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Lin JS, Webber EM, Bean SI, Martin AM, Davies MC. Rapid evidence review: Policy actions for the integration of public health and health care in the United States. Front Public Health 2023; 11:1098431. [PMID: 37064661 PMCID: PMC10090415 DOI: 10.3389/fpubh.2023.1098431] [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: 11/14/2022] [Accepted: 03/02/2023] [Indexed: 03/31/2023] Open
Abstract
ObjectiveTo identify policy actions that may improve the interface of public health and health care in the United States.MethodsA rapid review of publicly-available documents informing the integration of public health and health care, and case examples reporting objective measures of success, with abstraction of policy actions, related considerations, and outcomes.ResultsAcross 109 documents, there were a number of recurrent themes related to policy actions and considerations to facilitate integration during peace time and during public health emergencies. The themes could be grouped into the need for adequate and dedicated funding; mandates and shared governance for integration; joint leadership that has the authority/ability to mobilize shared assets; adequately staffed and skilled workforces in both sectors with mutual awareness of shared functions; shared health information systems with modernized data and IT capabilities for both data collection and dissemination of information; engagement with multiple stakeholders in the community to be maximally inclusive; and robust communication strategies and training across partners and with the public.ConclusionWhile the evidence does not support a hierarchy of policies on strengthening the interface of public health and health care, recurrent policy themes can inform where to focus efforts.
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Bahari NI, Ahmad N, Mahmud MH, Baharom M, Amir SM, Peng CS, Hassan MR, Nawi AM. Issues and Challenges in the Primary Prevention of Type 2 Diabetes Mellitus: A Systematic Review. JOURNAL OF PREVENTION (2022) 2023; 44:105-125. [PMID: 36129587 DOI: 10.1007/s10935-022-00707-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Primary prevention of type 2 diabetes mellitus (T2DM) is possible in at-risk populations, and prevention programmes have been shown to be effective in real-world scenarios. Despite this evidence, diabetes prevalence has tripled in recent decades and is expected to reach 700 million patients by 2045, making it one of the leading causes of death globally. This review is aimed at identifying the issues and challenges in the primary prevention of T2DM. METHODS Scopus, Web of Science, PubMed and Ovid MEDLINE were systematically searched for published articles. Articles were screened based of inclusion and exclusion criteria. The inclusion criteria were: (1) published in 2010-2020, (2) full original article, (3) written in English, (4) qualitative, mixed-methods article, observational or interventional study. The exclusion criteria were: (1) animal study, (2) in vivo/in vitro study, (3) type 1 diabetes or gestational DM and (4) conference abstract, book chapter, report, and systematic review. Eligible articles were assessed using Mixed Methods Appraisal Tool (MMAT) by three assessors. RESULTS A total of 11 articles were selected for qualitative synthesis from the initial 620 articles. The issues and challenges seen in T2DM primary prevention followed three themes: healthcare program (sub-themes: lack of resources, community partnership, participation, health literacy), health provider (sub-themes: lack of implementation, health care staff, collaboration, availability), individual (sub-themes: awareness, communication, misbehaviour, family conflict). CONCLUSION Factors relating to healthcare programmes, health providers, and individual issues are the main challenges in T2DM primary prevention. By establishing sustainable preventative initiatives that address these issues and challenges in the primary prevention of T2DM, a reduction in T2DM prevalence could be achievable.
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Affiliation(s)
- Nor Izyani Bahari
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Norfazilah Ahmad
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Muhammad Hilmi Mahmud
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Mazni Baharom
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Siti Maisara Amir
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Chua Su Peng
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia.
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Abel SL, Whitehead LC, Tipene-Leach DC, Coppell KJ. Proximal and distal influences on dietary change among a diverse group with prediabetes participating in a pragmatic, primary care nurse-led intervention: a qualitative study. Public Health Nutr 2021; 24:6015-6026. [PMID: 33966689 PMCID: PMC11148607 DOI: 10.1017/s1368980021001968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To understand motivators, facilitators and challenges to dietary change amongst a diverse sample of New Zealanders with prediabetes participating in a primary care nurse-led individualised dietary intervention. DESIGN A qualitative study involving semi-structured, face-to-face interviews with a stratified sample of adults with prediabetes and BMI ≥ 25 kg/m2, purposefully selected from a larger 2-year primary care-based prediabetes dietary intervention study. Thematic analysis was undertaken. A socio-ecological model guided interpretation. SETTING Hawke's Bay, Aotearoa/New Zealand, April 2018-March 2020. PARTICIPANTS Fifty-eight people aged 28-69 years, with similar numbers of men and women, indigenous Māori and non-Māori, and those who had and had not regressed to normoglycaemia at 6 months. RESULTS Motivators for wanting to make dietary changes were determination not to progress to diabetes; wanting to be healthy and contribute to others and encouragement by others. Facilitators for adopting and maintaining changes were a strong desire to be healthy; personal determination and feeling supported. Challenges were compromised control over life and environmental factors; feeling unsupported by others; social occasions; financial constraints and living with other health conditions. Developing their own strategies to overcome challenges was empowering, enabling a sense of control. These factors were similar across demographic and glycaemic outcome groups. CONCLUSIONS Influences on dietary change involved personal, interpersonal, organisational, environmental and policy factors. Although findings appeared similar across groups, dietary interventions need to address the specific ways motivators, facilitators and challenges manifest for individuals and social groups and be tailored accordingly within the context of the wider obesogenic and socio-economic environment.
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Affiliation(s)
- Sally L Abel
- Kaupapa Consulting Ltd, Napier, Aotearoa/New Zealand
| | - Lisa C Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - David C Tipene-Leach
- Eastern Institute of Technology, Taradale, Napier, Hawke's Bay, Aotearoa/New Zealand
| | - Kirsten J Coppell
- Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin9054, Aotearoa/New Zealand
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Drazba KT, Denton JJ, Hurst CB, McGwin G, MacLennan PA, Ovalle F. Incorporation of a genetics-based information module into standardized diabetes patient education. Prim Care Diabetes 2021; 15:706-712. [PMID: 33994279 DOI: 10.1016/j.pcd.2021.04.013] [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: 02/24/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate the effectiveness of a genetics educational module created to improve understanding about the genetics of diabetes, assess motivation to engage in healthy lifestyle behaviors, and gauge interest in genetic testing for diabetes. METHODS Participants were recruited from the Multidisciplinary Comprehensive Diabetes Clinic at the University of Alabama at Birmingham. Participants completed a pre-survey to assess three domains: (1) knowledge about diabetes etiology and testing, (2) healthy lifestyle behaviors, and (3) interest in genetic testing. Participants viewed a short, recorded educational module, then completed a post-survey to re-assess the domains. RESULTS Participants increased knowledge about genetics of diabetes (p < 0.0001) and genetic testing (p = 0.0184), demonstrated motivation to adopt healthy behaviors (p < 0.0001), and decreased interest in genetic testing (p = 0.0833) after viewing the module. CONCLUSIONS The educational module increased understanding of diabetes and increased motivation to adopt healthy behaviors. The need for patient-friendly educational modules explaining the genetics of diabetes will likely increase with continued discoveries of how genetics contributes to diabetes risk and outcomes. This short, educational module has the potential to provide genetic information in an effective way that is easily adapted in a routine clinic setting.
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Affiliation(s)
- Kathryn T Drazba
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jessica Johnson Denton
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Christina Barger Hurst
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Paul A MacLennan
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Fernando Ovalle
- Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham, Birmingham, AL, United States
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Gibson B, Umeh K, Davies I, Newson L. The best possible self-intervention as a viable public health tool for the prevention of type 2 diabetes: A reflexive thematic analysis of public experience and engagement. Health Expect 2021; 24:1713-1724. [PMID: 34258837 PMCID: PMC8483206 DOI: 10.1111/hex.13311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/10/2021] [Accepted: 06/06/2021] [Indexed: 11/30/2022] Open
Abstract
Background Public health initiatives seek to modify lifestyle behaviours associated with risk (e.g., diet, exercise, and smoking), but underpinning psychological and affective processes must also be considered to maximize success. Objective This study aimed to qualitatively assess how participants engaged with and utilized the best possible self (BPS)‐intervention specifically as a type 2 diabetes (T2D) prevention tool. Design and Methods Fourteen participants engaged with a tailored BPS intervention. Reflexive thematic analysis analysed accounts of participant's experiences and feasibility of use. Results All participants submitted evidence of engagement with the intervention. The analysis considered two main themes: Holistic Health and Control. The analysis highlighted several nuanced ways in which individuals conceptualized their health, set goals, and received affective benefits, offering insights into how people personalized a simple intervention to meet their health needs. Conclusions To our knowledge, this is the first study to tailor the BPS intervention as a public health application for the prevention of T2D. The intervention enabled users to identify their best possible selves in a way that encouraged T2D preventive behaviours. We propose that our tailored BPS intervention could be a flexible and brief tool to assist public health efforts in encouraging change to aid T2D prevention. Public Contribution The format, language and application of the BPS intervention were adapted in response to a public consultation group that developed a version specifically for application in this study.
