0.467, p < 0.001), while attitude was positively correlated with practice (r = 0.312, p < 0.001). The structural equation model showed that knowledge was directly and positively associated with attitude (path coefficient = 0.48, p < 0.001) and practice (path coefficient = 0.46, p < 0.001). In addition, the attitude was directly and positively associated with practice (path coefficient = 0.12, p < 0.001). Besides, diabetes was associated with lower knowledge (path coefficient = -0.81, p = 0.038) and practice (path coefficient = -0.42, p < 0.041).

Discussion

Population with the reduced sugar intake requirement showed poor knowledge, negative attitudes, and suboptimal practices toward non-nutritive sweeteners. To optimize the utilization of non-nutritive sweeteners in accordance with medical prescriptions, especially for individuals with diabetes, tailored educational interventions may be designed for participants with lower KAP.

Magnitude and predictors of pre-diabetes among adults in health facilities of Gondar city, Ethiopia: a cross-sectional study

Introduction

Impaired glucose tolerance currently affects 374 million (7.5%) people worldwide, and by 2030, this number is predicted to affect 454 million (8%). Urban inhabitants have an increased risk of developing pre-diabetes. Thus, the study aimed to assess the magnitude of pre-diabetes and associated factors among adults attending outpatient departments of the health facilities of Gondar, Ethiopia.

Method

From 3 March to 18 April 2020, an institution-based cross-sectional study was conducted. A systematic random sampling technique was used to select 992 participants. Data were gathered using an interviewer-administered questionnaire, and fasting blood glucose was assessed using capillary blood. Bivariable and multivariable binary logistic regression analyses were fitted to check the association between independent variables and pre-diabetes. Statistical significance was declared at a level of P of <0.05.

Results

The prevalence of pre-diabetes was 16.6% (95% CIs: 14.3-18.8%). Age [AOR = 3.66, 95% CIs (2.05, 6.52)], a family history of diabetes mellitus [AOR = 3.46, 95% CIs (2.16, 5.52)], waist circumference [AOR = 3.6, 95% CIs (2.26, 5.88)], physical activity [AOR: 5.02, 95% CIs (2.87, 8.77)], dietary diversity [AOR = 3.07, 95% CIs (1.95, 4.84)], and smoking [AOR = 2.9, 95% CI (1.42, 6.05)] were factors associated with pre-diabetes.

Conclusion

From our study, we can conclude that one in six adults in the health facilities have pre-diabetes. Age, family history of diabetes, waist circumference, physical activity, dietary diversity, and smoking were the factors associated with pre-diabetes. Therefore, it is recommended that adults should be educated on modifying their lifestyle, including their diet, and substantial care should be provided for older adults.

Predictive model of diabetes mellitus in patients with idiopathic inflammatory myopathies

Objectives

Cardiovascular diseases are the common cause of death in patients with idiopathic inflammatory myopathies (IIMs). Diabetes mellitus was associated with higher cardiovascular mortality, but few studies focused on the risk of diabetes mellitus in IIMs patients. Our study is aimed at developing a predictive model of diabetes mellitus in IIMs patients.

Methods

A total of 354 patients were included in this study, of whom 35 (9.9%) were diagnosed as new-onset diabetes mellitus. The predictive nomogram was drawn based on the features selected by least absolute shrinkage and selection operator (LASSO) regression, univariate logistic regression, multivariable logistic regression, and clinical relationship. The discriminative capacity of the nomogram was assessed by C-index, calibration plot, and clinical usefulness. The predictive model was verified by the bootstrapping validation.

Results

The nomogram mainly included predictors such as age, gender, hypertension, uric acid, and serum creatinine. This predictive model demonstrated good discrimination and calibration in primary cohort (C-index=0.762, 95% CI: 0.677-0.847) and validation cohort (C-index=0.725). Decision curve analysis indicated that this predictive model was clinically useful.

Conclusions

Clinicians can assess the risk of diabetes mellitus in IIMs patients by using this prediction model, and preventive measures should be taken early for high-risk patients, ultimately reducing the adverse cardiovascular prognosis.

Prevalence of Prediabetes and Related Modifiable Cardiovascular Risk Factors Among Employees of Ayder Comprehensive Specialized Hospital, Tigray, Northern Ethiopia

BACKGROUND

Prediabetes is considered an important risk factor for type 2 diabetes and related cardiovascular problems. However, evidence shows that both prediabetes and its associated cardiovascular risk factors could be mitigated through lifestyle modification. This study aims at determining the magnitude of prediabetes and related modifiable cardiovascular risk factors as an initial step towards undertaking such mitigation measures.

