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Seinfeld J, Sobrevilla A, Rosales ML, Ibáñez M, Ruiz D, Penny E, Londoño S. Economic burden of type-2 diabetes in Peru: a cost-of-illness study valuing cost differences associated with the level of glycemic control. Expert Rev Pharmacoecon Outcomes Res 2024; 24:661-669. [PMID: 38584495 DOI: 10.1080/14737167.2024.2333337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES Type 2 diabetes mellitus (T2DM) represents an increasing public health problem in Peru. This study aims to estimate the national economic burden of this disease for the public funder, the social security, and private sector insurers. METHODS Direct healthcare costs were estimated for a cohort of 45-to-75-year-old adults diagnosed with T2DM in 2019, over a 20-year period. Disease progression was modeled using PROSIT Models and literature, including acute and chronic microvascular and macrovascular complications. Three scenarios of glycemic control were considered: current levels of 35.8% of the population controlled (HbA1c < 7%) (S1); 100% controlled (S2) and; 100% uncontrolled (S3). The impact of diabetes prevalence on overall costs was evaluated in sensitivity analysis. RESULTS Total national economic burden was estimated at $15,405,448,731; an annual average per patient of $2,158. Total costs would decrease to $12,853,113,596 (-16.6%) in S2 and increase to $16,828,713,495 (+9.2%) in S3. Treating patients with complications and risk factors could cost 6.5 times more, being stroke the complication with the highest impact. Up to a 67.6% increase in total costs was found when increasing T2DM prevalence. CONCLUSIONS T2DM places a heavy burden on the Peruvian healthcare budget that will be even greater if poor glycemic control is maintained.
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Affiliation(s)
| | | | | | | | - Delia Ruiz
- Videnza Consultores, Videnza, Lima, Perú
| | | | - Sergio Londoño
- Health Economics & Value Assesment, Sanofi, Bogotá, Colombia
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Mhlaba L, Mpanya D, Tsabedze N. HbA1c control in type 2 diabetes mellitus patients with coronary artery disease: a retrospective study in a tertiary hospital in South Africa. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1258792. [PMID: 38028982 PMCID: PMC10645148 DOI: 10.3389/fcdhc.2023.1258792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Background Type 2 diabetes mellitus (T2DM) patients with coronary artery disease (CAD) have an increased risk of recurrent cardiovascular events. These patients require optimal glucose control to prevent the progression of atherosclerotic cardiovascular disease (ASCVD). Contemporary guidelines recommend an HbA1c ≤7% to mitigate this risk. The aim of this study was to evaluate HbA1c control in T2DM patients with angiographically proven ASCVD. Methods We conducted a cross-sectional, retrospective study on consecutive T2DM patients with acute and chronic coronary syndromes managed in a tertiary academic hospital in South Africa. Glycaemic control was assessed by evaluating the glycated haemoglobin (HbA1c) level measured at index presentation with acute and chronic coronary syndromes and during the most recent follow-up visit. Results The study population comprised 262 T2DM patients with a mean age of 61.3 ± 10.4 years. At index presentation, 110 (42.0%) T2DM patients presented with ST-segment elevation myocardial infarction, 69 (26.3%) had non-ST-segment elevation myocardial infarction, 43 (16.4%) had unstable angina, and 40 (15.3%) had stable angina. After a median duration of 16.5 months (IQR: 7-29), 28.7% of the study participants had an HbA1c ≤7%. On multivariable logistic regression analysis, females were less likely to have poor glycaemic control (HbA1c above 7%) [odds ratio (OR): 0.42, 95% confidence interval (CI): 0.19-0.95, p=0.038]. Also, T2DM patients prescribed metformin monotherapy (OR: 0.34, 95% CI: 0.14-0.82, p=0.017) and patients with ST-segment depression on the electrocardiogram (OR: 0.39, 95% CI: 0.16-0.96, p=0.041) were less likely to have poor glycaemic control. Conclusion After a median duration of 16.5 months, only 28.7% of T2DM patients with CAD had an HbA1c ≤7%. This finding underscores the substantial unmet need for optimal diabetes control in this very high-risk group.