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Affiliation(s)
- Benjamin Gibson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, Merseyside, UK
| | - Kanayo Umeh
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, Merseyside, UK
| | - Ian Davies
- School of Sports and Exercise Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, Merseyside, UK
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, Merseyside, UK
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Alemayehu AM, Sisay MM. Attitude towards diabetes mellitus among adult communities in Gondar city, Ethiopia. PLoS One 2021; 16:e0251777. [PMID: 34014991 PMCID: PMC8136679 DOI: 10.1371/journal.pone.0251777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 05/03/2021] [Indexed: 12/03/2022] Open
Abstract
Background Diabetes mellitus is a metabolic disorder characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Diabetes and its complications can be reduced by enhancing the attitude of the community. However, there is limited information regarding attitude towards diabetes in northwest Ethiopia. Therefore, this study determined the attitude and associated factors of diabetes mellitus among adult non-diabetic participants in Gondar city. Methods A community-based cross-sectional study was conducted in Gondar city. Systematic random sampling was employed to select 626 non-diabetic participants. The data were collected using a pre-tested structured questionnaire. Descriptive statistics, processing, and analysis were done using STATA version 14. Both bivariable and multivariable binary logistic regressions were used to identify the associated factors. An adjusted odds ratio with a 95% confidence interval was used to calculate a level of significance. Results Of 626 participants, 572 (91.37%) study subjects heard about diabetes mellitus. Three hundred and fifteen participants (55.07%) (95% CI: 50.9% - 59.1%) had a favorable attitude towards diabetes mellitus. Having good knowledge about diabetes (adjusted odds ratio = 2.69, 95% CI: 1.88, 3.87), and higher educational status (adjusted odds ratio = 1.69, 95% CI: 1.04, 2.78) were positively associated with a favorable attitude towards diabetes mellitus. Female gender (adjusted odds ratio = 0.68, 95% CI: 0.47, 0.98), on the other hand, had poor attitude towards diabetes mellitus. Conclusion In this study, a favorable attitude towards diabetes was low among adult non-diabetic participants. Good knowledge, higher educational status, and being male were the factors associated with a favorable attitude towards diabetes.
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Affiliation(s)
- Abiy Maru Alemayehu
- Department of Optometry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ehasanbakhsh H, Mirzaei A, Bakhtiyari S, Zavare MSA, Jalilian M. The Effect of Stress Management Program on Perceived Stress in Patients with Type 2 Diabetes: A Randomized Controlled Trial. Curr Diabetes Rev 2021; 17:e122820189540. [PMID: 33371851 DOI: 10.2174/1573399817666201228162950] [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: 06/02/2020] [Revised: 10/17/2020] [Accepted: 10/23/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Stress management plays an important role in improving metabolic control in type 2 diabetes patients. The aim of this study was to find the effect of educational intervention on improving stress management in type 2 diabetic patients in Dezful, Iran. METHODS In an experimental study, 92 patients with type 2 diabetes who were referred to the Diabetes Clinic of Ganjavian Hospital of Dezful were selected by available sampling method. Then, they were randomly divided into two groups: 46 as intervention and 46 as control. For the intervention group, a stress management training program was designed for one month (8 sessions), while there was no training for the control group. All participants filled the Cohen Perceived Stress Questionnaire (PSQ) in baseline and follow up (3 months) phases. All the data were analyzed using SPSS software by conducting an independent t- test, and paired sample t- test, and Chi-square test at a significant level of 0.05. RESULTS The mean age of participants was 52.70 ± 10.91 years. Pre-test data revealed that there was no significant difference between the stresses of the two groups (P> 0.05); however, the results of the independent t-test, 3 months after the educational intervention, demonstrated a significant decrease in stress level in the intervention group compared to the control group (P <0.05). CONCLUSION Based on the findings of this study, it is concluded that the design and implementation of health education interventions can be useful to improve stress management in people with type 2 diabetes.
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Affiliation(s)
- Hadi Ehasanbakhsh
- Diabetes Research Center of Ganjavian Hospital, Dezful University of Medical Sciences, Dezful, Iran
| | - Amin Mirzaei
- Department of Public Health, School of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Salar Bakhtiyari
- Department of Clinical biochemistry, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Mohsen Jalilian
- Department of Public Health, School of Health, Ilam University of Medical Sciences, Ilam, Iran
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Collaboration of primary care and public health at the local level: observational descriptive study of French local health contracts. Prim Health Care Res Dev 2020; 21:e61. [PMID: 33308346 PMCID: PMC7801931 DOI: 10.1017/s1463423620000559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM In this paper, we report on a study investigating the involvement of primary care providers in French local health contracts. BACKGROUND Worldwide actions are carried out to improve collaboration between primary care and public health to strengthen primary healthcare and consequently community health. In France, the local health contract is an instrument mobilising local stakeholders from different sectors to join in their actions to improve the health of the population. METHODS We developed an instrument to analyse the frequency and nature of involvement of primary care providers in 428 action plans extracted from a sample of 17 contracts (one per French region). The number of primary care actions were counted, and thematic analyses were conducted to identify the nature and level of involvement of the professionals. FINDINGS Primary care providers were involved in 20.1% (n = 86) of the action plans and were mostly described as a target of the action rather than leaders or partners. Within those action plans, 76.7% (n = 66) of these action plans aimed to improve access to care for local communities; an issue that appears as the main driver of collaboration between public health and primary care actors.
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Mamun A, Kitzman H, Dodgen L. Reducing metabolic syndrome through a community-based lifestyle intervention in African American women. Nutr Metab Cardiovasc Dis 2020; 30:1785-1794. [PMID: 32605881 PMCID: PMC7494631 DOI: 10.1016/j.numecd.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/09/2020] [Accepted: 06/01/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Metabolic syndrome (MetS) increases the risk of cardiovascular disease and type 2 diabetes. Despite a higher prevalence of MetS in African American (AA) women, little is known about the effectiveness of lifestyle interventions in improving metabolic markers in this high-risk group. This study investigated the effectiveness of a community-based lifestyle intervention delivered by lay health coaches in reducing MetS among AA women. METHODS AND RESULTS A cluster-randomized diabetes prevention program (DPP) was implemented in 11 churches utilizing a community-based participatory research (CBPR) approach to develop and deliver the interventions. A total of 221 adults, AA women who were overweight or obese, and did not have diabetes were included in this study. The prevalence of MetS was 42.08% before receiving the DPP intervention and 31.22% after the intervention that represented a 10.86% absolute reduction and a 25.81% relative reduction from baseline. The adjusted odds ratio (OR) of being free from MetS at post-intervention in contrast to baseline was 2.14 (p = 0.02). Factors that increased the odds of being free from MetS were younger age, reduction in intake of total calories, total fat, saturated and trans-fat, and dietary sodium. CONCLUSION A faith adapted lifestyle intervention held in church settings and delivered by minimally trained lay health coaches reduced the prevalence of MetS in AA women who were overweight or obese. Findings from this study can be used to translate evidence into public health programs at the community level for the prevention of type 2 diabetes and cardiovascular disease. CLINICAL TRIAL REGISTRATION NUMBER NCT04082702 (www.clinicaltrials.gov).
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Affiliation(s)
- Abdullah Mamun
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA.
| | - Heather Kitzman
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA; University of North Texas Health Science Center, Fort Worth, TX, USA; Baylor University, Waco, TX, USA
| | - Leilani Dodgen
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA; University of North Texas Health Science Center, Fort Worth, TX, USA
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Alemayehu AM, Dagne H, Dagnew B. Knowledge and associated factors towards diabetes mellitus among adult non-diabetic community members of Gondar city, Ethiopia 2019. PLoS One 2020; 15:e0230880. [PMID: 32214398 PMCID: PMC7098606 DOI: 10.1371/journal.pone.0230880] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/10/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Diabetes mellitus is a metabolic disorder resulting from either loss of insulin producing cells, insufficient insulin action, or both. Knowledge can play an important role in preventing diabetes mellitus and its complications. There is limited information regarding knowledge and related factors regarding diabetes mellitus among non-diabetic adult community members in the study area. Therefore, the current study aimed to determine knowledge and associated factors towards diabetes mellitus among non-diabetes community members of Gondar city. Methods Community-based cross-sectional study was conducted on non-diabetic community members from July 1–29, 2019 in Gondar city. The participants were selected randomly from each households. A structured questionnaire was used to collect the data. EpiData version 3.1 was used for data entry and SPSS version 20 was used for data processing and analysis. Descriptive statistics were calculated for most variables. Multivariable logistic regression was used to identify the associated factors. A variable was considered significantly associated at p-value<0.05. Result A total of 633 study subjects participated in this study with a mean age of 36.12 (± 12.87) years. Of these study participants, 572 had awareness about diabetes mellitus and 51.4% (95% CI: 47.4%, 55.8%) had good knowledge. Being male [Adjusted odds ratio = 1.62 (95% CI: 1.05, 2.48)], monthly income of 3000–5000 birr [Adjusted odds ratio = 1.88 (95% CI: 1.03, 3.41)], monthly income of ≥5001 birr [Adjusted odds ratio = 2.37 (95% CI: 1.17, 4.78)], previous training on diabetes mellitus [Adjusted odds ratio = 4.37 (95% CI; 3.04, 7.37)], being grade 9–12 [Adjusted odds ratio = 3.1 (95% CI: 1.09, 8.66)], having college and above educational qualification [Adjusted odds ratio = 3.70 (95% CI: 1.26, 10.85)] were significantly associated with good knowledge towards diabetes mellitus. Conclusion The level of knowledge regarding diabetes mellitus was low among study participants which indicates a need for health education intervention. Previous training on diabetes mellitus, educational status and average monthly income and being male were the factors associated with good knowledge of participants about diabetes mellitus.