METHODS

A cross-sectional study was conducted on employees of a tertiary care hospital from March to June/2019. Socio-demographic data were collected using a self-administered questionnaire. Anthropometric and blood pressure measurements were performed following WHO guidelines. Biochemical parameters were assayed following standard operating procedures. Categorical variables are summarized using frequencies and percentages. Normality test was performed ahead of describing the numeric data and log transformations were carried out when appropriate. International Diabetes Federation (IDF) and American Diabetes Association (ADA) criteria were used to classify glycemic status. Likewise, IDF and revised National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) were employed for the diagnosis of metabolic syndrome.

RESULTS

In this study, we engaged a total of 265 employees. About 35.1% were males and 64.9% were females. The median age was 29 (9) years. About 5.7% and 18.1% had prediabetes based on IDF and ADA criteria, respectively. Equally, 3.4% had FBS levels that meet the criteria for overt diabetes on IDF and ADA. Besides, 55.1% had a metabolic risk as implied by the elevated waist-to-height ratio (WhtR), 24.2% had hypertriglyceridemia, 27.9% had above optimal LDL and 57% had low HDL. Overall, 17.9% and 21.9% of the participants had metabolic syndrome according to IDF and revised NCEP ATP III criteria, respectively.

CONCLUSION

The prevalence of prediabetes and metabolic syndrome observed in hospital employees is comparable with the general population.

The Interaction Between Age and Risk Factors for Diabetes and Prediabetes: A Community-Based Cross-Sectional Study

OBJECTIVE

This study aimed to investigate the interaction between age groups and risk factors for diabetes and prediabetes in Shanghai communities and to identify the effect of age on other risk factors for diabetes and prediabetes.

METHODS

This study recruited 3540 participants with undiagnosed diabetes or prediabetes in 14 communities in Shanghai from February to August 2019. All participants underwent a comprehensive examination, including filling out a detailed questionnaire, physical examination, 75 g oral glucose tolerance test, and blood sample collection. In addition, logistic regression was used to analyze the interaction between age and risk factors for prediabetes and diabetes.

RESULTS

The statistical analysis included 2776 people. In this study, the prevalence of diabetes and prediabetes were 15.1% and 52.3%, respectively. The prevalence of diabetes and prediabetes is higher in the elderly than in the middle-aged group. Among the risk factors for diabetes, overweight was associated with higher age (P-interaction 0.028). In addition, among the risk factors for prediabetes, a high level of education was associated with higher age (P-interaction 0.039) and elevated serum cholesterol level was associated with lower age (P-interaction 0.019).

CONCLUSION

This study confirmed an interaction between age and other influencing factors, which may be important in explaining differences in risk factors for diabetes and prediabetes in the middle-aged and elderly populations. Community health facilities can provide health guidance to people of different age groups to prevent and control prediabetes and diabetes.

Prevalence and potential risk factors of self-reported diabetes among elderly people in China: A national cross-sectional study of 224,142 adults

Aim

To evaluated the prevalence and potential risk factors of self-reported diabetes among the elderly in China, by demographic data, socioeconomic factors, and psychological factors.

Methods

Descriptive analysis and Chi-square analysis were used to assess the prevalence and variation between self-reported diabetes and non-diabetes by demographic data, living habits, socioeconomic factors and comorbidities. Univariate and multivariate logistic regression were used to describe the odds ratios (OR) of diabetes prevalence in different groups, while stratification analysis was performed to describe prevalence based on gender, age, and urban/rural areas.

Results

215,041 elderly adults (102,692 males and 112,349 females) were eventually included in the analysis. The prevalence of self-reported diabetes among the elderly in China is about 8.7%, with the highest prevalence in Beijing (20.8%) and the lowest prevalence in Xizang (0.9%). Logistic regression analysis showed that urban area (P < 0.001), older age (65-84 years old, P < 0.001), female (P < 0.001), higher income(P < 0.001), poor sleep quality (P = 0.01) and some other factors were potential risk factors for diabetes.

Conclusions

This study illustrates the prevalence and potential risk factors of diabetes among the elderly in China Meanwhile, these results provide information to assist the government in controlling non-communicable diseases in the elderly.

Prevalence and correlates of pre-diabetes in adults of mixed ethnicities in the South African population: A systematic review and meta-analysis

INTRODUCTION

Pre-diabetes is a metabolic condition characterised by moderate glycaemic dysregulation and is a frontline risk factor for multiple metabolic complications such as type 2 diabetes mellitus. To the best of our knowledge, this will be the first systematic review and meta-analysis focusing on generating a comprehensive pooling of studies reporting on pre-diabetes prevalence in South Africa. Therefore, the review's purpose will be to screen and select reports that can be used to synthesise and provide the best estimate prevalence of pre-diabetes and its associated correlates in the South African population.

