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Hinneh T, Akyirem S, Bossman IF, Lambongang V, Ofori-Aning P, Ogungbe O, Commodore Mensah Y. Regional prevalence of hypertension among people diagnosed with diabetes in Africa, a systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001931. [PMID: 38051707 PMCID: PMC10697518 DOI: 10.1371/journal.pgph.0001931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/03/2023] [Indexed: 12/07/2023]
Abstract
Hypertension and diabetes comorbidity can increase healthcare expenditure and the risk of coronary heart disease. We conducted a systematic review and meta-analysis to estimate the prevalence of hypertension among people with diabetes in African countries. We searched EMBASE, PubMed and HINARI databases from inception to March 2023. Cross-sectional studies reporting the prevalence of hypertension among people with diabetes and published in English in Africa were eligible for inclusion. The cross-sectional study design component of the mixed method appraisal tool was used to assess the quality of the included studies. We quantified the overall and regional prevalence of hypertension among people with diabetes using random-effects meta-analysis. We assessed heterogeneity and publication bias using I2 statistics and funnel plots. Out of 3815 articles retrieved from the various databases, 41 met the inclusion criteria with sample sizes ranging from 80 to 116726. The mean age was 58 years (± 11) and 56% were women. The pooled prevalence of hypertension in people diagnosed with diabetes was 58.1% [95% CI: 52.0% - 63.2%]. By region, Central Africa had the highest hypertension prevalence; 77.6% [95% CI: 53.0% - 91.4%], Southern Africa 69.1% [95% CI: 59.8% - 77.1%;], North Africa 63.4% [95% CI: 37.1% - 69.1%;], West Africa 51.5% [95% CI: 41.8% - 61.1%] and East Africa 53.0% [95% CI: 45.8% - 59.1%]. Increasing age, being overweight/obese, being employed, longer duration of diabetes, urban residence, and male sex were reported to be associated with a higher likelihood of developing hypertension. The high prevalence of hypertension among people with diabetes in Africa highlights the critical need for an integrated differentiated service delivery to improve and strengthen primary care and prevent cardiovascular disease. Findings from this meta-analysis may inform the delivery of interventions to prevent premature cardiovascular disease deaths among persons in the region.
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Affiliation(s)
- Thomas Hinneh
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - Samuel Akyirem
- Yale School of Nursing, Yale University, New Haven, Connecticut, United States of America
| | | | - Victor Lambongang
- School of Health Sciences, Liberty University, Lynchburg, Virginia, United States of America
| | - Patriot Ofori-Aning
- Department of Medicine for Older People, Stockport NHS Foundation Trust, Manchester, United Kingdom
| | - Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Yvonne Commodore Mensah
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Cho YY, Cho SI. Treatment variation related to comorbidity and complications in type 2 diabetes: A real world analysis. Medicine (Baltimore) 2018; 97:e12435. [PMID: 30213022 PMCID: PMC6156008 DOI: 10.1097/md.0000000000012435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 08/23/2018] [Indexed: 12/14/2022] Open
Abstract
A complex comorbidity status may cause treatment variance interfering with type 2 diabetes (T2D) guideline-confirm therapy and influence the occurrence of complications but evidence on its relationships and alternative treatments are lacking. This study aimed to identify treatment variance and common T2D drug treatment related to comorbid status and the association with comorbidity and complications.Based on Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) databases, we conducted a retrospective, observational exploratory study including 7123 T2D patients without microvascular-, macrovascular complication. We explored patterns of comorbid status and drug treatment and its relation to the development of complications within 4-year period. Analysis was performed by two-step cluster analysis and nonlinear canonical correlation analysis.64.9% had at least one other chronic disease and 61.7% of T2D patients were treated with >1 glucose lowering drugs. 15.8% developed microvascular complications and 6.5% had ischemic heart disease or cerebrovascular complications. 82.2% of the treatment patterns were identified among T2D patients with 1 or no comorbidity while 14.4% was identified in patients with ≥2 comorbidities. Combination treatment such as, sulfonylurea or dipeptidyl peptidase-4 inhibitors combined with metformin were observed. Occurrence of microvascular- or/and macrovascular complication and its relation to comorbidity and treatment pattern was not identified.In conclusion, as number of comorbidity increased with both type of comorbidity (diabetes related-, unrelated) present, common treatment patterns were less or not identified. More treatment variance was observed in patient's groups that had developed complications.
