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Sastre MTM, Sorum PC, Kpanake L, Mullet E. Judging the possibility of the onset of diabetes mellitus type 2 from reported behavioral changes and from family history. Clin Diabetes Endocrinol 2023; 9:1. [PMID: 36631896 PMCID: PMC9832779 DOI: 10.1186/s40842-022-00147-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Undiagnosed type 2 diabetes is common and can lead to unrecognized health complications. Given that earlier detection can reduce the damage to vital organs, it is important for all persons to be able to make the connection between certain new manifestations in their bodies and the possibility of diabetes. This study examined the extent to which people use the behavioral changes they observe in others (or in themselves), as well as relevant family history, to judge the possibility of the onset of diabetes. METHODS One hundred and fifty-six adults living in France examined a set of realistic vignettes describing a person with (or without) signs suggestive of diabetes (e.g., increased thirst, family antecedents) and judged the possibility of the disease in each case. RESULTS Overall, 36% of participants focused on reported symptoms when judging the possibility of diabetes, 37% focused on family history, and 29% were not able to use the information or tended systematically to minimize the possibility of diabetes. CONCLUSIONS People in France and probably around the world need a greater awareness not only of the factors putting them at risk of diabetes, but also of the specific signs and symptoms suggesting that they might be developing it.
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Affiliation(s)
- María Teresa Muñoz Sastre
- grid.508721.9University of Toulouse, CERPPS, Maison de La Recherche, 5 Allées Antonio Machado, 31058 Toulouse Cedex 9, France
| | - Paul Clay Sorum
- grid.413558.e0000 0001 0427 8745Albany Medical College, AMC Med-Ped, 1019 New Loudon Road, Cohoes, NY 12047 USA
| | - Lonzozou Kpanake
- grid.38678.320000 0001 2181 0211University of Québec - TELUQ, 5800 Rue Saint-Denis, Bureau 1105, Montréal, QC H2S 3L5 Canada
| | - Etienne Mullet
- grid.424469.90000 0001 2195 5365Institute of Advanced Studies (EPHE), Paris, France ,Guadalajara, Spain
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Hirashiki A, Shimizu A, Nomoto K, Kokubo M, Suzuki N, Arai H. Systematic Review of the Effectiveness of Community Intervention and Health Promotion Programs for the Prevention of Non-Communicable Diseases in Japan and Other East and Southeast Asian Countries. Circ Rep 2022; 4:149-157. [PMID: 35434409 PMCID: PMC8977194 DOI: 10.1253/circrep.cr-21-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/27/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Non-communicable diseases (NCDs) are the leading cause of death worldwide. However, current evidence regarding the efficacy and cost-effectiveness of community intervention and health promotion programs for NCDs, specifically hypertension, obesity, diabetes, and dyslipidemia, in East and Southeast Asia has not yet been systematically reviewed. We systematically reviewed the literature from East and Southeast Asian countries to answer 2 clinical questions: (1) do health promotion programs for hypertension, obesity, diabetes, and dyslipidemia reduce cardiovascular events and mortality; and (2) are these programs cost-effective? Methods and Results: Electronic literature searches were performed across Medline, Cochrane Library, and Ichushi using key words and relevant subject headings related to randomized controlled trials, comparative studies, quasi-experimental studies, or propensity score matching that met eligibility criteria that were defined for each question. In all, 3,389 records were identified, of which 12 full-text articles were reviewed. Three papers were from Japan, 7 were from China/Hong Kong Special Administrative Region, and 2 were from South Korea. None were from Southeast Asia. Four papers examined the effect of community intervention or health promotion on the incidence of cardiovascular events or mortality. Eight studies examined the cost-effectiveness of interventions. Conclusions: The literature review revealed that community intervention and health promotion programs for the control of NCDs are a cost-effective means of reducing cardiovascular events and mortality in East Asian countries.