METHODS AND ANALYSIS

To determine the prevalence and correlates of pre-diabetes in South Africa, we searched PubMed, Web of Science, Google scholar and African Journal online for published or unpublished studies reporting the prevalence of pre-diabetes in South Africa starting from the year 2000 to 2020. Studies were assessed for eligibility by checking if they met the inclusion criteria.

RESULTS & CONCLUSION

The total number of studies deemed eligible is 13 and from these studies, an overall prevalence of pre-diabetes was reported to be 15,56% in the South African population. Hypertension, obesity and sedentary lifestyle were the common correlates recorded for the population of interest. Therefore, the review highlights the disturbingly high prevalence of pre-diabetes in South Africa and necessitates further investigations into the possible genetics, biochemical and hormonal changes in pre-diabetes.

ETHICS AND DISSEMINATION

The review will not require ethics clearance because non-identifiable data will be used. The review outcomes will give insight into the current burden that pre-diabetes has in South Africa.

PROSPERO REGISTRATION NUMBER

CRD42020182430.

Prevalence and Characteristics of Prediabetes and Metabolic Syndrome in Seemingly Healthy Persons at a Health Check-Up Clinic

Purpose

This study investigated the prevalence and characteristics of prediabetes (PreDM) and metabolic syndrome (MetS) in seemingly healthy persons attending a health check-up clinic at a tertiary care hospital.

Patients and Methods

This was a cross-sectional study that enrolled 1213 subjects (339 male, 874 female) who underwent an annual health check-up at Siriraj Hospital, Bangkok, Thailand from 2009 to 2019. Factors that independently related to PreDM were analyzed using unconditional logistic regression analysis with adjustments for age, BMI, and gender.

Results

The prevalence of PreDM and MetS was 54.3% and 19.7% respectively. Participants with impaired fasting glucose (IFG) and glycated hemoglobin (HbA_1c) 38.8–46.4 mmol/mol had significantly higher waist circumference (WC) and blood pressure (BP) compared to those with IFG or HbA_1c 38.8–46.4 mmol/mol alone (P < 0.05). Among three PreDM subgroups, the average age was lowest in the HbA_1c 38.8–46.4 mmol/mol subgroup (P < 0.001). PreDM participants with MetS were older (p = 0.03), had higher WC, BP, fasting plasma glucose and serum triglyceride level (all P < 0.001) but had lower serum high-density lipoprotein (HDL) cholesterol level (P < 0.001). Multivariate analysis revealed high MetS score, obesity, and low serum HDL cholesterol level to be independently associated with PreDM with odds ratios of 9.02 (95% confidence interval [CI]: 4.03–20.18), 1.8 (95% CI: 1.07–3.04), and 1.42 (95% CI: 1.02–1.96), respectively.

Conclusion

The prevalence of PreDM and MetS was relatively high in seemingly healthy persons. Distinct PreDM subgroups with or without MetS exhibited diverse clinical and biochemical features suggesting dissimilar pathogenesis.

The Prevalence of Diabetes, Prediabetes and Associated Risk Factors in Hangzhou, Zhejiang Province: A Community-Based Cross-Sectional Study

OBJECTIVE

Little information is available on the prevalence and associated risk factors of diabetes and prediabetes in the community located in Hangzhou city, Zhejiang Province, southeast China. This study aims to investigate the prevalence of adult diabetes and prediabetes and their associated risk factors among a community population in Hangzhou.

METHODS

A multistage sampling method was used in this study. Ten communities located in Shangcheng district of Hangzhou city were selected, and 3096 permanent residents (resident for ≥6 months) aged 18 years and above were enrolled into this study. Finally, a total of 2986 participants were included. A questionnaire interview and physical examination were conducted for all participants by trained investigators in a local medical center. Anthropometric measurements covered height, weight, waist circumference (WC) and blood pressure, while the blood tests included fasting blood glucose, an oral glucose tolerance test and fasting lipid profiles. The American Diabetes Association diabetes diagnosis criteria were used to discriminate among normal blood glucose, diabetes and prediabetes. The Rao-Scott adjusted χ ² test and complex sampling design-based unconditional multivariate logistic regression analysis were used to evaluate factors associated with diabetes and prediabetes. Descriptive and inferential statistics were calculated in Stata version 15. P-values <0.05 indicate statistical significance.

RESULTS

The overall prevalence of diabetes was 13.97%, of which 81.54% had prediagnosed diabetes and 18.46% were newly diagnosed with diabetes in the present study. The prevalence of prediabetes was 18.89%. Multivariable logistic regression analysis showed that age, education, once smoking, family history of diabetes, obesity, central obesity and hypertension were factors associated with diabetes, while age, smoking, drinking, central obesity and hypertension were significant factors related to prediabetes.