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Affiliation(s)
- Abiy Maru Alemayehu
- Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Henok Dagne
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Baye Dagnew
- Department of Human Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tan PY, Mitra SR. The Combined Effect of Polygenic Risk from FTO and ADRB2 Gene Variants, Odds of Obesity, and Post-Hipcref Diet Differences. Lifestyle Genom 2020; 13:84-98. [PMID: 32101872 DOI: 10.1159/000505662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/30/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Computing polygenic risk scores (PRS) to predict the degree of risk for obesity may contribute to weight management programs strategically. OBJECTIVES To investigate the combined effect of FTO rs9930501, rs9930506, and rs9932754 and ADRB2 rs1042713 and rs1042714 using PRS on (1) the odds of obesity and (2) post-intervention differences in dietary, anthropometric, and cardiometabolic parameters in response to high-protein calorie-restricted, high-vitamin E, high-fiber (Hipcref) diet intervention in Malaysian adults. METHODS Both a cross-sectional study (n = 178) and a randomized controlled trial (RCT) (n = 128) were conducted to test the aforementioned objectives. PRS was computed as the weighted sum of the risk alleles possessed by each individual participant. Participants were stratified into first (PRS 0-0.64), second (PRS 0.65-3.59), and third (PRS 3.60-8.18) tertiles. RESULTS The third tertile of PRS was associated with significantly higher odds of obesity: 2.29 (95% CI = 1.11-4.72, adjusted p = 0.025) compared to the first tertile. Indians (3.9 ± 0.3) had significantly higher PRS compared to Chinese (2.1 ± 0.4) (p = 0.010). In the RCT, a greater reduction in high-sensitivity C-reactive protein (hsCRP) levels was found in second and third tertiles after Hipcref diet intervention compared to the control diet (p interaction = 0.048). CONCLUSION Higher PRS was significantly associated with increased odds of obesity. Individuals with higher PRS had a significantly greater reduction in hsCRP levels after Hipcref diet compared to the control diet.
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Affiliation(s)
- Pui Yee Tan
- School of Biosciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Malaysia
| | - Soma Roy Mitra
- School of Biosciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Malaysia,
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Alkhaldy AA, Rizq NK, Del Jaylan SA, Alkendi EA, Alghamdi WM, Alfaraidi SM. Dietary Intake and Physical Activity in Relation to Insulin Resistance in Young Overweight Saudi Females: An Exploratory Pilot Study. Prev Nutr Food Sci 2020; 24:373-380. [PMID: 31915631 PMCID: PMC6941727 DOI: 10.3746/pnf.2019.24.4.373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022] Open
Abstract
Insulin resistance is a major contributor to the development of several chronic metabolic diseases, including type 2 diabetes mellitus, and is an increasing health concern in Saudi Arabia. Diet and physical activity have been postulated to affect insulin resistance; however, their effects on development of insulin resistance in young overweight Saudi females have not been explored. Therefore, the aim of the study is to investigate whether diet and physical inactivity increases the risk of insulin resistance in young overweight Saudi females. In a cross-sectional study, 42 overweight female Saudi students, aged between 20 and 30 years, were recruited from King Abdul-Aziz University. A questionnaire was used to collect demographics, anthropometric measurements, physical activity, and food frequency data. Blood biomarkers (lipid profile, fasting glucose, and fasting insulin) were measured. Insulin resistance was assessed using homeostasis model assessment 2 (HOMA2)-insulin resistance (IR) scores. A significant difference in median body mass index (BMI) was observed between the HOMA2-IR normal and HOMA2-IR raised index groups (P=0.04). In terms of dietary habits, the insulin resistant group had a higher intake of canned beverages compared with the normal group (P=0.03). No significant differences were found between the groups in terms of waist circumference, hip circumference, waist-to-hip ratio, or body fat percentage. The lipid profile also did not significantly differ between the two groups. This study demonstrates significant differences in HOMA2-IR-defined insulin resistance according to subjects’ BMI and canned beverage intake. A larger study is needed to confirm these associations.
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Affiliation(s)
- Areej Ali Alkhaldy
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdul-Aziz University, Jeddah 21589, the Kingdom of Saudi Arabia
| | - Nour Kamal Rizq
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdul-Aziz University, Jeddah 21589, the Kingdom of Saudi Arabia
| | - Sarah A Del Jaylan
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdul-Aziz University, Jeddah 21589, the Kingdom of Saudi Arabia
| | - Eman Ali Alkendi
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdul-Aziz University, Jeddah 21589, the Kingdom of Saudi Arabia
| | - Wijdan Mohammed Alghamdi
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdul-Aziz University, Jeddah 21589, the Kingdom of Saudi Arabia
| | - Sara Mohammed Alfaraidi
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdul-Aziz University, Jeddah 21589, the Kingdom of Saudi Arabia
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Hsueh L, Peña JM, Hirsh AT, de Groot M, Stewart JC. Diabetes Risk Perception Among Immigrant and Racial/Ethnic Minority Adults in the United States. DIABETES EDUCATOR 2019; 45:642-651. [PMID: 31725364 DOI: 10.1177/0145721719873640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to examine associations of immigrant and racial/ethnic status with diabetes risk perception among a population-based sample of US adults without diabetes. Racial/ethnic minorities are at increased risk of developing diabetes. Emerging research shows that immigrant (foreign born) individuals are also at increased risk, but less is understood about risk perception in this group. METHODS Respondents were 11,569 adults from the NHANES (2011-2016; National Health and Nutrition Examination Survey) reporting no diabetes or prediabetes. Immigrant status was coded as foreign born or US born and analyses used NHANES racial/ethnic categories: white, black, Mexican American, other Hispanic, Asian, and other/multiracial. Immigrant status and variables comparing each minority group with whites were simultaneously entered into models predicting risk perception (yes/no), adjusting for demographic and diabetes risk factors. RESULTS Being foreign born was associated with decreased odds of perceived risk, while being Mexican American, Asian, and other/multiracial were associated with increased odds of perceived risk. DISCUSSION Foreign-born adults are less likely than US-born adults to report perceived risk for diabetes. Lower diabetes risk perception among immigrants could result in poorer preventative behaviors and later diabetes detection.
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Affiliation(s)
- Loretta Hsueh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Juan M Peña
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Mary de Groot
- Diabetes Translational Research Center, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
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14
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The role of smartphone-based education on the risk perception of type 2 diabetes in women with gestational diabetes. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00342-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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15
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Al-Ibrahim AA, Jackson RT. Healthy eating index versus alternate healthy index in relation to diabetes status and health markers in U.S. adults: NHANES 2007-2010. Nutr J 2019; 18:26. [PMID: 30995902 PMCID: PMC6471947 DOI: 10.1186/s12937-019-0450-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 03/27/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND It remains to be determined whether the Alternate Healthy Eating Index 2010 (AHEI-2010) or the Healthy Eating Index 2010 (HEI-2010) is preferably recommended as means to assess dietary quality in people with type 2 diabetes (T2DM). METHODS The purpose of this study was to determine whether the AHEI-2010 provides a more accurate assessment of dietary quality than the HEI-2010 in relation to diabetes status, while controlling for health markers, sociodemographic and lifestyle factors. The 2007-2010 National Health and Nutrition Examination Survey (NHANES) was used as a representative sample of U.S. adults age 20+ years (n = 4097). HEI-2010 and the AHEI-2010 scores were used as measures of dietary quality and were calculated using data from the first 24-h dietary recall. Health markers evaluated include anthropometrics, blood pressure, lipid and inflammatory markers, and presence of co-morbid diseases. Least Squares Means were computed to determine differences across diabetes status (nondiabetes, prediabetes, T2DM) for total and sub-component HEI-2010 and AHEI-2010 scores, and to determine differences across total HEI-2010 and AHEI-2010 quartiles for health markers. Covariate-adjusted logistic regression was used to examine the association between total HEI-2010 and AHEI-2010 scores and diabetes status. RESULTS Adults with T2DM showed higher HEI-2010 and AHEI-2010 scores compared to adults with prediabetes and nondiabetes but did not have better health markers. For HEI-2010 component scores, adults with T2DM had highest consumption (highest score) of total protein foods and lowest consumption (highest score) for empty calories (p < 0.01). For AHEI-2010 component scores, adults with T2DM had the lowest consumption (highest score) for sugar-sweetened beverages and fruit juice, sodium, and alcohol (lowest score). In addition, adults with T2DM had the highest consumption (lowest score) for red and/or processed meats (p < 0.01). However, neither total HEI-2010 nor AHEI-2010 scores were significantly associated with diabetes status (p > 0.05). Results suggest that neither index was clearly superior to the other in terms of its predictive ability in relation to T2DM. CONCLUSION Neither total HEI-2010 nor AHEI-2010 scores performed better in terms of their relationship with diabetes status. However, the significant relationships between 1) diabetes status and health markers and 2) between HEI-2010 and AHEI-2010 scores and health markers suggest that diet has some influence on T2DM.