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Affiliation(s)
- Akihiro Hirashiki
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Atsuya Shimizu
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Kenichiro Nomoto
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Manabu Kokubo
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Noriyuki Suzuki
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Hidenori Arai
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology
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3
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Li L, Wang Z, Zhang M, Ruan H, Zhou L, Wei X, Zhu Y, Wei J, He S. New risk score model for identifying individuals at risk for diabetes in southwest China. Prev Med Rep 2021; 24:101618. [PMID: 34976674 PMCID: PMC8684021 DOI: 10.1016/j.pmedr.2021.101618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 11/01/2022] Open
Abstract
The prevalence of diabetes is increasing rapidly and becoming a major public health issue worldwide. We aimed to develop a novel nomogram model for long-term diabetic risk prediction in a Chinese population. A prospective cohort study was performed on 687 nondiabetic individuals who underwent routine physical examination in 1992 and 2007. Using the least absolute shrinkage and selection operator model to optimize feature selection. Multiple Cox regression analysis was performed, and a simple nomogram was constructed. The area under receiver operating characteristic curve (AUC) and calibration plot were conducted to assess the predictive accuracy of the model. The model was subjected to bootstrap internal validation. Of the 687 participants without diabetes at baseline, 74 developed diabetes during the follow-up time. This simple nomogram model was constructed by family history of diabetes, height, waist circumference, triglycerides, fasting plasma glucose and white blood cell count. The AUCs were 0.812 (95% CI: 0.729-0.895) and 0.794 (95% CI: 0.734-0.854) for 10-year and 15-year diabetic risk. The bootstrap corrected c-index was 0.771 (95% CI: 0.721-0.821). The calibration plot also achieved good agreement between observational and actual diabetic incidence. The stratification into different risk groups by optimal cut-off value of 12.8 allowed significant distinction between cumulative diabetic incidence curves in the whole cohort and several subgroups. We established and internally validated a novel nomogram which can provide individual diabetic risk prediction for Chinese population and this practical screening model may help clinicians to identify individuals at high risk of diabetes.
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Affiliation(s)
- Liying Li
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Ziqiong Wang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Muxin Zhang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.,Department of Cardiology, First People's Hospital, Longquanyi District, Chengdu, China
| | - Haiyan Ruan
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.,Department of Cardiology, Traditional Chinese Medicine Hospital of Shuangliu District, Chengdu, China
| | - Linxia Zhou
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.,Department of Cardiology, Traditional Chinese Medicine Hospital of Shuangliu District, Chengdu, China
| | - Xin Wei
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.,Department of Cardiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ye Zhu
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Jiafu Wei
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Sen He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
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4
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Sheiner E, Kapur A, Retnakaran R, Hadar E, Poon LC, McIntyre HD, Divakar H, Staff AC, Narula J, Kihara AB, Hod M. FIGO (International Federation of Gynecology and Obstetrics) Postpregnancy Initiative: Long-term Maternal Implications of Pregnancy Complications-Follow-up Considerations. Int J Gynaecol Obstet 2019; 147 Suppl 1:1-31. [PMID: 32323876 DOI: 10.1002/ijgo.12926] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Eyal Sheiner
- Department of Obstetrics and Gynecology B, Soroka University Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | - Ravi Retnakaran
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liona C Poon
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - H David McIntyre
- University of Queensland Mater Clinical School, Brisbane, Qld, Australia
| | - Hema Divakar
- Divakar's Speciality Hospital, Bengaluru, Karnataka, India
| | - Anne Cathrine Staff
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Cardiology, Mount Sinai St Luke's Hospital, New York, NY, USA
| | - Anne B Kihara
- African Federation of Obstetricians and Gynaecologists, Khartoum, Sudan
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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Sun J, Bao G, Cui J, Yasmeen N, Aslam B, Xin H, Shanshan L, Fu P, Baloch Z. The association of diabetes risk score and body mass index with incidence of diabetes among urban and rural adult communities in Qingdao, China. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00740-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Katoh S, Peltonen M, Zeniya M, Kaji M, Sakamoto Y, Utsunomiya K, Tuomilehto J. Analysis of the Japanese Diabetes Risk Score and fatty liver markers for incident diabetes in a Japanese cohort. Prim Care Diabetes 2016; 10:19-26. [PMID: 26303223 DOI: 10.1016/j.pcd.2015.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 07/22/2015] [Accepted: 07/30/2015] [Indexed: 01/07/2023]
Abstract
AIMS We examined the effectiveness of the Japanese Diabetes Risk Score (JPDRISC) and fatty liver markers for predicting incident diabetes. METHODS We created the JPDRISC. The study periods I and II were January 2007 to May 2009 and June 2009 to December 2011, respectively. A total of 2084 people (1389 men, 695 women; mean age: 46 years) were included. People with diabetes in the Period I and those with ethanol intake >140 g/week were excluded. A total of 1515 people were included. Fatty liver using ultrasonography scores (FLUS) were assigned. RESULTS The mean observation period was 26.3 months, and 24 people had developed diabetes between the Periods I and II. In logistic regression analysis, the JPDRISC (OR=1.197, 95% C.I.: 1.062-1.350, p=0.003) and FLUS (OR=2.591, 95% C.I.: 1.411-4.758, p=0.002) in the Period I were independent determinants of incident diabetes. In receiver operating characteristic analysis, sensitivity and specificity for incident diabetes were 0.885 and 0.536, respectively, in people with both FLUS≥1 and the total JPDRISC≥6 in the Period I. The sensitivity was better than the JPDRISC alone (sensitivity 0.696) and FLUS alone (sensitivity 0.750). CONCLUSIONS JPDRISC and FLUS were independently associated with incident diabetes and their combination is useful.