CONCLUSION

The prevalence of diabetes and prediabetes in adults in Hangzhou city remains high. Interventions aiming to modify risk factors such as drinking, obesity, central obesity and hypertension are urgently required.

Renal Dysfunction in Prediabetes: Confirmed by Glomerular Hyperfiltration and Albuminuria

Objectives Prediabetes is defined as an intermediate state of hyperglycemia with glucose levels above normal but below the diagnostic cutoff of diabetes mellitus. Prediabetes is considered as an important risk factor for the development of diabetes and complications associated with diabetes. Since glomerular hyperfiltration (elevated GFR) and albuminuria represent early and reversible stages of kidney damage seen in patients with type 2 diabetes, we aim to assess the impact of hyperglycemia in prediabetic range on renal functions measured by estimated GFR and urine albumin excretion (UAE).

Materials and Methods The study included 1,031 patients aged 30 to 70 years, attending regular health checkup. Patients were grouped as normal, prediabetes, and diabetes according to the American Diabetic Association (ADA) criteria based on fasting blood sugar and hemoglobin A1c (HbA1c). Further, the patients were grouped into multiple subgroups based on age and gender. UAE was measured by using immunoturbidimetric method, and GFR was estimated by chronic kidney disease epidemiology collaboration (CKD EPI) equation.

Statistical Analysis Prevalence of hyperfiltration (estimated glomerular filtration rate above the age and gender specific 95th percentile), and albuminuria in prediabetes and diabetes was compared with normal controls. Odds ratio and 95% confidence interval were calculated by using logistic regression analysis to predict the occurrence of hyperfiltration in prediabetes and diabetes. Analysis of variance followed by post hoc comparison was done to assess the significance of difference, and p -value < 0.05 was considered statistically significant.

Results Prevalence of hyperfiltration was more in prediabetes and diabetes compared with normal controls, and it increased with surging HbA1c level that was shown as higher odds ratio for hyperfiltration in both the groups. UAE was more in the prediabetes and diabetes group when compared with normal controls, but the difference was significant only in diabetes.

Conclusion Since glomerular hyperfiltration represents an early and reversible stage of renal damage manifesting before the appearance of albuminuria, elevated GFR can be used to identify asymptomatic patients with intermediate hyperglycemia having high risk of developing nephropathy in the future. Prediabetes represents a window of opportunity to initiate preventive strategies at an early stage before the occurrence of significant renal damage.

Participants' Views on Lifestyle Intervention Program Enhancing Long-Term Health-Related Behaviors Improvement among Prehypertension and/or Prediabetes Mellitus Older Adults: A Qualitative Study Examined in Thailand at Health Promoting Hospitals

This study aimed to investigate the view of prediabetes and prehypertension elderly patients living around temple on long-term self-management in proficient way underneath the lifestyle intervention program based on both focus-group discussion and In-depth interview methods to fill the gap in partially successful intervention. 62 participants were selected from 220 participants of the quantitative published study by 2 researchers. The triangulation method was used to put great emphasis on the consistency and the credibility of the results. Almost all of the participants had benefited from the program regarding proper foods, suitable exercise and an inspiration of lifestyle modification. They made changes of eating behavior and exercise behavior during program attendance, however, after the program had finished, they had minimal concern to take care of themselves. Nonetheless, more than half of them demonstrated some health-related behaviors changes due to they gave the value of the suggestion in different aspects. Moreover, high-frequency program attendance was not related to blood results improvement. The knowledge obtained from program intervention together with adequate contact between the patient and the program staff, personal problems solving, personal attitude, practice and acceptable played a key role for long-term lifestyle modification and completely successful intervention.

Prevalence of Diabetes, Prediabetes, and Associated Risk Factors Among Agricultural Village Residents in the Dominican Republic

This study examined the prevalence and risk factors of prediabetes and type 2 diabetes among residents of agricultural settlement villages (bateyes) in the Dominican Republic. From March to April 2016, a cross-sectional, multi-stage cluster survey was conducted across the country's three agricultural regions (southwest, east, and north). At selected households, an adult completed a questionnaire to assess demographics, diabetes knowledge, and care, and two household residents of any age provided finger-prick blood samples that were analyzed for hemoglobin A1c (HbA1c). HbA1c was categorized as normal (< 5.7%), prediabetic (5.7-6.4%), or diabetic (≥ 6.5%). The prevalence rates of diabetes and prediabetes were 8.6% (95% confidence interval [CI], 6.2-11.8%) and 20.4% (95% CI, 17.9-23.2%), respectively, among all participants (N = 1293; median age, 35 years; range, 2-96 years), and 10.0% (95% CI, 7.2-13.8%) and 20.0% (95% CI, 17.4-23.0%), respectively, among adults 18 years or older (N = 730). The average age of participants with diabetes was 47.2 years. The average age of participants with prediabetes was 40.7 years. Among adult questionnaire respondents, 64.8% of all participants and 39.4% of patients with diabetes had not been tested for diabetes previously. Among patients with diabetes, 28.4% were previously diagnosed; 1.2% of prediabetes patients were previously diagnosed. Half (50.7%) of the respondents had heard of diabetes. The majority (94.1%) of patients previously diagnosed with diabetes reported using diabetes medication. Among both undiagnosed and previously diagnosed patients with diabetes, diabetes knowledge, previous diabetes testing, and diabetes care-seeking were lowest among Haitian-born participants. A high burden of undiagnosed diabetes and deficiencies in diabetes knowledge, access to care, and diagnosis exist among all batey inhabitants, but most acutely among Haitians. Improvements will require a multi-sectoral approach.