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Affiliation(s)
- Afnan A. Al-Ibrahim
- Department of Nutrition and Food Science, University of Maryland, 0112 Skinner Building, College Park, MD 20742 USA
| | - Robert T. Jackson
- Department of Nutrition and Food Science, University of Maryland, 0112 Skinner Building, College Park, MD 20742 USA
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16
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Haire-Joshu D, Hill-Briggs F. The Next Generation of Diabetes Translation: A Path to Health Equity. Annu Rev Public Health 2019; 40:391-410. [PMID: 30601723 DOI: 10.1146/annurev-publhealth-040218-044158] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Disparities in diabetes burden exist in large part because of the social determinants of health (SDOH). Translation research and practice addressing health equity in diabetes have generally focused on changing individual behavior or providing supportive approaches to compensate for, rather than directly target, SDOH. The purpose of this article is to propose a pathway for addressing SDOH as root causes of diabetes disparities and as an essential target for the next generation of interventions needed to achieve health equity in diabetes prevention and treatment. This review describes ( a) the current burden of diabetes disparities, ( b) the influence of SDOH on diabetes disparities, ( c) gaps in and implications of current translation research, and ( d) approaches to achieving health equity in the next generation of diabetes translation.
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Affiliation(s)
- Debra Haire-Joshu
- Public Health and Medicine, Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA;
| | - Felicia Hill-Briggs
- Departments of Medicine; Health, Behavior and Society; and Acute and Chronic Care; and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA;
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17
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Valaitis R, Meagher-Stewart D, Martin-Misener R, Wong ST, MacDonald M, O'Mara L. Organizational factors influencing successful primary care and public health collaboration. BMC Health Serv Res 2018; 18:420. [PMID: 29880042 PMCID: PMC5992823 DOI: 10.1186/s12913-018-3194-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 05/09/2018] [Indexed: 11/14/2022] Open
Abstract
Background Public health and primary care are distinct sectors within western health care systems. Within each sector, work is carried out in the context of organizations, for example, public health units and primary care clinics. Building on a scoping literature review, our study aimed to identify the influencing factors within these organizations that affect the ability of these health care sectors to collaborate with one another in the Canadian context. Relationships between these factors were also explored. Methods We conducted an interpretive descriptive qualitative study involving in-depth interviews with 74 key informants from three provinces, one each in western, central and eastern Canada, and others representing national organizations, government, or associations. The sample included policy makers, managers, and direct service providers in public health and primary care. Results Seven major organizational influencing factors on collaboration were identified: 1) Clear Mandates, Vision, and Goals; 2) Strategic Coordination and Communication Mechanisms between Partners; 3) Formal Organizational Leaders as Collaborative Champions; 4) Collaborative Organizational Culture; 5) Optimal Use of Resources; 6) Optimal Use of Human Resources; and 7) Collaborative Approaches to Programs and Services Delivery. Conclusion While each influencing factor was distinct, the many interactions among these influences are indicative of the complex nature of public health and primary care collaboration. These results can be useful for those working to set up new or maintain existing collaborations with public health and primary care which may or may not include other organizations. Electronic supplementary material The online version of this article (10.1186/s12913-018-3194-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruta Valaitis
- School of Nursing, McMaster University, HSc Room 3N25, 1280 Maim Street West, Hamilton, ON, L8S4K1, Canada.
| | - Donna Meagher-Stewart
- Dalhousie University, Room G26, Forrest Bldg., PO Box 15000, 5869 University Avenue, Halifax, NS, B3H 4R2, Canada
| | - Ruth Martin-Misener
- Dalhousie University, Room G26, Forrest Bldg., PO Box 15000, 5869 University Avenue, Halifax, NS, B3H 4R2, Canada
| | - Sabrina T Wong
- UBC School of Nursing and Centre for Health Services and Policy Research, T201 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Marjorie MacDonald
- University of Victoria, HSD B220, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Linda O'Mara
- School of Nursing, McMaster University, HSc Room 3N25, 1280 Maim Street West, Hamilton, ON, L8S4K1, Canada
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18
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Owolabi MO, Yaria JO, Daivadanam M, Makanjuola AI, Parker G, Oldenburg B, Vedanthan R, Norris S, Oguntoye AR, Osundina MA, Herasme O, Lakoh S, Ogunjimi LO, Abraham SE, Olowoyo P, Jenkins C, Feng W, Bayona H, Mohan S, Joshi R, Webster R, Kengne AP, Trofor A, Lotrean LM, Praveen D, Zafra-Tanaka JH, Lazo-Porras M, Bobrow K, Riddell MA, Makrilakis K, Manios Y, Ovbiagele B. Gaps in Guidelines for the Management of Diabetes in Low- and Middle-Income Versus High-Income Countries-A Systematic Review. Diabetes Care 2018; 41:1097-1105. [PMID: 29678866 PMCID: PMC5911785 DOI: 10.2337/dc17-1795] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/17/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The extent to which diabetes (DM) practice guidelines, often based on evidence from high-income countries (HIC), can be implemented to improve outcomes in low- and middle-income countries (LMIC) is a critical challenge. We carried out a systematic review to compare type 2 DM guidelines in individual LMIC versus HIC over the past decade to identify aspects that could be improved to facilitate implementation. RESEARCH DESIGN AND METHODS Eligible guidelines were sought from online databases and websites of diabetes associations and ministries of health. Type 2 DM guidelines published between 2006 and 2016 with accessible full publications were included. Each of the 54 eligible guidelines was assessed for compliance with the Institute of Medicine (IOM) standards, coverage of the cardiovascular quadrangle (epidemiologic surveillance, prevention, acute care, and rehabilitation), translatability, and its target audiences. RESULTS Most LMIC guidelines were inadequate in terms of applicability, clarity, and dissemination plan as well as socioeconomic and ethical-legal contextualization. LMIC guidelines targeted mainly health care providers, with only a few including patients (7%), payers (11%), and policy makers (18%) as their target audiences. Compared with HIC guidelines, the spectrum of DM clinical care addressed by LMIC guidelines was narrow. Most guidelines from the LMIC complied with less than half of the IOM standards, with 12% of the LMIC guidelines satisfying at least four IOM criteria as opposed to 60% of the HIC guidelines (P < 0.001). CONCLUSIONS A new approach to the contextualization, content development, and delivery of LMIC guidelines is needed to improve outcomes.
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Affiliation(s)
| | | | - Meena Daivadanam
- Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | | | | | | | | | - Shane Norris
- University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | | | | | | | | | - Wuwei Feng
- Medical University of South Carolina, Charleston, SC
| | - Hernán Bayona
- Fundación Santa Fe de Bogotá Hospital, University of the Andes, Bogota, Colombia
| | | | - Rohina Joshi
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Ruth Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Andre P Kengne
- South African Medical Research Council, Cape Town, South Africa
| | - Antigona Trofor
- Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
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Simmavong PK, Hillier LM, Petrella RJ. Lessons Learned in the Implementation of HealtheSteps: An Evidence-Based Healthy Lifestyle Program. Health Promot Pract 2018; 20:300-310. [PMID: 29544358 DOI: 10.1177/1524839918759946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HealtheSteps is a pragmatic, evidence-based lifestyle prescription program aimed at reducing the rates of chronic disease, in particular, type 2 diabetes. A process evaluation was completed to assess the feasibility of the implementation of HealtheSteps in primary care and community-based settings across Canada. Key informant interviews (program providers and participants) were conducted to identify facilitators and barriers to implementation and opportunities for future program adaptation and improvement. Forty-three interviews were conducted across five regions in Canada (15 sites ranging from remote, rural, suburban, and urban). Transcripts were analyzed using a qualitative naturalistic inquiry approach with several facilitating factors identified: pragmatic program design, in-line goals with sites' mandates, and access to ongoing support. Barriers were related to administrative challenges such as booking space, personnel changeovers, and scheduling participants. Findings from this analysis revealed insights on program delivery, design, and importance of site champions. Key lessons learned focused on two areas: infrastructure support and program implementation. The application of these learnings from the HealtheSteps program may inform the development of strategies that can optimize program adaptation and support while reducing real and perceived barriers experienced, thus increasing the success of translation of the evidence-based diabetes program to different points of care.
