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Yehualashet FA, Kessler D, Bizuneh S, Donnelly C. Feasibility of diabetes self-management coaching program for individuals with type 2 diabetes in the Ethiopian primary care setting: a protocol for a feasibility mixed-methods parallel-group randomized controlled trial. Pilot Feasibility Stud 2024; 10:59. [PMID: 38589966 PMCID: PMC11000297 DOI: 10.1186/s40814-024-01487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Diabetes mellitus is the third most prevalent chronic metabolic disorder and a significant contributor to disability and impaired quality of life globally. Diabetes self-management coaching is an emerging empowerment strategy for individuals with type 2 diabetes, enabling them to achieve their health and wellness goals. The current study aims to determine the feasibility of a diabetes self-management coaching program and its preliminary effectiveness on the clinical and psychosocial outcomes in the Ethiopian primary healthcare context. METHODS The study will employ a mixed-method feasibility randomized controlled trial design. Forty individuals with type 2 diabetes will be randomly allocated to treatment and control groups using block randomization. The primary feasibility outcomes include acceptability, eligibility, recruitment, and participant retention rates, which will be computed using descriptive analysis. The secondary outcomes are self-efficacy, self-care activity, quality of life, and glycated hemoglobin A1c. For normally distributed continuous variables, the mean difference within and between the groups will be determined by paired sample Student t-test and independent sample Student t-test, respectively. Non-parametric tests such as the Mann-Whitney U test, the Wilcoxon signed rank test, and the Friedman analysis of variance test will determine the median difference for variables that violated the normality assumption. A repeated measure analysis of variance will be considered to estimate the variance between the baseline, post-intervention, and post-follow-up measurements. A sample of 10 volunteers in the treatment group will participate in the qualitative interview to explore their experience with the diabetes self-management coaching program and overall feasibility. The study will follow a qualitative content analysis approach to analyze the qualitative data. Qualitative and quantitative findings will be integrated using a joint display technique. DISCUSSION Evidence reveals diabetes self-management coaching programs effectively improve HbA1c, self-efficacy, self-care activity, and quality of life. This study will determine the feasibility of a future large-scale randomized controlled trial on diabetes self-management coaching. The study will also provide evidence on the preliminary outcomes and contribute to improving the diabetes self-management experience and quality of life of individuals with type 2 diabetes. TRIAL REGISTRATION The trial was registered online at ClinicalTrials.gov on 12/04/2022 and received a unique registration number, NCT05336019, and the URL of the registry is https://beta. CLINICALTRIALS gov/study/NCT05336019 .
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Affiliation(s)
- Fikadu Ambaw Yehualashet
- School of Rehabilitation Therapy, Faculty of Health Science, Queen's University, 31 George St, Kingston, ON, K7M 3N6, Canada.
- College of Medicine and Health Sciences, The University of Gondar, Gondar, Ethiopia.
| | - Dorothy Kessler
- School of Rehabilitation Therapy, Faculty of Health Science, Queen's University, 31 George St, Kingston, ON, K7M 3N6, Canada
| | - Segenet Bizuneh
- College of Medicine and Health Sciences, The University of Gondar, Gondar, Ethiopia
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Faculty of Health Science, Queen's University, 31 George St, Kingston, ON, K7M 3N6, Canada
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Koye DN, Melaku YA, Gelaw YA, Zeleke BM, Adane AA, Tegegn HG, Gebreyohannes EA, Erku DA, Tesfay FH, Gesesew HA, Mekonnen A, Dadi AF, Alene KA. Mapping national, regional and local prevalence of hypertension and diabetes in Ethiopia using geospatial analysis. BMJ Open 2022; 12:e065318. [PMID: 36600383 PMCID: PMC9743363 DOI: 10.1136/bmjopen-2022-065318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study aimed to map the national, regional and local prevalence of hypertension and diabetes in Ethiopia. DESIGN AND SETTING Nationwide cross-sectional survey in Ethiopia combined with georeferenced ecological level data from publicly available sources. PARTICIPANTS 9801 participants aged between 15 and 69 years. PRIMARY OUTCOME MEASURES Prevalence of hypertension and diabetes were collected using the WHO's STEPS survey approach. Bayesian model-based geostatistical techniques were used to estimate hypertension and diabetes prevalence at national, regional and pixel levels (1×1 km2) with corresponding 95% credible intervals (95% CrIs). RESULTS The national prevalence was 19.2% (95% CI: 18.4 to 20.0) for hypertension and 2.8% (95% CI: 2.4 to 3.1) for diabetes. Substantial variation was observed in the prevalence of these diseases at subnational levels, with the highest prevalence of hypertension observed in Addis Ababa (30.6%) and diabetes in Somali region (8.7%). Spatial overlap of high hypertension and diabetes prevalence was observed in some regions such as the Southern Nations, Nationalities and People's region and Addis Ababa. Population density (number of people/km2) was positively associated with the prevalence of hypertension (β: 0.015; 95% CrI: 0.003-0.027) and diabetes (β: 0.046; 95% CrI: 0.020-0.069); whereas altitude in kilometres was negatively associated with the prevalence of diabetes (β: -0.374; 95% CrI: -0.711 to -0.044). CONCLUSIONS Spatial clustering of hypertension and diabetes was observed at subnational and local levels in Ethiopia, which was significantly associated with population density and altitude. The variation at the subnational level illustrates the need to include environmental drivers in future NCDs burden estimation. Thus, targeted and integrated interventions in high-risk areas might reduce the burden of hypertension and diabetes in Ethiopia.
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Affiliation(s)
- Digsu Negese Koye
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Methods and Implementation Support for Clinical and Health research Hub (MISCH), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Yohannes Adama Melaku
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Yalemzewod Assefa Gelaw
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Berihun Megabiaw Zeleke
- Planetary Health Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Akilew Awoke Adane
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, Western Australia, Australia
| | - Henok Getachew Tegegn
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Eyob Alemayehu Gebreyohannes
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Daniel Asfaw Erku
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Fisaha Haile Tesfay
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Institute of Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Hailay Abrha Gesesew
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia
| | - Alemayehu Mekonnen
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Abel Fekadu Dadi
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Menzies Health Research Institute, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kefyalew Addis Alene
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
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Habebo TT, Jaafaripooyan E, Mosadeghrad AM, Foroushani AR, Gebriel SY, Babore GO. A Mixed Methods Multicenter Study on the Capabilities, Barriers, and Opportunities for Diabetes Screening and Management in the Public Health System of Southern Ethiopia. Diabetes Metab Syndr Obes 2022; 15:3679-3692. [PMID: 36465989 PMCID: PMC9709844 DOI: 10.2147/dmso.s391926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background More than half of diabetics' in Ethiopia live undiagnosed, and the majority of those who already knew their status also struggle to manage their diseases. However, the underlying challenges are less understood in the study area. Therefore, this study aimed to assess diabetes screening and management capabilities, barriers, and opportunities in southern Ethiopia. Methods We applied a mixed methods study. To assess the healthcare systems' capabilities, we collected quantitative data from randomly selected ten hierarchically organized healthcare facilities, and purposive maximum variation sampling was applied to recruit twenty-nine individuals for face-to-face in-depth interviewing. The interviews were audio recorded, transcribed verbatim, thematically analyzed, and presented accordingly. Results Our study findings indicated that there were good opportunities and encouraging capabilities like government commitment and expansion of services to improve diabetes screening and management in southern Ethiopia. Nevertheless, poor governance, the system's structural problems, skilled professionals' inaccessibility and lack of teamwork, poor service integration, poor planning, and lack of monitoring and evaluation mechanisms have been hampering the service delivery at the system level. While service unaffordability, low awareness level, and lifestyle modification problems were the main challenges at the patient level. Furthermore, outdated paper-based medical record documentation, frequent essential drug stock-outing, essential laboratory service interruptions, and none-use of some available services like HbA1c have been contributing to the barriers. Conclusion Despite favorable capabilities available, diabetes management in southern Ethiopia has been struggling with solvable structural defects, poor service delivery and inaccessibility, and patients' poor lifestyle modification. Therefore, public health system restructuring, optimum financing, computerization of medical records documentation, and health system and patient capacity building are strongly recommended interventions to tackle the problem at the grass-root level.
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Affiliation(s)
- Teshome Tesfaye Habebo
- Disease Prevention and Control Directorate, Kembata Tembaro Zone Health Department, Durame, SNNPRS, Ethiopia
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ebrahim Jaafaripooyan
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ali Mohammad Mosadeghrad
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Getachew Ossabo Babore
- Department of Nursing, College of Health Sciences and Medicine, Wachemo University, Hossana, Ethiopia
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Waist-to-hip circumference and waist-to-height ratio could strongly predict glycemic control than body mass index among adult patients with diabetes in Ethiopia: ROC analysis. PLoS One 2022; 17:e0273786. [DOI: 10.1371/journal.pone.0273786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/15/2022] [Indexed: 11/11/2022] Open
Abstract
Background
Poorly controlled blood glucose is prevalent and contributes to the huge burden of diabetes related morbidity, and central obesity has a great role in the pathogenesis of diabetes and its adverse complications, which could predict such risks, yet evidence is lacking. Hence, this paper is to evaluate the predictive performance of central obesity indices for glycemic control among adult patients with diabetes in eastern Ethiopia.