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Chary AN, Nandi M, Flood D, Tschida S, Wilcox K, Kurschner S, Garcia P, Rohloff P. Qualitative study of pathways to care among adults with diabetes in rural Guatemala. BMJ Open 2023; 13:e056913. [PMID: 36609334 PMCID: PMC9827254 DOI: 10.1136/bmjopen-2021-056913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The burden of diabetes mellitus is increasing in low-income and middle-income countries (LMICs). Few studies have explored pathways to care among individuals with diabetes in LMICs. This study evaluates care trajectories among adults with diabetes in rural Guatemala. DESIGN A qualitative investigation was conducted as part of a population-based study assessing incidence and risk factors for chronic kidney disease in two rural sites in Guatemala. A random sample of 807 individuals had haemoglobin A1c (HbA1c) screening for diabetes in both sites. Based on results from the first 6 months of the population study, semistructured interviews were performed with 29 adults found to have an HbA1c≥6.5% and who reported a previous diagnosis of diabetes. Interviews explored pathways to and experiences of diabetes care. Detailed interview notes were coded using NVivo and used to construct diagrams depicting each participant's pathway to care and use of distinct healthcare sectors. RESULTS Participants experienced fragmented care across multiple health sectors (97%), including government, private and non-governmental sectors. The majority of participants sought care with multiple providers for diabetes (90%), at times simultaneously and at times sequentially, and did not have longitudinal continuity of care with a single provider. Many participants experienced financial burden from out-of-pocket costs associated with diabetes care (66%) despite availability of free government sector care. Participants perceived government diabetes care as low-quality due to resource limitations and poor communication with providers, leading some to seek care in other health sectors. CONCLUSIONS This study highlights the fragmented, discontinuous nature of diabetes care in Guatemala across public, private and non-governmental health sectors. Strategies to improve diabetes care access in Guatemala and other LMICs should be multisectorial and occur through strengthened government primary care and innovative private and non-governmental organisation care models.
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Affiliation(s)
- Anita Nandkumar Chary
- Medicine & Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | - Meghna Nandi
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Family Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - David Flood
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott Tschida
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | - Katharine Wilcox
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Family Medicine, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Sophie Kurschner
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Pablo Garcia
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Peter Rohloff
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Boake M, Mash R. Diabetes in the Western Cape, South Africa: A secondary analysis of the diabetes cascade database 2015 - 2020. Prim Care Diabetes 2022; 16:555-561. [PMID: 35672227 DOI: 10.1016/j.pcd.2022.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
AIM The aim was to describe the demographics, comorbidities and outcomes of care for patients with diabetes at primary care facilities in the Western Cape, South Africa, between 2015 and 2020. METHODS This was a secondary analysis of the diabetes cascade database. RESULTS The database included 116726 patients with mean age of 61.4 years and 63.8 % were female. The mean age at death was 66.0 years. Co-morbidities included hypertension (69.5 %), mental health disorders (16.2 %), HIV (6.4 %) and previous TB (8.2 %). Sixty-three percent had at least one previous hospital admission and 20.2 % of all admissions were attributed to cardiovascular diseases. Coronavirus was the third highest reason for admission over a 10-year period. Up to 70% were not receiving an annual HbA1c test. The mean value for the last HBA1c taken was 9.0%. Three-quarters (75.5 %) of patients had poor glycaemic control (HbA1c >7 %) and a third (33.7 %) were very poorly controlled (HbA1c>10 %). Glycaemic control was significantly different between urban sub-districts and rural areas. Renal disease was prevalent in 25.5 %. CONCLUSION Diabetes was poorly controlled with high morbidity and mortality. There was poor compliance with guidelines for HbA1c and eGFR measurement. At least 7% of diabetic patients were being admitted for complications annually.
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Affiliation(s)
- Megan Boake
- Division of Family Medicine and Primary Care, Stellenbosch University, Box241, Cape Town 8000, South Africa
| | - Robert Mash
- Division of Family Medicine and Primary Care, Stellenbosch University, Box241, Cape Town 8000, South Africa.