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Affiliation(s)
- Yeon Young Cho
- Division of Epidemiology, Department of Public Health Science, Graduate School of Public Health
| | - Sung-il Cho
- Department of Public Health Science, Graduate School of Public Health, and Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
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Cho YY, Cho SI. Metformin combined with dipeptidyl peptidase-4 inhibitors or metformin combined with sulfonylureas in patients with type 2 diabetes: A real world analysis of the South Korean national cohort. Metabolism 2018. [PMID: 29530797 DOI: 10.1016/j.metabol.2018.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS We explored the risks associated with metformin plus sulfonylurea (MET + SU) or MET plus a dipeptidyl peptidase-4 inhibitor (MET + DPP4i) for hypoglycemia, cardiovascular disease (CVD) events and all-cause mortality in type 2 diabetes (T2D) patients with comorbidities. METHODS This retrospective cohort study is based on the South Korean National Health Insurance Service-National Sample Cohort, enrolling T2D patients with one or more diabetes-related comorbidities who switched from monotherapy to MET + SU or MET + DPP4i between July 1, 2008 and December 31, 2013. The risk of hypoglycemia, CVD events and all-cause mortality was examined using Cox's proportional hazard modeling and propensity score matching. RESULTS Overall, 5693 patients with a mean of 2.6 comorbidities in addition to diabetes were included. Compared with MET + SU, MET + DPP4i treatment was associated with a lower risk of hypoglycemia, CVD events and all-cause mortality; adjusted HRs (95% CI), 0.39 (0.18-0.83), 0.72 (0.54-0.97), and 0.64 (0.39-1.05), respectively. Propensity score matching showed comparable results. In further subgroup analyses according to comorbidity type and number, MET + DPP4i was associated with less CVD events and all-cause mortality compared to MET + SU. This increased with more complex comorbid status. CONCLUSIONS In T2D patients with comorbidities, MET + DPP4i treatment is associated with lower risks of CVD events and all-cause mortality compared with MET + SU, independent of type or number of comorbidities. A more complex comorbid status further increases this effect.
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Affiliation(s)
- Yeon Young Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
| | - Sung-Il Cho
- Department of Public Health Science, Graduate School of Public Health, Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea.
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Chavan S, Gavale KS, Khan A, Joshi R, Kumbhar N, Chakravarty D, Dhavale DD. Iminosugars Spiro-Linked with Morpholine-Fused 1,2,3-Triazole: Synthesis, Conformational Analysis, Glycosidase Inhibitory Activity, Antifungal Assay, and Docking Studies. ACS OMEGA 2017; 2:7203-7218. [PMID: 30023541 PMCID: PMC6044920 DOI: 10.1021/acsomega.7b01299] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/13/2017] [Indexed: 05/21/2023]
Abstract
Synthesis of iminosugars 1, 2, 3a, and 4a and N-alkyl (ethyl, butyl, hexyl, octyl, decyl, and dodecyl) derivatives 3b-g and 4b-g spiro-linked with morpholine-fused 1,2,3-triazole is described. Conformation of the piperidine ring in each spiro-iminosugar was evaluated by 1H NMR spectroscopy, and conformational change in N-alkylated compounds 4b-g with respect to parent spiro-iminosugar 4a is supported by density functional theory calculations. Out of 16 new spiro-iminosugars, the spiro-iminosugars 3a (IC50 = 0.075 μM) and 4a (IC50 = 0.036 μM) were found to be more potent inhibitors of α-glucosidase than the marketed drug miglitol (IC50 = 0.100 μM). In addition, 3a (minimum inhibition concentration (MIC) = 0.85 μM) and 4a (MIC = 0.025 μM) showed more potent antifungal activity against Candida albicans than antifungal drug amphotericin b (MIC = 1.25 μM). In few cases, the N-alkyl derivatives showed increase of α-glucosidase inhibition and enhancement of antifungal activity compare to the respective parent iminosugar. The biological activities were further substantiated by molecular docking studies.