Methods
A survey of 432 randomly chosen patients with diabetes was conducted using a pretested questionnaire supplemented by chart review, anthropometrics, and biomarkers by trained data collectors. The poor glycemic control was assessed using a fasting blood glucose (FBS) level of above 130 and/or an HgA1c level above 7%. Weight, height, waist circumference (WC), and hip circumference (HC) were measured under standard procedures and we calculated waist-to-hip circumference ratio (WHR) and waist-to-height ratio (WHtR). The receiver operating characteristics curve was used to assess the predictive performance of obesity indices for glycemic control using area under the curve (AUC) and corresponding validity measures.
Results
A total of 432 (92%) patients with diabetes were enrolled with a mean age of 49.6 (±12.4) years. The mean fasting blood glucose level was 189 (±72) mg dl-1 where 330 (76.4%) (95% CI: 74.4–78.4%) and 93.3% of them had poor glycemic control based on FBS and HgA1c, respectively. WC (AUC = 0.90; 95% CI: 0.85–0.95), WHR (AUC = 0.64; 95% CI: 0.43–0.84), and WHtR (AUC = 0.87; 95% CI: 0.83–0.94) have a higher predictive performance for poor glycemic control at cut-off points above 100 cm, 0.95, and 0.62, respectively. However, obesity indices showed a lower predictive performance for poor glycemic control based on FBS. Body mass index (BMI) had a poor predictive performance for poor glycemic control (AUC = 0.26; 95% CI: 0.13–0.40).
Conclusions
Poor glycemic control is a public health concern and obesity indicators, typically WC, WHR, and WHtR, have a better predictive performance for poor glycemic control than BMI.
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Techane T, Nigussa E, Lemessa F, Fekadu T. Factors Associated with Length of Intensive Care Unit Stay Following Cardiac Surgery in Cardiac Center Ethiopia, Addis Ababa, Ethiopia: Institution Based Cross Sectional Study. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2022. [DOI: https://doi.org/10.2147/rrcc.s349038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Techane T, Nigussa E, Lemessa F, Fekadu T. Factors Associated with Length of Intensive Care Unit Stay Following Cardiac Surgery in Cardiac Center Ethiopia, Addis Ababa, Ethiopia: Institution Based Cross Sectional Study. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2022. [DOI: 10.2147/rrcc.s349038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Desse TA, Namara KM, Yifter H, Manias E. Development of a Complex Intervention for Effective Management of Type 2 Diabetes in a Developing Country. J Clin Med 2022; 11:1149. [PMID: 35268240 PMCID: PMC8911192 DOI: 10.3390/jcm11051149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 02/07/2023] Open
Abstract
There has been little focus on designing tailored diabetes management strategies in developing countries. The aim of this study is to develop a theory-driven, tailored and context-specific complex intervention for the effective management of type 2 diabetes at a tertiary care setting of a developing country. We conducted interviews and focus groups with patients, health professionals, and policymakers and undertook thematic analysis to identify gaps in diabetes management. The results of our previously completed systematic review informed data collection. We used the United Kingdom Medical Research Council framework to guide the development of the intervention. Results comprised 48 interviews, two focus groups with 11 participants and three co-design panels with 24 participants. We identified a lack of structured type 2 diabetes education, counselling, and collaborative care of type 2 diabetes. Through triangulation of the evidence obtained from data collection, we developed an intervention called VICKY (patient-centred collaborative care and structured diabetes education and counselling) for effective management of type 2 diabetes. VICKY comprised five components: (1) patient-centred collaborative care; (2) referral system for patients across transitions of care between different health professionals of the diabetes care team; (3) tools for the provision of collaborative care and documentation of care; (4) diabetes education and counselling by trained diabetes educators; and (5) contextualised diabetes education curriculum, educational materials, and documentation tools for diabetes education and counselling. Implementation of the intervention may help to promote evidence-based, patient-centred, and contextualised diabetes care for improved patient outcomes in a developing country.
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Affiliation(s)
- Tigestu Alemu Desse
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC 3217, Australia;
| | - Kevin Mc Namara
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Geelong, VIC 3217, Australia;
- Deakin Health Economics, Institute for Healthcare Transformation, Deakin University, Geelong, VIC 3217, Australia
| | - Helen Yifter
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia;
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC 3217, Australia;
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Amdie FZ, Luctkar-Flude M, Snelgrove-Clarke E, Sawhney M, Alemu S, Woo K. Feasibility of Virtual Simulation-Based Diabetes Foot Care Education in Patients with Diabetes in Ethiopia: Protocol for a Randomized Controlled Trial. Diabetes Metab Syndr Obes 2022; 15:995-1009. [PMID: 35386589 PMCID: PMC8979753 DOI: 10.2147/dmso.s345722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Diabetes mellitus is a rapidly growing global public health problem; the number of adults with diabetes is expected to increase from 424.9 million in 2017 to 628.6 million in 2045. Approximately 80% of diabetic patients live in low- and middle-income countries where access to care may be limited. For example, in Ethiopia, diabetes care is often rudimentary, and formal, structured diabetes education is almost non-existent. One potential solution to the lack of diabetes management education for patients could be virtual simulation-based diabetes education incorporating the contextual realities of patients in Ethiopia. Despite its great potential to improve glycemic control, delay diabetes-related complications and reduce mortality associated with diabetes, the feasibility of virtual simulation-based diabetes self-management education has not been studied in low- and middle-income settings. OBJECTIVE The purpose of the current study is to evaluate the feasibility of a virtual simulation-based Diabetes Foot Care Education (DFCE) program among adult patients with diabetes in Ethiopia. METHODS A randomized controlled feasibility study including participants from University of Gondar Referral Hospital (UoGRH) will be conducted. A sample of 40 participants will be recruited, of which 20 participants will receive the virtual simulation-based education program, and the other 20 participants will continue with their usual diabetes care. After the education program, a questionnaire and structured interview will be used to explore the feasibility (acceptability, practicality) and the potential impact of virtual simulation-based DFCE intervention in patients with diabetes. Data will be analyzed using SPSS version 25 using descriptive statistics, independent t-tests, paired sample t-test, and factorial ANOVA at significance levels of less than 0.05. DISCUSSION Our study seeks to understand the perceived usefullness and usability of virtual simulation-based diabetes foot care education on behavioural (diabetes foot-care knowledge, foot self-care practices, and foot self-care efficacy). Furthermore, the study will provide insight to assist in the development of technologically assisted and contextually designed DFCE programs. TRIAL REGISTRATION NUMBER NCT04841291 (ClinicalTrials.gov Identifier).
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Affiliation(s)
- Fisseha Zewdu Amdie
- School of Nursing, University of Gondar, Gondar, Ethiopia
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
- Correspondence: Fisseha Zewdu Amdie, Email
| | | | | | - Monakshi Sawhney
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
| | - Shitaye Alemu
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Kevin Woo
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
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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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Dantas PPDA, Colussi PRG, Dezingrini KDS, Sachetti DG, Muniz FWMG. Pairs of natural teeth rather than use of dental prosthesis are associated with nutritional status in older adults: A cross-sectional study. J Dent 2021; 108:103656. [PMID: 33819455 DOI: 10.1016/j.jdent.2021.103656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the association between pairs of natural teeth and nutritional status among older adults. METHODS This cross-sectional study evaluated a total of 569 home-dwelling adults from two southern Brazilian cities aged ≥60 years. Present teeth were counted, and pairs of natural teeth were defined as antagonistic teeth. Nutritional status was assessed using Mini Nutritional Assessment. Sociodemographic, behavioral, medical and dental history were collected. Sample was dichotomized into well-nourished and at nutritional risk (including at risk of malnutrition and malnourished). Multiple multivariate models were performed considering different categorizations of pairs of natural teeth. RESULTS For each number of present teeth, a decrease of 1.8 % in the prevalence ratio (PR) for nutritional risk was detected (p = 0.040). For each pair of natural teeth, there was 4.4 % decrease in PR for nutritional risk (95 % confidence interval [95 % CI]: 0.917 - 0.997). No statistically significant association was found for pairs of natural anterior teeth (p = 0.222). For pairs of natural premolar, molar and posterior teeth, reductions of 15.4 %, 22.8 % and 11.5 %, respectively, in PR for nutritional risk were observed (p < 0.05). The presence of at least two pairs of natural molars or three pairs of natural posterior teeth was significantly associated with nutritional risk (p < 0.05). CONCLUSION Older adults with fewer teeth or pairs of natural teeth, especially posterior teeth, presented poorer nutritional status. CLINICAL SIGNIFICANCE Demonstrating threshold correlation between natural teeth and nutrition, data showed significant association between at least two pairs of natural molars or three pairs of natural posterior teeth and lower nutritional status.
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Affiliation(s)
| | | | | | - Diandra Genoveva Sachetti
- Department of Periodontology, School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
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Gebermariam AD, Tiruneh SA, Ayele AA, Tegegn HG, Ayele BA, Engidaw M. Level of glycemic control and its associated factors among type II diabetic patients in debre tabor general hospital, northwest Ethiopia. Metabol Open 2020; 8:100056. [PMID: 32984805 PMCID: PMC7493082 DOI: 10.1016/j.metop.2020.100056] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Poor glycemic control is the major risk factor for the development of acute and chronic diabetes complications. There are limited studies on the level of glycemic control and its associated factors among diabetic patients. So, this study aimed to assess the level of glycemic control and its associated factors among type II DM patients in Debre Tabor General Hospital. METHODS An institution based cross sectional study was conducted from November 1-30, 2017. Totally, 413 diabetic patients selected by systematic random sampling. The three months average fasting blood glucose was used to determine glycemic control. Regressions were fitted to identify associated factors. A p-value <0.05 was used to declare statistical significance. RESULT A total of 398 study participants were participated in the study with a response rate of 96.4%. Among 398 type II DM patients, 284 (71.4%) had poor glycemic control. Patient's educational status (able to read and write; AOR = 3.0, 95%CI (1.5, 5.7), (primary education; AOR = 4.5, 95%CI (1.8, 10.9), and (secondary education; AOR = 5.7, 95% CI (2.9, 11.2)))), family history of DM (AOR = 2.3, 95%CI (1.4, 3.9)), duration of DM since diagnosis (AOR = 0.3, 95% CI (0.1, 0.9)), and dietary adherence (AOR = 2.4, 95% CI (1.4, 4.1)) were associated factors to had good glycemic control. CONCLUSION Poor glycemic control was high. Educational status, family history of DM, duration of DM, and dietary adherence were the associated factors of glycemic control. Appropriate attention shall be given for glycemic control especially for patients with a longer duration. Health promotion related to medical recommendations is a cross-cutting intervention for diabetic patients and should be provided for all type II diabetic patients.