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Affiliation(s)
- Shuichi Katoh
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan; Jikei University Harumi Triton Clinic, Jikei University School of Medicine, 1-8-8 W3 Harumi, Chuo-ku, Tokyo, 104-0053, Japan.
| | - Markku Peltonen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Mannerheimintie 164A, FI-00271, Helsinki, Finland.
| | - Mikio Zeniya
- Jikei University Harumi Triton Clinic, Jikei University School of Medicine, 1-8-8 W3 Harumi, Chuo-ku, Tokyo, 104-0053, Japan; Health-Care Center, Gastroenterology & Division of Oncology, Institute of DNA Medicine, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Masanobu Kaji
- Jikei University Harumi Triton Clinic, Jikei University School of Medicine, 1-8-8 W3 Harumi, Chuo-ku, Tokyo, 104-0053, Japan.
| | - Yoichi Sakamoto
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan; Jikei University Harumi Triton Clinic, Jikei University School of Medicine, 1-8-8 W3 Harumi, Chuo-ku, Tokyo, 104-0053, Japan.
| | - Kazunori Utsunomiya
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Jaakko Tuomilehto
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Mannerheimintie 164A, FI-00271, Helsinki, Finland; Instituto de Investigacion Sanitaria del Hospital Universario LaPaz (IdiPAZ), Hospital Universitario La Paz, Paseo de la Castellana, 261, 28048, Madrid, Spain; Centre for Vascular Prevention, Danube-University Krems, Doktor-Karl-Dorrek-Straße 30, A-3500, Krems, Austria; King Abdulaziz University, Jeddah, Saudi Arabia.
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7
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Zhang Y, Ning F, Sun J, Pang Z, Wang X, Kapur A, Sintonen H, Qiao Q. Impact of a diabetes screening program on a rural Chinese population: a 3-year follow-up study. BMC Public Health 2015; 15:198. [PMID: 25881270 PMCID: PMC4349746 DOI: 10.1186/s12889-015-1570-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/17/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Screening for type 2 diabetes helps detect previously unknown diabetes and identify people with pre-diabetes, but the adverse impact of such screening on individuals labelled as pre-diabetes or classified as normal, is less known. In this study the health-related quality of life (HRQoL), depression and lifestyle changes in a rural Chinese population are assessed three years after a screening program. METHODS A total of 647 (39.1%) individuals with pre-diabetes and 1009 (60.9%) individuals with normoglycaemia from a population-based diabetes screening program in 2009 were re-examined in 2012-2013. Changes at the end of 3 years in HRQoL, depression, BMI, weight, frequency of physical activity and vegetable intake were assessed. RESULTS In men with normoglycaemia the mean (SD) 15D scores were 0.974 (0.04) at baseline and 0.973 (0.05) at follow-up; and 0.971 (0.05) and 0.966 (0.06) for men with pre-diabetes. In women the scores were 0.973 (0.05) and 0.963 (0.06) for normoglycaemia and 0.959 (0.06) and 0.954 (0.07) for pre-diabetes, respectively. Compared to baseline, the HRQoL was slightly lower at 3 years in all groups but the change was not considered to be clinically important, and was only statistically significant for women with normoglycaemia (p < 0.05). The depression score was slightly elevated in women, but not in men. No significant changes in BMI were noticed, but weight increased slightly in the normoglycemia group (p < 0.05). Screening had a significant positive impact on physical activity and vegetable intake. CONCLUSIONS This population-based diabetes screening program generated long-term positive changes toward a healthy lifestyle as measured by physical activity and vegetable intake for all the participants without adverse effects on the HRQoL and depression.