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Affiliation(s)
- Shrawan
R. Chavan
- Garware
Research Centre, Department of Chemistry, Department of Chemistry, Institute of Bio-informatics
and Biotechnology, and Central Instrumentation Facility, Savitribai Phule Pune University (Formerly University of Pune), Ganeshkhind Road, Pune 411007, India
| | - Kishor S. Gavale
- Garware
Research Centre, Department of Chemistry, Department of Chemistry, Institute of Bio-informatics
and Biotechnology, and Central Instrumentation Facility, Savitribai Phule Pune University (Formerly University of Pune), Ganeshkhind Road, Pune 411007, India
| | - Ayesha Khan
- Garware
Research Centre, Department of Chemistry, Department of Chemistry, Institute of Bio-informatics
and Biotechnology, and Central Instrumentation Facility, Savitribai Phule Pune University (Formerly University of Pune), Ganeshkhind Road, Pune 411007, India
| | - Rakesh Joshi
- Garware
Research Centre, Department of Chemistry, Department of Chemistry, Institute of Bio-informatics
and Biotechnology, and Central Instrumentation Facility, Savitribai Phule Pune University (Formerly University of Pune), Ganeshkhind Road, Pune 411007, India
| | - Navanath Kumbhar
- Garware
Research Centre, Department of Chemistry, Department of Chemistry, Institute of Bio-informatics
and Biotechnology, and Central Instrumentation Facility, Savitribai Phule Pune University (Formerly University of Pune), Ganeshkhind Road, Pune 411007, India
| | - Debamitra Chakravarty
- Garware
Research Centre, Department of Chemistry, Department of Chemistry, Institute of Bio-informatics
and Biotechnology, and Central Instrumentation Facility, Savitribai Phule Pune University (Formerly University of Pune), Ganeshkhind Road, Pune 411007, India
| | - Dilip D. Dhavale
- Garware
Research Centre, Department of Chemistry, Department of Chemistry, Institute of Bio-informatics
and Biotechnology, and Central Instrumentation Facility, Savitribai Phule Pune University (Formerly University of Pune), Ganeshkhind Road, Pune 411007, India
- E-mail: ,
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Gao N, Yuan Z, Tang X, Zhou X, Zhao M, Liu L, Ji J, Xue F, Ning G, Zhao J, Zhang H, Gao L. Prevalence of CHD-related metabolic comorbidity of diabetes mellitus in Northern Chinese adults: the REACTION study. J Diabetes Complications 2016; 30:199-205. [PMID: 26718938 DOI: 10.1016/j.jdiacomp.2015.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/09/2015] [Accepted: 11/23/2015] [Indexed: 01/19/2023]
Abstract
AIM To gain more precise understanding of the epidemiology of comorbidities with diabetes and to clarify the correlation with coronary heart disease (CHD) in Chinese population. METHODS Based on REACTION study, 18,696 participants aged over 40 years were included in the cross-sectional analysis. Prevalence and patterns of comorbid diseases were demonstrated, and their impact on CHD was also analyzed by logistic regression. RESULTS Diabetes was more prevalent in patients with older age and lower education level, with relatively low awareness (36.3%), treatment (27.9%) and control (34.7%) rate. The proportion of diabetics with additional condition was 88.8%; 53.2% had more than two comorbidities. Compared with patients with comorbidities, diabetics only had the highest controlled HbA1c rate (37.9%). Dyslipidemia (71.97%) was the most common comorbidity, followed by hypertension (58.19%), and hypothyroidism (21.24%). A strong gradient existed between the number of comorbidities and CHD versus "diabetes only" group; the odds ratio was 1.38, 2.48 and 3.01 for diabetics with one, two and three additional diseases, respectively. CONCLUSIONS Low glycemic control and high prevalence of diabetes comorbidities are common in China, which increases the risk of CHD. Full-scale and individualized guidelines for diabetics should be planned.