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Relation between Glycemic Control and Cardiac Autonomic Neuropathy in Patients with Diabetes Mellitus type 2. Curr Probl Cardiol 2022; 48:101135. [DOI: 10.1016/j.cpcardiol.2022.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/23/2022]
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Koesoemadinata RC, McAllister SM, Soetedjo NNM, Santoso P, Ruslami R, Damayanti H, Rahmadika N, Alisjahbana B, van Crevel R, Hill PC. Educational counselling of patients with combined TB and diabetes mellitus: a randomised trial. Public Health Action 2021; 11:202-208. [PMID: 34956849 DOI: 10.5588/pha.21.0064] [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: 07/08/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Newly diagnosed pulmonary TB with diabetes mellitus (DM) comorbidity attending clinics in Bandung City, Indonesia. OBJECTIVE To describe the effect of educational counselling on patients' knowledge about TB (transmission, treatment, risk factors) and DM (symptoms, treatment, complications, healthy lifestyle), adherence to medication, and to assess characteristics associated with knowledge. DESIGN All patients received counselling and were then randomised to either structured education on TB-DM, combined with clinical monitoring and medication adjustment (intervention arm), or routine care (control arm). Knowledge and adherence were assessed using a questionnaire. RESULTS Baseline and 6-month questionnaires were available for 108 of 150 patients randomised (60/76 in the intervention arm and 48/74 in the control arm). Patients knew less about DM than about TB. There was no significant difference in the proportion with knowledge improvement at 6 months, both for TB (difference of differences 14%; P = 0.20) or for DM (10%; P = 0.39) between arms. Intervention arm patients were more likely to adhere to taking DM medication, with fewer patients reporting ever missing oral DM drugs than those in the control arm (23% vs. 48%; P = 0.03). Higher education level was associated with good knowledge of both TB and DM. CONCLUSIONS Structured education did not clearly improve patients' knowledge. It was associated with better adherence to DM medication, but this could not be attributed to education alone. More efforts are needed to improve patients' knowledge, especially regarding DM.
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Affiliation(s)
- R C Koesoemadinata
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - S M McAllister
- Department of Preventive and Social Medicine, Centre for International Health, University of Otago Medical School, Dunedin, New Zealand
| | - N N M Soetedjo
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - P Santoso
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R Ruslami
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - H Damayanti
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - N Rahmadika
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - B Alisjahbana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R van Crevel
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P C Hill
- Department of Preventive and Social Medicine, Centre for International Health, University of Otago Medical School, Dunedin, New Zealand
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Mohamed SF, Uthman OA, Mutua MK, Asiki G, Abba MS, Gill P. Prevalence of uncontrolled hypertension in people with comorbidities in sub-Saharan Africa: a systematic review and meta-analysis. BMJ Open 2021; 11:e045880. [PMID: 34903530 PMCID: PMC8671923 DOI: 10.1136/bmjopen-2020-045880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The burden of uncontrolled hypertension in sub-Saharan Africa (SSA) is high and hypertension is known to coexist with other chronic diseases such as kidney disease, diabetes among others. This is the first systematic review and meta-analysis to determine the burden of uncontrolled hypertension among patients with comorbidities in SSA. METHODS A comprehensive search was conducted on MEDLINE, Excerpta Medica Database (Embase) and Web of Science to identify all relevant articles published between 1 January 2000 and 17 June 2021. We included studies that reported on the prevalence of uncontrolled hypertension among people in SSA who report taking antihypertensive treatment and have another chronic condition. A random-effects meta-analysis was performed to obtain the pooled estimate of the prevalence of uncontrolled hypertension among patients with comorbid conditions while on treatment across studies in SSA. RESULTS In all, 20 articles were included for meta-analyses. Eleven articles were among diabetic patients, five articles were among patients with HIV, two were among patients with stroke while chronic kidney disease and atrial fibrillation had one article each. The pooled prevalence of uncontrolled hypertension among patients with comorbidities was 78.6% (95% CI 71.1% to 85.3%); I² 95.9%, varying from 73.1% in patients with stroke to 100.0% in patients with atrial fibrillation. Subgroup analysis showed differences in uncontrolled hypertension prevalence by various study-level characteristics CONCLUSION: This study suggests a high burden of uncontrolled hypertension in people with comorbidities in SSA. Strategies to improve the control of hypertension among people with comorbidities are needed. PROSPERO REGISTRATION NUMBER CRD42019108218.