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Affiliation(s)
- P Karen Simmavong
- Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Loretta M Hillier
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, Ontario, Canada
| | - Robert J Petrella
- Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,St. Joseph's Health Care, London, Ontario, Canada
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20
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Weisman A, Fazli GS, Johns A, Booth GL. Evolving Trends in the Epidemiology, Risk Factors, and Prevention of Type 2 Diabetes: A Review. Can J Cardiol 2018; 34:552-564. [PMID: 29731019 DOI: 10.1016/j.cjca.2018.03.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 02/07/2023] Open
Abstract
Currently, the global prevalence of diabetes is 8.8%. This figure is expected to increase worldwide, with the largest changes projected to occur in low- and middle-income countries. The aging of the world's population and substantial increases in obesity have contributed to the rise in diabetes. Global shifts in lifestyles have led to the adoption of unhealthy behaviours such as physical inactivity and poorer-quality diets. Correspondingly, diabetes is a rapidly-increasing problem in higher- as well as lower-income countries. In Canada, the prevalence of diabetes increased approximately 70% in the past decade. Although diabetes-related mortality rates have decreased in Canada, the number of people affected by diabetes has continued to grow because of a surge in the number of new diabetes cases. Non-European ethnic groups and individuals of lower socioeconomic status have been disproportionately affected by diabetes and its risk factors. Clinical trials have proven efficacy in reducing the onset of diabetes in high-risk populations through diet and physical activity interventions. However, these findings have not been broadly implemented into the Canadian health care context. In this article we review the evolving epidemiology of type 2 diabetes, with regard to trends in occurrence rates and prevalence; the role of risk factors including those related to ethnicity, obesity, diet, physical activity, socioeconomic status, prediabetes, and pregnancy; and the identification of critical windows for lifestyle intervention. Identifying high-risk populations and addressing the upstream determinants and risk factors of diabetes might prove to be effective diabetes prevention strategies to curb the current diabetes epidemic.
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Affiliation(s)
- Alanna Weisman
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ghazal S Fazli
- The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Ashley Johns
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Gillian L Booth
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
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A Randomized Trial of Weight Change in a National Home Visiting Program. Am J Prev Med 2018; 54:341-351. [PMID: 29455756 PMCID: PMC5826618 DOI: 10.1016/j.amepre.2017.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 11/14/2017] [Accepted: 12/07/2017] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Clinical trials have demonstrated significant impact in reducing weight and incidence of type 2 diabetes mellitus. However, the intensity of these trials limits their scalability to real world settings. The purpose of this study was to embed a lifestyle intervention for overweight and obese mothers within the routine practice of a parent education, home visiting organization. DESIGN Pragmatic trial that used a stratified random design. SETTING/PARTICIPANTS Overweight or obese mothers of preschool children located across St. Louis, Missouri, enrolled in Parents As Teachers, a home visiting organization reaching women and children nationwide. INTERVENTION A lifestyle intervention derived from the Diabetes Prevention Program was embedded within Parents As Teachers entitled Healthy Eating and Active Living Taught at Home (HEALTH). MAIN OUTCOME MEASURES Outcomes included the proportion of women that achieved 5% weight loss at 24 months and improvements in clinical and behavioral outcomes at 12 and 24 months. Participants were enrolled from 2012 to 2014 and data analysis began in 2016. RESULTS Women in the usual care versus intervention group were significantly less likely to achieve 5% weight loss at 24 months (11% vs 26%, p=0.01). At 12 months, there was a 2.8-kg difference in weight between groups (p=0.0006), and by 24 months a 4.7-kg difference in weight (3.2 [SD=7.6] kg vs -1.5 [SD=8.3] kg, p=0.002); group differences in waist circumference were also evident by 12 months (2.1 [SD=8.4] cm vs -0.7 [SD=9.8] cm, p=0.04) and 24 months (3.8 [SD=10.6] cm vs -2.5 [SD=9.1] cm, p=0.005), as were improvements in behavioral outcomes. There was no difference in blood pressure between groups. CONCLUSIONS HEALTH achieved modest but clinically significant weight loss outcomes, and reduced weight gain in mothers of young children. The scalability of this embedded intervention offers the potential to reach mothers in Parents As Teachers programs nationally. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01567033.
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Berman MA, Guthrie NL, Edwards KL, Appelbaum KJ, Njike VY, Eisenberg DM, Katz DL. Change in Glycemic Control With Use of a Digital Therapeutic in Adults With Type 2 Diabetes: Cohort Study. JMIR Diabetes 2018; 3:e4. [PMID: 30291074 PMCID: PMC6238888 DOI: 10.2196/diabetes.9591] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/16/2018] [Accepted: 01/21/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Intensive lifestyle change can treat and even reverse type 2 diabetes. Digital therapeutics have the potential to deliver lifestyle as medicine for diabetes at scale. OBJECTIVE This 12-week study investigates the effects of a novel digital therapeutic, FareWell, on hemoglobin A1c (HbA1c) and diabetes medication use. METHODS Adults with type 2 diabetes and a mobile phone were recruited throughout the United States using Facebook advertisements. The intervention aim was to effect a sustainable shift to a plant-based dietary pattern and regular exercise by advancing culinary literacy and lifestyle skill acquisition. The intervention was delivered by an app paired with specialized human support, also delivered digitally. Health coaching was provided every 2 weeks by telephone, and a clinical team was available for participants requiring additional support. Participants self-reported current medications and HbA1c at the beginning and end of the 12-week program. Self-efficacy related to managing diabetes and maintaining dietary changes was assessed via survey. Engagement was recorded automatically through the app. RESULTS We enrolled 118 participants with a baseline HbA1c >6.5%. Participants were 81.4% female (96/118) and resided in 38 US states with a mean age of 50.7 (SD 9.4) years, baseline body mass index of 38.1 (SD 8.8) kg/m2, and baseline HbA1c of 8.1% (SD 1.6). At 12 weeks, 86.2% (94/109) of participants were still using the app. Mean change in HbA1c was -0.8% (97/101, SD 1.3, P<.001) for those reporting end-study data. For participants with a baseline HbA1c >7.0% who did not change medications midstudy, HbA1c change was -1.1% (67/69, SD 1.4, P<.001). The proportion of participants with an end-study HbA1c <6.5% was 28% (22/97). After completion of the intervention, 17% (16/97) of participants reported a decrease in diabetic medication while 8% (8/97) reported an increase. A total of 57% (55/97) of participants achieved a composite outcome of reducing HbA1c, reducing diabetic medication use, or both; 92% (90/98) reported greater confidence in their ability to manage their diabetes compared to before the program, and 91% (89/98) reported greater confidence in their ability to maintain a healthy dietary pattern. Participants engaged with the app an average of 4.3 times per day. We observed a significantly greater decrease in HbA1c among participants in the highest tertile of app engagement compared to those in the lowest tertile of app engagement (P=.03). CONCLUSIONS Clinically meaningful reductions in HbA1c were observed with use of the FareWell digital therapeutic. Greater glycemic control was observed with increasing app engagement. Engagement and retention were both high in this widely distributed sample.
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Affiliation(s)
- Mark A Berman
- Better Therapeutics LLC, San Francisco, CA, United States
| | | | | | | | - Valentine Y Njike
- Prevention Research Center, Griffin Hospital, Yale University, Derby, CT, United States
| | - David M Eisenberg
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States
| | - David L Katz
- Better Therapeutics LLC, San Francisco, CA, United States.,Prevention Research Center, Griffin Hospital, Yale University, Derby, CT, United States
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Williamson DA. Fifty Years of Behavioral/Lifestyle Interventions for Overweight and Obesity: Where Have We Been and Where Are We Going? Obesity (Silver Spring) 2017; 25:1867-1875. [PMID: 28944593 DOI: 10.1002/oby.21914] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This paper reviews the literature pertaining to the structure and content of intensive lifestyle interventions (ILIs) for overweight/obesity since Richard Stuart described this new treatment approach in 1967. A consensus opinion has formed that behavioral/lifestyle treatment of overweight and obesity should be viewed as a mainstream intervention for the treatment and prevention of type 2 diabetes and medical complications associated with obesity. METHODS The development of modern ILIs and demonstration of their efficacy are compared by structure, content, and efficacy of four major randomized controlled trials: Diabetes Prevention Program (DPP), Look AHEAD, POUNDS Lost, and CALERIE. RESULTS The results of these studies indicated that modification of lifestyle behaviors related to nutrition and physical activity can yield weight loss and prevention or improvement of a variety of medical conditions associated with obesity in a variety of subpopulations. CONCLUSIONS Recommendations for the structure and length of behavioral/lifestyle interventions have been recently adopted by agencies and institutions that approve reimbursement for medical services. These recommendations represent a giant step in the effort to recognize ILIs as a mainstream approach for the treatment of obesity and comorbid medical conditions. Nevertheless, they do not adequately represent advances made since the publication of the DPP results.