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Affiliation(s)
| | | | - Asnakew Achaw Ayele
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Henok Getachew Tegegn
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Ethiopia
- School of Medicine and Pharmacy, University of New England, Armidale, NSW, 2351, Australia
| | - Belete Achamyelew Ayele
- Department of Epidemiology and Biostatics, Institute of Public Health College of Medicine and Health Science, University of Gondar, Ethiopia
| | - MelakuTadege Engidaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Ethiopia
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Mariye Zemicheal T, Bahrey Tadesse D, Tasew Atalay H, Teklay Weldesamuel G, Gebremichael GB, Tesfay HN, Haile TG. Determinants of Diabetic Nephropathy among Diabetic Patients in General Public Hospitals of Tigray, Ethiopia, 2018/19. Int J Endocrinol 2020; 2020:6396483. [PMID: 33014045 PMCID: PMC7525305 DOI: 10.1155/2020/6396483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/29/2020] [Accepted: 09/13/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Diabetic nephropathy is real damage resulting from having uncontrolled diabetes mellitus. Unmanaged diabetic nephropathy is one of the most leading causes of kidney failure. There is a scarcity of information on the determinants of diabetic nephropathy among diabetes mellitus patients in Ethiopia. Identification of the determinants can help devise a strategy to properly address the disease and its consequences. Therefore, this study was designed to assess the determinants of diabetic nephropathy among diabetes mellitus patients. METHODS Unmatched case-control study design with 168 cases and 672 controls with a mean age of 45.18 and 62.12, respectively, participated in the study. An interviewer-administered questionnaire was employed for data collection, and a systematic sampling technique was used to select the study participants. Data were entered into Epi data and exported to SPSS for data clarification and analysis. Binary logistic regression analysis was carried out to check the level of association between diabetic nephropathy and the independent variables. RESULTS Comorbidity (AOR: 4.96 at 95 CI: 1.77-13.87), hypertension (AOR: 6.33, 95% CI: 2.51-16.02), poor glycemic control (AOR: 3.27, 95% CI: 1.31, 8.21), age (AOR: 1.14, 95%: 1.09-1.19), duration with diabetes mellitus since diagnosis (AOR: 1.83, 95 CI: 1.62-2.06), and nonadherence to diabetic medication (AOR: 3.3, 95% CI: 1.34, 8.15), diet (AOR: 5.96, 95%: 1.92-18.54), and exercise (AOR: 5.60, 95% CI: 1.94-16.21) were the determinants of diabetic nephropathy. CONCLUSION Adherence to medication, diet, and exercise should be empowered to achieve glycemic control and to prevent diabetic nephropathy. More attention has to be also given for old aged diabetic patients, long duration since diagnosis of diabetes mellitus, hypertension, and other comorbidities.
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Affiliation(s)
- Teklewoini Mariye Zemicheal
- Department of Adult Health Nursing, School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Degena Bahrey Tadesse
- Department of Adult Health Nursing, School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Hagos Tasew Atalay
- Department of Pediatric Nursing, School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Girmay Teklay Weldesamuel
- Department of Pediatric Nursing, School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Gebrewahd Bezabh Gebremichael
- Department of Adult Health Nursing, School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Mekelle University, Mek'ele, Ethiopia
| | - Haben Nuguse Tesfay
- Department of Pediatrics, School of Medicine, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Teklehaimanot Gereziher Haile
- Department of Maternity and Child Health Nursing, School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
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Dessie G, Wagnew F, Mulugeta H, Belachew A, Negesse A, Kassa GM, Habtewold TD, Parchinski K. Association Between the Level of Reported Good Medication Adherence and the Geographic Location of a Patient's Residence and Presence of a Glucometer Among Adult Patients with Diabetes in Ethiopia: A Systematic and Meta-Analysis. Curr Ther Res Clin Exp 2020; 92:100585. [PMID: 32714468 PMCID: PMC7378857 DOI: 10.1016/j.curtheres.2020.100585] [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: 11/07/2018] [Accepted: 03/11/2020] [Indexed: 12/31/2022] Open
Abstract
Seven thousand seven hundred fifty-six participants were included for the final analysis. Reported good medication adherence among adult diabetic patients in Ethiopia was 68.59%. Reported good medication adherence among adult diabetic patients in regions was 67.81%. Reported good medication adherence among adult diabetic patients in Addis Ababa was 70.37%. Presence of glucometer at home has positive association with reported good medication adherence among adult diabetic patients.
Background Diabetes mellitus (DM) is a major public health problem worldwide that was estimated to have affected the lives of 425 million people globally in 2017. The prevalence and mortality rates of DM have increased rapidly in low- and middle-income countries with an estimated 2.6 million cases of DM occurring in Ethiopia alone in 2015. Objective Considering that Ethiopia is undergoing an epidemiological transition, it is increasingly important to understand the significant influence DM has on Ethiopians annually. A systematic review and meta-analysis of the existing studies were conducted to better understand the factors that are associated with DM medication adherence across Ethiopia and to elucidate areas for further studies. Methods Studies were retrieved through search engines in Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, PubMed, Google Scholar, Web of Science, Science Direct, and Scopus. The Newcastle–Ottawa Scale for cross-sectional studies was used to assess the critical appraisal of the included studies. Random effects model was used to estimate the association between the level of medication adherence and the geographic location of a patient's residence and presence of a glucometer at 95% CI with its respective odds ratio. Meta-regression was also used to identify the potential source of heterogeneity. Beggs and Egger tests were performed to determine publication bias. Subgroup analyses, based on the study area, were also performed. Results A total of 1046 articles were identified through searching, of which 19 articles representing 7756 participants were included for the final analysis stage. Reported good medication adherence among patients with diabetes in Ethiopia was 68.59% (95% CI, 62.00%–75.18%). Subgroup analysis was performed, and the pooled estimate of reported good medication adherence among these patients in regions outside Addis Ababa was 67.81% (95% CI, 59.96%–75.65%), whereas in Addis Ababa it was 70.37% (95% CI, 57.51%–83.23%). Patients who used a glucometer at home had an odds ratio of 2.12 (95% CI, 1.42–3.16) and thus reported good adherence. We found no statistically significant association between the geographic location of a patient's residence and a good level of reported medication adherence (odds ratio, 1.81; 95% CI, 0.78–4.21). Conclusions Most adult patients with diabetes in these studies had a good level of reported DM medication adherence. Having a glucometer was significantly associated with reported increased medication adherence. Our findings suggest the need for interventions to improve diabetes medication adherence.
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Affiliation(s)
- Getenet Dessie
- Department of Nursing, School of Health Science, College of Medicine and Health Science Bahir Dar University, Bahir Dar, Ethiopia
| | - Fasil Wagnew
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Henok Mulugeta
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Amare Belachew
- Department of Nursing, School of Health Science, College of Medicine and Health Science Bahir Dar University, Bahir Dar, Ethiopia
| | - Ayenew Negesse
- Department of Human Nutrition and Food Sciences, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | | | - Tesfa Dejenie Habtewold
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kaley Parchinski
- School of Public Health, University of California, Berkeley, California
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Negera GZ, Weldegebriel B, Fekadu G. Acute Complications of Diabetes and its Predictors among Adult Diabetic Patients at Jimma Medical Center, Southwest Ethiopia. Diabetes Metab Syndr Obes 2020; 13:1237-1242. [PMID: 32368116 PMCID: PMC7182448 DOI: 10.2147/dmso.s249163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/05/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia resulting from impairment in insulin secretion, insulin action, or both. It is responsible for a wide range of acute and chronic complications. In this study, we aimed to assess acute complications of diabetes and its predictors among adult DM patients at Jimma Medical Center (JMC), southwest Ethiopia. METHODS A facility-based cross-sectional study involving 348 diabetic patients was conducted from February to May 31, 2019 at JMC. Logistic regression was conducted to identify predictors of acute complications of diabetes. Variables with P≤0.25 on bivariate logistic regression were considered candidates for multivariate regression. ORs and 95% CIs with P<0.05 were considered statistically significant. RESULTS Of the 348 patients, 225 (64.7%) were male, and the mean age of study participants was 46±15.5 years. Most (281, 80.7%) had type 2 DM. More than two-thirds (240, 69%)had diabetes duration of <5 years. During the study period, 92 (26.4%) patients developed acute complications of diabetes. Of these, 68 (73.9%) had diabetic ketoacidosis, 21 (22.8%) a hyperglycemic hyperosmolar state, and three (3.3%) hypoglycemia. Presence of comorbidity (AOR 5.6, 95% CI 2.80-11.19), type 1 DM (AOR 9.3, 95% CI 4.36-19.82), uncontrolled blood glucose (AOR 1.91, 95% CI 1.05-3.45), and lack of access to a health facility within a reasonable distance (AOR 1.96, 95% CI 1.11-3.45) were independent predictors of acute complications of diabetes. CONCLUSION The magnitude of acute complications among DM patients at JMC was high. Comorbidity, type 1 DM, uncontrolled blood sugar, and lack of access to a health facility within a reasonable distance were independent predictors of acute complications. Clinicians should follow up this subgroup of DM patients closely.