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Affiliation(s)
- Yanlei Zhang
- Department of Public Health, Clinicum, University of Helsinki, Mannerheimintie 172, PL41, Helsinki, 00014, Finland.
| | - Feng Ning
- Qingdao Municipal Centre for Disease Control and Prevention, Qingdao, China.
| | - Jianping Sun
- Qingdao Municipal Centre for Disease Control and Prevention, Qingdao, China.
| | - Zengchang Pang
- Qingdao Municipal Centre for Disease Control and Prevention, Qingdao, China.
| | - Xiaoyong Wang
- Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
| | - Anil Kapur
- World Diabetes Foundation, Gentofte, Denmark.
| | - Harri Sintonen
- Department of Public Health, Clinicum, University of Helsinki, Mannerheimintie 172, PL41, Helsinki, 00014, Finland.
| | - Qing Qiao
- Department of Public Health, Clinicum, University of Helsinki, Mannerheimintie 172, PL41, Helsinki, 00014, Finland. .,Observational Research Center, GMA, AstraZeneca, Mölndal, Sweden.
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8
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Senekal M, Seme Z, de Villiers A, Steyn NP. Health status of primary school educators in low socio-economic areas in South Africa. BMC Public Health 2015; 15:186. [PMID: 25880662 PMCID: PMC4358724 DOI: 10.1186/s12889-015-1531-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/13/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Non-communicable Diseases (NCDs) are major health concerns in South Africa. According to the life cycle approach NCD prevention strategies should target children. Educators are important external factors influencing behaviour of learners. The objective of this study was to assess the prevalence of selective NCD risk factors in educators of primary school learners. METHODS A cross-sectional design was used to assess the body mass index (BMI) and waist circumference (WC), blood glucose (BG), cholesterol (BC), blood pressure (BP), perceived health and weight, and parental NCD history of 517 educators in the Western Cape of South Africa. RESULTS The sample included 40% males and 60% females; 64% urban and 36% rural, 87% were mixed ancestry, 11% white and 2% black. Mean age for the total group was 52 ± 10.1 years, BMI 30 ± 1.2 kg/m(2) (31% overweight, 47% obese), diastolic BP 84 ± 10.0 mmHg, systolic BP 134 ± 18.7 mmHg (46% high BP), BG 4.6 ± 2.3 mmol/L (2% high BG), BC 4.4 ± 0.9 (30.4% high BC) and WC 98 ± 14.1 cm for males (38% high WC) and 95 ± 15.3 for females (67% high WC). BMI was higher (p = 0.001) and systolic (p = 0.001) and diastolic (p = 0.005) BP lower in females. Rural educators were more obese (p = 0.001). BMI (p = 0.001) and systolic BP (p = 0.001) were lower in younger educators. Correct awareness of personal health was 65% for BP, 79.2% for BC and 53.3% for BG. Thirty-eight percent overweight/obese females and 33% males perceived their weight as normal. CONCLUSION The findings of this study demonstrated a number of characteristics of educators in the two study areas that may influence their risk for developing NCDs and their potential as role models for learners. These included high levels of obesity, high blood pressure, high waist circumference, high cholesterol levels, and high levels of blood glucose. Furthermore, many educators had a wrong perception of their actual body size and a lack of awareness about personal health.
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Affiliation(s)
- Marjanne Senekal
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, UCT Medical campus, Anzio Road, Anatomy Building, Floor 2, Room 2.04, Observatory 7925, Cape Town, South Africa.
| | - Zibuyile Seme
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, UCT Medical campus, Anzio Road, Anatomy Building, Floor 2, Room 2.04, Observatory 7925, Cape Town, South Africa.
| | - Anniza de Villiers
- Chronic Diseases of Lifestyle Unit, Medical Research Council (MRC), Francie van Zyl Ave, Tygerberg, 7505, South Africa.
| | - Nelia P Steyn
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, UCT Medical campus, Anzio Road, Anatomy Building, Floor 2, Room 2.04, Observatory 7925, Cape Town, South Africa.
