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Sethi B, Sahay R, Tiwaskar M, Negalur V, Dhediya R, Gaurav K, Rathod R, Kotak B, Dhanaki G, Shah S. Effectiveness of Dapagliflozin as Add-On to Metformin with or without Other Oral Antidiabetic Drugs in Type 2 Diabetes Mellitus: A Multicentre, Retrospective, Real-World Database Study. Drugs Real World Outcomes 2024; 11:81-90. [PMID: 37898577 DOI: 10.1007/s40801-023-00398-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Real-world Indian studies evaluating effectiveness of dapagliflozin as an add-on to other oral antidiabetic drugs (OAD) in patients with type 2 diabetes mellitus (DM) are scarce. METHODS An electronic medical record (EMR)-based, retrospective, multicentre study was conducted to evaluate the effectiveness of dapagliflozin as add-on therapy in adult patients with inadequately controlled DM on metformin with or without other OAD. Baseline characteristics (visit 1: metformin or metformin plus OAD treatment for at least 30 days) and treatment-related outcomes (visit 2: follow-up) considered between 60 and 140 days after adding/switching dapagliflozin [glycated haemoglobin (HbA1c), body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP)] were analysed. RESULTS A total of 3616 patients were screened from 478 centres. Most patients had received dapagliflozin (D) + metformin (M) + at least one other OAD [D + M + OAD, n = 2907 (80.4%), 408 followed-up with HbA1c reported], while 709 patients (19.6%, 138 followed-up with HbA1c reported) received dapagliflozin + metformin (D + M). Treatment with dapagliflozin as an add-on therapy resulted in significant change in HbA1c (-1.1 ± 1.44%; p < 0.05 for HbA1c subgroup ≥ 7.5%; -1.6 ± 1.41%; p < 0.05 for HbA1c subgroup ≥ 8%) at visit 2 compared with visit 1. Significant change in body weight (-1.4 ± 3.31 kg; p < 0.05 for HbA1c subgroup ≥ 7.5%; - 1.5 ± 3.22 kg; p < 0.05 for HbA1c subgroup ≥ 8%) was observed at visit 2. Similarly, a significant change in BMI was noted for the HbA1c subgroup ≥ 7.5% (-1.0 ± 8.38 kg/m2). However, the change in BMI in the HbA1c subgroup ≥ 8% was noted to be -1.4 ± 10.4 kg/m2, which was not statistically significant (p = 0.08). In the overall study population, significant change in the SBP (-4.5 ± 14.9 mmHg; p < 0.05 for HbA1c subgroup ≥ 7.5%; -4.5 ± 15.1 mmHg; p < 0.0001 for HbA1c subgroup ≥ 8%) was observed at visit 2 compared with visit 1. On identical lines, significant change in DBP (-1.5 ± 8.94 mmHg; p < 0.05 for HbA1c subgroup ≥ 7.5%; -1.4 ± 8.91 mmHg; p < 0.05 for HbA1c subgroup ≥ 8%) was noted. CONCLUSIONS Dapagliflozin showed significant improvement in glycemic parameter, BMI and BP when added to metformin, with or without other OADs in a real-world scenario.
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Affiliation(s)
- Bipin Sethi
- Department of Endocrinology, Care Hospitals, Hyderabad, Telangana, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | - Mangesh Tiwaskar
- Department of Diabetology, Shilpa Medical Research Centre, Mumbai, India
| | - Vijay Negalur
- Dr. Negalur's Diabetes and Thyroid Specialty Centre, Gloria Chambers, Thane, India
| | - Rajnish Dhediya
- Department of Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India.
| | - Kumar Gaurav
- Department of Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Rahul Rathod
- Department of Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Bhavesh Kotak
- Department of Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Gauri Dhanaki
- Department of Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Snehal Shah
- Department of Clinical Insights, HealthPlix Technologies, Bengaluru, India
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Romano JGU, Malkin SJP, Hunt B. The Short-Term Cost-Effectiveness of a Fixed-Ratio Combination of Insulin Degludec and Aspart: A Cost of Control Analysis in Australia and India. Value Health Reg Issues 2024; 41:108-113. [PMID: 38320441 DOI: 10.1016/j.vhri.2023.12.007] [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: 07/05/2023] [Revised: 11/10/2023] [Accepted: 12/14/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVES The real-world ARISE study demonstrated initiation of fixed-ratio combination insulin degludec and aspart (IDegAsp) led to improvements in people achieving key glycemic control targets compared with prior therapies in Australia and India. This study evaluated the short-term cost-effectiveness of IDegAsp in these countries, in terms of the cost per patient achieving these targets. METHODS A model was developed to evaluate the cost of control (treatment costs divided by the proportion of patients achieving each target) of IDegAsp versus prior therapies received in ARISE for 2 endpoints: glycated hemoglobin (HbA1c) <7.0%, and HbA1c less than a predefined individual treatment target. Costs, expressed from a healthcare payer perspective, were captured in 2022 Australian dollars (AUD) and 2022 Indian rupees (INR). RESULTS The number of patients needed to treat to bring one to endpoints of HbA1c <7.0% and less than an individualized target with IDegAsp was 51% and 87% lower, respectively, than with prior therapies in Australia, and 52% and 66% lower, respectively, versus prior therapies in India. Cost of control was AUD 2449 higher and AUD 64 863 lower with IDegAsp versus prior therapies for endpoints of HbA1c <7.0% and less than an individualized target, respectively, in Australia and INR 211 142 and INR 537 490 lower with IDegAsp compared with prior therapies in India. CONCLUSIONS IDegAsp was estimated to be cost-effective versus prior therapies when considering an individualized HbA1c target in Australia, and when considering an individualized HbA1c target and HbA1c <7.0% in India.
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Affiliation(s)
| | | | - Barnaby Hunt
- Ossian Health Economics and Communications, Basel, Switzerland
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Sullivan M, O'Connor R, Hannigan A. Determinants of poor glycaemic control and proteinuria in patients with type 2 diabetes: a retrospective analysis of general practice records in Ireland. BMC PRIMARY CARE 2024; 25:22. [PMID: 38200427 PMCID: PMC10777496 DOI: 10.1186/s12875-023-02252-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Analysis of general practice records can address the information gap on the epidemiology of type 2 diabetes (T2DM) in Ireland, informing practice and the development of interventions in primary care. The aim of this study was to identify patients with poor glycaemic control, risk factors for complications and evidence of end organ damage in a large multi-practice study and to profile their characteristics. METHODS Patients with T2DM were identified using disease coding in Health One practice management software in 41 general practices. Patients' demographics and clinical data were extracted. Rates of poor glycaemic control (glycated haemoglobin > 58 mmol/mol) and albumin creatinine ratio > 3 mg/mmol were calculated. A multilevel logistic regression analysis using both patient and practice variables was conducted. RESULTS Data was collected from 3188 patients of whom 29% (95% CI 28 to 31%) had poor glycaemic control, which was associated with younger age, higher BMI and higher total cholesterol. Only 42% of patients (n = 1332) had albumin creatinine ratio measured with 42% (95% CI 40 to 45%) of these having values > 3 mg/mmol. Older age groups, men, those with hypertension, eGFR < 60 ml/min/1.73m2 and poor glycaemic control were most associated with higher values of albumin creatinine ratio. CONCLUSIONS Analysing this large multi-practice dataset gives important information on the prevalence and characteristics of diabetic patients who are most at risk of poor outcomes. It highlights that recording of some data could be improved.
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Affiliation(s)
- Maria Sullivan
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Ailish Hannigan
- School of Medicine, University of Limerick, Limerick, Ireland.
- Health Research Institute, University of Limerick, Limerick, Ireland.
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Behera P, Patro BK, Singh AK, Dora S, Bandhopadhyay D, Saharia GK, Dey A, Behera SM, Subba SH. Effectiveness of peer-led intervention in control of non-communicable diseases in rural areas of Khordha district: study protocol for a cluster randomized controlled trial. Trials 2024; 25:22. [PMID: 38172967 PMCID: PMC10765738 DOI: 10.1186/s13063-023-07824-w] [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: 08/21/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The main contributors to death and disability from chronic illnesses in developing nations are elevated blood pressure (hypertension), blood sugar (diabetes mellitus), and blood cholesterol (dyslipidaemia). Even though there are affordable treatments, the treatment gap for these conditions is still significant. Few pilot studies from industrialized nations discuss the value of peer-led interventions for achieving community-level management of blood pressure and blood sugar. This study aims to evaluate the effectiveness of peer-led intervention compared to standard care in achieving control of selected non-communicable diseases (NCDs) in Indian context at 1 year of intervention among people of 30-60 years with hypertension and/or diabetes mellitus and/or dyslipidaemia. METHODS A cluster-randomized controlled trial will be conducted in villages of two rural blocks of the Khordha district of Odisha from August 2023 to December 2024. A total of 720 eligible participants (360 in the intervention group and 360 in the control group) will be recruited and randomized into two study arms. The participants in the intervention arm will receive a peer-led intervention model for 6 months in addition to standard care. The sessions will be based on the six domains of NCDs - self-care, follow-up care, medication, physical activity, diet, limiting substance use, mental health and co-morbidities. The mean reduction in blood pressure, HbA1C, and blood cholesterol in the intervention arm compared to the standard care arm will be the main outcome. DISCUSSION The increasing burden of NCDs demands for newer strategies for management. Peer-led interventions have proven to be useful at the international level. Incorporating it in India will have remarkable results in controlling NCDs. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI) CTRI/2023/02/050022. Registered on 23 February 2023.