Diagnostic Thresholds for Pre-Diabetes Mellitus and Diabetes Mellitus and Subclinical Cardiac Disease in the General Population: Data From the ACE 1950 Study

Background Diabetes mellitus (DM) is associated with left ventricular remodeling and incident heart failure, but the association between glycated hemoglobin A1c (HbA1c) and subclinical cardiac disease is not established. We aimed to determine the associations between HbA1c and (1) echocardiographic measures of left ventricular structure and function, and (2) cardiovascular biomarkers: cardiac troponin T, NT-proBNP (N-terminal pro-B-type natriuretic peptide), and CRP (C-reactive protein). Methods and Results Participants (n=3688) born in 1950 from the population-based ACE (Akershus Cardiac Examination) 1950 Study were classified as DM (HbA1c≥6.5% or self-reported DM), pre-DM (HbA1c 5.7%-6.5%), and no-DM (HbA1c<5.7%). DM, pre-DM, and no-DM were classified in 380 (10%), 1630 (44%), and 1678 (46%) participants, respectively. Mean age was 63.9±0.7 years, mean body mass index was 27.2±4.4 kg/m², and 49% were women. Higher HbA1c was associated with worse left ventricular systolic (ejection fraction and global longitudinal strain) and diastolic (E/e'-ratio) function, myocardial injury (cardiac troponin T), inflammation (CRP), and impaired neurohormonal homeostasis (NT-proBNP) (P<0.001 in unadjusted and P<0.01 in adjusted analysis for all). The associations between HbA1c and cardiovascular biomarkers were independent of the echocardiographic variables, and vice versa. Associations were nonlinear (P<0.05 for nonlinearity) and appeared stronger in the pre-DM range of HbA1c than the no-DM and DM range. Conclusions HbA1c was associated with indexes of subclinical cardiovascular disease, and this was more pronounced in pre-DM. Our results suggest that cardiovascular preventive measures should be considered also in subjects with hyperglycemia and HbA1c below the established DM cutoff. Registration clinicaltrials.gov. Identifier: NCT01555411.

The Hidden Burden of Diabetes Mellitus in an Urban Community of Southwest Ethiopia

INTRODUCTION

Early detection of the unrecognized diabetes mellitus (DM) and its risk factors in the community is crucial to minimizing the burden of DM and associated complications. Hence, this study aimed to assess unrecognized DM and its relationship with behavioral characteristics, physical characteristics, and lipid profile among adults in Jimma Town, Southwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted on 915 adults in Jimma Town from June 17 to July 27, 2019. Physical measurements, lipid profile, and blood sugar levels were measured. The collected data were entered and analyzed using Epi Data 3.1 and SPSS version 21, respectively. Multivariable logistic regression was fitted to assess predictors of unrecognized DM where adjusted odds ratio (AOR) with its corresponding 95% confidence interval (CI) was used to assess the strength of association at P-value ≤05.

RESULTS

The prevalence of unrecognized DM and impaired glucose metabolism (pre-diabetes) were 3.1% (95% CI; 2.0-4.4) and 14.8% (95% CI; 12.5-17.2), respectively. The risk of unrecognized DM was higher among male participants (AOR = 2.94, 95% CI: 1.19, 7.29), age group of 35 years and above (AOR = 3.45, 95% CI: 1.16, 10.27), and high waist circumference (AOR = 4.21, 95% CI: 1.72, 10.33). On the other hand, participants who perform sufficient physical activity (AOR = 0.14, 95% CI: 0.03, 0.58) had low risk of undetected DM.

CONCLUSION

The prevalence of unrecognized diabetes mellitus was relatively high. Male sex, advanced age, physical inactivity, and high waist circumference were found to be predictors of unrecognized DM. Thus, awareness needs to be created among the community to practice regular physical activity and maintaining normal body weight. Additionally, screening of DM should be promoted for early detection, prevention, and treatment.