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Affiliation(s)
- Getandale Zeleke Negera
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Belachew Weldegebriel
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ginenus Fekadu
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Prevalence and Associated Factors of Diabetes Mellitus in Hosanna Town, Southern Ethiopia. Ann Glob Health 2020; 86:18. [PMID: 32140428 PMCID: PMC7047764 DOI: 10.5334/aogh.2663] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background/Objectives Diabetes is a global public health problem, and its burden is rising, particularly in developing countries. However, limited data is available from sub-Sahara African communities to assess and monitor the disease burden. The study aimed to determine the prevalence and associated factors of diabetes in Hosanna, Ethiopia. Methods A community-based cross-sectional study was conducted among 634 randomly selected adults in Hosanna. The study participants were recruited by multi-stage stratified sampling. A face-to-face interview using a structured questionnaire was administered by trained nurses. Anthropometry, blood pressure and fasting blood glucose levels were measured. Diabetes mellitus was considered when the fasting blood glucose level was ≥126 mg/dl on two separate measurements or when the participant self-reported a previous diagnosis of diabetes by healthcare providers or when the participant was currently receiving treatment for diabetes. Multi-variable binary logistic regression was used to identify factors associated with diabetes mellitus. Findings The overall prevalence of diabetes was found to be 5.7% (95% CI; 4.0-7.7), out of which more than one third (36%) were not aware of it prior to the survey. Nearly two thirds (61.1%) of the diabetic participants were also found to be hypertensive. In the multi-variable analysis, diabetes was associated with current alcohol use, sitting on average of more than 8 hours/day, abnormal BMI and being hypertensive. Conclusion The prevalence of diabetes among the adult population in the town is alarming. If appropriate measures to address the burden are not emplaced, it might result in serious complications to the patients and unnecessarily high costs to the health system of the country. Active screening for raised blood glucose level should be given due consideration, particularly in the community setting. Designing health education programs on the importance of physical activity and the risks of alcohol use should also be considered.
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Chicharro-Luna E, Pomares-Gómez FJ, Ortega-Ávila AB, Coheña-Jiménez M, Gijon-Nogueron G. Variability in the clinical diagnosis of diabetic peripheral neuropathy. Prim Care Diabetes 2020; 14:53-60. [PMID: 31208891 DOI: 10.1016/j.pcd.2019.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/13/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
AIMS The aims of this study are to assess the variability in the prevalence of diabetic peripheral neuropathy (DPN), according to the diagnostic and clinical guidelines used. METHODS A cross-sectional observational study was conducted of 111 patients with diabetes mellitus. The presence/absence of DPN was determined according to 12 different criteria stipulated in various clinical guidelines (ADA 2018, IWGDF 2016, IDF 2012 and CONUEI 2018). The Cohen's kappa coefficient (κ) was performed to determine the degree of agreement for DPN diagnosis among the different criteria. RESULTS The recorded prevalence of DPN ranged from 13.1% (criterion ADA 2018) to 68.5% (criterion IDF 2012). The sensory parameter that was most commonly affected was the non-perception of vibration (68.5%) and the absence of Achilles reflexes (59.4%). IWGDF, based on the use of a monofilament, cotton wisp and tuning fork, was the test with more agreements, presenting good agreement with 2 criteria from ADA 2018 (k=0.845), 1b2 (k=0.817), 2 criteria from IWGDF 2016 (k=0.933), (k=0.817), 1 criteria from IDF 2012 (k=0.845) and 1 criteria from CONUEI 2018 (k=0.860), all p<0.001. CONCLUSION The IWGDF criterion based on the use of a monofilament, cotton wisp and tuning fork for the diagnosis presented the highest level of concordance with the other criteria (>0.8).
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Affiliation(s)
- Esther Chicharro-Luna
- Departament of Behavioral Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, San Juan de Alicante, Spain.
| | | | - Ana Belén Ortega-Ávila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Spain.
| | | | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Spain; Instituto de Investigación Biomedica de Malaga (IBIMA), Spain.
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Engidaw MT, Feyisa MS. Prevalence of Anemia and Its Associated Factors Among Adult Diabetes Mellitus Patients at Debre Tabor General Hospital, Northcentral Ethiopia. Diabetes Metab Syndr Obes 2020; 13:5017-5023. [PMID: 33376371 PMCID: PMC7755378 DOI: 10.2147/dmso.s286365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/02/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a cluster of metabolic disorders which is characterized by hyperglycemia. The occurrence of anaemia is a significant public health problem among diabetic patients because of complication and dietary modifications. So, this study aimed to assess the magnitude of anaemia among adult diabetes mellitus patients in Debre Tabor General Hospital, Ethiopia. METHODS A cross-sectional study design was conducted. A simple random sampling technique was employed to collect data from 297 adult diabetic mellitus patients. After taking venous blood, the haemoglobin level was determined by using HemoCue 301 machine. Anaemia among diabetic patients was determined by using the haemoglobin level (<13.0g/dL for male and <12.0g/dL for female). Data were entered using EpiInfo version 7.2 and analyzed using SPSS version 21. The binary logistic regression model was used to explore the association of independent variables with anaemia. Finally, p-value <0.05 was used to declare the level of statistical significance. RESULTS The prevalence of anemia among diabetic patient was 29.81% (95% CI: 24.27, 35.35). Diabetic patients unable to read and write (AOR = 3.51, 95% CI: 1.40, 8.75), able to read and write (AOR = 9.76, 95% CI: 3.15, 30.24), ≥4 family size (AOR = 0.53, 95% CI: 0.29, 0.99), intake of flesh meat (AOR=0.19, 95% CI: 0.05, 0.74), and parasitic infections (AOR = 0.26, 95% CI: 0.07, 0.95) were more likely to develop anemia. CONCLUSION Anemia is a moderate public health problem among diabetic patients. Here, educational status, family size, intake of flesh meat, and intestinal parasite infections were the factors associated with the development of anaemia. So, working on these significant factors by health care providers during routine care is vital to prevent anaemia among diabetic patients.
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Affiliation(s)
- Melaku Tadege Engidaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Correspondence: Melaku Tadege Engidaw Department of Public Health, College of Health Sciences, Debre Tabor University, P.O. Box: 031, Debre Tabor, Ethiopia Email
| | - Mahider Shimelis Feyisa
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Yehualashet AS. Toll-like Receptors as a Potential Drug Target for Diabetes Mellitus and Diabetes-associated Complications. Diabetes Metab Syndr Obes 2020; 13:4763-4777. [PMID: 33311992 PMCID: PMC7724365 DOI: 10.2147/dmso.s274844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/03/2020] [Indexed: 12/15/2022] Open
Abstract
Diabetes mellitus (DM) is a chronic endocrine disease distinguished by hyperglycemia due to disturbance in carbohydrate or lipid metabolism or insulin function. To date, diabetes, and its complications, is established as a global cause of morbidity and mortality. The intended aim during the management of diabetes is to maintain blood glucose close to normal because the majority of patients have poor control of their elevated blood glucose and are highly prone to severe macrovascular and microvascular complications. To decrease the burden of the disease and its complications, scientists from various disciplines are working intensively to identify novel and promising drug targets for diabetes and its complications. Increased and ongoing investigations on mechanisms relating to diabetes and associated complications could potentially consider inflammatory cascades as a promising component of the strategy in the prevention and control of diabetes and its complications. The potential of targeting mediators of inflammation like toll-like receptors (TLRs) are part of current investigation by the scientific community. Hence, the aim of the present review is to discuss the role of TLRs as a potential drug target for diabetes and diabetes associated complications.
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Affiliation(s)
- Awgichew Shewasinad Yehualashet
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
- Correspondence: Awgichew Shewasinad Yehualashet Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Berhan University, Debre Berhan, EthiopiaTel +251935450290 Email
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Fekadu G, Bula K, Bayisa G, Turi E, Tolossa T, Kasaye HK. Challenges And Factors Associated With Poor Glycemic Control Among Type 2 Diabetes Mellitus Patients At Nekemte Referral Hospital, Western Ethiopia. J Multidiscip Healthc 2019; 12:963-974. [PMID: 31819470 PMCID: PMC6878927 DOI: 10.2147/jmdh.s232691] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/24/2019] [Indexed: 12/14/2022] Open
Abstract
Background Diabetes is increasing at an alarming rate throughout the world, and ~80% of diabetics live in developing countries. Similar to the rest of sub-Saharan African countries, Ethiopia is experiencing a significant burden of diabetes, with increased prevalence, complications, and mortality, as well as life threatening disabilities. Reasons for poor glycemic control among type 2 diabetes patients are complex and multivariable. Hence, this study aimed to identify challenges and factors associated with poor glycemic control among type 2 diabetes patients. Method A hospital-based cross-sectional study was conducted among type 2 diabetic patients attending the diabetic clinic of Nekemte Referral Hospital (NRH) from February 1 to April 30, 2018. Fasting blood glucose levels of the last three clinic visits were obtained and the mean fasting blood glucose measurement was used to determine the level of glycemic control. Analysis included both descriptive and inferential statistics with SPSS version 20.0. Predictor variable P<0.05 was considered statistically significant. Results Out of the total 228 included type 2 diabetes mellitus (DM) patients, 51.8% were males. The mean age of patients was 43±12.4 years and 154 (67.5%) were found to not be following their general dietary program correctly. Nearly one third, 73 (32%), of patients never attended diabetic education and 52 (22.8%) of the patients had greater than 10 years’ duration on treatment. The majority, 148 (64.9%), of patients had poor blood glucose control. Age 40–60 years (AOR=2.01, 95% CI=0.04–0.06, P=0.044), being illiterate (AOR=3.12, 95% CI=1.52–8.50, P=0.001), having informal education only (AOR=2.28, 95% CI=2.14–32.60, P=0.024), longer duration of diabetes treatment (>10 years) (AOR=3.94, 95% CI=1.51–27.83, P=0.012), inadequate physical exercise (AOR=3.19, 95% CI=1.05–19.84, P=0.019), and smoking (AOR=4.51, 95% CI=0.00–0.50, P=0.022) were independent predictors of poor glycemic control on multivariable logistic regression analysis. Conclusion Nearly two-thirds of patients had poorly controlled diabetes. Age, exercise, level of education, duration of the treatment, and smoking were significantly associated with poor glycemic control. Health facilities should provide continuous education, and barriers of glycemic control should be explored with further research.