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Affiliation(s)
- Shukri F Mohamed
- Academic Unit of Primary Care (AUPC) and the NIHR Global Health Research Unit on Improving Health in Slums, University of Warwick, Coventry, UK
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
- Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Olalekan A Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), University of Warwick, Coventry, West Midlands, UK
| | - Martin K Mutua
- Data, Measurement and Evaluation unit, African Population and Health Rsearch Center, Nairobi, Kenya
| | - G Asiki
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
| | - Mustapha S Abba
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Paramjit Gill
- Academic Unit of Primary Care (AUPC) and the NIHR Global Health Research Unit on Improving Health in Slums, University of Warwick, Coventry, UK
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Widayanti AW, Sigalingging KK, Dewi FP, Widyakusuma NN. Issues Affecting Medication-Taking Behavior of People with Type 2 Diabetes in Indonesia: A Qualitative Study. Patient Prefer Adherence 2021; 15:989-998. [PMID: 34040353 PMCID: PMC8139640 DOI: 10.2147/ppa.s301501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE It has been widely acknowledged that non-adherence to medication among people with type 2 diabetes is a significant problem worldwide. Studies have suggested that non-adherence to medication may be caused by the complexity of issues surrounding medication use which further created burdens related to medication. However, studies on this topic in the Indonesian context were still limited. This study aimed to understand the experiences of people with type 2 diabetes in medication-taking and explore any practical issues that potentially affect their behavior when taking medication. METHODS Qualitative phenomenological study with semi-structured interviews was applied. The participants were purposefully recruited and selected from some primary healthcare facilities in Yogyakarta Province. The eligibility criteria included: diagnosed with type 2 diabetes by healthcare professionals for at least six months and were able to comprehend information. Information about the study was explained, and written informed consent was collected. The interviews were recorded, transcribed verbatim, and analyzed with a deductive qualitative content analysis method. RESULTS Fifty-one people with type 2 diabetes were involved in this study. Most of the participants were between 40 and 59 years old, and many of them were female and housewives. The thematic analysis found some practical issues that affected people's behavior in taking type 2 diabetes medication. These included individual's mealtime, characteristics of the medications, accessibility of healthcare services, experiences of side effects and social activities. CONCLUSION The practical issues identified in this study can be resolved by improving the role of healthcare providers in managing people with diabetes. Future research needs to be conducted to evaluate the effectiveness of interventions developed based on understanding of the practical factors identified.
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Affiliation(s)
- Anna Wahyuni Widayanti
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Furi Patriana Dewi
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Niken Nur Widyakusuma
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Ruslami R, Koesoemadinata RC, Soetedjo NNM, Imaculata S, Gunawan Y, Permana H, Santoso P, Alisjahbana B, McAllister SM, Grint D, Critchley JA, Hill PC, van Crevel R. The effect of a structured clinical algorithm on glycemic control in patients with combined tuberculosis and diabetes in Indonesia: A randomized trial. Diabetes Res Clin Pract 2021; 173:108701. [PMID: 33609618 DOI: 10.1016/j.diabres.2021.108701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 10/05/2020] [Accepted: 02/04/2021] [Indexed: 11/20/2022]
Abstract
AIMS Diabetes mellitus (DM) is associated with worse tuberculosis (TB) treatment outcomes, especially among those with poor glycemic control. We examined whether a structured clinical algorithm could improve glycemic control in TB patients with DM. METHODS In an open label randomized trial, TB-DM patients were randomized to scheduled counselling, glucose monitoring, and adjustment of medication using a structured clinical algorithm (intervention arm) or routine DM management (control arm), with glycated hemoglobin (HbA1c) at month 6 as the primary end point. RESULTS We randomized 150 pulmonary TB-DM patients (92% culture positive, 51.3% male, mean age 53 years). Baseline mean HbA1c was 11.0% in the intervention arm (n = 76) and 11.6% in the control arm (n = 74). At 6 months, HbA1c had decreased more in the intervention arm compared with the control arm (a difference of 1.82% HbA1c, 95% CI 0.82-2.83, p < 0.001). Five patients were hospitalized in the intervention arm and seven in the control arm. There was more hypoglycemia (35.0% vs 11.8%; p = 0.002) in the intervention arm. Two deaths occurred in the intervention arm, one due to cardiorespiratory failure and one because of suspected septic shock and multiorgan failure. CONCLUSION Regular monitoring and algorithmic adjustment of DM treatment led to improved glycemic control.