Pesticides-induced energy metabolic disorders

Metabolic disorders have become a heavy burden on society. Recently, through excessive use, pesticides have been found to be present in environmental matrixes and sometimes even accumulate in humans or other mammals through the food chain, which then causes health concerns. Evidence has indicated that pesticides have the potential to induce energy metabolic disorders by disturbing the physical process of energy absorption in the intestine and energy storage in the liver, adipose tissue and skeletal muscle in humans or other mammals. In addition, the homeostasis of energy regulation by the pancreas and immune cells is also affected by pesticides. These pesticide-induced disruptions ultimately cause abnormal levels of blood glucose and lipids, which in turn induce the development of related metabolic diseases, including overweight, underweight, insulin resistance and even diabetes. In this review, the results of previous studies focused on the induction of metabolic disorders by pesticides are summarized. We hope that this work will facilitate the discovery of a potential strategy for the treatment of diseases caused by pesticides.

Complicated Posterior Cervical Skin and Soft Tissue Infections at a Single Referral Center

Background

Although the incidence and mortality of complicated skin and soft tissue infections have decreased, this infection is still relatively frequent and can be associated with lethal complications. In this study, the authors present our clinical experience of patients with complicated posterior cervical skin and soft tissue infections (CPCSSTIs) diagnosed and treated in a reconstructive unit in northeastern China.

Methods

A retrospective chart review of patients diagnosed with CPCSSTIs from January 2009 to December 2018 was performed. To make the results objective and convincing, a data analysis was performed relating to demographic characteristics, clinical presentation, predisposing factor, bacterial culture, laboratory and radiographic evaluations, diagnostic clues, management, and complications as well as the clinical course and outcome.

Results

During the ten-year period, there were 174 consecutive patients admitted to our reconstructive center with final diagnosis of CPCSSTIs included. All the patients were adults, and the majority were male (67.2%). The patient's mean age was 51.3 years (range, 15-88 years). There were 114 patients (65.5%) that had associated systemic diseases, with diabetes mellitus (40.2%) as the most common predisposing factor. Common presented clinical symptoms were pain (90.8%), swelling (85.1%), and erythema (77%) of the neck. Surgical treatment was performed in all the patients, and most of them (83.9%) received the first surgery within 24 h. The most commonly isolated pathogen was Staphylococcus aureus (30%). Vancomycin (21.3%) was the most commonly used antibiotics, followed by cefepime (18.4%). All the patients survived and were discharged with a mean duration of hospitalization of 28.7 days. Those patients with predisposing factors (31.4 ± 12.35 days) or complications (41.0 ± 12.5 days) tended to have a longer hospital stay. The mean total costs of admission per patient were 47 644 RMB.

Conclusion

This study highlights the high cost burden of CPCSSTI patients. Those patients with predisposing factors or complications tended to have a longer hospital stay.

Prevalence, treatment, control of type 2 diabetes and the risk factors among elderly people in Shenzhen: results from the urban Chinese population

Background

Type 2 diabetes is regarded as one of the major public health problems worldwide. We aim to investigate the prevalence, treatment, and control rate in the Chinese urban population aged 65 years or older and also identified associated risk factors.

Methods

One hundred twenty-four thousand seven participants aged 65 years old and older were recruited from January 2018 through December 2018 at local community health service centers in Shenzhen. Fasting plasma glucose, as well as other biochemical indicators, were measured by standard methods. The analysis of multivariate logistic regression was applied to assess associated risk factors of type 2 diabetes.

Results

Approximately 22.5% of elderly urban Chinese residents had diabetes. Among people with diabetes, 54.8% received medical treatment. Only 34.4% of those who were treated had their glycemic controlled. The prevalence of T2D increased with increasing age before 80 years old, male, inadequate active physical activity, drinking, previous history of CVD, higher BMI, central obesity, and hypertension.

Conclusions

Our findings suggested that attention should be paid to the prevention and control of T2D in Chinese urban elderly population. The health policy department should develop effective strategies aimed at improving health care management of T2D in elderly adults.

Shifting the Care of Type 2 Diabetes Mellitus from Hospital to Primary Health Care Institutions through an Educational Intervention for Health Care Professionals: An Example from Rural China

This study assessed the impact of an educational intervention on the knowledge, attitudes, and practice regarding Type 2 Diabetes Mellitus (T2DM) of Primary Health Care (PHC) professionals, as well as on the types of T2DM care services which they were able to provide. The intervention was carried out in collaboration with county hospitals. The study was conducted from 2015 to 2016 among 241 health care professionals in 18 township health centers and 55 village clinics in three counties in Jiangsu Province, randomly divided into an intervention group and a control group. Participants in the intervention group received professional skills training sessions and team communication and were involved in regular meetings. The control group followed the routine work plan. At one-year follow up, the diabetes knowledge score, practice score, and attitudes score were significantly higher in the intervention group than in the control group. A significantly higher proportion of health care professionals in the intervention group was able to provide services compared with the control group, for all types of services, except T2DM emergency treatment. The intervention among health care professionals in PHC had a positive impact on their professional diabetes skills, knowledge, attitudes, practices, and types of services they were able to provide, at one-year follow-up.