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Affiliation(s)
- Ginenus Fekadu
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Kejela Bula
- School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Getu Bayisa
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ebisa Turi
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Habtamu Kebebe Kasaye
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Tenaye L, Mengiste B, Baraki N, Mulu E. Diabetes Mellitus among Adult Tuberculosis Patients Attending Tuberculosis Clinics in Eastern Ethiopia. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7640836. [PMID: 31781641 PMCID: PMC6875401 DOI: 10.1155/2019/7640836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/17/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Developing countries are suffering from the previously existing infectious diseases and alarmingly growing burden of noncommunicable diseases like diabetes mellitus. There is increased speculation that diabetes mellitus might attribute to high infectious diseases burden, such as tuberculosis. The global importance of diabetes mellitus as a tuberculosis-risk factor is still not a well-established fact. Thus, we conducted this study to determine the prevalence of diabetes mellitus and its associated factors among adult tuberculosis patients attending tuberculosis clinics. METHODOLOGY We conducted a cross-sectional survey, from March 10 to April 15, 2017, among 421 tuberculosis patients receiving tuberculosis treatment in health facilities of Dire Dawa City Administration Council, Eastern Ethiopia. Study participants were selected using systematic random technique, and data were collected using a structured questionnaire. Fasting blood sugar and anthropometric measurements were carried out for all participants. A logistic regression analysis was performed to identify factors associated with diabetes mellitus. RESULT The prevalence of diabetes mellitus in this study was 13.5%. Age 26-40 (AOR = 6, 95% CI: (1.28, 27.5)), age ≥41(AOR = 9, 95% CI: (1.9, 44.4)), and family history of diabetes (AOR = 3.14, 95% CI: (1.23, 8.02)) were found to have a significant association with diabetes mellitus. CONCLUSION This study found that the magnitude of diabetes mellitus among tuberculosis patients was higher than the national estimated prevalence of diabetes mellitus in Ethiopia. This study suggests the need for screening each tuberculosis patient for diabetes.
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Affiliation(s)
- Lucy Tenaye
- College of Health Sciences and Medicine, Haramaya University, Harar, Ethiopia
| | - Bizatu Mengiste
- College of Health Sciences and Medicine, Haramaya University, Harar, Ethiopia
| | - Negga Baraki
- College of Health Sciences and Medicine, Haramaya University, Harar, Ethiopia
| | - Ermiyas Mulu
- College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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Bishu KG, Jenkins C, Yebyo HG, Atsbha M, Wubayehu T, Gebregziabher M. Diabetes in Ethiopia: A systematic review of prevalence, risk factors, complications, and cost. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.obmed.2019.100132] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Zekewos A, Loha E, Egeno T, Wubshet K, Merga Z. Prevalence of Diabetes Mellitus and Associated Factors in Southern Ethiopia: A Community Based Study. Ethiop J Health Sci 2019; 28:451-460. [PMID: 30607058 PMCID: PMC6308729 DOI: 10.4314/ejhs.v28i4.11] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Like in all populations of the world, recently, diabetes became serious health problem in Ethiopian population, as indicated by few community- and institution-based studies. As high as 6.5% diabetes prevalence was reported in Addis Ababa while 5.1% in urban setting and 2.1% in rural setting of Northwest Ethiopia have been reported. This study aimed to provide additional data on the magnitude of diabetes and associated risk factors. The study aimed to determine the prevalence of diabetes in Bona District and identify contributing risk factors. Methods and Materials A cross-sectional community based survey for diabetes and associated factors was done from February-June, 2016 on a total of 2670 participants in the age range of 15-110 years. Participants were recruited to the study by using a two-stage simple random sampling technique. Data were collected by using structured questionnaire from consented participants. Data were entered, checked for quality and analyzed using SPSS for Windows version 20.0. Since the outcome variable was ordered categorical, we used ordinal regression model to identify associated factors. There was no multicollinearity among the independent variables included in the model. All the independent variables with p<0.25 during bivariate analysis were included in the multivariate model. The level of significance was set at P value < 0.05. Results The overall prevalence of diabetes (1.9%) from our survey was so high in rural setting that prevention and control mechanisms should be designed. The risk factors include advanced age (β=1.04(0.57-1.50)), systolic hypertension (β=0.59(0.01-1.18)), high waist circumference (β=0.86(0.34-1.39)) and postsecondary education (β=0.87(0.03-1.71)).
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Affiliation(s)
- Alemayehu Zekewos
- Bioghemistry Unit, College of Medicine and Health Science, Hawassa University, Ethiopia
| | - Eskindir Loha
- College of Medicine and Health Science, Hawassa University, Ethiopia
| | - Tariku Egeno
- Internal Medicine, College of Medicine and Health Science, Hawassa University, Ethiopia
| | - Kindie Wubshet
- Internal Medicine, College of Medicine and Health Science, Hawassa University, Ethiopia
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Demoz GT, Gebremariam A, Yifter H, Alebachew M, Niriayo YL, Gebreslassie G, Woldu G, Bahrey D, Shibeshi W. Predictors of poor glycemic control among patients with type 2 diabetes on follow-up care at a tertiary healthcare setting in Ethiopia. BMC Res Notes 2019; 12:207. [PMID: 30947749 PMCID: PMC6449968 DOI: 10.1186/s13104-019-4248-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/01/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Contemporary clinical guidelines endorsed that glycemic control is the ultimate goal in the management patients with diabetes. The aim of this study was to assess the prevalence of glycemic control and to identify predictors of poor glycemic control in patients with type 2 diabetes (T2D). A cross-sectional study was conducted among systematically selected 357 diabetic patients. Data were collected through direct patients' interviews and medical chart review. Binary logistic regression analyses were performed and analyzed using SPSS version 22.0. RESULTS Participants' mean age was (± SD) 56.1 ± 11.6 years. Nearly four in five (77.9%) of the participants had comorbidities, mainly of hypertension, and 60.2% had diabetic complications, mainly diabetes neuropathy. Poor glycemic control was found in 68.3% of the participants with a mean (± SD) FBG of 174.1 ± 48.9 mg/dL. Being female gender, having greater body mass index and low medication adherence was significantly associated with poor glycemic control. In conclusion, the overall aspects of glycemic control level of patients were far from the standards. Being female, greater body mass index and poor medication adherence were predictors of poor glycemic control. In response to this finding, an aggressive intervention that targets in improving the glycemic control is required.
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Affiliation(s)
| | | | - Helen Yifter
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | | | - Degena Bahrey
- School of Nursing, Aksum University, Aksum, Ethiopia
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Bedaso A, Oltaye Z, Geja E, Ayalew M. Diabetic ketoacidosis among adult patients with diabetes mellitus admitted to emergency unit of Hawassa university comprehensive specialized hospital. BMC Res Notes 2019; 12:137. [PMID: 30871605 PMCID: PMC6419397 DOI: 10.1186/s13104-019-4186-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/11/2019] [Indexed: 01/27/2023] Open
Abstract
Objective This study was aimed to assess the prevalence and associated factors of diabetic ketoacidosis among adult patients admitted in emergency department of Hawassa university comprehensive specialized hospital. An institution based retrospective cross-sectional study design was conducted among 195 adult patients aged 16 years and above with known or previously unknown diabetes cases presented in the emergency unit. Result In our study from the total 195 patients medical record reviewed 78 (40%) developed DKA. Out of the total reviewed medical record 55 (28.2%) and 23 (11.8%) were with type-1 and type 2 diabetes mellitus respectively. From acute complication of diabetes, diabetic ketoacidosis was a leading cause 78 (77%) followed by hypoglycemia 14 (14%) and hyperosmolar hyperglycemic state (9%). During multiple logistic regression analysis age and hypertension were found to have significant association with diabetic ketoacidosis. Electronic supplementary material The online version of this article (10.1186/s13104-019-4186-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Asres Bedaso
- College of Medicine and Health Sciences, School of Nursing, Hawassa University, P.O.BOX: 1560, Hawassa, SNNPR, Ethiopia.