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Affiliation(s)
- Nannan Gao
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
| | - Zhongshang Yuan
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China; Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong,250021, China
| | - Xulei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu,730000, China
| | - Xiaoming Zhou
- Scientific Center, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Meng Zhao
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
| | - Lu Liu
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
| | - Jiadong Ji
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong,250021, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong,250021, China
| | - Guang Ning
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jiajun Zhao
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
| | - Haiqing Zhang
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China.
| | - Ling Gao
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China; Scientific Center, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China.
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Moretto MC, Tadoni MI, Neri AL, Guariento ME. Associations among self-reported diabetes, nutritional status, and socio-demographic variables in community-dwelling older adults. REV NUTR 2014. [DOI: 10.1590/1415-52732014000600001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective:The aim of this study was to describe relationships between self-reported diabetes mellitus and its treatment, according to demographic and socioeconomic data, as well as indicators of nutritional status in community-dwelling older adults.Methods:This is a population-based and a cross-sectional study derived from the multicentric survey "Frailty in Brazilian Elderly". The random sample consisted of 881 community-dwelling older adults aged 65 years and older from the city of Campinas. The self-reported variables were: age, gender, family income (minimum salaries), education (years of education); and absolute data (yes versusno) regarding unintentional weight loss and weight gain, diabetes, and its treatment. Anthropometric variables were collected by trained examiners following classic protocols. Body mass index was classified as: underweight <23; normal weight ≥23 and <28; overweight ≥28 and <30; and obesity ≥30. Waist-to-hip ratio, indicator of abdominal adiposity, was classified according the metabolic risk, for male and female, respectively: low 0.90-0.95 and 0.80-0.85; moderate 0.96-1.00 and 0.86-0.90; and high >1.00 and >0.90.Results:The variables most associated with diabetes were obesity (OR=2.19), abdominal adiposity (OR=2.97), and unintentional weight loss (OR=3.38). The lack of diabetes treatment was associated with advanced age (p=0.027), lower educational level (p=0.005), and low metabolic risk (p=0.004).Conclusion: Self-reported diabetes was associated with obesity but mostly with abdominal adiposity and unintentional weight loss. Not being treated for diabetes mellituswas associated with advanced age, lower levels of education, and lower abdominal adiposity.
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Affiliation(s)
| | | | | | - Maria Elena Guariento
- Universidade Estadual de Campinas, Brasil; Universidade Estadual de Campinas, Brasil
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Anti-Diabetic Potential of the Essential Oil ofPinus koraiensisLeaves toward Streptozotocin-Treated Mice and HIT-T15 Pancreatic β Cells. Biosci Biotechnol Biochem 2014; 77:1997-2001. [DOI: 10.1271/bbb.130254] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Corser WD. Increasing comorbidity with diabetes in the community: diabetes research challenges. Diabetes Res Clin Pract 2013; 100:173-80. [PMID: 23228391 DOI: 10.1016/j.diabres.2012.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/29/2012] [Accepted: 11/15/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The purpose of this paper is to discuss the ongoing definitional, measurement and analytic challenges imposed on community-based diabetes researchers examining the experiences and outcomes of home-dwelling adults surviving longer with diabetes and additional comorbid health conditions. When selecting from the still limited number of standard hospital-oriented comorbidity methods, researchers across the world will need to consider a frequently complex series of methodological decisions from their enrolling such adults with increased comorbidity into study samples. CONCLUSIONS Three categories of methodological implications from increasing forms of comorbid diabetes are discussed for diabetes researchers. Six sequenced research design strategies with specific examples are offered regarding how to most rigorously incorporate elements of comorbidity into prospective diabetes study designs.