Observational study of the efficacy of prolonged-release metformin in people with prediabetes

Objectives: Prediabetes is characterized by elevation of indices of blood glucose that is insufficient to provoke a diagnosis of type 2 diabetes, but markedly increases the risk of developing type 2 diabetes in the future. Lifestyle interventions are the main therapeutic intervention for the management of prediabetes. Current guidelines also support treatment of prediabetes with metformin for selected subgroups of patients, and metformin has a therapeutic indication for this use in a number of countries.Methods: We performed an observational, non-interventional study of the effects on glycaemia of prolonged-release metformin (Glucophage XR, referred to henceforth as metformin XR) in 686 subjects with prediabetes. Metformin was prescribed according to physicians' usual care practices, and the study duration was 12 weeks.Results: Mean (SD) fasting plasma glucose (FPG) at baseline was 6.2 (0.4) mmol/L [111 (8) mg/dL) and was reduced by -0.55 (0.7) mmol/L [-10 (13) mg/dL] after 12 weeks of metformin XR. FPG was normalized to below the American Diabetes Association cut-off for the diagnosis of prediabetes (<5.7 mmol/L [100 mg/dL]) in 43% of subjects. Increasing age, increasing body mass index, not following a weight-loss diet and alcohol use predicted a lower probability of normalized FPG. Metformin was well tolerated, with most side effects occurring in the gastrointestinal system, as expected.Conclusions: Metformin XR normalized FPG in about two-fifths of subjects with prediabetes. These real-world data add further support a role for metformin in the management of prediabetes, in line with current guidelines in this area.

Fasting and postprandial lipid parameters: A comparative evaluation of cardiovascular risk assessment in prediabetes and diabetes

Context:

Dyslipidemia plays a crucial role in atherogenesis, in both prediabetes and diabetes. There persists a lacuna in the evaluation of postprandial lipid parameters in prediabetes.

Aims:

To comparatively evaluate fasting and postprandial blood lipid parameters and atherogenic lipid ratios for cardiovascular risk assessment, in prediabetes and diabetes.

Materials and Methods:

Fifty-one patients diagnosed with diabetes mellitus and thirty-two with prediabetes were selected for the study. Lipid profile and blood glucose were analyzed in fasting and postprandial blood samples.

Statistical Analysis Used:

Kolmogorov–Smirnov test, Shapiro–Wilk test, one-way ANOVA, and Pearson's regression analysis were applied.

Results:

Postprandially, triglycerides (TG) was increased significantly in diabetes compared to controls (P < 0.01) and prediabetics (P < 0.05). Among the lipid ratios, triglyceride/high density lipoprotein (TG/HDLc) was significantly increased postprandially in diabetes compared to controls (P < 0.05). A comparative analysis of fasting and postprandial parameters within each group showed a significant increase in postprandial TG/HDLc compared to the fasting state in prediabetes (P < 0.001) and diabetes (P < 0.001). Postprandial TG (P < 0.01) and TG/HDLc (P < 0.01) showed a stronger correlation with HbA_1c compared to fasting TG (P < 0.05) and TG/HDLc (P > 0.05). The prevalence of dyslipidemia and insulin resistance was higher in postprandial state than the fasting state in prediabetes and diabetes.

Conclusions:

Postprandial TG and the TG/HDLc reflect lipid abnormalities than the corresponding fasting variables in diabetes and prediabetes. Postprandial TG and TG/HDLc are better reflectors of cardiovascular status in prediabetes and diabetes.

Association between Diabetes Knowledge and Self-Efficacy in Patients with Type 2 Diabetes Mellitus in China: A Cross-Sectional Study

OBJECTIVE

This study aimed to explore the association between DM knowledge and self-efficacy in Chinese patients with T2DM. The influence factors for DM knowledge were explored, and evidence on interventions was provided to patients for information.

DESIGN

A cross-sectional survey was conducted in various hospitals in Hunan Province, China, from April 2017 to February 2019, by using multistage stratified randomized sampling. DM knowledge and self-efficacy were measured using the Audit of Diabetes Knowledge (ADKnowl) and the General Self-efficacy (GSE) Scale. The relationship between the ADKnowl and the GSE scores was analyzed using the Spearman correlation analysis. Differences in the ADKnowl and GES scores among groups with different sociodemographic characteristics were computed; significant variables and GES scores were input in the multiple stepwise linear regression model to predict the influencing factors of ADKnowl scores.