| | - Zewdie Oltaye
- College of Medicine and Health Sciences, School of Nursing, Hawassa University, P.O.BOX: 1560, Hawassa, SNNPR, Ethiopia
| | - Ephrem Geja
- College of Medicine and Health Sciences, School of Nursing, Hawassa University, P.O.BOX: 1560, Hawassa, SNNPR, Ethiopia
| | - Mohammed Ayalew
- College of Medicine and Health Sciences, School of Nursing, Hawassa University, P.O.BOX: 1560, Hawassa, SNNPR, Ethiopia
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Ayelign B, Genetu M, Wondmagegn T, Adane G, Negash M, Berhane N. TNF-α (-308) Gene Polymorphism and Type 2 Diabetes Mellitus in Ethiopian Diabetes Patients. Diabetes Metab Syndr Obes 2019; 12:2453-2459. [PMID: 31819571 PMCID: PMC6886533 DOI: 10.2147/dmso.s229987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/21/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a metabolic disorder resulting from insulin insufficiency or function. Predisposing factors for T2DM are mainly genetic and environmental. Genetic polymorphism of cytokines like tumor necrosis factor-alpha (TNF-α) is suggestive of interference with insulin-sensitive glucose uptake and induces insulin resistance that ultimately could lead to T2DM. In this study, we assessed the effect of TNF-α (-308) G/A gene polymorphism and its association with the development of T2DM in an Ethiopian population. METHODS An institutional-based cross-sectional study was conducted on study subjects with T2DM and non-diabetic healthy controls. DNA was extracted and genotyping was carried out by using amplification refractory mutation system polymerase chain reaction. A genetic-polymorphism on TNF-α (-308) G/A with T2DM was evaluated by logistic regression and Student's t-test. A P-value <0.05 was considered as statistically significant. RESULTS In the present study, we observed a significant association between T2DM and TNF-α (-308) gene polymorphism's GG genotype [χ2 test P = 0.005, OR (95% CI) =2.667 (1.309-5.45d8)]. In contrast, no statistically significant differences were observed in the frequencies of genotypes AA and AG (χ2 test P=0.132 and 0.067, respectively). Moreover, T2DM individuals had higher concentrations of lipid profiles for those carrying the TNF-α (-308) GG genotype as compared to the control group. CONCLUSION TNF-α (-308) genetic polymorphism may be implicated in the genetic susceptibility for, as well as the development of T2DM and lipid metabolism in the Ethiopian population. Therefore, a large-scale study and early screening of TNF-α (-308) genetic polymorphism may help in early management and control of diabetes and related outcomes.
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Affiliation(s)
- Birhanu Ayelign
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopa
- Correspondence: Birhanu Ayelign Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopa Email
| | - Meaza Genetu
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopa
| | - Tadelo Wondmagegn
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopa
| | - Gashaw Adane
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopa
| | - Markos Negash
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopa
| | - Nega Berhane
- Institute of Biotechnology, College of Computational and Natural Science, University of Gondar, Gondar, Ethiopa
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Gurmu Y, Gela D, Aga F. Factors associated with self-care practice among adult diabetes patients in West Shoa Zone, Oromia Regional State, Ethiopia. BMC Health Serv Res 2018; 18:732. [PMID: 30249246 PMCID: PMC6154910 DOI: 10.1186/s12913-018-3448-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 08/06/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diabetes, a rising global health problem, requires continuous self-care practice to prevent acute and chronic complications. However, studies show that few diabetes patients practice the recommended self-care in Ethiopia. The aim of this study was to assess factors associated with self-care practice among adult diabetes patients in public hospitals of West Shoa Zone, Oromia Regional State, Ethiopia. METHODS In this cross-sectional study, 257 diabetes patients (mean age 42.9 ± 14.6 years, 54.1% male) completed the survey in Afan Oromo and Amharic languages. A questionnaire consisting standardized tools was used to collect the data. Descriptive and logistic regression analyses were conducted using SPSS version 21. RESULTS The mean score for diabetes self-care was 39.8 ± 9.5 and 45.5% of the participants scored below the mean. Multiple logistic regression analysis revealed that having higher diabetes knowledge (AOR = 2.42, 95% CI = 1.22, 4.80), self-efficacy (AOR = 3.30, 95% CI = 1.64, 6.62), social support (AOR = 2.86, 95% CI = 1.37, 5.96), secondary school education (AOR = 6.0, 95% CI = 1.90, 18.85), and longer duration of diabetes (AOR = 5.55, 95% CI = 2.29, 13.44) were important predictors of good diabetes self-care practice. CONCLUSION The diabetes education programs should use strategies that enhance patients' diabetes knowledge, self-efficacy, and social support. Patients with recent diabetes diagnosis need special attention as they may relatively lack knowledge and skills in self-care. Further studies are needed to elucidate pathways through which diabetes knowledge, self-efficacy, social support, and health literacy affect diabetes self-care.
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Affiliation(s)
- Yonas Gurmu
- Department of Nursing, College of Medicine & Health Sciences, Ambo University, P. O. Box: 19, Ambo, Ethiopia
| | - Debela Gela
- Department of Nursing & Midwifery, School of Allied Health Sciences, College of Health Science, Addis Ababa University, P.O. Box: 4412, Addis Ababa, Ethiopia
| | - Fekadu Aga
- Department of Nursing & Midwifery, School of Allied Health Sciences, College of Health Science, Addis Ababa University, P.O. Box: 9083, Addis Ababa, Ethiopia
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Fiseha T, Alemayehu E, Kassahun W, Adamu A, Gebreweld A. Factors associated with glycemic control among diabetic adult out-patients in Northeast Ethiopia. BMC Res Notes 2018; 11:316. [PMID: 29776447 PMCID: PMC5960206 DOI: 10.1186/s13104-018-3423-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/10/2018] [Indexed: 12/16/2022] Open
Abstract
Objective The aim of this study was to determine the status of glycemic control and identify factors associated with poor glycemic control among diabetic out-patients. Results A hospital based cross-sectional study was conducted among randomly selected 384 (126 type 1 and 258 type 2) diabetic adults attending a hospital in Northeast Ethiopia from January 1 to April 30, 2017. Of the total participants, 70.8% had poor status of glycemic control (defined as mean fasting blood glucose level above 130 mg/dl). In the multivariate analysis, rural residence (AOR = 2.61, 95% CI 1.37–4.96), low educational level (AOR = 7.10, 95% CI 2.94–17.17) and longer duration of diabetes (AOR = 2.20, 95% CI 1.18–4.08) were significantly associated with increased odds of poor glycemic control. Moreover, merchants (AOR = 3.39, 95% CI 1.16–9.96) were significantly more likely to have poor glycemic control compared to government employee. Diabetic patients receiving oral anti-diabetics (AOR = 5.12, 95% CI 2.10–12.52) or insulin (AOR = 3.26, 95% CI 1.26–8.48) were more likely to be poorly controlled. These results highlight the needed for appropriate management of patients focusing on associated factors identified for poor glycemic control to maintain good glycemic control and improve adverse outcomes of the disease in this study setting.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Ermiyas Alemayehu
- Department of Medical Laboratory Science, College of Health & Medical Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wongelawit Kassahun
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Aderaw Adamu
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Angesom Gebreweld
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Yimer EM, Zewdie KA, Hishe HZ. Netrin as a Novel Biomarker and Its Therapeutic Implications in Diabetes Mellitus and Diabetes-Associated Complications. J Diabetes Res 2018; 2018:8250521. [PMID: 30320139 PMCID: PMC6167572 DOI: 10.1155/2018/8250521] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/14/2018] [Accepted: 09/04/2018] [Indexed: 12/16/2022] Open
Abstract
Diabetes is a multifactorial metabolic syndrome and is one of the shared long-lasting illnesses globally. It is linked to long-term microvascular and macrovascular complications that contribute to disability, compromised quality of life, and reduction in lifespan, which eventually leads to death. This disease is not only incurring significant economic burden but also adversely affects the patients, caregivers, communities, and the society at large. The interruption of diabetes progress and its complications is a primary focus of scientific communities. In spite of various diagnostic modalities for diabetes, there is a limited marker to investigate the risk and progress of its complications. Netrin has recently received more attention as a biomarker of diabetes and a broader range of long-term complication. Therefore, the impetus of this review is to exhaustively discuss the role of Netrin as a potential biomarker and its therapeutic implication in diabetes and diverse sets of microvascular and macrovascular complications of diabetes. It also discourses the possible mechanisms of Netrin for the said pharmacological effect for a better understanding of the development and progression of diabetes and its complications in relation to this protein. It enables protective measures to be applied at the subclinical stage and the responses to preventive or therapeutic measures to be scrutinized. Besides, it might also facilitate the appraisal of novel therapeutic options for diabetes and various complications through modifying the endogenous Netrin and provide surrogate endpoints for intervention.