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Du Y, Heidemann C, Gößwald A, Schmich P, Scheidt-Nave C. Prevalence and comorbidity of diabetes mellitus among non-institutionalized older adults in Germany - results of the national telephone health interview survey 'German Health Update (GEDA)' 2009. BMC Public Health 2013; 13:166. [PMID: 23433228 PMCID: PMC3599814 DOI: 10.1186/1471-2458-13-166] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 02/08/2013] [Indexed: 12/30/2022] Open
Abstract
Background Despite the major public health impact of diabetes, recent population-based data regarding its prevalence and comorbidity are sparse. Methods The prevalence and comorbidity of diabetes mellitus were analyzed in a nationally representative sample (N = 9133) of the non-institutionalized German adult population aged 50 years and older. Information on physician-diagnosed diabetes and 20 other chronic health conditions was collected as part of the national telephone health interview survey ‘German Health Update (GEDA)’ 2009. Overall, 51.2% of contacted persons participated. Among persons with diabetes, diabetes severity was defined according to the type and number of diabetes-concordant conditions: no diabetes-concordant condition (grade 1); hypertension and/or hyperlipidemia only (grade 2); one comorbidity likely to represent diabetes-related micro- or macrovascular end-organ damage (grade 3); several such comorbidities (grade 4). Determinants of diabetes severity were analyzed by multivariable ordinal regression. Results The 12-month prevalence of diabetes was 13.6% with no significant difference between men and women. Persons with diabetes had a significantly higher prevalence and average number of diabetes-concordant as well as diabetes-discordant comorbidities than persons without diabetes. Among persons with diabetes, 10.2%, 46.8%, 35.6% and 7.4% were classified as having severity grade 1–4, respectively. Determinants of diabetes severity included age (cumulative odds ratio 1.05, 95% confidence interval 1.03-1.07, per year) and number of discordant comorbidities (1.40, 1.25-1.55). With respect to specific discordant comorbidities, diabetes severity was correlated to depression (2.15, 1.29-3.56), respiratory disease (2.75, 1.72-4.41), musculoskeletal disease (1.53, 1.06-2.21), and severe hearing impairment (3.00, 1.21-7.41). Conclusions Diabetes is highly prevalent in the non-institutionalized German adult population 50 years and older. Diabetes comorbidities including diabetes-concordant and diabetes-discordant conditions need to be considered in epidemiological studies, in order to monitor disease burden and quality of diabetes care. Definitional standards of diabetes severity need to be refined and consented.
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Affiliation(s)
- Yong Du
- Department of Epidemiology and Health Monitoring, Division of Non-Communicable Disease Epidemiology, Robert Koch Institute, General-Pape-Str. 62-66, D-12101, Berlin, Germany
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Rachmiel M, Rubio-Cabezas O, Ellard S, Hattersley AT, Perlman K. Early-onset, severe lipoatrophy in a patient with permanent neonatal diabetes mellitus secondary to a recessive mutation in the INS gene. Pediatr Diabetes 2012; 13:e26-9. [PMID: 21910811 DOI: 10.1111/j.1399-5448.2011.00809.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We describe a case of neonatal diabetes due to a homozygous mutation (c.3 G>T) at the INS gene, leading to lack of insulin expression and severe hyperglycemia from day one of life requiring permanent insulin replacement therapy. The genetic loss of endogenous insulin production likely led to lack of immune tolerance to insulin, with resultant autoantibody production against exogenous insulin and progressive immune-mediated lipoatrophy at injection sites.
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Affiliation(s)
- Marianna Rachmiel
- Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin (affiliated to Sackler Faculty of Medicine, Tel Aviv University), Israel.