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Affiliation(s)
- Priyamadhaba Behera
- Department Of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - Binod Kumar Patro
- Department Of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Arvind Kumar Singh
- Department Of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Susmita Dora
- Department Of Community Medicine, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, India
| | | | - Gautom Kumar Saharia
- Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anupam Dey
- Department of General Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Surama Manjari Behera
- Department Of Community Medicine, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, India
| | - Sonu H Subba
- Department Of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
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Krishna N S, Sharma S, Lahiri A, Sai M, Kesri S, Pakhare A, Kokane AM, Joshi R, Joshi A. Risk Factors for Unfavorable Glycemic Control Trajectory in Type-2 Diabetes Mellitus: A Community-based Longitudinal Study in Urbanslums of Central India. Curr Diabetes Rev 2024; 20:e270423216246. [PMID: 37102489 DOI: 10.2174/1573399819666230427094530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/30/2023] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is a chronic disease, which requires optimal glycemic control to prevent its ensuing vascular complications. Pathway to optimal glycemic control in T2DM has a complex socio-behavioral construct, especially in vulnerable populations, like slum dwellers, who have reduced health-care access and lower prioritization of health needs. OBJECTIVE The study aimed to map trajectories of glycemic control amongst individuals with T2DM living in urban slums and identify key determinants associated with unfavourable glycaemic trajectory. METHODS This study was a community-based longitudinal study conducted in an urban slum of Bhopal in Central India. Adult patients diagnosed with T2DM and on treatment for more than one year were included. All 326 eligible participants underwent a baseline interview, which captured sociodemographic, personal behavior, medication adherence, morbidity profile, treatment modality, anthropometric and biochemical measurements (HbA1c). Another 6-month follow-up interview was conducted to record anthropometric measurements, HbA1c and treatment modality. Four mixed effect logistic regression models (through theory-driven variable selections) were created with glycemic status as dependent variable and usage of insulin was considered as random effect. RESULTS A total of 231 (70.9%) individuals had unfavorable glycemic control trajectory (UGCT), and only 95 (29.1%) had a favorable trajectory. Individuals with UGCT were more likely to be women, with lower educational status, non-vegetarian food preference, consumed tobacco, had poor drug adherence, and were on insulin. The most parsimonious model identified female gender (2.44,1.33-4.37), tobacco use (3.80,1.92 to 7.54), and non-vegetarian food preference (2.29,1.27 to 4.13) to be associated with UGCT. Individuals with good medication adherence (0.35,0.13 to 0.95) and higher education status (0.37,0.16 to 0.86) were found to be protective in nature. CONCLUSION Unfavorable glycemic control trajectory seems to be an inescapable consequence in vulnerable settings. The identified predictors through this longitudinal study may offer a cue for recognizing a rational response at societal level and adopting strategy formulation thereof.
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Affiliation(s)
- Subba Krishna N
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Shweta Sharma
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Anuja Lahiri
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Madhu Sai
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Shashwat Kesri
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Abhijit Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Arun M Kokane
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Rajnish Joshi
- Department of General Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
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Lever CS, Williman JA, Boucsein A, Watson A, Sampson RS, Sergel-Stringer OT, Keesing C, Chepulis L, Wheeler BJ, de Bock MI, Paul RG. Study protocol: glycaemic outcomes in people with type 2 diabetes initiating continuous glucose monitoring: the 2GO-CGM study. J Diabetes Metab Disord 2023; 22:1779-1792. [PMID: 37969919 PMCID: PMC10638210 DOI: 10.1007/s40200-023-01244-y] [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: 02/20/2023] [Accepted: 05/31/2023] [Indexed: 11/17/2023]
Abstract
Purpose Improving glycaemic control in type 2 diabetes (T2D) is essential to reducing social and health-economic burden of diabetes-related complications. Continuous glucose monitoring (CGM) has been established as beneficial in improving glycaemic control and reducing hypoglycaemia in people with type 1 diabetes, however data in T2D is limited. This study has been designed to assess the effect of initiating real-time CGM (rtCGM) on glycaemic control in a high-risk population of adults with T2D. Secondary objectives are to assess the cost-effectiveness and safety of rtCGM, and the effects of rtCGM on diet/lifestyle and the burden of diabetic complications, including cardiovascular risk. Methods This multicentre randomised controlled trial (RCT) will be conducted at three sites in New Zealand (Waikato, Christchurch and Dunedin). Eighty adults with T2D on insulin with suboptimal glycaemic control (HbA1c > 8.0% or 64 mmol/mol) will be randomised 1:1 to rtCGM or routine care with self-monitoring of blood glucose levels (SMBG) for three months. This intervention phase will be followed by a three-month continuation phase where SMBG group crossover to use rtCGM. Participants will then be invited to join the extension phase with continued use of rtCGM for a further 12 months. During the extension phase, both groups will independently titrate their insulin under the remote supervision of prescribing diabetes nurse specialists following an insulin titration algorithm. The primary outcome of the study is time in target glucose range (3.9-10 mmol/L or 70-180 mg/dL; TIR). Secondary outcomes include CGM metrics as per consensus statement recommendations, and HbA1c. Additional planned analyses include cardiovascular risk profile, incremental cost-effectiveness analyses, dietary patterns, and qualitative analyses. Trial registration number The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621000889853) on 8 July 2021 and the World Health Organisation International Clinical Trial Registry Platform (Universal Trial Number U1111-1264-5822).
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Affiliation(s)
- Claire S. Lever
- Te Huataki Waiora, School of Health, University of Waikato, Hamilton, Aotearoa New Zealand
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
- Aotearoa Diabetes Collective, Hamilton, Waikato New Zealand
| | | | - Alisa Boucsein
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Antony Watson
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Rachael S. Sampson
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
- Aotearoa Diabetes Collective, Hamilton, Waikato New Zealand
| | - Oscar T. Sergel-Stringer
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Celeste Keesing
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
- Pinnacle Midlands Health Network, New Plymouth, New Zealand
| | - Lynne Chepulis
- Te Huataki Waiora, School of Health, University of Waikato, Hamilton, Aotearoa New Zealand
| | - Benjamin J. Wheeler
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Paediatrics, Te Whatu Ora Southern, Dunedin, New Zealand
| | - Martin I. de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Te Whatu Ora Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Ryan G. Paul
- Te Huataki Waiora, School of Health, University of Waikato, Hamilton, Aotearoa New Zealand
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
- Aotearoa Diabetes Collective, Hamilton, Waikato New Zealand
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Pitak P, Tasai S, Kumpat N, Na Songkla P, Fuangchan A, Krass I, Dhippayom T. The prevalence of glycemic control in patients with type 2 diabetes treated with insulin: a systematic review and meta-analysis. Public Health 2023; 225:218-228. [PMID: 37939463 DOI: 10.1016/j.puhe.2023.10.015] [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: 04/06/2023] [Revised: 07/28/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To estimate the overall prevalence of glycemic control among patients with type 2 diabetes (T2D) treated with insulin. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic search was performed in PubMed, EMBASE, Cochrane CENTRAL, and ProQuest Dissertation and Theses from 2000 to January 2022. Cross-sectional studies were included if they were conducted on more than 292 patients with T2D and reported the number of insulin-treated patients who were justified as achieving glycemic control. The Joanna Briggs Institute critical appraisal checklist was used to assess the quality of the included studies. Pooled estimates of the prevalence of glycemic control were calculated and reported with a 95% confidence interval (95% CI) using a random-effects model. All analyses were conducted using RStudio Version 2022.02.0, Build 443 (meta package). RESULTS A total of 42 studies (234,345 patients) met the inclusion criteria and were classified as having a low risk of bias. The overall estimated prevalence of glycemic control to insulin therapy among patients with T2D was 26.02% (95% CI: 23.17, 29.08). A subgroup of 34 studies that set the target HbA1c <7% showed that 23.75% (95% CI: 21.47, 26.18) of patients with T2D treated with insulin were justified as achieving good glycemic control. CONCLUSIONS This study provided summative evidence that glycemic control among patients with T2D treated with insulin was suboptimal and should be appropriately addressed.
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Affiliation(s)
- P Pitak
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Clinical Department, Nan Hospital, Nan, Thailand; The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Science, Naresuan University, Phitsanulok, Thailand
| | - S Tasai
- Inventory Department, Ramathibodi Hospital, Bangkok, Thailand
| | - N Kumpat
- Clinical Department, Wisetchaichan Hospital, Angthong, Thailand
| | - P Na Songkla
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - A Fuangchan
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - I Krass
- School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - T Dhippayom
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Science, Naresuan University, Phitsanulok, Thailand.
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Basu S, Maheshwari V, Malik M, Agarwal P. Diabetes care cascade and their predictors in young and middle-aged population in India: evidence from the National Family Health Survey (2019-21). J Diabetes Metab Disord 2023; 22:1405-1415. [PMID: 37975129 PMCID: PMC10638169 DOI: 10.1007/s40200-023-01263-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/04/2023] [Indexed: 11/19/2023]
Abstract
Purpose Weak care cascade of diabetes from the time of screening, diagnosis, treatment initiation and attainment of optimal glycemic control is a public health challenge particularly in resource limited settings. We aimed to assess the diabetes care cascade in India and its determinants in the 15-49 age group. Methods We conducted a secondary data analysis of the National Family Health Survey (NFHS-5, 2019-2021), a nationally representative cross-sectional survey, including a total of 724,115 women and 101,839 men with mean (SD) age 30.6 (9.9) years. Results The prevalence of self-reported Diabetes Mellitus (DM) in the sample was 2.14% (n = 14,116, 95% CI: 2.06, 2.21) of which 55.13% (n = 6990, 95% CI: 53.37, 56.88) were currently undergoing anti-diabetes therapy. The net prevalence of DM including both old and new cases detected on screening was 2.9%. Poor glycemic control was observed in 52.43% (n = 3506, 95% CI: 50.69, 54.16) of patients with DM on anti-diabetes therapy. Patients from the richest wealth quintile (aOR = 5.17, 95% CI: 1.93, 13.84) had significantly higher odds of accessing private health facilities, while female patients with DM were less likely to be on anti-diabetes therapy. Conclusion The prevalence of self-reported DM in India has increased from 1.7% (NFHS-4, 2015-16) to 2.1% (NFHS-5, 2019-21) while more than half of existing patients continue to remain undiagnosed. Consequently, diabetes care cascade have major lacunae at every stage from screening to diagnosis, initiation of effective treatment, and achievement of safe blood glucose levels. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01263-9.