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Affiliation(s)
- Ebrahim M. Yimer
- Department of Pharmacology and Toxicology, College of Health Sciences, Mekelle University, Ethiopia
| | - Kaleab Alemayehu Zewdie
- Department of Pharmacology and Toxicology, College of Health Sciences, Mekelle University, Ethiopia
| | - Hailemichael Zeru Hishe
- Department of Pharmacology and Toxicology, College of Health Sciences, Mekelle University, Ethiopia
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Habte BM, Kebede T, Fenta TG, Boon H. Barriers and facilitators to adherence to anti-diabetic medications: Ethiopian patients' perspectives. Afr J Prim Health Care Fam Med 2017; 9:e1-e9. [PMID: 29113442 PMCID: PMC5675919 DOI: 10.4102/phcfm.v9i1.1411] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 08/02/2017] [Accepted: 08/10/2017] [Indexed: 12/20/2022] Open
Abstract
Background Little is known about the experiences of Ethiopian patients with type 2 diabetes related to adherence to their anti-diabetic medications. This may limit attempts to develop and implement patient-centred approaches that consider Ethiopian contexts. Objectives To conduct an exploratory study with a focus on identifying barriers and facilitators to anti-diabetic medications adherence in Ethiopian patients with type 2 diabetes. Methods Qualitative methods were used to conduct semi-structured interviews with 39 purposively selected participants attending clinic in three public hospitals in central Ethiopia. Open coding was used to analyse the data to identify key themes. Results A number of factors were identified as barriers and facilitators to participants’ adherence to their anti-diabetic medications. The most common factors were perceptions related to their illness including symptoms, consequences and curability; perceptions of medications including safety concerns, convenience and their necessity; religious healing practices and beliefs; perceptions about and experiences with their healthcare providers and the healthcare system including the availability of medications and diabetes education; and finally perceived self-efficacy and social support. Conclusions The findings of this study provide guidance to strengthen diabetes education programmes so that they reflect local patient contexts focusing among other things on the illness itself and the anti-diabetic medications.
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Affiliation(s)
- Bruck M Habte
- School of Pharmacy, College of Health Sciences, Addis Ababa University.
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May J. Keystones affecting sub-Saharan Africa's prospects for achieving food security through balanced diets. Food Res Int 2017; 104:4-13. [PMID: 29433782 DOI: 10.1016/j.foodres.2017.06.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/23/2017] [Accepted: 06/25/2017] [Indexed: 11/28/2022]
Abstract
Socio-economic dynamics determine the transition from diets characterized by the risk of famine, to those characterized by the risk of diet-related non-communicable disease (DR-NCD). This transition is of particular concern in Sub-Saharan Africa (SSA) in which key socio-economic interactions that influence diet include economic growth and rapid urbanization; inequality and a growing middle class; and obesogenic food environments and an increasing prevalence of DR-NCD. In each case, countries in SSA are among those experiencing the most rapid change in the world. These interactions, styled as 'keystones', affect the functioning of other components of the food system and the diets that result. Data from the wealthiest quartile of countries in SSA suggest that these keystones may be increasing the risk of DR-NCD, widening inequalities in health outcomes due to unbalanced diets. To address this, new consumer and government capabilities that address these keystones are required. Food sensitive urban planning, supporting food literacy and fiscal management of consumption are examples.
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Affiliation(s)
- Julian May
- School of Government Building, University of the Western Cape, Robert Sobukwe Road, Bellville, Western Cape, South Africa.
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Scherrer SA, Chu Yu Chee J, Vu N, Lu P, Ishack M, Archambault PS. Experts' opinion on manual wheelchair adjustments for adults with diabetes. Disabil Rehabil Assist Technol 2017. [PMID: 28633615 DOI: 10.1080/17483107.2017.1283543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Diabetes is a global health concern that can lead to mobility limitations necessitating a wheelchair. However, there are currently no guidelines for wheelchair adjustments tailored to the diabetic population. PURPOSE To describe relevant manual wheelchair adjustments for adults with diabetes, and to explore how these adjustments apply to populations living in less-resourced countries. METHODS Semi-structured interviews were conducted with 13 wheelchair experts from five different countries working with adult with diabetes. Interviews were analyzed using the constant comparison method. RESULTS The most frequently mentioned wheelchair adjustments were related to neuropathies, skin integrity, decreased strength and amputations. Air cushions were preferred for managing seat sores. Lightweight wheelchairs could be advantageous for people with decreased strength and endurance. In less-resourced settings, wheelchair adjustment decisions prioritized durability and low maintenance. DISCUSSION The recommendation of lightweight wheelchairs for adults with diabetes may be limited by the lack of adjustment possibilities compared to regular weight wheelchairs. In less-resourced settings, prioritizing durability and low maintenance may limit prevention and management of conditions associated to diabetes. CONCLUSION This study represents a first step towards the development of guidelines for manual wheelchair adjustments specifically tailored to adults with diabetes, in a global health context. Implications of rehabilitation When prescribing manual wheelchairs to persons with diabetes, expert clinicians agree that skin integrity, neuropathies and decreased strength are their primary concerns. Compromises are often necessary when adjusting a wheelchair for a person with diabetes, due to the complexity of their symptoms: same modification can be indicated for one symptom but contraindicated for another. Diabetes prevalence is high in less-resourced settings. There is a need for increased availability of affordable wheelchair equipment that is durable, reliable and adapted to persons with diabetes.
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Affiliation(s)
- Sophie-Anne Scherrer
- a School of Physical and Occupational Therapy, McGill University , Montreal , Quebec , Canada
| | - Joelle Chu Yu Chee
- a School of Physical and Occupational Therapy, McGill University , Montreal , Quebec , Canada
| | - Nhi Vu
- a School of Physical and Occupational Therapy, McGill University , Montreal , Quebec , Canada
| | - Patrice Lu
- a School of Physical and Occupational Therapy, McGill University , Montreal , Quebec , Canada
| | - Michelle Ishack
- b Constance Lethbridge Rehabilitation Centre , Montreal , Quebec , Canada
| | - Philippe S Archambault
- a School of Physical and Occupational Therapy, McGill University , Montreal , Quebec , Canada.,c Interdisciplinary Research Centre in Rehabilitation (CRIR) , Montreal , Quebec , Canada
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Habte BM, Kebede T, Fenta TG, Boon H. Ethiopian patients' perceptions of anti-diabetic medications: implications for diabetes education. J Pharm Policy Pract 2017; 10:14. [PMID: 28405339 PMCID: PMC5385044 DOI: 10.1186/s40545-017-0101-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 03/21/2017] [Indexed: 12/12/2022] Open
Abstract
Background The purpose of this study is to explore medication-related perceptions of adult patients with type 2 diabetes attending treatment in public hospitals of urban centers in central Ethiopia. Methods Qualitative in-depth interviews were held with 39 participants selected to represent a range of treatment experiences and socio-demographic characteristics who were attending their treatment in 3 public hospitals. Interviews continued until key themes were saturated. The interview and analysis was guided by Horne’s necessity-concerns model. Results The findings revealed medication-related perceptions some of which were similar to those of Western patients and others that seem to be informed by local socio-cultural contexts. Participants’ perceptions focused on the necessity of and concerns about their anti-diabetic medications, giving more emphasis to the latter. Concerns were expressed about both perceived and experienced adverse effects, inconveniences in handling the medications and access. It was evident that some of these concerns were exaggerated but could nevertheless negatively affect adherence to prescribed medications including resistance to initiate insulin with potential impact on health outcomes. Conclusions Understanding patients’ perceptions of their medications is critical for developing a diabetes education program that considers local contexts and beliefs to enhance adherence. Education programs should consider patients’ concerns about medication adverse effects and reasons for use so as to improve their adherence and health outcomes.
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Affiliation(s)
- Bruck Messele Habte
- School of Pharmacy, College of Health Sciences (CHS), Addis Ababa University (AAU), Addis Ababa, Ethiopia
| | - Tedla Kebede
- School of Medicine, CHS, AAU, Addis Ababa, Ethiopia
| | - Teferi Gedif Fenta
- School of Pharmacy, College of Health Sciences (CHS), Addis Ababa University (AAU), Addis Ababa, Ethiopia
| | - Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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Habte BM, Kebede T, Fenta TG, Boon H. Explanatory models of adult patients with type 2 diabetes mellitus from urban centers of central Ethiopia. BMC Res Notes 2016; 9:441. [PMID: 27623807 PMCID: PMC5022171 DOI: 10.1186/s13104-016-2248-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes, which is increasing as a public health problem in the low resource settings of Africa has been associated with the high prevalence of micro-vascular complications and increasing levels of macro-vascular complications. There is evidence from the developed world that understanding patient perceptions of chronic illness is important to design effective strategies for helping patients manage these conditions. This study utilized Kleinman's model to explore the illness perceptions of type 2 diabetes patients attending treatment in Addis Ababa and Butajira (Ethiopia) and better understand how they manage their illness. DESIGN Qualitative interviews were conducted to elicit the explanatory models of purposively sampled type 2 diabetes patients attending treatment in three hospitals in central Ethiopia until saturation of key emerging themes was achieved. Analysis of interview transcripts was guided by Kleinman's model. RESULTS A total of 39 participants, 24 from Addis Ababa and the rest from Butajira took part in the study. This study revealed that patients' explanatory models were informed by both the traditional and biomedical models with emotional distress evident in some of the participants. The traditional model seemed to reflect the strong religious and cultural influences for the majority of study participants. The findings also revealed that symptoms played significant roles in how patients viewed their illness including assessment of its severity. Most were uncertain about the cause of their illness, with those expressing certainty citing factors over which they believed they had little or no control. This may have contributed to the perceptions about the use of religious healing and traditional medicines in a complementary or alternative manner to the biomedical regimen which could affect their adherence to recommended regimens and their health outcomes. CONCLUSION This study suggests the need for a strong diabetes care program that is sensitive to patients' experiences of their illness including emotional distress. Individuals providing the diabetes care should consider local and individual contexts and strive to make their approach patient-centered and engage active participation of patients. There appears to be a need for better training of health providers in different areas including health communications and the fundamentals of mental healthcare.