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Voorham J, Haaijer-Ruskamp FM, Wolffenbuttel BHR, de Zeeuw D, Stolk RP, Denig P. Differential effects of comorbidity on antihypertensive and glucose-regulating treatment in diabetes mellitus--a cohort study. PLoS One 2012; 7:e38707. [PMID: 22679516 PMCID: PMC3367971 DOI: 10.1371/journal.pone.0038707] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 05/11/2012] [Indexed: 12/20/2022] Open
Abstract
Background Comorbidity is often mentioned as interfering with “optimal” treatment decisions in diabetes care. It is suggested that diabetes-related comorbidity will increase adequate treatment, whereas diabetes-unrelated comorbidity may decrease this process of care. We hypothesized that these effects differ according to expected priority of the conditions. Methods We evaluated the relationship between comorbidity and treatment intensification in a study of 11,248 type 2 diabetes patients using the GIANTT (Groningen Initiative to Analyse type 2 diabetes Treatment) database. We formed a cohort of patients with a systolic blood pressure ≥140 mmHg (6,820 hypertensive diabetics), and a cohort of patients with an HbA1c ≥7% (3,589 hyperglycemic diabetics) in 2007. We differentiated comorbidity by diabetes-related or unrelated conditions and by priority. High priority conditions include conditions that are life-interfering, incident or requiring new medication treatment. We performed Cox regression analyses to assess association with treatment intensification, defined as dose increase, start, or addition of drugs. Results In both the hypertensive and hyperglycemic cohort, only patients with incident diabetes-related comorbidity had a higher chance of treatment intensification (HR 4.48, 2.33–8.62 (p<0.001) for hypertensives; HR 2.37, 1.09–5.17 (p = 0.030) for hyperglycemics). Intensification of hypertension treatment was less likely when a new glucose-regulating drug was prescribed (HR 0.24, 0.06–0.97 (p = 0.046)). None of the prevalent or unrelated comorbidity was significantly associated with treatment intensification. Conclusions Diabetes-related comorbidity induced better risk factor treatment only for incident cases, implying that appropriate care is provided more often when complications occur. Diabetes-unrelated comorbidity did not affect hypertension or hyperglycemia management, even when it was incident or life-interfering. Thus, the observed “undertreatment” in diabetes care cannot be explained by constraints caused by such comorbidity.
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Affiliation(s)
- Jaco Voorham
- Department of Clinical Pharmacology, Faculty of Medical Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Corser WD. Increasing Primary Care Comorbidity: A Conceptual Research and Practice Framework. Res Theory Nurs Pract 2011; 25:238-51. [DOI: 10.1891/1541-6577.25.4.238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: To present a “contrasting perspectives” conceptual framework reflecting the typically strained experiences of many comorbid adults now interacting with primary care clinicians across the world. Background: More comorbidity-related needs are presented to primary care clinicians during typically shorter office-based health care encounters. The overall perceptual differences between many comorbid consumers and health care clinicians and systems in many countries are likely to worsen. Conclusions: Conceptual implications are discussed for primary care researchers testing interventions and attempting to influence the outcomes of increasingly comorbid primary care adults. Implications for Nursing Research and Practice: Three strategies are offered for researchers and clinicians considering how to include elements of comorbidity into their prospective primary care study interventions and care delivery processes.
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Poole JL, Gonzales I, Tedesco T. Self-reports of hand function in persons with diabetes. Occup Ther Health Care 2010; 24:239-248. [PMID: 23898930 DOI: 10.3109/07380571003793957] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
ABSTRACT The purpose of this study was to examine the reliability and validity of three self-reports of hand function for persons with diabetes. Thirty-six people with type II diabetes completed self-report questionnaires of hand function including the Hand Function Disability Scale (HFDS), Michigan Hand Outcomes Questionnaire (MHQ), and Dreiser's Functional Hand Index (DFI) at two points in time to assess test-retest reliability. To determine validity, participants were also administered performance-based tests of hand strength, dexterity, and joint motion using the Keital Function Test, and Hand Mobility in Scleroderma Test. Test-retest reliability intraclass correlation coefficients for test-retest reliability ranged from 0.89 to 0.96 for the HFDS; 0.58 to 0.94 for the MHQ; and 0.90 for the DFI. Spearman Rho correlations showed fair correlations between the HFDS and applied hand strength. Fair correlations were also found between the scores on the MHQ and hand strength and joint motion, while scores on the DFI did not correlate with hand strength, dexterity, or joint motion. Overall, the HFDS and the MHQ appear to be reliable and valid measures of hand function in persons with diabetes and may help occupational therapists determine the level of difficulty with daily tasks and monitor outcomes of therapy in persons with diabetes.
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Affiliation(s)
- Janet L Poole
- Janet L. Poole, PhD, OTR/L, FAOTA, is Professor, Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, New Mexico
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