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Affiliation(s)
- Rovina Ruslami
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Raspati C Koesoemadinata
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Nanny N M Soetedjo
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran / Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Sofia Imaculata
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Yuanita Gunawan
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Hikmat Permana
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran / Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Prayudi Santoso
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran / Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Bachti Alisjahbana
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran / Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Susan M McAllister
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin, New Zealand
| | - Daniel Grint
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England, UK
| | - Julia A Critchley
- Population Health Research Institute, St George's University of London, London, England, UK
| | - Philip C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin, New Zealand
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Centre for Infectious Disease (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
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Cock IE, Ndlovu N, Van Vuuren SF. The use of South African botanical species for the control of blood sugar. JOURNAL OF ETHNOPHARMACOLOGY 2021; 264:113234. [PMID: 32768640 DOI: 10.1016/j.jep.2020.113234] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/07/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Diabetes mellitus (DM) is one of the most prevalent diseases globally and is of considerable concern to global health. Approximately 425 million people are estimated to have DM globally and this is predicted to increase to >642 million by 2040. Whilst the prevalence of DM in South Africa is slightly lower than the global average, it is expected to rise rapidly in future years as more South Africans adopt a high calorie "westernised" diet. Traditional medicines offer an alternative for the development of new medicines to treat DM and the usage of South African plants is relatively well documented. AIM OF THE STUDY To critically review the literature on the anti-diabetic properties of South African plants and to document plant species used for the treatment of DM. Thereafter, a thorough examination of the related research will highlight where research is lacking in the field. MATERIALS AND METHODS A review of published ethnobotanical books, reviews and primary scientific studies was undertaken to identify plants used to treat DM in traditional South African healing systems and to identify gaps in the published research. The study was non-biased, without taxonomic preference and included both native and introduced species. To be included, species must be recorded in the pharmacopeia of at least one South African ethnic group for the treatment of DM. RESULTS One hundred and thirty-seven species are recorded as therapies for DM, with leaves and roots most commonly used. The activity of only 43 of these species have been verified by rigorous testing, and relatively few studies have examined the mechanism of action. CONCLUSION Despite relatively extensive ethnobotanical records and a diverse flora, the anti-diabetic properties of South African medicinal plants is relatively poorly explored. The efficacy of most plants used traditionally to treat DM are yet to be verified and few mechanistic studies are available. Further research is required in this field.
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Affiliation(s)
- I E Cock
- School of Environment and Science, Nathan Campus, Griffith University, 170 Kessels Rd, Nathan, Queensland, 4111, Australia; Environmental Futures Research Institute, Nathan Campus, Griffith University, 170 Kessels Rd, Nathan, Queensland, 4111, Australia
| | - N Ndlovu
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Gauteng, 2193, South Africa
| | - S F Van Vuuren
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Gauteng, 2193, South Africa.
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van Crevel R, Critchley JA. The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice. Trop Med Infect Dis 2021; 6:tropicalmed6010008. [PMID: 33435609 PMCID: PMC7838867 DOI: 10.3390/tropicalmed6010008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetes Mellitus increases the risk of developing Tuberculosis (TB) disease by about three times; it also doubles the risk of death during TB treatment and other poor TB treatment outcomes. Diabetes may increase the risk of latent infection with Mycobacterium tuberculosis (LTBI), but the magnitude of this effect is less clear. Whilst this syndemic has received considerable attention, most of the published research has focussed on screening for undiagnosed diabetes in TB patients or observational follow-up of TB treatment outcomes by diabetes status. There are thus substantial research and policy gaps, particularly with regard to prevention of TB disease in people with diabetes and management of patients with TB-diabetes, both during TB treatment and after successful completion of TB treatment, when they likely remain at high risk of TB recurrence, mortality from TB and cardiovascular disease. Potential strategies to prevent development of TB disease might include targeted vaccination programmes, screening for LTBI and preventive therapy among diabetes patients or, perhaps ideally, improved diabetes management and prevention. The cost-effectiveness of each of these, and in particular how each strategy might compare with targeted TB prevention among other population groups at higher risk of developing TB disease, is also unknown. Despite research gaps, clinicians urgently need practical management advice and more research evidence on the choice and dose of different anti-diabetes medication and effective medical therapies to reduce cardiovascular risks (statins, anti-hypertensives and aspirin). Substantial health system strengthening and integration may be needed to prevent these at risk patients being lost to care at the end of TB treatment.