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Affiliation(s)
- Saurav Basu
- Indian Institute of Public Health – Delhi, Public Health Foundation of India, Plot No 47, Institutional Area, Sector 44, Gurugram, 122002 Haryana India
| | - Vansh Maheshwari
- Indian Institute of Public Health – Delhi, Public Health Foundation of India, Plot No 47, Institutional Area, Sector 44, Gurugram, 122002 Haryana India
| | - Mansi Malik
- Indian Institute of Public Health – Delhi, Public Health Foundation of India, Plot No 47, Institutional Area, Sector 44, Gurugram, 122002 Haryana India
| | - Paras Agarwal
- Max Healthcare, Max Multi Speciality Centre, Panchsheel Park, New Delhi India
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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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Adhikari P, Sriyuktasuth A, Phligbua W. Social determinants of health and glycemic control in persons with type 2 diabetes mellitus attending a tertiary hospital in Nepal: A cross-sectional study. BELITUNG NURSING JOURNAL 2023; 9:489-497. [PMID: 37901380 PMCID: PMC10600700 DOI: 10.33546/bnj.2753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/03/2023] [Accepted: 09/05/2023] [Indexed: 10/31/2023] Open
Abstract
Background Diabetes mellitus (DM) is an emerging global public health challenge worldwide, including Nepal. Social determinants of health (SDOH) play a major role in glycemic control among persons with type 2 DM (T2DM). However, little is known about the association between SDOH and glycemic control among individuals with T2DM in Nepal. Objective This study aimed to identify the level of glycemic control and SDOH associated with glycemic control among Nepalese with T2DM. Methods This cross-sectional study was conducted at a tertiary hospital in Kathmandu, Nepal, among 135 Nepalese diagnosed with T2DM who attended follow-up appointments. Convenience sampling and inclusion criteria were utilized for participant selection. Data were collected from April to June 2021 using validated scales. Descriptive statistics, Chi-square test, and binary logistic regression were employed to analyze the data. Results The mean age of the participants in this study was 53.84 (SD = 11.78) years, and the average monthly household income was 567.64 (SD = 362.30) USD. The majority of the participants (77.8%) were literate and had no health insurance coverage (73.3%). Approximately 64.4% of the participants showed suboptimal glycemic control indicated by glycated hemoglobin (HbA1c) ≥7%. The significant determinants of good glycemic control included monthly household income of >850 USD (odds ratio [OR] = 12.20, 95% confident interval [CI] = 1.76-84.61, p = 0.011) and 341-600 USD (OR = 7.64, 95% CI 1.35-42.98, p = 0.021), being literate (OR = 6.37, 95% CI = 1.65-24.49, p = 0.007), having health insurance (OR = 5.82, 95% CI = 1.49-22.65, p = 0.011), sufficient health literacy (OR = 3.46, 95% CI = 1.10-10.83, p = 0.03), and high (OR = 16.17, 95% CI = 2.36-110.67, p = 0.005) and moderate (OR = 7.02, 95% CI = 1.26-39.07, p = 0.026) food availability, respectively. Conclusion The study revealed suboptimal glycemic control in Nepalese with T2DM. This study presents essential social determinants of glycemic control in this population. Therefore, healthcare providers, particularly nurses, should pay more attention to assessing social determinants and provide targeted interventions to patients with T2DM who have low income, are illiterate, have no health insurance coverage, have insufficient health literacy, and have low resources for food availability.
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Affiliation(s)
- Prava Adhikari
- Faculty of Nursing, Mahidol University, Bangkok, Thailand
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Khan M, Agarwal M, Usman K, Mishra P. Prevalence of Self-care Practices among Type 2 Diabetes Mellitus Patients and its Effect on Glycemic Control: A Cross-sectional Study in Secondary and Tertiary Health-care Centers in Lucknow. Int J Appl Basic Med Res 2023; 13:246-254. [PMID: 38229723 PMCID: PMC10789459 DOI: 10.4103/ijabmr.ijabmr_212_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 01/18/2024] Open
Abstract
Background Globally, prevalence of diabetes is 10.5%, and in 2019, approximately 463 million adults were living with diabetes by 2045; this will increase to 700 million (10.9%). India is a diabetic capital of world, prevalence of diabetes in India is 8.3%. Aim This study aimed to assess self-care practices (SCPs) among type 2 diabetes mellitus (T2DM) patients, its predictors, and effect of SCP on glycemic control. Materials and Methods A cross-sectional hospital-based study was conducted among 300 known T2DM patients in the age group of 18-60 years attending noncommunicable diseases clinic at Secondary and Tertiary Care Hospitals of Lucknow, Uttar Pradesh, selected using two-stage purposive sampling method. Data were collected using a predesigned and pretested semi-structured questionnaire. Data were collected from consenting respondents on the sociodemographic profile (about their residence, gender, marital status, type of family, educational status, family income, employment status, etc.). SCP was assessed using Summary of Diabetes Self-Care Activities. Data were analyzed using SPSS. Results Among 300 patients with a mean age 50 ± 8.9 years, the prevalence of good SCPs was 37%. Out of 189 T2DM patients with poor SCPs, 66.4% had uncontrolled blood sugar level (285.4 ± 67 mg/dL). Out of 73 T2DM patients with poor SCPs, 65.7% had uncontrolled glycated hemoglobin level (8.4% ± 2%), and this was statistically significant. Conclusion The practice of self-care was found to be suboptimal among patients with T2DM in the study.
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Affiliation(s)
- Maviya Khan
- Department of Community Medicine and Public Health, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Monika Agarwal
- Department of Community Medicine and Public Health, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Kauser Usman
- Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
- Department of Geriatric Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Dutta A, Bhansali A, Rastogi A. Early and Intensive Glycemic Control for Diabetic Foot Ulcer Healing: A Prospective Observational Nested Cohort Study. INT J LOW EXTR WOUND 2023; 22:578-587. [PMID: 34279130 DOI: 10.1177/15347346211033458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We aimed to assess the effect of glycemic control on diabetic foot ulcer (DFU) healing. A prospective nested cohort study was employed of individuals with poorly controlled diabetes (glycated hemoglobin [HbA1c] >9%) and neuropathic DFU of >2-week duration. All individuals received standard diabetes and ulcer interventions for 12 weeks. Baseline demographic characteristics, ulcer area (automated assessment by wound zoom camera), and biochemical parameters were analyzed. The cohort was stratified into ulcer healed and unhealed groups. Ulcer area and glycemic parameters at 4 and 12 weeks on follow up were compared. Forty-three individuals (47 DFU) with baseline HbA1c 11.6% and ulcer area 9.87 cm2 were enrolled. After 12 weeks, mean HbA1c was 7.2%, 17 ulcers closed (healed group) and 30 ulcers did not close (unhealed group). The median time to ulcer healing was 10 weeks. Individuals in the healed group had lower fasting blood glucose (P = .010), postprandial blood glucose (P = .006), and HbA1c at 4 weeks (P = .001), and 12 weeks (0.018) compared to the unhealed group. Cox-regression analysis that revealed lower baseline ulcer area (P = .013) and HbA1c at 4 weeks (P = .009) significantly predicted DFU healing by 12 weeks. Baseline ulcer area of >10.58 cm2 and HbA1c at 4 weeks of >8.15% predicted delayed DFU healing. In conclusion, early and intensive glycemic control in the first 4 weeks of treatment initiation is associated with greater healing of DFU independent of initial ulcer area.
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Affiliation(s)
- Aditya Dutta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Bhansali
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashu Rastogi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Das AK, Kalra S, Joshi S, Mithal A, Kumar KMP, Unnikrishnan AG, Thacker H, Sethi B, Chowdhury S, Sugumaran A, Satpathy A, Gadekar A, Menon SK, Neogi R, Chodankar D, Trivedi C, Wangnoo SK, Zargar AH, Rais N. The LongitudinAl Nationwide stuDy on Management And Real-world outComes of diabetes in India over 3 years (LANDMARC trial). Endocrinol Diabetes Metab 2023; 6:e422. [PMID: 37392036 PMCID: PMC10495555 DOI: 10.1002/edm2.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION LANDMARC (CTRI/2017/05/008452), a prospective, observational real-world study, evaluated the occurrence of diabetes complications, glycemic control and treatment patterns in people with type 2 diabetes mellitus (T2DM) from pan-India regions over a period of 3 years. METHODS Participants with T2DM (≥25 to ≤60 years old at diagnosis, diabetes duration ≥2 years at the time of enrollment, with/without glycemic control and on ≥2 antidiabetic therapies) were included. The proportion of participants with macrovascular and microvascular complications, glycemic control and time to treatment adaptation over 36 months were assessed. RESULTS Of the 6234 participants enrolled, 5273 completed 3 years follow-up. At the end of 3-years, 205 (3.3%) and 1121 (18.0%) participants reported macrovascular and microvascular complications, respectively. Nonfatal myocardial infarction (40.0%) and neuropathy (82.0%) were the most common complications. At baseline and 3-years, 25.1% (1119/4466) and 36.6% (1356/3700) of participants had HbA1c <7%, respectively. At 3-years, population with macrovascular and microvascular complications had higher proportion of participants with uncontrolled glycemia (78.2% [79/101] and 70.3% [463/659], respectively) than those without complications (61.6% [1839/2985]). Over 3-years, majority (67.7%-73.9%) of the participants were taking only OADs (biguanides [92.2%], sulfonylureas [77.2%] and DPP-IV inhibitors [62.4%]). Addition of insulin was preferred in participants who were only on OADs at baseline, and insulin use gradually increased from 25.5% to 36.7% at the end of 3 years. CONCLUSION These 3-year trends highlight the burden of uncontrolled glycemia and cumulative diabetes-related complications, emphasizing the importance of optimizing diabetes management in India.
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Affiliation(s)
- Ashok K. Das
- Mahatma Gandhi Medical College and Research InstituteSri Balaji VidyapeetPuducherryIndia
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- Apollo Hospital Education and Research FoundationNew DelhiIndia
| | - A. H. Zargar
- Center for Diabetes & Endocrine CareSrinagarIndia
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Tamez-Torres KM, Mongua-Rodríguez N, Ferreyra-Reyes L, Torres-Gonzalez P, Delgado-Sánchez G, Martínez-Hernández M, Bobadilla-del-Valle M, Jasso-Sosa VY, López-Castillo PDS, Ferreira-Guerrero E, Cruz-Hervert LP, Sifuentes-Osornio J, Aguilar-Salinas CA, García-García L, Ponce-de-Leon A. Safety and Tolerability of Six Months of Isoniazid Plus Pyridoxine or Three Months of Rifampicin for Tuberculosis among Subjects with Diabetes Mellitus: A Randomized Trial. Microorganisms 2023; 11:1917. [PMID: 37630477 PMCID: PMC10459081 DOI: 10.3390/microorganisms11081917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
Tuberculosis (TB) associated with diabetes mellitus (DM) is a growing problem, particularly in low- and medium-resource countries. We conducted an open-label, parallel-group, randomized, and controlled trial in a tertiary care center in Mexico City to assess TB preventive treatment (TPT) with isoniazid (INH) or rifampicin (RIF) in people with type 2 DM. Participants were assigned six months of INH 300 mg/day plus pyridoxine 75 mg or three months of RIF 600 mg/day. The primary outcomes were adverse events resulting in permanent treatment cessation and considered possibly or probably related to study drugs. We included 130 subjects, 68 randomized to INH and 62 to RIF. We prematurely halted the study based on recommendations of the Adverse Event Safety Panel. There was no difference between arms in the overall frequency of adverse events. However, the INH group had significantly more permanent treatment interruptions due to grade 2 recurrent or grade 3 or 4 hepatoxicity. In comparison, the RIF arm had more treatment interruptions due to grade 3 or 4 gastrointestinal intolerance. TPT using INH or RIF is not safe enough to be considered a universal indication to patients with type 2 DM and TB infection. These results underline the need to search for alternative TB preventions with better safety profiles for type 2 DM patients.