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9
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Zhou M, Astell-Burt T, Bi Y, Feng X, Jiang Y, Li Y, Page A, Wang L, Xu Y, Wang L, Zhao W, Ning G. Geographical variation in diabetes prevalence and detection in china: multilevel spatial analysis of 98,058 adults. Diabetes Care 2015; 38:72-81. [PMID: 25352654 PMCID: PMC4392931 DOI: 10.2337/dc14-1100] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the geographic variation in diabetes prevalence and detection in China. RESEARCH DESIGN AND METHODS Self-report and biomedical data were collected from 98,058 adults aged ≥18 years (90.5% response) from 162 areas spanning mainland China. Diabetes status was assessed using American Diabetes Association criteria. Among those with diabetes, detection was defined by prior diagnosis. Choropleth maps were used to visually assess geographical variation in each outcome at the provincial level. The odds of each outcome were assessed using multilevel logistic regression, with adjustment for person- and area-level characteristics. RESULTS Geographic visualization at the provincial level indicated widespread variation in diabetes prevalence and detection across China. Regional prevalence adjusted for age, sex, and urban/rural socioeconomic circumstances (SECs) ranged from 8.3% (95% CI 7.2%, 9.7%) in the northeast to 12.7% (11.1%, 14.6%) in the north. A clear negative gradient in diabetes prevalence was observed from 13.1% (12.0%, 14.4%) in the urban high-SEC to 8.7% (7.8%, 9.6%) in rural low-SEC counties/districts. Adjusting for health literacy and other person-level characteristics only partially attenuated these geographic variations. Only one-third of participants living with diabetes had been previously diagnosed, but this also varied substantively by geography. Regional detection adjusted for age, sex, and urban/rural SEC, for example, spanned from 40.4% (34.9%, 46.3%) in the north to 15.6% (11.7%, 20.5%) in the southwest. Compared with detection of 40.8% (37.3%, 44.4%) in urban high-SEC counties, detection was poorest among rural low-SEC counties at just 20.5% (17.7%, 23.7%). Person-level characteristics did not fully account for these geographic variations in diabetes detection. CONCLUSIONS Strategies for addressing diabetes risk and improving detection require geographical targeting.
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Affiliation(s)
- Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Thomas Astell-Burt
- School of Science and Health, University of Western Sydney, Sydney, Australia School of Geography and Geosciences, University of St. Andrews, St. Andrews, U.K
| | - Yufang Bi
- State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of the Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Xiaoqi Feng
- Centre for Health Research, School of Medicine, University of Western Sydney, Sydney, Australia
| | - Yong Jiang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yichong Li
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Andrew Page
- School of Science and Health, University of Western Sydney, Sydney, Australia
| | - Limin Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Xu
- State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of the Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenhua Zhao
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guang Ning
- State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of the Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
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Schwartz JI, Guwatudde D, Nugent R, Kiiza CM. Looking at non-communicable diseases in Uganda through a local lens: an analysis using locally derived data. Global Health 2014; 10:77. [PMID: 25406738 PMCID: PMC4240853 DOI: 10.1186/s12992-014-0077-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 10/24/2014] [Indexed: 11/25/2022] Open
Abstract
The demographic and nutritional transitions taking place in Uganda, just as in other low- and middle-income countries (LMIC), are leading to accelerating growth of chronic, non-communicable diseases (NCDs). Though still sparse, locally derived data on NCDs in Uganda has increased greatly over the past five years and will soon be bolstered by the first nationally representative data set on NCDs. Using these available local data, we describe the landscape of the globally recognized major NCDs- cardiovascular disease, diabetes, cancer, and chronic respiratory disease- and closely examine what is known about other locally important chronic conditions. For example, mental health disorders, spawned by an extended civil war, and highly prevalent NCD risk factors such as excessive alcohol intake and road traffic accidents, warrant special attention in Uganda. Additionally, we explore public sector capacity to tackle NCDs, including Ministry of Health NCD financing and health facility and healthcare worker preparedness. Finally, we describe a number of promising initiatives that are addressing the Ugandan NCD epidemic. These include multi-sector partnerships focused on capacity building and health systems strengthening; a model civil society collaboration leading a regional coalition; and a novel alliance of parliamentarians lobbying for NCD policy. Lessons learned from the ongoing Ugandan experience will inform other LMIC, especially in sub-Saharan Africa, as they restructure their health systems to address the growing NCD epidemic.
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Affiliation(s)
- Jeremy I Schwartz
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
- Young Professionals Chronic Disease Network, Boston, MA, USA.
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda.
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
| | - Rachel Nugent
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Charles Mondo Kiiza
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda.
- Department of Medicine, Mulago National Referral Hospital, Kampala, Uganda.