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Affiliation(s)
- Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Correspondence:
| | - Julia A. Critchley
- Population Health Research Institute, St George’s, University of London, London SW17 ORE, UK;
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Ugarte-Gil C, Alisjahbana B, Ronacher K, Riza AL, Koesoemadinata RC, Malherbe ST, Cioboata R, Llontop JC, Kleynhans L, Lopez S, Santoso P, Marius C, Villaizan K, Ruslami R, Walzl G, Panduru NM, Dockrell HM, Hill PC, Mc Allister S, Pearson F, Moore DAJ, Critchley JA, van Crevel R. Diabetes Mellitus Among Pulmonary Tuberculosis Patients From 4 Tuberculosis-endemic Countries: The TANDEM Study. Clin Infect Dis 2021; 70:780-788. [PMID: 30958536 DOI: 10.1093/cid/ciz284] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/03/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) increases active tuberculosis (TB) risk and worsens TB outcomes, jeopardizing TB control especially in TB-endemic countries with rising DM prevalence rates. We assessed DM status and clinical correlates in TB patients across settings in Indonesia, Peru, Romania, and South Africa. METHODS Age-adjusted DM prevalence was estimated using laboratory glycated hemoglobin (HbA1c) or fasting plasma glucose in TB patients. Detailed and standardized sociodemographic, anthropometric, and clinical measurements were made. Characteristics of TB patients with or without DM were compared using multilevel mixed-effect regression models with robust standard errors. RESULTS Of 2185 TB patients (median age 36.6 years, 61.2% male, 3.8% human immunodeficiency virus-infected), 12.5% (267/2128) had DM, one third of whom were newly diagnosed. Age-standardized DM prevalence ranged from 10.9% (South Africa) to 19.7% (Indonesia). Median HbA1c in TB-DM patients ranged from 7.4% (Romania) to 11.3% (Indonesia). Compared to those without DM, TB-DM patients were older and had a higher body mass index (BMI) (P value < .05). Compared to those with newly diagnosed DM, TB patients with diagnosed DM had higher BMI and HbA1c, less severe TB, and more frequent comorbidities, DM complications, and hypertension (P value < .05). CONCLUSIONS We show that DM prevalence and clinical characteristics of TB-DM vary across settings. Diabetes is primarily known but untreated, hyperglycemia is often severe, and many patients with TB-DM have significant cardiovascular disease risk and severe TB. This underlines the need to improve strategies for better clinical management of combined TB and DM.
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Affiliation(s)
- Cesar Ugarte-Gil
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,TB Centre, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Bachti Alisjahbana
- Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Indonesia.,Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Katharina Ronacher
- South African Department of Science & Technology and the National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.,Translational Research Institute, Mater Research Institute-University of Queensland, Brisbane, Australia
| | - Anca Lelia Riza
- Department of Internal Medicine and Radboud Center of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Craiova, Romania.,Regional Centre for Human Genetics-Dolj, Emergency Clinical County Hospital, Craiova, Romania
| | - Raspati C Koesoemadinata
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Stephanus T Malherbe
- South African Department of Science & Technology and the National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - Ramona Cioboata
- Hospital for Infectious Diseases and Pneumology "Victor Babeș," Craiova, Romania
| | | | - Leanie Kleynhans
- South African Department of Science & Technology and the National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - Sonia Lopez
- Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Prayudi Santoso
- Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Indonesia.,Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Ciontea Marius
- Pneumology Hospital Tudor Vladimirescu, Dobrita, jud. Gorj, Bucharest, Romania
| | - Katerine Villaizan
- Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Rovina Ruslami
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Gerhard Walzl
- South African Department of Science & Technology and the National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - Nicolae Mircea Panduru
- 2nd Clinical Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Hazel M Dockrell
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Philip C Hill
- Centre for International Health, University of Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Susan Mc Allister
- Centre for International Health, University of Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Fiona Pearson
- Population Health Research Institute, St Georges, University of London, United Kingdom
| | - David A J Moore
- TB Centre, London School of Hygiene and Tropical Medicine, United Kingdom.,Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Julia A Critchley
- Population Health Research Institute, St Georges, University of London, United Kingdom
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
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Suastika K. The challenges of metabolic disorders in Indonesia: focus on metabolic syndrome, prediabetes, and diabetes. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.com.205108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
[No abstract available]