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Affiliation(s)
- Karla M. Tamez-Torres
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
| | - Norma Mongua-Rodríguez
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Leticia Ferreyra-Reyes
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Pedro Torres-Gonzalez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
| | - Guadalupe Delgado-Sánchez
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Maribel Martínez-Hernández
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Miriam Bobadilla-del-Valle
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico;
| | - Velma Y. Jasso-Sosa
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
| | - Priscila del S. López-Castillo
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
| | - Elizabeth Ferreira-Guerrero
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Luis Pablo Cruz-Hervert
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
- División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Jose Sifuentes-Osornio
- Dirección de Medicina, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico;
| | - Carlos A. Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico;
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Lourdes García-García
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Alfredo Ponce-de-Leon
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
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Rama Chandran S, Tan HC, Chen Q, Lee PC, Gardner DSL, Chin YA, Lam AYR, Teh MM, Bee YM. Telemonitoring With a Connected Glucose Meter Improves Glycemia Among People With Insulin-Treated Type 2 Diabetes. J Diabetes Sci Technol 2023; 17:909-915. [PMID: 36825611 PMCID: PMC10348008 DOI: 10.1177/19322968231157387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Delayed initiation and inadequate titration remain critical challenges to optimizing insulin therapy in type 2 diabetes (T2D). We aimed to study whether hemoglobin A1c (HbA1c) can be lowered in people with insulin-treated T2D using telemonitoring. METHODS This single-center study recruited adults with greater than or equal to six months of diabetes, greater than or equal to three months of insulin therapy, HbA1c ≥8.5% and ≤12.5%, and body mass index (BMI) ≤40 kg/m2. All participants received a connected glucose meter and the accompanying smartphone application. Participants sent weekly blood glucose (BG) diary to their primary endocrinologist via email. Adjustments in insulin doses were communicated to the participants. HbA1c, proportion of BG readings in range (70-180 mg/dL, PIR), below range (<70 mg/dL, PBR) and above range (>180 mg/dL, PAR), and glycemic variability as the coefficient of variation (% CV) were measured at baseline, week 12, and week 24 and compared using repeated-measures analysis of variance (ANOVA) or Friedman's ANOVA. RESULTS We recruited 40 people (55% women). Mean age was 57.9 years, BMI 27.8 kg/m2, and baseline HbA1c 9.8% (83.7 mmol/mol). Mean HbA1c improved by 1.7%, % CV reduced from 32.9% to 30.7%, PIR increased from 58.8% to 67.1% (all P <.01) by week 24, without any change in PBR. This was achieved with a 0.04 U/kg/d median increase in total daily dose of insulin and 0.9 kg weight gain over 24 weeks. CONCLUSION Telemonitoring and titration of insulin using a connected glucose meter resulted in significant improvements in glycemia, characterized by a reduction in HbA1c, increase in PIR, and reduction in glycemic variability without any increase in hypoglycemia.
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Affiliation(s)
| | - Hong Chang Tan
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Qifan Chen
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Singapore
| | | | - Yun Ann Chin
- Department of Endocrinology, Singapore General Hospital, Singapore
| | | | - Ming Ming Teh
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore
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Reddy Peddi D, Pallekonda H, Reddy V. Evaluation of the Prevalence and Risk Factors of Drug-Related Problems in Hypertension and Type 2 Diabetes Mellitus Patients at a Tertiary Care Hospital: A Cross-Sectional Study. Cureus 2023; 15:e42775. [PMID: 37663988 PMCID: PMC10469343 DOI: 10.7759/cureus.42775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/05/2023] Open
Abstract
Background Drug-related problems (DRPs) potentially interfere with the desired treatment goals which may lead to increased healthcare costs, morbidity, and mortality. Despite the negative consequences of DRPs, there is a lack of comprehensive research on their prevalence and risk factors, particularly in chronic diseases such as hypertension and type 2 diabetes mellitus (DM). This study aims to evaluate the prevalence and contributing factors of DRPs among hypertension, type 2 DM, and hypertension with type 2 DM in the outpatient general medicine department. Methodology A hospital-based, prospective, observational study was conducted over three months. DRPs were classified using the Helper-Strand classification. The potential risk factors contributing to DRPs were assessed using binary and multinomial logistic regression methods. A p-value <0.05 was considered statistically significant. Results Among the 236 study participants, DRPs were more prevalent in males, and the mean age of the participants was 51.73 ± 9.47 years. DRPs were found in 76% of the study participants, and the mean number of DRPs per patient was 1.16 ± 0.45. Among the identified DRPs, suboptimal therapeutic goals (33%) were the most frequently observed, followed by ineffective drugs (32%), medication non-adherence (23%), and drug-drug interaction (5%). Therapeutic duplication and overdose were less commonly encountered as DRPs. The presence of comorbidity (adjusted odds ratio (AOR) = 5.77), and smoking (AOR = 21.07) were found to be significant risk factors (p < 0.05) contributing to DRPs. Conclusions DRPs are more prevalent in hypertension, type 2 DM, and hypertension with type 2 DM. Age range (40-60 years), comorbidity, and smoking were found to be associated with a higher incidence of DRPs. The implementation of a multidisciplinary team approach involving clinical pharmacists and physicians can effectively identify the prevalence and determine the associated risk factors of DRPs and subsequently may help employ targeted interventions to mitigate the development of DRPs.
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Affiliation(s)
- Divya Reddy Peddi
- Department of Pharmacy Practice, Arya College of Pharmacy, Osmania University, Sangareddy, IND
| | - Hephzibha Pallekonda
- Department of Pharmacy Practice, Arya College of Pharmacy, Osmania University, Sangareddy, IND
| | - Vikas Reddy
- Department of General Medicine, Government District Hospital, Sangareddy, IND
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Sarraf DP, Gupta PP. A hospital-based assessment of glycemic control and medication adherence in type 2 diabetes mellitus in Eastern Nepal. J Family Med Prim Care 2023; 12:1190-1196. [PMID: 37636174 PMCID: PMC10451609 DOI: 10.4103/jfmpc.jfmpc_90_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/04/2023] [Accepted: 03/02/2023] [Indexed: 08/29/2023] Open
Abstract
Background Poor glycemic control in type 2 diabetes mellitus (T2DM) causes damage to various organs and leads to the development of disabling and life-threatening complications. Objectives To find out the prevalence of glycemic control and medication adherence (MA) and the factors affecting them. Methods A cross-sectional study was conducted among patients with T2DM. The patients were categorized as good glycemic control (HbA1c <7.0%) and poor glycemic control (HbA1c ≥7.0%). MA was categorized as low (score <6), medium (score 6 or 7), and high (score 8). The Statistical Package for Social Science (version 11.5) was used for statistical analysis at a P value less than 0.05. Results Of 129 patients, 65 (50.39%) were females. The mean age was 48.33 ± 12.86 years. The combination of metformin and glimepiride was prescribed to 37 (28.68%) patients. Diabetic knowledge was poor in 84 (65.12%) patients. Glycemic control was good in 108 (83.72%) patients. MA was medium in 72 (55.81%) patients. Patients taking regular fruit, having shorter duration of drug therapy, and having good diabetic knowledge had good glycemic control and were statistically significant (P value < 0.05). Patients having family support, nonalcoholic, taking regular fruit, being involved in daily jogging, having shorter duration of drug therapy, and having good diabetic knowledge had high MA and were statistically significant (P value < 0.05). Conclusion The majority of the diabetic patients had good glycemic control and medium MA. Patients taking regular fruit, being involved in daily jogging, having a shorter duration of drug therapy, and having good diabetic knowledge were identified as factors that affect both glycemic control and MA.
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Affiliation(s)
- Deependra Prasad Sarraf
- Department of Clinical Pharmacology and Therapeutics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Pramendra Prasad Gupta
- Department of General Practice and Emergency Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Verma R, Bhardwaj S, Lathia T, Kalra S, Ranadive R, Tanna S, Padsalge M, Juneja A, Samundra K, Thakkar PB, Jain V, Kini V, Kothari S, Guntur S, Joshi S, Singal A. Personalized glycemic response led digital therapeutics program improves time in range in a period of 14 days. Int J Diabetes Dev Ctries 2023; 43:425-432. [PMID: 35892065 PMCID: PMC9303844 DOI: 10.1007/s13410-022-01111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 06/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Lifestyle modification is an integral aspect for the management of type 2 diabetes (T2D). However, it is difficult to ensure the accuracy of personalized lifestyle advice. The study aims to analyse the real-world effectiveness of personalized glycemic response based Diabefly-Pro digital therapeutics for better glycemic control. Methods Data from continuous glucose monitoring (CGM) of 64 participants with T2D was analysed. All participants were provided with modified lifestyle plan based on their personalized glycemic response. The CGM data was analysed for a period of 7 days, before and after the introduction of modified lifestyle plan. Primary outcome of the study was change in time in range (TIR). Secondary outcomes of the study were change in mean blood glucose, time above range (TAR), time below range (TBR) and glucose management indicator (GMI). Results Significant improvement in glycemic control was observed after the introduction of personalized lifestyle plan. Median reduction in mean blood glucose was from 139.5 (118.3 to 169.3) mg/dL to 122.0 (101.5 to 148.8) mg/dL (p < 0.0001). TIR and GMI improved from 70.50 (50.75 to 83.50) % to 75.00 (58.25 to 89.00) % (p = 0.0001) and 6.64 (6.13 to 7.35) % to 6.23 (5.74 to 6.86) % (p < 0.0001) respectively. TAR reduced significantly from 17.00 (4.25 to 38.0) % to 6.00 (1.25 to 26.0) % (p < 0.0001). No significant increase in TBR was observed (p = 0.198). Conclusion Personalized glycemic response-based Diabefly-Pro digital therapeutics program was effective in achieving better glycemic control in people with T2D.
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Affiliation(s)
- Ritika Verma
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | - Shefali Bhardwaj
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | | | - Sanjay Kalra
- Bharti Research Institute of Diabetes & Endocrinology, Haryana, India
| | - Ruchira Ranadive
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | | | | | | | | | | | - Vandana Jain
- Advanced Eye Hospital and Institute, Navi Mumbai, India
| | - Vishal Kini
- Care n Cure Speciality Clinic, Navi Mumbai, India
| | | | - Saimala Guntur
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | - Shilpa Joshi
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | - Arbinder Singal
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
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Tayabali K, Pothiwalla H, Narayanan S. Epidemiology of COVID-19-Associated Mucormycosis. CURRENT FUNGAL INFECTION REPORTS 2023; 17:1-20. [PMID: 37360859 PMCID: PMC10155162 DOI: 10.1007/s12281-023-00464-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/28/2023]
Abstract
Purpose of the Review To describe the epidemiology and risk factors for Coronavirus disease-19 (COVID-19)-associated mucormycosis (CAM) based on current published literature. Recent Findings COVID-19 is associated with an increased risk of secondary infections. Mucormycosis is an uncommon invasive fungal infection that typically affects people with immunocompromising conditions and uncontrolled diabetes. Treatment of mucormycosis is challenging and is associated with high mortality even with standard care. During the second wave of the COVID 19 pandemic, an abnormally high number of CAM cases were seen particularly in India. Several case series have attempted to describe the risk factors for CAM. Summary A common risk profile identified for CAM includes uncontrolled diabetes and treatment with steroids. COVID-19-induced immune dysregulation as well as some unique pandemic specific risk factors may have played a role.