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Zhou X, Qiao Q, Ji L, Ning F, Yang W, Weng J, Shan Z, Tian H, Ji Q, Lin L, Li Q, Xiao J, Gao W, Pang Z, Sun J. Nonlaboratory-based risk assessment algorithm for undiagnosed type 2 diabetes developed on a nation-wide diabetes survey. Diabetes Care 2013; 36:3944-52. [PMID: 24144651 PMCID: PMC3836161 DOI: 10.2337/dc13-0593] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To develop a New Chinese Diabetes Risk Score for screening undiagnosed type 2 diabetes in China. RESEARCH DESIGN AND METHODS Data from the China National Diabetes and Metabolic Disorders Study conducted from June 2007 to May 2008 comprising 16,525 men and 25,284 women aged 20-74 years were analyzed. Undiagnosed type 2 diabetes was detected based on fasting plasma glucose ≥7.0 mmol/L or 2-h plasma glucose ≥11.1 mmol/L in people without a prior history of diabetes. β-Coefficients derived from a multiple logistic regression model predicting the presence of undiagnosed type 2 diabetes were used to calculate the New Chinese Diabetes Risk Score. The performance of the New Chinese Diabetes Risk Score was externally validated in two studies in Qingdao: one is prospective with follow-up from 2006 to 2009 (validation 1) and another cross-sectional conducted in 2009 (validation 2). RESULTS The New Chinese Diabetes Risk Score includes age, sex, waist circumference, BMI, systolic blood pressure, and family history of diabetes. The score ranges from 0 to 51. The area under the receiver operating curve of the score for undiagnosed type 2 diabetes was 0.748 (0.739-0.756) in the exploratory population, 0.725 (0.683-0.767) in validation 1, and 0.702 (0.680-0.724) in validation 2. At the optimal cutoff value of 25, the sensitivity and specificity of the score for predicting undiagnosed type 2 diabetes were 92.3 and 35.5%, respectively, in validation 1 and 86.8 and 38.8% in validation 2. CONCLUSIONS The New Chinese Diabetes Risk Score based on nonlaboratory data appears to be a reliable screening tool to detect undiagnosed type 2 diabetes in Chinese population.
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Zhang Y, Sun J, Pang Z, Gao W, Sintonen H, Kapur A, Qiao Q. Evaluation of two screening methods for undiagnosed diabetes in China: an cost-effectiveness study. Prim Care Diabetes 2013; 7:275-282. [PMID: 24021478 DOI: 10.1016/j.pcd.2013.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 07/16/2013] [Accepted: 08/17/2013] [Indexed: 10/26/2022]
Abstract
AIMS To evaluate the performance and cost-effectiveness of two screening methods to identify undiagnosed diabetes at primary care settings among a Chinese population. METHODS Two screening methods using a fasting capillary glucose (FCG) test or a Chinese diabetes risk score (DRS) at primary care settings followed by diagnostic tests were compared. The performance of FCG and DRS was evaluated by using receiver operating characteristic (ROC) curve analysis. The main economic outcome measures were the total cost of screening per 1000 persons, proportion of undiagnosed diabetes detected, and cost per undiagnosed diabetes identified from the societal perspective. RESULTS Among all participants, 14.6% (1349/9232) had undiagnosed diabetes defined by fasting plasma glucose ≥ 7.0mmol/l and/or 2h plasma glucose ≥ 11.1mmol/l and/or hemoglobin A1c ≥ 6.5%. At the optimal cutoff point of 6.1mmol/l for FCG and 14 for DRS, the sensitivity was 65.1% and 65.8%, and specificity was 72.4% and 55.2%, respectively. The area under the ROC curve was 75.3% for FCG and 63.7% for DRS (P<0.001). Based on the input costs, the total cost of screening 1000 persons was ¥64,000 ($9143) for FCG and ¥81,000 ($11,571) for DRS. The average cost per case identified was ¥674 ($96) for FCG at cutoff point of 6.1mmol/l and ¥844 ($121) for DRS at score of 14. The incremental cost per case identified was ¥17,000 ($2429) for DRS compared to FCG. The dominance relations between strategies remained with the changed in sensitivity analysis. CONCLUSIONS As a first-line screening tool for undiagnosed diabetes, the FCG test performed better than the DRS in primary care settings in China. The non-invasive and layperson-oriented DRS was feasible and detected more cases but more expensive. No strategy has strong dominance that was both more effective and less costly. The favorable strategy will depend on if the purpose of the screening program is to identify more cases or to have lower cost per case.
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Affiliation(s)
- Yanlei Zhang
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
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