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24
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Joiner KL, Nam S, Whittemore R. Lifestyle interventions based on the diabetes prevention program delivered via eHealth: A systematic review and meta-analysis. Prev Med 2017; 100:194-207. [PMID: 28456513 PMCID: PMC5699208 DOI: 10.1016/j.ypmed.2017.04.033] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/26/2017] [Accepted: 04/23/2017] [Indexed: 01/05/2023]
Abstract
The objective was to describe Diabetes Prevention Program (DPP)-based lifestyle interventions delivered via electronic, mobile, and certain types of telehealth (eHealth) and estimate the magnitude of the effect on weight loss. A systematic review was conducted. PubMed and EMBASE were searched for studies published between January 2003 and February 2016 that met inclusion and exclusion criteria. An overall estimate of the effect on mean percentage weight loss across all the interventions was initially conducted. A stratified meta-analysis was also conducted to determine estimates of the effect across the interventions classified according to whether behavioral support by counselors post-baseline was not provided, provided remotely with communication technology, or face-to-face. Twenty-two studies met the inclusion/exclusion criteria, in which 26 interventions were evaluated. Samples were primarily white and college educated. Interventions included Web-based applications, mobile phone applications, text messages, DVDs, interactive voice response telephone calls, telehealth video conferencing, and video on-demand programing. Nine interventions were stand-alone, delivered post-baseline exclusively via eHealth. Seventeen interventions included additional behavioral support provided by counselors post-baseline remotely with communication technology or face-to-face. The estimated overall effect on mean percentage weight loss from baseline to up to 15months of follow-up across all the interventions was -3.98%. The subtotal estimate across the stand-alone eHealth interventions (-3.34%) was less than the estimate across interventions with behavioral support given by a counselor remotely (-4.31%), and the estimate across interventions with behavioral support given by a counselor in-person (-4.65%). There is promising evidence of the efficacy of DPP-based eHealth interventions on weight loss. Further studies are needed particularly in racially and ethnically diverse populations with limited levels of educational attainment. Future research should also focus on ways to optimize behavioral support.
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Affiliation(s)
- Kevin L Joiner
- Yale University, School of Nursing, 400 West Campus Drive, Orange, CT 06477, United States.
| | - Soohyun Nam
- Yale University, School of Nursing, 400 West Campus Drive, Orange, CT 06477, United States.
| | - Robin Whittemore
- Yale University, School of Nursing, 400 West Campus Drive, Orange, CT 06477, United States.
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Davies MJ, Gray LJ, Ahrabian D, Carey M, Farooqi A, Gray A, Goldby S, Hill S, Jones K, Leal J, Realf K, Skinner T, Stribling B, Troughton J, Yates T, Khunti K. A community-based primary prevention programme for type 2 diabetes mellitus integrating identification and lifestyle intervention for prevention: a cluster randomised controlled trial. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BackgroundPrevention of type 2 diabetes mellitus (T2DM) is a global priority; however, there is a lack of evidence investigating how to effectively translate prevention research into a primary care setting.Objectives(1) To develop and validate a risk score to identify individuals at high risk of T2DM in the UK; and (2) to establish whether or not a structured education programme targeting lifestyle and behaviour change was clinically effective and cost-effective at preventing progression to T2DM in people with prediabetes mellitus (PDM), identified through a risk score screening programme in primary care.DesignA targeted screening study followed by a cluster randomised controlled trial (RCT), with randomisation at practice level. Participants were followed up for 3 years.SettingA total of 44 general practices across Leicestershire, UK. The intervention took place in the community.ParticipantsA total of 17,972 individuals from 44 practices identified through the risk score as being at high risk of T2DM were invited for screening; of these, 3449 (19.2%) individuals attended. All received an oral glucose tolerance test. PDM was detected in 880 (25.5%) of those screened. Those with PDM were included in the trial; of these, 36% were female, the average age was 64 years and 16% were from an ethnic minority group.InterventionPractices were randomised to receive either standard care or the intervention. The intervention consisted of a 6-hour group structured education programme, with an annual refresher and regular telephone contact.Main outcome measuresThe primary outcome was progression to T2DM. The main secondary outcomes were changes in glycated haemoglobin concentrations, blood glucose levels, cardiovascular risk, the presence of metabolic syndrome, step count and the cost-effectiveness of the intervention.ResultsA total of 22.6% of the intervention group did not attend the education and 29.1% attended all sessions. A total of 131 participants developed T2DM (standard care,n = 67; intervention,n = 64). There was a 26% reduced risk of T2DM in the intervention arm compared with standard care, but this did not reach statistical significance (hazard ratio 0.74, 95% confidence interval 0.48 to 1.14;p = 0.18). There were statistically significant improvements in glycated haemoglobin concentrations, low-density lipoprotein cholesterol levels, psychosocial well-being, sedentary time and step count in the intervention group. The intervention was found to result in a net gain of 0.046 quality-adjusted life-years over 3 years at a cost of £168 per patient, with an incremental cost-effectiveness ratio of £3643 and a probability of 0.86 of being cost-effective at a willingness-to-pay threshold of £20,000.ConclusionsWe developed and validated a risk score for detecting those at high risk of undiagnosed PDM/T2DM. We screened > 3400 people using a two-stage screening programme. The RCT showed that a relatively low-resource pragmatic programme may lead to a reduction in T2DM and improved biomedical and psychosocial outcomes, and is cost-effective.LimitationsOnly 19% of those invited to screening attended, which may limit generalisability. The variation in cluster size in the RCT may have limited the power of the study.Future workFuture work should focus on increasing attendance to both screening and prevention programmes and offering the programme in different modalities, such as web-based modalities. A longer-term follow-up of the RCT participants would be valuable.Trial registrationCurrent Controlled Trials ISRCTN80605705.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Dariush Ahrabian
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marian Carey
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Azhar Farooqi
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stephanie Goldby
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Sian Hill
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Kenneth Jones
- Patient and Public Involvement Group, Leicester Diabetes Centre, Leicester, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kathryn Realf
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Timothy Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, NT, Australia
| | - Bernie Stribling
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Joiner KL, Sternberg RM, Kennedy C, Chen JL, Fukuoka Y, Janson SL. A Spanish-Language Risk Perception Survey for Developing Diabetes: Translation Process and Assessment of Psychometric Properties. J Nurs Meas 2016; 24:365-378. [PMID: 28714443 PMCID: PMC5634892 DOI: 10.1891/1061-3749.24.3.365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Create a Spanish-language version of the Risk Perception Survey for Developing Diabetes (RPS-DD) and assess psychometric properties. RESEARCH DESIGN AND METHODS The Spanish-language version was created through translation, harmonization, and presentation to the tool's original author. It was field tested in a foreignborn Latino sample and properties evaluated in principal components analysis. RESULTS Personal Control, Optimistic Bias, and Worry multi-item Likert subscale responses did not cluster together. A clean solution was obtained after removing two Personal Control subscale items. Neither the Personal Disease Risk scale nor the Environmental Health Risk scale responses loaded onto single factors. Reliabilities ranged from .54 to .88. Test of knowledge performance varied by item. CONCLUSIONS This study contributes to evidence of validation of a Spanish-language RPS-DD in foreign-born Latinos.
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Affiliation(s)
- Kevin L Joiner
- University of California, San Francisco, School of Nursing, USA
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Desai JR, Vazquez-Benitez G, Xu Z, Schroeder EB, Karter AJ, Steiner JF, Nichols GA, Reynolds K, Xu S, Newton K, Pathak RD, Waitzfelder B, Lafata JE, Butler MG, Kirchner HL, Thomas A, O'Connor PJ. Who Must We Target Now to Minimize Future Cardiovascular Events and Total Mortality?: Lessons From the Surveillance, Prevention and Management of Diabetes Mellitus (SUPREME-DM) Cohort Study. Circ Cardiovasc Qual Outcomes 2016; 8:508-16. [PMID: 26307132 DOI: 10.1161/circoutcomes.115.001717] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Examining trends in cardiovascular events and mortality in US health systems can guide the design of targeted clinical and public health strategies to reduce cardiovascular events and mortality rates. METHODS AND RESULTS We conducted an observational cohort study from 2005 to 2011 among 1.25 million diabetic subjects and 1.25 million nondiabetic subjects from 11 health systems that participate in the Surveillance, Prevention and Management of Diabetes Mellitus (SUPREME-DM) DataLink. Annual rates (per 1000 person-years) of myocardial infarction/acute coronary syndrome (International Classification of Diseases-Ninth Revision, 410.0–410.91, 411.1–411.8), stroke (International Classification of Diseases-Ninth Revision, 430–432.9, 433–434.9), heart failure (International Classification of Diseases-Ninth Revision, 428–428.9), and all-cause mortality were monitored by diabetes mellitus (DM) status, age, sex, race/ethnicity, and a prior cardiovascular history. We observed significant declines in cardiovascular events and mortality rates in subjects with and without DM. However, there was substantial variation by age, sex, race/ethnicity, and prior cardiovascular history. Mortality declined from 44.7 to 27.1 (P<0.0001) for those with DM and cardiovascular disease (CVD), from 11.2 to 10.9 (P=0.03) for those with DM only, and from 18.9 to 13.0 (P<0.0001) for those with CVD only. Yet, in the [almost equal to]85% of subjects with neither DM nor CVD, overall mortality (7.0 to 6.8; P=0.10) and stroke rates (1.6–1.6; P=0.77) did not decline and heart failure rates increased (0.9–1.15; P=0.0005). CONCLUSIONS To sustain improvements in myocardial infarction, stroke, heart failure, and mortality, health systems that have successfully focused on care improvement in high-risk adults with DM or CVD must broaden their improvement strategies to target lower risk adults who have not yet developed DM or CVD.