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Affiliation(s)
- Khadija Tayabali
- Institute of Human Virology, University of Maryland Medical Center, 725 W Lombard St, S211A, Baltimore, MD 21201 USA
| | | | - Shivakumar Narayanan
- Institute of Human Virology, University of Maryland Medical Center, 725 W Lombard St, S211A, Baltimore, MD 21201 USA
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Abegaz TM, Ahmed M, Sherbeny F, Diaby V, Chi H, Ali AA. Application of Machine Learning Algorithms to Predict Uncontrolled Diabetes Using the All of Us Research Program Data. Healthcare (Basel) 2023; 11:1138. [PMID: 37107973 PMCID: PMC10137945 DOI: 10.3390/healthcare11081138] [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: 02/24/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
There is a paucity of predictive models for uncontrolled diabetes mellitus. The present study applied different machine learning algorithms on multiple patient characteristics to predict uncontrolled diabetes. Patients with diabetes above the age of 18 from the All of Us Research Program were included. Random forest, extreme gradient boost, logistic regression, and weighted ensemble model algorithms were employed. Patients who had a record of uncontrolled diabetes based on the international classification of diseases code were identified as cases. A set of features including basic demographic, biomarkers and hematological indices were included in the model. The random forest model demonstrated high performance in predicting uncontrolled diabetes, yielding an accuracy of 0.80 (95% CI: 0.79-0.81) as compared to the extreme gradient boost 0.74 (95% CI: 0.73-0.75), the logistic regression 0.64 (95% CI: 0.63-0.65) and the weighted ensemble model 0.77 (95% CI: 0.76-0.79). The maximum area under the receiver characteristics curve value was 0.77 (random forest model), while the minimum value was 0.7 (logistic regression model). Potassium levels, body weight, aspartate aminotransferase, height, and heart rate were important predictors of uncontrolled diabetes. The random forest model demonstrated a high performance in predicting uncontrolled diabetes. Serum electrolytes and physical measurements were important features in predicting uncontrolled diabetes. Machine learning techniques may be used to predict uncontrolled diabetes by incorporating these clinical characteristics.
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Affiliation(s)
- Tadesse M. Abegaz
- Economic, Social and Administrative Pharmacy (ESAP), College of Pharmacy and Pharmaceutical Sciences, Institute of Public Heath, Florida A&M University, Tallahassee, FL 32307, USA
| | - Muktar Ahmed
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Fatimah Sherbeny
- Economic, Social and Administrative Pharmacy (ESAP), College of Pharmacy and Pharmaceutical Sciences, Institute of Public Heath, Florida A&M University, Tallahassee, FL 32307, USA
| | - Vakaramoko Diaby
- College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Hongmei Chi
- The Department of Computer and Information Sciences, Florid A&M University, Tallahassee, FL 32307, USA
| | - Askal Ayalew Ali
- Economic, Social and Administrative Pharmacy (ESAP), College of Pharmacy and Pharmaceutical Sciences, Institute of Public Heath, Florida A&M University, Tallahassee, FL 32307, USA
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Chawla M, Chawla P, Jethwani P, Shah K, Reddy S. Metformin Sustained-Release and Vildagliptin Fixed-Dose Combination for Optimizing Glycemic Control: A Review with Real-World Case Reports. Clin Pract 2023. [DOI: 10.3390/clinpract13020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
(1) Background: There is a high burden of poor glycemic control in the Indian population with type 2 diabetes mellitus (T2DM). Currently, the use of metformin sustained-release (SR)–vildagliptin fixed-dose combination (FDC) is very low as compared to metformin immediate-release (IR)–vildagliptin FDC which is associated with higher adverse events (AEs). Here, we present real-world effectiveness of metformin SR–vildagliptin FDC treatment in patients with T2DM; (2) Methods: This retrospective analysis was carried out from the medical records of adult T2DM patients visiting a single study center in India (December 2020–February 2021). A total of 10 patients (aged ≥20 years) were treated with vildagliptin 50 mg and metformin SR 500 mg FDC for 15 days. The treatment response was assessed by the percentage of time spent in the target glucose range (TIR at baseline and 15 days after treatment); (3) Results: The glycated hemoglobin (HbA1c) levels at baseline varied between 6.5% to 12%. The glycemic control improved in 70% of patients (mean increase in TIR: 18.9%). Treatment adherence was 100%. No gastrointestinal symptoms or AEs were reported; (4) Conclusions: Early intervention with metformin SR–vildagliptin FDC in patients with T2DM can ensure therapy compliance in terms of superior efficacy along with safety and tolerability. Key summary points: Early initiation of combination therapy helps in early achievement of glycemic goals; Early initiation of metformin and vildagliptin FDC results in significant glycemic control with good tolerability and compliance; Metformin SR–vildagliptin FDC has lower adverse events, compared to metformin IR–vildagliptin FDC; A case series of ten patients with T2DM treated with metformin SR–vildagliptin FDC is presented to assess the real-world effectiveness of this combination.
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Maiti S, Akhtar S, Upadhyay AK, Mohanty SK. Socioeconomic inequality in awareness, treatment and control of diabetes among adults in India: Evidence from National Family Health Survey of India (NFHS), 2019-2021. Sci Rep 2023; 13:2971. [PMID: 36805018 PMCID: PMC9941485 DOI: 10.1038/s41598-023-29978-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Diabetes is a growing epidemic and a major threat to most of the households in India. Yet, there is little evidence on the extent of awareness, treatment, and control (ATC) among adults in the country. In this study, we estimate the prevalence and ATC of diabetes among adults across various sociodemographic groups and states of India. We used data on 2,078,315 individuals aged 15 years and over from the recent fifth round, the most recent one, of the National Family Health Survey (NFHS-5), 2019-2021, that was carried out across all the states of India. Diabetic individuals were identified as those who had random blood glucose above 140 mg/dL or were taking diabetes medication or has doctor-diagnosed diabetes. Diabetic individuals who reported diagnosis were labelled as aware, those who reported taking medication for controlling blood glucose levels were labelled as treated and those whose blood glucose levels were < 140 mg/dL were labelled as controlled. The estimates of prevalence of diabetes, and ATC were age-sex adjusted and disaggregated by household wealth quintile, education, age, sex, urban-rural residence, caste, religion, marital status, household size, and state. Concentration index was used to quantify socioeconomic inequalities and multivariable logistic regression was used to estimate the adjusted differences in those outcomes. We estimated diabetes prevalence to be 16.1% (15.9-16.1%). Among those with diabetes, 27.5% (27.1-27.9%) were aware, 21.5% (21.1-21.7%) were taking treatment and 7% (6.8-7.1%) had their diabetes under control. Across the states of India, the adjusted rates of awareness varied from 14.4% (12.1-16.8%) to 54.4% (40.3-68.4%), of treatment from 9.3% (7.5-11.1%) to 41.2% (39.9-42.6%), and of control from 2.7% (1.6-3.7%) to 11.9% (9.7-14.0%). The age-sex adjusted rates were lower (p < 0.001) among the poorer and less educated individuals as well as among males, residents of rural areas, and those from the socially backward groups Among individuals with diabetes, the richest fifth were respectively 12.4 percentage points (pp) (11.3-13.4; p < 0.001), 10.5 pp (9.7-11.4; p < 0.001), and 2.3 pp (1.6-3.0; p < 0.001) more likely to be aware, getting treated, and having diabetes under control, than the poorest fifth. The concentration indices of ATC were 0.089 (0.085-0.092), 0.083 (0.079-0.085) and 0.017 (0.015-0.018) respectively. Overall, the ATC of diabetes is low in India. It is especially low the poorer and the less educated individuals. Targeted interventions and management can reduce the diabetes burden in India.
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Affiliation(s)
- Suraj Maiti
- International Institute for Population Sciences, Mumbai, India.
| | - Shamrin Akhtar
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, India
| | - Ashish Kumar Upadhyay
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, India
| | - Sanjay K. Mohanty
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, India
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Inbaraj LR, Heylen E, Srinivasan K, Ekstrand ML. Is self-reported adherence a valid measure of glycaemic control among people living with diabetes in rural India? A cross-sectional analysis. Prim Care Diabetes 2022; 16:849-852. [PMID: 36336604 PMCID: PMC9675721 DOI: 10.1016/j.pcd.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Visual analogue scale (VAS) is one of the simplest to measure medication adherence. It has neither been widely used for Non communicable diseases (NCD) nor validated for in the Indian setting. We examined the validity of self-reported medication adherence measures in relation to HbA1C in a rural population with diabetes mellitus (DM). METHODS Participants with DM was administered VAS, Diabetes Self-Management Questionnaire (DMSQ) and assessed for missed pills. Descriptive statistics and logistic regression analysis were done. RESULTS We recruited 1347 participants and 84% of them reported being 100% adherent as per VAS and 83.8% stated that they did not miss any pills. However, 58.2% of participants who reported having 100% adherence had poor glycaemic control, as did 58.1% of those who did not miss any pills. None of the diabetic self-care measures was significantly associated with glycaemic control. CONCLUSION We found a lack of association between self-reported adherence measures and glycaemic control in participants with DM suggesting that self-reported adherence scales may not be valid in this population.
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Affiliation(s)
- Leeberk Raja Inbaraj
- Department of Community Health and Family Medicine, Bangalore Baptist Hospital, Bengaluru, India; Department of Clinical Research, ICMR- National Institute for Research in Tuberculosis, Chennai, India.
| | - Elsa Heylen
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, USA
| | - Krishnamachari Srinivasan
- Department of Psychiatry, St John's Medical College Hospital, Bengaluru, Karnataka, India; Division of Mental Health and Neurosciences, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Maria L Ekstrand
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, USA; Division of Mental Health and Neurosciences, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
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Dey S, Mukherjee A, Pati MK, Kar A, Ramanaik S, Pujar A, Malve V, Mohan HL, Jayanna K, N S. Socio-demographic, behavioural and clinical factors influencing control of diabetes and hypertension in urban Mysore, South India: a mixed-method study conducted in 2018. Arch Public Health 2022; 80:234. [DOI: 10.1186/s13690-022-00996-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Inadequate control of diabetes and hypertension is a major concern in India because of rising mortality and morbidity. Few studies in India have explored factors that influence control of diabetes and hypertension. The current study aimed to improve the understanding of multifactorial influence on the control of diabetes and hypertension among patients in Primary Health Care Settings(PHC) of urban Karnataka.