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Affiliation(s)
- Bruck M Habte
- School of Pharmacy, College of Health Sciences (CHS), Addis Ababa University (AAU), P. O. Box 1176, Addis Ababa, Ethiopia.
| | - Tedla Kebede
- School of Medicine, CHS, AAU, P. O. Box 1176, Addis Ababa, Ethiopia
| | - Teferi G Fenta
- School of Pharmacy, College of Health Sciences (CHS), Addis Ababa University (AAU), P. O. Box 1176, Addis Ababa, Ethiopia
| | - Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street (Room 514), Toronto, ON, M5S 3M2, Canada
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Cheneke W, Suleman S, Yemane T, Abebe G. Assessment of glycemic control using glycated hemoglobin among diabetic patients in Jimma University specialized hospital, Ethiopia. BMC Res Notes 2016; 9:96. [PMID: 26879899 PMCID: PMC4754850 DOI: 10.1186/s13104-016-1921-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 02/08/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Globally, diabetes mellitus (DM) has risen dramatically over the past two decades and is expected to keep rising for the next 20 years. If uncontrolled it may lead to complications to the patients that could be prevented or delayed. The disease could be diagnosed and monitored by blood glucose and/or glycated hemoglobin (HbA1) testing. HbA1 can tell long term hyperglycemia of the last 2-3 months period and can predict the risk of diabetic complications; however, the use of glycated hemoglobin test in the country, specifically, in the study area is almost none. Therefore, this study had the aim of assessing glycemic control and describing the risk of complications among diabetic patients using glycated hemoglobin. METHODS Cross-sectional study was conducted in Jimma University specialized hospital among 148 diabetic patients from May to July 2012. After the study was ethically approved, HbA1, random blood sugar (RBS), socio-demographic data and clinical information were collected from every diabetic patients who were willing to participate in the study among patients coming to the hospital for their routine follow up visits. RESULTS Even though all the study participants were on diabetes treatment, majority of them were found to be poor glycemic control. It was found out that the mean HbA1 and RBS level of the participants were 7.6 % and 280 mg/dL (15.5 mmol/L), respectively. Using HbA1,5 9.5 % of the patients had poor glycemic control and these patients were considered to be at higher risk of developing complications. Among all the study subjects with poor glycemic control, 70.8 % were within 15-30 years of age; 62.3 % were females; 60.8 % were urban dwellers; 67.4 % were illiterate; 69.6 % were with BMI less than 18.5 kg/m(2), and 61.4 % were taking injectable drugs. Among 136 patients whose clinical history was reviewed, 52.9 % had one or more documented history of major microvascular complications: visual disturbance accounting for 21.3 %, nephropathy 19.1 % and peripheral neuropathy 13.2 %. Eighty-four had poor glycemic control of which 54.7 % had already documented history of one or more complications but the remaining 45.2 % had no documented history. CONCLUSION Even if all of the diabetic patients were on treatment, the mean HbA1 level as well as RBS level of the study subjects was above the normal range indicating poor glycemic control. More than half of diabetic patients in the hospital had poor glycemic control and were at higher risk of developing diabetic complications or they already developed the complications. Accordingly we recommended tracing the cause of this poor glycemic control for mitigating the problem.
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Affiliation(s)
- Waqtola Cheneke
- Department of Medical Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, P.O. Box 378, Jimma, Ethiopia.
| | - Sultan Suleman
- Department of Pharmacy, College of Health Sciences, Jimma University, P.O. Box 378, Jimma, Ethiopia.
| | - Tilahun Yemane
- Department of Medical Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, P.O. Box 378, Jimma, Ethiopia.
| | - Gemeda Abebe
- Department of Medical Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, P.O. Box 378, Jimma, Ethiopia.
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Desse TA, Eshetie TC, Gudina EK. Predictors and treatment outcome of hyperglycemic emergencies at Jimma University Specialized Hospital, southwest Ethiopia. BMC Res Notes 2015; 8:553. [PMID: 26455633 PMCID: PMC4601134 DOI: 10.1186/s13104-015-1495-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 09/21/2015] [Indexed: 12/11/2022] Open
Abstract
Background Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) commonly known as hyperglycemic emergencies are the two most common life-threatening acute metabolic complications of diabetes. The objective of this study is to assess predictors and treatment outcome of hyperglycemic emergencies (HEs) among diabetic patients admitted to Jimma University Specialized Hospital (JUSH). Methods It is a three year retrospective review of medical records of patients admitted with HEs at JUSH. Patient demographics, admission clinical characteristics, precipitants, insulin used and treatment outcomes were extracted. Statistical analysis was done using student’s t test, Chi square test, and binary logistic regression with level of α set at 0.05. Statistical significance was considered for variables with p < 0.05. Results Complete data was available for 163 out of 421 patients admitted with HEs. The majority (62.6 %) were males. Mean age of patients was 36.6 ± 15.9 years. About 64 % of patients had type 1 diabetes. About 93 % of the participants developed DKA. The most common precipitants of HEs were infections 95 (59 %), non-compliance to medications 52 (32.3 %), and newly diagnosed diabetes 38 (23.6 %). Recurrent hyperglycemia, hypoglycemia and ketonuria occurred in 88 (54 %), 34 (20.9 %) and 31 (20.5 %) patients respectively. Mean amount of insulin used and duration of treatment till resolution of DKA were 136.85 ± 152.41 units and 64.38 ± 76.34 h respectively. The median length of hospital stay was 6 days. Mortality from HEs was 16 (9.8 %). Admission serum creatinine >1.2 mg/dL (P = 0.018), co-morbidity (P < 0.001) and sepsis (P = 0.014) were independent predictors of HEs mortality. Conclusions Infections, non-compliance and new onset diabetes were the most common precipitants of HEs. Length of hospital stay and mortality were high. High use of insulin, recurrent hyperglycemia, hypoglycemia, and ketonuria were common during HEs management. Elevated serum creatinine, sepsis and co-morbidity are independent predictors of HEs mortality.
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Affiliation(s)
- Tigestu Alemu Desse
- Clinical Pharmacy Department, School of Pharmacy, Jimma University, Jimma, Ethiopia.
| | | | - Esayas Kebede Gudina
- Departments of Internal Medicine, School of Medicine, Jimma University, Jimma, Ethiopia.
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Gizaw M, Harries AD, Ade S, Tayler-Smith K, Ali E, Firdu N, Yifter H. Diabetes mellitus in Addis Ababa, Ethiopia: admissions, complications and outcomes in a large referral hospital. Public Health Action 2015; 5:74-8. [PMID: 26400605 DOI: 10.5588/pha.14.0107] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/09/2015] [Indexed: 11/10/2022] Open
Abstract
SETTING The Black Lion Referral Hospital, Addis Ababa, Ethiopia. OBJECTIVE To document indications for admission, complications and outcomes of patients with diabetes mellitus (DM) admitted between 2010 and 2013. DESIGN A descriptive retrospective study using medical files. RESULTS Of 8048 admissions, 523 (6.5%) had DM; of these, 418 medical records were retrieved: 301 (72%) patients had type 2 and 104 (28%) type 1 disease, with male sex (62%) and older age (median age 60 years) being features of type 2 disease. Main admission diagnoses for type 2 disease were diabetic foot ulcer (39%) and cardiovascular disease (21%); for type 1 disease, it was diabetic ketoacidosis (62%). Hypertension, neuropathy, nephropathy, retinopathy and diabetic foot accounted for 85% of the 756 existing complications. Overall in-patient mortality was 21%. Of the 89 deaths, 77 occurred among patients with type 2 disease; the main indications for admission were diabetic foot ulcer/gangrene and cardiovascular disease. CONCLUSION DM, especially type 2 DM, is an important cause of admission to Ethiopia's largest referral hospital. Many patients had already developed disease-related complications at admission, and mortality was high. There is a need to improve awareness about and care for DM in Ethiopia.
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Affiliation(s)
- M Gizaw
- Department of Preventive Medicine, School of Public Health, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - S Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France ; National Tuberculosis Programme, Cotonou, Benin
| | - K Tayler-Smith
- Medical Department, Operational Centre Brussels, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - E Ali
- Medical Department, Operational Centre Brussels, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - N Firdu
- Department of Preventive Medicine, School of Public Health, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - H Yifter
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Pradeepa R, Prabhakaran D, Mohan V. Emerging economies and diabetes and cardiovascular disease. Diabetes Technol Ther 2012; 14 Suppl 1:S59-67. [PMID: 22650226 DOI: 10.1089/dia.2012.0065] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Diabetes and cardiovascular diseases (CVDs) are increasing in epidemic proportions globally, with the most marked increase in emerging economies. Among emerging economies, China and India have the highest numbers of people with diabetes and CVD. Over the last two decades, 80% of CVD and diabetes mortality occurred in low- and middle-income countries, suggesting that these disorders have become a leading threat to public health in most of the developing countries. The burden of CVD and diabetes in the developing countries affects the productive younger age group, and this has serious economic implications. Diabetes shares many characteristics and risk factors with CVD, and thus the risk for CVD also escalates with the increase in prevalence of diabetes. Both genetic and environmental factors play a major role in causation of diabetes and CVD. However, the major drivers of this dual epidemic are demographic changes with increased life expectancy, lifestyle changes due to rapid urbanization, and industrialization. To reduce the burden of diabetes and CVD in the coming decades, emerging economies need to set national goals for early diagnosis, effective management, and primary prevention of these disorders. In order to curb the epidemic of diabetes and CVD, population-based, multisectoral, multidisciplinary, and culturally relevant approaches including various departments of the government as well as non-governmental agencies are required.
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Affiliation(s)
- Rajendra Pradeepa
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, International Diabetes Federation Centre for Education, Gopalapuram, Chennai, India
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