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Joiner KL, Sternberg RM, Kennedy CM, Fukuoka Y, Chen JL, Janson SL. Perception of Risk for Developing Diabetes Among Foreign-Born Spanish-Speaking US Latinos. THE DIABETES EDUCATOR 2016; 42:418-28. [PMID: 27150605 PMCID: PMC5634899 DOI: 10.1177/0145721716646204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of the study was to describe perception of risk for developing diabetes among foreign-born Spanish-speaking US Latinos. METHODS Participants (N = 146), recruited at food-pantry distribution events and free clinics, were surveyed using the Risk Perception Survey for Developing Diabetes in Spanish. Type 2 diabetes risk factors measured included body mass index, physical activity, and A1C. RESULTS Sample characteristics were mean (SD) age of 39.5 (9.9) years, 58% with less than a high school graduate-level education, and 65% with a family income less than $15,000/year. Prevalence of risk factors was 81% overweight or obese, 47% less than 150 minutes/week moderate/vigorous-intensity physical activity, and 12% A1C consistent with prediabetes. Of the 135 participants with complete data, 31% perceived a high/moderate risk for developing diabetes. In univariate logistic regression analyses, 9 of 18 potential variables were significant (P < .05) predictors of perception of risk. When these 9 variables were entered into a multiple logistic regression model, 5 were significant predictors of perception of risk: history of gestational diabetes, high school graduate or above, optimistic bias, worry, and perceived personal disease risk. CONCLUSIONS Use of the Spanish-language translation of the Risk Perception Survey for Developing Diabetes revealed factors influencing perception of risk for developing diabetes. Results can be used to promote culturally acceptable type 2 diabetes primary prevention strategies and provide a useful comparison to other populations.
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Affiliation(s)
- Kevin L. Joiner
- University of California School of Nursing, San Francisco, CA
| | | | | | - Yoshimi Fukuoka
- University of California Institute for Health and Aging, San
Francisco, CA
| | - Jyu-Lin Chen
- University of California School of Nursing, San Francisco, CA
| | - Susan L. Janson
- University of California School of Nursing, San Francisco, CA
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Masood I, Saleem A, Hassan A, Zia A, Khan AT. Evaluation of diabetes awareness among general population of Bahawalpur, Pakistan. Prim Care Diabetes 2016; 10:3-9. [PMID: 26137919 DOI: 10.1016/j.pcd.2015.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/01/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
AIMS To evaluate diabetes awareness among general population of Bahawalpur, Pakistan. METHODS A questionnaire based descriptive cross sectional study was performed during 2014. Descriptive and inferential statistics were applied using the IBM Statistical Package for Social Sciences version 20. RESULTS Total 383 respondents participated in this study giving a response rate of about 88%. Mean age of the participants was 33±13.3 years and the majority of the participants were females (50.4%). Mean scores of the participants were 20.77±6.65 out of 34 and only one participant scored 34/34 marks. Kruskal-Wallis and Mann-Whitney U test revealed that females scored significantly higher diabetes awareness score than males (p<0.05). Moreover, urban residential status, better education and higher socioeconomic status were significantly associated with higher diabetes awareness. CONCLUSIONS Majority of our study population had adequate awareness regarding diabetes. However, lack of awareness was observed among illiterate, poor and rural participants that indicated the immediate need of diabetes awareness programs for these participants.
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Affiliation(s)
- Imran Masood
- Faculty of Pharmacy and Alternative Medicine, The Islamia university of Bahawalpur, Bahawalpur, Pakistan.
| | - Ahsan Saleem
- Faculty of Pharmacy and Alternative Medicine, The Islamia university of Bahawalpur, Bahawalpur, Pakistan
| | - Asma Hassan
- Pulmonology Department, Bahawal Victoria Hospital, Bahawalpur, Pakistan
| | - Amna Zia
- Faculty of Pharmacy and Alternative Medicine, The Islamia university of Bahawalpur, Bahawalpur, Pakistan
| | - Aisha Tahir Khan
- Faculty of Pharmacy and Alternative Medicine, The Islamia university of Bahawalpur, Bahawalpur, Pakistan
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Vita P, Cardona-Morrell M, Bauman A, Singh MF, Moore M, Pennock R, Snow J, Williams M, Jackson L, Milat A, Colagiuri S. Type 2 diabetes prevention in the community: 12-Month outcomes from the Sydney Diabetes Prevention Program. Diabetes Res Clin Pract 2016; 112:13-19. [PMID: 26724186 DOI: 10.1016/j.diabres.2015.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 11/02/2015] [Accepted: 11/19/2015] [Indexed: 01/24/2023]
Abstract
AIMS/HYPOTHESIS The Sydney Diabetes Prevention Program (SDPP) was a community-based type 2 diabetes prevention translational research study with screening and recruitment in the primary health care setting. We aimed to investigate the program's effectiveness in reducing risk factors for diabetes as well as the program's reach, adoption and implementation. METHODS 1238 participants aged 50-65 years at high-risk of developing type 2 diabetes were recruited by primary care physicians in the greater Sydney region. The intervention, delivered by trained allied health professionals, included an initial consultation, three group sessions/individual sessions, three follow-up phone calls, and a final review at 12 months. Biomarkers and behavioural goals were compared between baseline and 12 months. RESULTS At baseline, the mean age of those who entered the program was 58.8 ± 4.4 years, 63% female, and the mean body mass index was 31.6 ± 5.2 kg/m(2). There was a significant weight reduction of 2 ± 4.3 kg (p<0.02) in the 850 participants who completed the 12-month follow-up accompanied by improvements in diet (total fat, saturated fat, and fibre intake) and physical activity. There were also significant reductions in waist circumference 2.6 ± 4.7 cm (p<0.001) and total cholesterol -0.2 ± 0.8 mmol/L (p<0.001) but not blood glucose. The diabetes risk reduction was estimated to be 30%, consistent with similar trials. CONCLUSIONS/INTERPRETATION This study demonstrates that a community-based lifestyle modification program is effective in reducing important risk factors for diabetes in individuals at high-risk of developing type 2 diabetes.
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Affiliation(s)
- Philip Vita
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, University of Sydney, Sydney 2006, NSW, Australia.
| | - Magnolia Cardona-Morrell
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney 2006, NSW, Australia; The Simpson Centre for Health Services Research, The University of New South Wales, Sydney, NSW, Australia.
| | - Adrian Bauman
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney 2006, NSW, Australia.
| | - Maria Fiatarone Singh
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, University of Sydney, Sydney 2006, NSW, Australia.
| | - Michael Moore
- Inner West Sydney Medicare Local, Sydney 2131, NSW, Australia.
| | - Rene Pennock
- Sydney South West Medicare Local, Sydney 2560, NSW, Australia.
| | - Jill Snow
- Sydney South West Medicare Local, Sydney 2560, NSW, Australia.
| | - Mandy Williams
- Sydney South West and Sydney Local Health District, Sydney 2170, NSW, Australia.
| | | | - Andrew Milat
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney 2006, NSW, Australia; New South Wales Ministry of Health, Sydney 2060, NSW, Australia.
| | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, University of Sydney, Sydney 2006, NSW, Australia.
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Jackson SL, Long Q, Rhee MK, Olson DE, Tomolo AM, Cunningham SA, Ramakrishnan U, Narayan KMV, Phillips LS. Weight loss and incidence of diabetes with the Veterans Health Administration MOVE! lifestyle change programme: an observational study. Lancet Diabetes Endocrinol 2015; 3:173-80. [PMID: 25652129 PMCID: PMC4401476 DOI: 10.1016/s2213-8587(14)70267-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Programmes for lifestyle change are aimed at improving health but little is known about their effectiveness in clinical settings. The Veterans Health Administration (VA) MOVE! lifestyle change programme is the largest in the USA. We investigated whether participation in MOVE! is associated with reduced incidence of diabetes. METHODS We did a retrospective observational analysis of data from VA databases in overweight patients and obese patients with a weight-related disorder who had undergone at least 3 years of continuous outpatient care in 2005-12. We used generalised estimating equations to assess characteristics associated with MOVE! participation, and Cox's proportional hazards regression to analyse the association between participation and diabetes incidence. FINDINGS Of 1·8 million eligible individuals, 238 540 (13%) participated in the MOVE! programme. 19 367 (1% overall, 8% of participants) met criteria for intense and sustained participation (at least eight sessions within 6 months over at least a 4-month span), which was associated with greater weight loss at 3 years than low-intensity or no participation (-2·2% vs -0·64% or 0·46%). Compared with non-participation, incidence of diabetes was reduced by intense and sustained participation (hazard ratio 0·67, 95% CI 0·61-0·74) and low-intensity participation (0·80, 0·77-0·83) in MOVE!. These patterns were consistent across sex, ethnic origin, and age. Participation was most beneficial in patients with high BMI or high random glucose concentrations at baseline (both pinteraction<0·0001). INTERPRETATION Participation in the MOVE! programme was associated with weight loss and reduced incidence of diabetes, but the rate of participation was low and, therefore, selection bias could have exaggerated these effects. FUNDING US Department of Veterans Affairs, National Institutes of Health.