Methods
We used a mixed-method study design, within a project aiming to improve non-communicable disease (NCD) continuum of care across PHC in Mysore city, India, conducted in 2018. The quantitative study was conducted among 399 patients with diabetes and/or hypertension and a logistic regression model was used to assess the factors responsible for biological control levels of diabetes and hypertension measured through Glycated Haemoglobin(HbA1c) and blood pressure. Further, in-depth interviews(IDI) were conducted among these patients and the counsellors at PHCs to understand the barriers and enablers for better control.
Result
The quantitative assessment found odds of poor control amongst diabetics’ increased with older age, longer duration of disease, additional chronic conditions, and tobacco consumption. For hypertensives, odds of poor control increased with higher body mass index(BMI), alcohol consumption, and belongingness to lower social groups. These findings were elaborated through qualitative assessment which found that the control status was affected by stress as a result of family or financial worries. Stress, poor lifestyle, and poor health-seeking behaviour interplay with other factors like diet and exercise leading to poor control of diabetes and hypertension.
Conclusion
A better understanding of determinants associated with disease control can assist in designing focused patient outreach plans, customized communication strategies, need-based care delivery plans, and specific competency-based capacity-building models for health care workers. Patient-centric care focusing on biological, social and behavioural determinants is pivotal for appropriate management of NCDs at community level in low-middle income countries.
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Prameha purvaroopa as diabetes risk predictor - trends from a retrospective cohort study of newly diagnosed type 2 diabetes patients. J Ayurveda Integr Med 2022; 14:100671. [PMID: 36384710 PMCID: PMC10105213 DOI: 10.1016/j.jaim.2022.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/15/2022] Open
Abstract
STUDY BACKGROUND Increasing prevalence of type 2 diabetes has shifted the focus of world from its management to prevention. Life style modifications programs related to diabetes prevention are found to delay the progress of prediabetes into diabetes. Reaching out to community with diabetes prevention program however is still a challenge to meet. OBJECTIVE Of the study: This study proposed to retrospectively screen the presence of prediabetes symptoms depicted in Ayurveda literature in a newly diagnosed diabetic population and to compare this prevalence with non-diabetic and healthy population. The idea is to put weightage upon prediabetes symptoms as a disease predictor if these are available early in the course of the disease. MATERIAL AND METHODS A questionnaire based upon detailed literature survey of three Ayurveda classics from the subject area of prameha (identical to diabetes) identified 22 features under the class of prediabetes. A questionnaire was developed to find the presence of these features in selected diabetic population retrospectively before the onset of diabetes. 141 newly diagnosed diabetics were selected on the basis of a defined inclusion and exclusion criteria and surveyed for chronological presence of prediabetes features as identified through the literature search and validated through a validation process. This feature prevalence was further compared with non-diabetic and healthy population. RESULTS A significant difference (p < 0.001) was observed in specific symptom occurrence in diabetic population comparing to non-diabetic and healthy control for at least 11 of the selected items. CONCLUSION The study observes that few prediabetes features show their clear retrospective presence in diabetic population comparing to non-diabetic and healthy population. This observation can help formulating a risk calculator for future diabetes on the basis of available pre diabetic features in an individual. A prospective cohort study however would be essential to prove any such realistic relation between prediabetes symptoms and future diabetes development among high risk individuals.
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Saher T, Al-Worafi YM, Iqbal MN, Wahid A, Iqbal Q, Khan A, Atif M, Ahmad N. Doctors' adherence to guidelines recommendations and glycaemic control in diabetic patients in Quetta, Pakistan: Findings from an observational study. Front Med (Lausanne) 2022; 9:978345. [PMID: 36388939 PMCID: PMC9661729 DOI: 10.3389/fmed.2022.978345] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/12/2022] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Poor control of diabetes mellitus (DM) is partly attributed to doctors' poor adherence to guidelines. OBJECTIVE To evaluate doctors' adherence to pharmacotherapeutic recommendations of DM management guidelines and factors associated with guidelines adherence and glycaemic control. METHODS This prospective observational study included 30 doctors who were treating DM patients in their private clinics in Quetta, Pakistan. On visit 1, a total of 600 prescriptions written by 30 enrolled doctors (20 patients per doctor) were noted along with patients' sociodemographic and clinical characteristics. American Diabetes Association guidelines was used as a reference. The prescriptions noted were judged for guidelines compliance. Of 600 enrolled patients, 450 patients (15 patients per doctor) were followed for one more visit and included in final analysis. Glycated hemoglobin (HbA1c) level noted one visit 2 was related with the respective prescription on visit 1. Data were analyzed by SPSS (version 23). A p-value <0.05 was considered statistically significant. RESULTS Patients received a median of two antidiabetic drugs (range: 1-5). A total of 73.1% patients were on polytherapy. Metformin was the most frequently prescribed (88.4%) antidiabetic followed by gliptins (46.2%). A total of 41.6% prescriptions were judged guidelines compliant. In multivariate binary logistic regressions (MVBLR) analysis, chronic kidney disease (CKD) (OR = 0.422) and polytherapy (OR = 0.367) had statistically significant negative associations (p-value <0.05) with guidelines' compliant prescriptions. The group of doctors comprised of specialists and consultants wrote significantly (p-value = 0.004) high number of guidelines adherent prescriptions (mean rank = 20.25) than the group comprised of medical officers (mean rank = 11.34). On visit 2, only 39.5% patients were on goal glycemic levels. In MVBLR analysis, suffering from dyslipidemia (OR = 0.134) and CKD (OR = 0.111), receiving sulfonylurea (OR = 0.156) and guidelines' compliant prescription (OR = 4.195) were significantly (p-value <0 .05) associated with glycemic control. CONCLUSION Although guidelines compliant prescriptions produced better glycemic control, but doctors' adherence to guidelines and glycemic control were poor. Polytherapy and CKD emerged as risk factors for guidelines divergent prescriptions. Dyslipidemia, CKD and reception of sulfonylureas had negative association with glycemic control.
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Affiliation(s)
- Tabassum Saher
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Yaser Mohammed Al-Worafi
- Department of Clinical Sciences, College of Pharmacy, University of Science and Technology of Fujairah, Fujairah, United Arab Emirates
| | | | - Abdul Wahid
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Qaiser Iqbal
- Department of Pharmaceutics, Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Asad Khan
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
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Rajput R, Ghosh S, Banerjee S, Bansal B, Chawla M, Ahluwalia AI, Lathia T, Das AK. First-in-Class Oral Semaglutide: Overcoming Barriers of Incretinisation in the Indian Context. Indian J Endocrinol Metab 2022; 26:417-427. [PMID: 36618518 PMCID: PMC9815186 DOI: 10.4103/ijem.ijem_217_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/19/2022] Open
Abstract
Despite the availability of multiple therapeutic options and strategies, patients with type 2 diabetes mellitus (T2DM) the world over have inadequate glycaemic control and India is no exception. Patients with T2DM in India have benefitted from glucagon-like peptide-1 analogues similar to that of patients from other parts of the world. However, subcutaneous treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is limited by their injectable mode of administration. The present review highlights barriers to incretinisation with GLP-1RAs and the role of first-in-class oral semaglutide in the Indian context and provides guidance to physicians on its initiation and uses.
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Affiliation(s)
- Rajesh Rajput
- Department of Endocrinology, PGIMS, Rohtak, Haryana, India
| | - Sujoy Ghosh
- Department of Endocrinology, IPGME&R, Kolkata, West Bengal, India
| | - Samar Banerjee
- Department of Medicine, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Beena Bansal
- Consultant, Department of Endocrinologist, Door-To-Care, An Endocrine and Diabetes Clinic, Gurugram, Haryana, India
| | - Manoj Chawla
- MBBS, Diabetologist, FRSSDI, FRCP (Edin), Director and Consultant Diabetologist, Lina Diabetes Care Centre, Mumbai, Maharashtra, India
| | - Abhay I. Ahluwalia
- Senior Consultant, Department of Endocrinologist Manipal Hospital, Gurgaon, Haryana, India
| | - Tejal Lathia
- Consultant, Department of Endocrinologist, Fortis, Apollo and Cloud Nine Hospitals, Navi Mumbai, Maharashtra, India
| | - Ashok K. Das
- Consultant, Department of Endocrinologist, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
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Khanal MK, Bhandari P, Dhungana RR, Gurung Y, Rawal LB, Pandey G, Bhandari M, Devkota S, de Courten M, de Courten B. Poor glycemic control, cardiovascular disease risk factors and their clustering among patients with type 2 diabetes mellitus: A cross-sectional study from Nepal. PLoS One 2022; 17:e0271888. [PMID: 35877664 PMCID: PMC9312399 DOI: 10.1371/journal.pone.0271888] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/01/2022] [Indexed: 02/06/2023] Open
Abstract
Background Cardiovascular disease (CVD) is the most common complication of diabetes mellitus (DM). To prevent morbidity and mortality among patients with type 2 diabetes mellitus (T2DM), optimization of glycemic status and minimizing CVD risk factors is essential. As Nepal has limited data on these CVD risk parameters, we assessed the prevalence of poor glycemic control, CVD risk factors, and their clustering among patients with T2DM. Methods Using a cross-sectional study design, we collected data of 366 patients with T2DM. We applied a multistage cluster sampling technique and used the WHO STEPS tools. Binary logistic and Poisson regression was applied to calculate odds and prevalence ratio of clustering of risk factors, considering P< 0.05 statistically significant. Results The mean age of participants was 54.5±10.7 years and 208 (57%) were male. The prevalence of poor glycemic control was 66.4% (95% C.I: 61.5–71.2). The prevalence of smoking, alcohol users, inadequate fruit and vegetables intake and physical inactivity were 18% (95% C.I:14 to 21.9), 14.8% (95% C.I:11.1 to 18.4), 98.1% (95% C.I: 96.7–99.4), and 9.8% (95% C.I:6.7–12.8), respectively. Overall, 47.3% (95% C.I: 42.1–52.4) were overweight and obese, 59% (95% C.I: 52.9–63) were hypertensive, and 68% (95% C.I: 63.2–72.7) had dyslipidemia. Clustering of two, three, four, five and more than five risk factors was 12.6%, 30%, 30%,19%, and 8.7%, respectively. Four or more risk factors clustering was significantly associated with gender, age, level of education, T2DM duration, and use of medication. Risk factors clustering was significantly higher among males and users of anti-diabetic medications with prevalence ratio of 1.14 (95% C.I:1.05–1.23) and 1.09 (95% C.I: 1.09–1.18)], respectively. Conclusions The majority of the patients with T2DM had poor glycemic control and CVD risk factors. Policies and programs focused on the prevention and better management of T2DM and CVD risk factors should be implemented to reduce mortality in Nepal.