RESULTS

A total of 1,512 eligible patients with T2DM were included in this study, and their mean ADKnowl score was 59.04 ± 16.24. The top score of the eight dimensions in the ADKnowl scale was reducing the complication risk by 71.01%. The mean GSE score was 2.42 ± 0.59. The Spearman correlation analysis showed that the GSE score displayed a significantly positive correlation with DM knowledge at the ADKnowl scale (r = 0.172, P < 0.001). The best fit multivariable linear regression analysis revealed eight variables that explained 37.6% of the variance of ADKnowl scores. They were diabetes-learning experience, educational background, complication, therapy, waist-to-hip ratio, diabetes duration, marital status, and GSE (R ² = 0.376, F = 5.971, P=0.015).

CONCLUSIONS

In Chinese patients with T2DM, the self-efficacy in managing DM positively influenced DM knowledge. DM knowledge, as a protective factor, conversely improved the efficiency of self-management for T2DM. Some ignored influence factors in previous studies can be showed by investigating and analyzing from two scales. Health educators and promoters should help in developing DM knowledge and self-efficacy.

Prevalence of Diabetes, Prediabetes, and Associated Factors in an Adult Chinese Population: Baseline of a Prediabetes Cohort Study

PURPOSE

To report baseline information of a prediabetes mellitus (PDM) cohort with the aim of exploring related factors for the progression of PDM and its complications.

METHODS

This study is an exploratory and cross-sectional analysis of the baseline data from a cohort study. Residents aged 18 to 70 years from Houtang Village, Nanyue Town, Yueqing City, Zhejiang Province, China, were invited to participate between October 1, 2018 and July 1, 2019. Blood samples were collected for analysis, and questionnaire interviews were conducted to assess behavioral characteristics. The study participants were divided into DM, PDM, and normal groups for comparisons based on their blood work, and multiple multinomial logistic regression analyses were used to assess the risk factors for DM and PDM.

RESULTS

Data from 406 participants were used in the baseline analysis, with a mean age of 51.2 ± 11.0 years and 160 (33.0%) males. The number of participants in the DM, PDM, and normal group was 58 (14.3%), 166 (40.9%), and 182 (44.8%), respectively. The prevalence of DM was 14.3%, and the prevalence of PDM was 40.9%. The regression analysis showed that older age (relative risk ratio (RRR) = 1.06; 95% CI, 1.01-1.11, P = 0.018), higher systolic blood pressure (RRR = 1.04; 95% CI, 1.004-1.08, P = 0.030), higher BMI (RRR = 1.20; 95% CI, 1.06-3.06, P = 0.004), higher TG (RRR = 1.80; 95% CI, 1.06-3.06, P = 0.029), and higher WBC count (RRR = 1.32; 95% CI, 1.07-1.64, P = 0.010) were significantly associated with a higher risk of DM. Meanwhile, higher systolic blood pressure (RRR = 1.03; 95% CI, 1.004-1.06, P = 0.025) was the only factor significantly associated with a higher risk of PDM.

CONCLUSION

The prevalence of DM and PDM is relatively high in this wealthy East China village population. Many modifiable risk factors exist for DM and PDM, which will be closely monitored during our longitudinal observation.

Stratified Diabetes Mellitus Prevalence for the Northwestern Nigerian States, a Data Mining Approach

An accurate classification for diabetes mellitus (DBM) allows for the adequate treatment and handling of its menace, particularly in developing countries like Nigeria. This study proposes data mining techniques for the classification and identification of the prevalence of diagnosed diabetes cases, stratified by age, gender, diabetic conditions and residential area in the northwestern states of Nigeria, based on the real-life data derived from government-owned hospitals in the region. A K-mean assessment was used to cluster the instances, after 12 iterations the instances classified out of 3022: 2662 (88.09%) non-insulin dependent (NID), 176 (5.82%) insulin-dependent (IND) and 184 (6.09%) gestational diabetes (GTD). The total number of diagnosed diabetes cases was 3022: 1380 males (45.66%) and 1642 females (54.33%). The higher prevalence was found to be in females compared to males, and in cities and towns, rather than in villages (36.5%, 34.2%, and 29.3%, respectively). The highest prevalence among the age groups was in the age group 50-69 years, which constituted 43.9% of the total diagnosed cases. Furthermore, the NID condition had the highest prevalence of cases (88.09%). These were the first findings of the stratified prevalence in the region, and the figures have been of utmost significance to the healthcare authorities, policymakers, clinicians, and non-governmental organizations for the proper planning and management of diabetes mellitus.