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Affiliation(s)
- Sandra L Jackson
- Atlanta VA Medical Center, Decatur, GA, USA; Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA.
| | - Qi Long
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Mary K Rhee
- Atlanta VA Medical Center, Decatur, GA, USA; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Darin E Olson
- Atlanta VA Medical Center, Decatur, GA, USA; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Anne M Tomolo
- Atlanta VA Medical Center, Decatur, GA, USA; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Solveig A Cunningham
- Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Usha Ramakrishnan
- Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - K M Venkat Narayan
- Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lawrence S Phillips
- Atlanta VA Medical Center, Decatur, GA, USA; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Knowledge of diabetes mellitus: does gender make a difference? Osong Public Health Res Perspect 2014; 5:199-203. [PMID: 25379370 PMCID: PMC4215000 DOI: 10.1016/j.phrp.2014.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 06/24/2014] [Accepted: 06/24/2014] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Diabetes mellitus (DM) is a chronic disease considered an important public health problem. In recent years, its prevalence has been exponentially rising in many developing countries. Chronic complications of DM are important causes of morbidity and mortality among patients, which impair their health and quality of life. Knowledge on disease prevention, etiology, and management is essential to deal with parents, patients, and caregivers. The aim of this study was to evaluate the knowledge regarding DM in an adult population from a Middle-western Brazilian city. METHODS This was a cross-sectional study covering 178 adults, aged 18-64 years, who answered a diabetes knowledge questionnaire. In order to identify the difference between groups, analysis of variance was used. RESULTS Higher knowledge scores were found regarding the role of sugars on DM causality, diabetic foot care, and the effects of DM on patients (blindness, impaired wound healing, and male sexual dysfunction). However, lower scores were found amongst types of DM, hyperglycemic symptoms, and normal blood glucose levels. Females tended to achieve better knowledge scores than males. CONCLUSION Women had better knowledge regarding types of DM, normal blood glucose values, and consequences of hyperglycemia revealed that diabetes education should be improved.
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Poly-ADP-ribose-polymerase inhibition ameliorates hind limb ischemia reperfusion injury in a murine model of type 2 diabetes. Ann Surg 2014; 258:1087-95. [PMID: 23549425 DOI: 10.1097/sla.0b013e31828cced3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Diabetes is known to increase poly-ADP-ribose-polymerase (PARP) activity and posttranslational poly-ADP-ribosylation of several regulatory proteins involved in inflammation and energy metabolism. These experiments test the hypothesis that PARP inhibition will modulate hind limb ischemia reperfusion (IR) in a mouse model of type-II diabetes and ameliorate the ribosylation and the activity/transnuclear localization of the key glycolytic enzyme glyceraldehyde-3-phosphate dehydrogenase (GAPDH). METHODS db/db mice underwent 1.5 hours of hind limb ischemia followed by 1, 7, or 24 hours of reperfusion. The treatment group received the PARP inhibitor PJ34 (PJ34) over a 24-hour period; the untreated group received Lactated Ringer (LR) at the same time points. IR muscles were analyzed for indices of PARP activity, fiber injury, metabolic activity, inflammation, GAPDH activity/intracellular localization, and poly-ADP-ribosylation of GAPDH. RESULTS PARP activity was significantly lower in the PJ34-treated groups than in the Lactated Ringer group at 7 and 24 hours of reperfusion. There was significantly less muscle fiber injury in the PJ34-treated group than in the Lactated Ringer-treated mice at 24 hours of reperfusion. PJ34 lowered levels of select proinflammatory molecules at 7 hours and 24 hours of IR. There were significant increases in metabolic activity only at 24 hours of IR in the PJ34 group, which temporally correlated with increase in GAPDH activity, decreased GAPDH poly-ADP-ribosylation, and nuclear translocation of GAPDH. CONCLUSIONS PJ34 reduced PARP activity, GAPDH ribosylation, and GAPDH translocation; ameliorated muscle fiber injury; and increased metabolic activity after hind limb IR injury in a murine model of type-II diabetes. PARP inhibition might be a therapeutic strategy after IR in diabetic humans.
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Abstract
Research focusing on the social determinants of diabetes has focused on individual-level factors such as health behaviors, socioeconomic status, and depression. Fewer studies that incorporate a broader consideration of the multiple contexts or organizational levels (eg, family, health care setting, neighborhood) within which individuals are embedded exist in the mainstream diabetes literature. Such an approach would enhance our understanding of this complex disease, and thus, future avenues of research should consider the following: (1) a life-course approach, which examines the influence of early life exposures on the development of diabetes; (2) aiming to understand the biological mechanisms of social determinants of diabetes; and (3) implementing interventions on multiple levels. Integrating this multilevel and life-course approach will require transdisciplinary science that brings together highly specialized expertise from multiple disciplines. Broadening the study of social determinants is a necessary step toward improving the prevention and treatment of type 2 diabetes.
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Affiliation(s)
- Tiffany L Gary-Webb
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W. 168th St, New York, NY, 10032, USA,
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Akhtar-Danesh N, Valaitis R, O'Mara L, Austin P, Munroe V. Viewpoints about collaboration between primary care and public health in Canada. BMC Health Serv Res 2013; 13:311. [PMID: 23945461 PMCID: PMC3765372 DOI: 10.1186/1472-6963-13-311] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 08/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there is a global movement toward health system integration and collaboration, little is known about values, beliefs, and attitudes towards collaboration between stakeholders in public health (i.e. promotion, protection, and prevention with vulnerable groups and/or at the population level) and primary care (i.e., family practices, nurse-led clinics). The purpose of this study was to explore viewpoints of key stakeholders regarding primary care (PC) and public health (PH) collaboration in Canada. METHODS We used Q-methodology to identify common viewpoints held by participants who attended a national meeting in Canada in 2010 to discuss PC and PH collaboration. The study was conducted in two phases. In Phase 1 a Q-sample, a Q-sort table, and a short demographic questionnaire were developed which were used in Phase 2 for data collection. The Q-sorts then were analysed to identify the salient factors and consensus statements. RESULTS In total, 25 multidisciplinary individuals including researchers, policy-makers, directors, managers, and practitioners (e.g., nurses, family physicians, dietitians) participated. Using a by-person factor analysis, three factors (salient viewpoints) emerged. Factors were named based on their distinguishing statements as follows: a) System Driven Collaborators, b) Cautious Collaborators, and c) Competent Isolationists. System Driven Collaborators strongly believed that a clear mandate from the top is needed to enable PH, PC and the rest of the health system to effectively work together and that people in different branches in the Ministry/ Ministries have to strongly believe in collaboration, actively support it, and develop directed policies to foster organizations work together. Cautious Collaborators strongly supported the idea of having better consciousness-raising about what collaborations might be possible and beneficial, and also reflecting on the collaborations already in place. The Competent Isolationists strongly believed that it is necessary for PC and PH sectors to spend time to ensure that both parties clearly understand the differences between their roles. They believe that physicians, nurses, and social workers will not see the value in collaboration because they lack inter-professional educational programs. CONCLUSIONS Different viewpoints are held by stakeholders around PC and PH collaboration which have the potential to influence the success of collaborations. Understanding and managing these differences is important to assist change management processes required to build and maintain strong PC and PH collaborations.
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Huang MTTK, Brownson PR, Esposito L, Green L, Homer C. Next steps in obesity prevention: applying the systems approach. Child Obes 2013; 9:11-4. [PMID: 23327746 PMCID: PMC4702441 DOI: 10.1089/chi.2013.9102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Moderator: Terry T.-K. Huang
- Professor and Chair, Department of Health Promotion, Social, and Behavioral Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE
| | - Participants: Ross Brownson
- Professor, Brown School and Division of Public Health Sciences, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Layla Esposito
- Program Director, Child Development and Behavior Branch and Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Lawrence Green
- Professor, Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Charles Homer
- CEO and President, National Initiative for Children's Healthcare Quality (NICHQ); Associate Clinical Professor, Department of Pediatrics, Harvard Medical School, Boston, MA
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Truswell AS, Hiddink GJ, Green LW, Roberts R, van Weel C. Practice-based evidence for weight management: alliance between primary care and public health. Fam Pract 2012; 29 Suppl 1:i6-9. [PMID: 22399558 DOI: 10.1093/fampra/cmr058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- A Stewart Truswell
- University of Sydney, Human Nutrition Unit, Biochemistry Building, NSW 2006, Sydney, Australia
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