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Affiliation(s)
- Mahesh Kumar Khanal
- Provincial Ayurveda Hospital, Ministry of Health, Population and Family Welfare, Dang, Lumbini Province, Nepal
- * E-mail:
| | | | - Raja Ram Dhungana
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Yadav Gurung
- Child and Youth Health Research Center, Auckland University of Technology, Auckland, New Zealand
| | - Lal B. Rawal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney, Australia
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Sydney, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, Australia
| | | | - Madan Bhandari
- Provincial Ayurveda Hospital, Ministry of Health, Population and Family Welfare, Dang, Lumbini Province, Nepal
| | - Surya Devkota
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Centre, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Maximilian de Courten
- Mitchell Institute for Education and Health Policy, Victoria University, Melbourne, Australia
| | - Barbora de Courten
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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Letta S, Aga F, Yadeta TA, Geda B, Dessie Y. Correlates of Glycemic Control Among Patients With Type 2 Diabetes in Eastern Ethiopia: A Hospital-Based Cross-Sectional Study. Front Endocrinol (Lausanne) 2022; 13:939804. [PMID: 35942179 PMCID: PMC9356126 DOI: 10.3389/fendo.2022.939804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/14/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction Even though optimal blood glucose control reduces the risk of diabetes-related complications, many patients with type 2 diabetes (T2D) fail to achieve it for a variety of reasons. In the study area, there was a paucity of evidence regarding correlates of glycemic control. Therefore, this study aimed to find out the correlates of glycemic control among patients with T2D in Eastern Ethiopia. Methods A cross-sectional study was conducted among 879 adult patients with T2D on follow-up at two public hospitals in Harar. Data were collected through interviews, physical measurements, and record reviews. The level of glycemic control was determined from three consecutive fasting plasma glucose (FPG) measurements. A mean value of FPG measurements falling in the normal range (80-130 mg/dl) was considered as optimal glycemic control; otherwise, a mean FPG level that is below or above the normal range (<80 mg/dl or >130 mg/dl) was defined as suboptimal glycemic control. Descriptive statistics were used to summarize the data, while a linear regression model was used to find out the correlates of glycemic control. A beta coefficient and a 95% CI reported associations. The statistical significance was declared at a p-value ≤0.05. Results The mean age of the patients with T2D was 52.7 ( ± 13.3) years. The mean FPG level was 172 ± 56 mg/dl. Suboptimal glycemic control was found in 76% (95% CI: 73.41, 79.04) of patients with T2D. In a multivariable linear regression, khat chewing (β = 6.12; 95% CI: 1.55, 8.69), triglycerides (β = 0.56; 95% CI: 0.41.48, 0.65), comorbidity (β = 5.29; 95% CI: 1.39, 9.13), and poor level of self-care practices (β = 5.43; 95% CI: 1.41, 6.46) showed a significant correlation with glycemic control. Conclusions This study found that about three-fourths of patients with T2D had suboptimal glycemic control. Khat chewing, comorbidity, and poor level of self-care practices were independently correlated with glycemic control. Thus, suppressing glycemic levels through appropriate treatment and strict diabetes self-care practices including avoidance of Khat chewing is a useful approach to attaining glycemic target that subsequently reduces cardiovascular risks.
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Affiliation(s)
- Shiferaw Letta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fekadu Aga
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- Department of Nursing, College of Health Sciences, Madda Walabu University, Shashamene, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Jung J, Her SH, Lee K, Jung JH, Yoo KD, Moon KW, Moon D, Lee SN, Jang WY, Choi IJ, Lee JH, Lee JH, Lee SR, Lee SW, Yun KH, Lee HJ. Impact of Diabetes Duration on Clinical Outcome in Patients Receiving Rotational Atherectomy in Calcified Lesions in Korea-Results from ROCK Registry. Life (Basel) 2022; 12:993. [PMID: 35888082 PMCID: PMC9324660 DOI: 10.3390/life12070993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023] Open
Abstract
There are limited data regarding the clinical impact of diabetes duration for patients with heavy calcified coronary lesions. We sought to determine the clinical impact of diabetes duration on clinical outcomes in patients with heavily calcified lesions who required rotational atherectomy during percutaneous coronary intervention (PCI). A total of 540 diabetic patients (583 lesions) were enrolled between January 2010 and October 2019. Patients were classified into three subgroups: patients with no diabetes mellitus (non-DM), shorter duration (S-DM), and longer duration (L-DM), of which duration was divided at 10 years. During 18 months of follow-up-duration, diabetes duration was significantly associated with the primary outcome. The incidence rate of target-vessel failure (TVF), the primary outcome, was significantly higher in the L-DM group compared with non-DM or S-DM. Among secondary outcomes, any repeat revascularization (RR) was frequently observed in the L-DM compared with other groups. In multivariate analysis, the risk of TVF and any RR was 1.9 times and 2.4 times higher in L-DM than in non-DM, respectively. This study firstly demonstrated that there is an association between a longer DM duration and poor clinical outcomes in patients with severe calcified CAD after PCI. More careful monitoring for recurrence is needed during follow-up in those patients.
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Affiliation(s)
- Jin Jung
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Sung-Ho Her
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Kyusup Lee
- Department of Cardiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 34943, Korea
| | - Ji-Hoon Jung
- Korea Institute of Toxicology, Daejeon 34114, Korea;
| | - Ki-Dong Yoo
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Keon-Woong Moon
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Donggyu Moon
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Su-Nam Lee
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Won-Young Jang
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Ik-Jun Choi
- Department of Cardiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Korea;
| | - Jae-Hwan Lee
- Department of Cardiology in Internal Medicine, Chungnam National University School of Medicine, Daejeon 35015, Korea;
| | - Jang-Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu 41944, Korea;
| | - Sang-Rok Lee
- Department of Cardiology, Chonbuk National University Hospital, Jeonju 54907, Korea;
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Kyeong-Ho Yun
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan 54538, Korea;
| | - Hyun-Jong Lee
- Department of Internal Medicine, Sejong General Hospital, Bucheon 14754, Korea;
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Glycemic control and its associated factors in type 2 diabetes patients at Felege Hiwot and Debre Markos Referral Hospitals. Sci Rep 2022; 12:9459. [PMID: 35676526 PMCID: PMC9177638 DOI: 10.1038/s41598-022-13673-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/26/2022] [Indexed: 12/02/2022] Open
Abstract
Poor glycemic control is a main public health problem among type 2 diabetes mellitus (T2DM) patients and a significant cause of the development of diabetic complications. This study aimed to assess the glycemic control status and its associated factors among type 2 diabetes patients in Felege-Hiwot and Debre Markos Referral Hospitals. A retrospective cohort study was conducted at Felege-Hiwot and Debre Markos Referral Hospitals from December 2014 to December 2015. We have reviewed the chart of these patients until January 2020. Type 2 diabetic patients on follow-up at Felege-Hiwot and Debre Markos Referral Hospitals who fulfilled the inclusion criteria of the study were included. The primary outcome was the level of blood glucose during the study period. Good glycemic control was defined as patients whose average fasting blood glucose measurement for three consecutive visits was between 70 and 130 mg/dL. A generalized linear mixed autoregressive order one model was used to identify the determinants of glycemic control. A total of 191 patients with 1740 observations were included in the study. The overall prevalence of good glycemic control was 58.4% (95% CI: 57.159.7%). The factors associated with good glycemic control at 95% confidence level adjusted odds ratio were being residing in rural (CI: 0.454, 0.614), negative proteinuria (CI: 1.211, 1.546), diastolic blood pressure < 90 (CI: 1.101, 1.522), systolic blood pressure < 140 (CI: 1.352, 1.895), serum creatinine (CI: 0.415, 0.660), duration per visit (CI: 0.913, 0.987), duration since diagnosis (CI: 0.985, 0.998), weight ≥ 78 kg (CI: 0.603, 0.881). Age 38–50, 51–59 and 60–66 years (CI: 1.267, 1.776), (CI: 1.057, 1.476) and (CI: 1.004, 1.403), respectively. The overall prevalence of poor glycemic control was high at Debre Markos and Felege Hiwot Referral Hospital. Living in a rural area, older age (≥ 67 years), positive proteinuria, higher weight (≥ 78 kg), higher serum creatinine levels, higher duration per visit, higher time duration of T2DM since diagnosis, and developing hypertension (SBP ≥ 140, DBP ≥ 90) were the predictors of lower good glycemic control achievements of T2DM patients. In response to this finding, an aggressive intervention that targets improving glycemic control is required.
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Basit A, Waris N, Fawwad A, Tahir B, Siddiqui IA. Glycemic status and general characteristics among individuals with undiagnosed diabetes; findings from second National Diabetes Survey of Pakistan 2016-2017 (NDSP 08). Diabetes Metab Syndr 2022; 16:102535. [PMID: 35700662 DOI: 10.1016/j.dsx.2022.102535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/20/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM To observe the glycemic status among individuals with undiagnosed diabetes in urban and rural areas of all four provinces of Pakistan. METHODS The findings of this study are obtained from the second National Diabetes Survey of Pakistan (NDSP) 2016-2017, a nationwide epidemiological survey. Out of 12,486 individuals approached, 10,834 participants agreed to be included in the second NDSP. An oral glucose tolerance test was used to assess undiagnosed diabetes individuals according to World Health Organization criteria. RESULTS The overall weighted prevalence of undiagnosed diabetes was 7.1% (2.4% in urban and 4.7% in rural areas). Based on isolated fasting plasma glucose or 2-h post 75 gm glucose load or combining both, the weighted prevalence of undiagnosed diabetes was 43.5%, 17.6%, and 38.9%, respectively. Out of the 43.5% of individuals, 15.3% had fasting plasma glucose higher than 250 mg/dl at the time of presentation. Among all the individuals, 23.7% were found to be of less than 40 years of age, 29.2% had a positive family history of diabetes, 80.8% were abdominal obese, 53.8% were hypertensive, and 98% were dyslipidemic. In comparison to the elder group, poor glycemic control of ≥10% HbA1c was observed in most of the younger age groups (p < 0.05). CONCLUSION A significant number of people remain undiagnosed in this part of the world. The glycemic status along with the other associated risk factors at the time of presentation is alarming. Thus, for the early detection of diabetes, awareness and education in the community are crucial. Hence, long-term complications of diabetes can be prevented.
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Affiliation(s)
- Abdul Basit
- Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.
| | - Nazish Waris
- Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan; Clinical Biochemistry and Psychopharmacology Research Unit, Department of Biochemistry, University of Karachi, Pakistan.
| | - Asher Fawwad
- Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan; Biochemistry Department, Baqai Medical University, Karachi, Pakistan.
| | - Bilal Tahir
- Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.