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Adverse drug reactions to anti-diabetic drugs are commonest in patients whose treatment do not adhere to diabetes management clinical guidelines: cross-sectional study in a tertiary care service in sub-Saharan Africa. Eur J Clin Pharmacol 2020; 76:1601-1605. [PMID: 32607780 DOI: 10.1007/s00228-020-02949-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/26/2020] [Indexed: 01/19/2023]
Abstract
AIMS The study aimed to identify and describe adverse drug reactions and adherence to clinical guidelines in patients receiving treatment for type 2 diabetes mellitus (T2DM) in Cameroon. METHODS The method used was a cross-sectional study at a tertiary diabetes care service in Yaoundé, Cameroon. Adult T2DM patients attending the diabetes clinic were interviewed using a pre-structured data collection form. Adverse drug reactions (ADRs) were self-reported by the patients. Naranjo's algorithm and Hartwig and Siegel's scale were used for assessment of causality and severity of ADRs, respectively. A blinded senior endocrinologist assessed whether treatment pattern of patients was "adherent" or not to local clinical guidelines for the management of diabetes. RESULTS Of a total of 350 patients enrolled into the study 61.1% were on oral hypoglycaemic agents only, 24.9% were on both oral hypoglycaemic agents and insulin, while 13.4% were on insulin alone. Metformin was used by 96.3% of the patients. Ninety patients reported 101 suspected ADRs. The proportion of ADRs among patients with poor adherence to clinical guidelines was higher than ADRs reported among adherent patients (Chi-square test = 7.3273; p = 0.007). Hypoglycaemia was more frequent ADR among non-adherent (25.7% of the suspected ADR) than adherent participants (11.6%). In the participants whose treatment pattern did not adhere to local clinical guidelines, ADRs were definite in 63.9%, probable in 16.6%, doubtful in 13.9% and possible in 5.6% of the cases. ADRs were moderate in 61.1% and severe in 19.4% of cases whose treatment pattern was non-adherent to clinical guidelines. INTERPRETATION Adverse drug reactions may be frequent in type 2 diabetes patients whose treatment pattern does not adhere to local clinical guidelines in Cameroon. Therefore, the promotion of active pharmacovigilance and the design of training activities to promote the appropriate use of medicines at hospital level in Cameroon could help to improve the management of diabetes and reduce the incidence of avoidable ADRs in the future.
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Mansour AA, Alibrahim NTY, Alidrisi HA, Alhamza AH, Almomin AM, Zaboon IA, Kadhim MB, Hussein RN, Nwayyir HA, Mohammed AG, Al-Waeli DKJ, Hussein IH. Prevalence and correlation of glycemic control achievement in patients with type 2 diabetes in Iraq: A retrospective analysis of a tertiary care database over a 9-year period. Diabetes Metab Syndr 2020; 14:265-272. [PMID: 32272433 DOI: 10.1016/j.dsx.2020.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study was designed to assess the achievement of a glycated hemoglobin (HbA1c) target in Iraqi type 2 diabetes mellitus (T2DM) patients via retrospective analysis of a tertiary care database over a 9-year period. METHODS A total of 12,869 patients with T2DM with mean (SEM) age: 51.4(0.1) years, and 54.4% were females registered into Faiha Specialized Diabetes, Endocrine and Metabolism Center(FDEMC) database between August 2008 and July 2017 were included in this retrospective study. Data were recorded for each patient during routine follow-up visits performed at the center every 3-12 months. RESULTS Patients were under oral antidiabetic drugs (OAD; 45.8%) or insulin+ OAD (54.2%) therapy. Hypertension was evident in 42.0% of patients, while dyslipidemia was noted in 70.5%. Glycemic control (HbA1c <7%) was achieved by 13.8% of patients. Multivariate analysis revealed <55 years of age, female gender, >3 years duration of diabetes, HbA1c >10% at the first visit, presence of dyslipidemia, and insulin treatment as significant determinants of an increased risk of poor glycemic control. BMI <25 kg/m2 and presence of hypertension were associated with a decreased risk of poor glycemic control. CONCLUSION Using data from the largest cohort of T2DM patients from Iraq to date, this tertiary care database analysis over a 9-year period indicated poor glycemic control. Younger patient age, female gender, longer disease duration, initially high HbA1c levels, dyslipidemia, insulin treatment, overweight and obesity, and lack of hypertension were associated with an increased risk of poor glycemic control in Iraqi T2DM patients.
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Affiliation(s)
- Abbas Ali Mansour
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq.
| | - Nassar T Y Alibrahim
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Haider A Alidrisi
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Ali H Alhamza
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Ammar M Almomin
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Ibrahim Abbood Zaboon
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Muayad Baheer Kadhim
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Rudha Naser Hussein
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Hussein Ali Nwayyir
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Adel Gassab Mohammed
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Dheyaa K J Al-Waeli
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Ibrahim Hani Hussein
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
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