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Joshi SR, Rajput R, Chowdhury S, Singh AK, Bantwal G, Das AK, Unnikrishnan AG, Saboo BD, Kesavadev J, Ghosal S, Mohan V. The role of oral semaglutide in managing type 2 diabetes in Indian clinical settings: Addressing the unmet needs. Diabetes Metab Syndr 2022; 16:102508. [PMID: 35653929 DOI: 10.1016/j.dsx.2022.102508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
AIMS Despite their established benefits, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) remain underutilized for type 2 diabetes mellitus (T2DM) management, which indicates that subcutaneous injection is an unfavorable mode of delivery from the patient's perspective. This review summarizes existing challenges related to medication adherence and the use of antihyperglycemia injectables, revisits the established safety and efficacy of oral semaglutide, and explores its features and considerations for use among the Indian T2DM population. METHODS We performed a literature search using MEDLINE and the National Institutes of Health Clinical Trials Registry from July 1, 2016, to July 1, 2021, to identify publications on oral semaglutide approval, T2DM treatment guidelines, and clinical evidence for oral drug formulation. RESULTS Oral semaglutide is the first oral GLP-1 RA approved for T2DM patients based on phase 3, randomized PIONEER trials. The multitargeted action of this drug offers glycemic control, weight control, and cardiovascular, renal, and additional benefits, including patient convenience and enhanced medication adherence. In addition to achieving glycemic control, the cost of semaglutide is reported to be lower than other GLP-1 RA in the West, thus potentially mitigating the economic burden that appears to be high among the Indian population. CONCLUSIONS Currently, there is no data available on oral semaglutide in Indian clinical settings. However, significant improvements in glycemic control, cardiac and renal benefits, as well as weight loss across clinical trials should encourage clinicians to prioritize oral semaglutide over other antidiabetic agents.
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Affiliation(s)
- Shashank R Joshi
- Grant Medical College and Consulting Endocrinologist, Lilavati Hospital, Mumbai, India.
| | - Rajesh Rajput
- Department of Endocrinology, PGIMS, Rohtak, Haryana, India.
| | | | - Awadhesh K Singh
- G. D. Hospital & Diabetes Institute, Kolkata, West Bengal, India.
| | | | - Ashok K Das
- Department of General Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India.
| | | | | | | | | | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialties Centre & Madras Diabetes Research Foundation, Chennai, India.
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Bej S, Sarkar J, Biswas S, Mitra P, Chakrabarti P, Wolkenhauer O. Identification and epidemiological characterization of Type-2 diabetes sub-population using an unsupervised machine learning approach. Nutr Diabetes 2022; 12:27. [PMID: 35624098 PMCID: PMC9142500 DOI: 10.1038/s41387-022-00206-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/11/2022] [Accepted: 05/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background Studies on Type-2 Diabetes Mellitus (T2DM) have revealed heterogeneous sub-populations in terms of underlying pathologies. However, the identification of sub-populations in epidemiological datasets remains unexplored. We here focus on the detection of T2DM clusters in epidemiological data, specifically analysing the National Family Health Survey-4 (NFHS-4) dataset from India containing a wide spectrum of features, including medical history, dietary and addiction habits, socio-economic and lifestyle patterns of 10,125 T2DM patients. Methods Epidemiological data provide challenges for analysis due to the diverse types of features in it. In this case, applying the state-of-the-art dimension reduction tool UMAP conventionally was found to be ineffective for the NFHS-4 dataset, which contains diverse feature types. We implemented a distributed clustering workflow combining different similarity measure settings of UMAP, for clustering continuous, ordinal and nominal features separately. We integrated the reduced dimensions from each feature-type-distributed clustering to obtain interpretable and unbiased clustering of the data. Results Our analysis reveals four significant clusters, with two of them comprising mainly of non-obese T2DM patients. These non-obese clusters have lower mean age and majorly comprises of rural residents. Surprisingly, one of the obese clusters had 90% of the T2DM patients practising a non-vegetarian diet though they did not show an increased intake of plant-based protein-rich foods. Conclusions From a methodological perspective, we show that for diverse data types, frequent in epidemiological datasets, feature-type-distributed clustering using UMAP is effective as opposed to the conventional use of the UMAP algorithm. The application of UMAP-based clustering workflow for this type of dataset is novel in itself. Our findings demonstrate the presence of heterogeneity among Indian T2DM patients with regard to socio-demography and dietary patterns. From our analysis, we conclude that the existence of significant non-obese T2DM sub-populations characterized by younger age groups and economic disadvantage raises the need for different screening criteria for T2DM among rural Indian residents.
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Affiliation(s)
- Saptarshi Bej
- Department of Systems Biology and Bioinformatics, University of Rostock, Rostock, Germany. .,Leibniz-Institute for Food Systems Biology at the Technical University Munich, Munich, Germany.
| | - Jit Sarkar
- Division of Cell Biology and Physiology, CSIR-Indian Institute of Chemical Biology, Kolkata, India. .,Academy of Innovative and Scientific Research, Ghaziabad, India.
| | - Saikat Biswas
- Advanced Technology Development Centre, Indian Institute of Technology, Kharagpur, India
| | - Pabitra Mitra
- Department of Computer Science & Engineering, Indian Institute of Technology, Kharagpur, India
| | - Partha Chakrabarti
- Division of Cell Biology and Physiology, CSIR-Indian Institute of Chemical Biology, Kolkata, India.,Academy of Innovative and Scientific Research, Ghaziabad, India
| | - Olaf Wolkenhauer
- Department of Systems Biology and Bioinformatics, University of Rostock, Rostock, Germany. .,Leibniz-Institute for Food Systems Biology at the Technical University Munich, Munich, Germany. .,Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa.
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Shita NG, Isayu AS. Predictors of blood glucose change and microvascular complications of type 2 diabetes mellitus patients in Felege Hiwot and Debre Markos referral hospital, North West Ethiopia. BMC Endocr Disord 2022; 22:136. [PMID: 35606785 PMCID: PMC9128238 DOI: 10.1186/s12902-022-01047-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Microvascular complications lead to disability, dependency, and accelerated morbidity and mortality. This study aimed to identify predictors of blood glucose change and time to microvascular complications among patients with type 2 diabetes. METHODS A retrospective cohort study was conducted among type 2 diabetes mellitus patients enrolled between December 2014 and December 2015 at Felege Hiwot and Debre Markos Referral Hospital. A total of 318 T2DM patients were included in the study. Joint modelling of longitudinal and survival analysis was employed to identify predictors of Blood Glucose Change and Microvascular Complications in Type 2 Diabetes Mellitus Patients. RESULTS The prevalence of microvascular complications in Type 2 diabetes patients was 26.3%, 95%confidence interval(CI):(21.5, 31.1). Of which, half of the patients developed a microvascular complication after 30 months from the onset of the follow-up. The significant predictors of developing microvascular complication were positive proteinurea (adjusted hazard ratio (AHR) = 1.418, 95%CI: 1.080, 1.861), Serum creatinine (AHR = 3.704, 95%CI: 1.992, 6.887), Weight (AHR = 1.058, 95%CI: 1.023, 1.094), and log fasting blood glucose(log(FBS))(AHR = 1.013, 95%CI: 1.010, 1.015). The predictors of fasting blood glucose progression were higher baseline FBS(est(estimate) = 0.002,95%CI:0.0018, 0.0022), Systolic blood pressure (SBP) (est = 0.003, 95%CI: 0.002, 0.004), diastolic blood pressure (DBP) (est = 0.002, 95%CI: 0.0002, 0.004), and age (est = 0.003, 95%CI: 0.001, 0.004). CONCLUSION The progression of the fasting blood glucose level for rural patients was faster than for urban patients. Patients having higher baseline FBS, previous hypertension history, higher SBP, higher DBP, older age, and fewer visits to the hospital have a relatively more progressive change in blood sugar levels. Patients having higher triglyceride levels, positive proteinuria, higher fasting blood sugar, higher weight, and a lesser number of hospital visits have a higher risk of developing a complication. In response to this finding, an aggressive intervention that targets to prevent microvascular complications is required.
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Ragoori DR, Shanti D, Sharma G, Enganti B, Bendigeri T, Syed Md. G, Kondakindi PR, Chiruvella M. Role of Retrograde Intrarenal Surgery in the Management of Diabetic Renal Papillary Necrosis. J Endourol 2022; 36:1399-1404. [DOI: 10.1089/end.2022.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Deepak Reddy Ragoori
- Asian Institute of Nephrology and Urology, 519389, Urology, 6-3-562/A, behind MORE megamart, Errum Manzil, Hyderabad, Telangana, India, 500082,
| | - Darga Shanti
- Asian Institute of Nephrology and Urology, 519389, Urology, errumanzil, hyderabad, Hyderabad, Telangana, India, 500082
| | - Gaurav Sharma
- Asian Institute of Nephrology and Urology, 519389, Urology, Hyderabad, Telangana, India
| | - Bhavatej Enganti
- Asian Institute of Nephrology and Urology, 519389, Urology, Hyderabad, Telangana, India
| | - Taif Bendigeri
- Asian Institute of Nephrology and Urology, 519389, Urology, Hyderabad, Telangana, India
| | - Ghouse Syed Md.
- Asian Institute of Nephrology and Urology, 519389, Urology, Hyderabad, Telangana, India
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Kalra S, Bantwal G, Sahay RK, Bhattacharya S, Baruah MP, Sheikh S, Lathia T. Incorporating Integrated Personalised Diabetes Management (iPDM) in Treatment Strategy: A Pragmatic Approach. Indian J Endocrinol Metab 2022; 26:106-110. [PMID: 35873934 PMCID: PMC9302415 DOI: 10.4103/ijem.ijem_478_21] [Citation(s) in RCA: 2] [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: 11/19/2021] [Revised: 02/10/2022] [Accepted: 04/17/2022] [Indexed: 12/03/2022] Open
Abstract
Diabetes is a global public health concern. Vigilant monitoring and effective management of glycaemic variations are essential to prevent complications of diabetes. Effectively incorporating monitoring strategies in management of diabetes is a serious challenge. Patient-centered approach is necessary to customise monitoring and therapy of diabetes. This has been made possible by integrating technology with personalised therapeutic strategy. The integrated personalised diabetes management (iPDM) is a holistic, patient-centered approach that focuses on personalising diabetes management to streamline therapy and improve outcome. iPDM helps strengthen the care process, facilitates communication between patients and their healthcare team, and integrates digital tools that visualise and analyse data. The five E's which includes enthusiasm, education, expertise, empathy and engagement are the key pillars of a strong foundation for the iPDM model. iPDM model is a convenient and easily accessible tool that shifts the management paradigm from an "algorithmic" to "personalized" care to optimise treatment outcomes. Structured self-monitoring of blood glucose (SMBG) should be available as part of the self-management process for people with sub-optimally controlled type 2 diabetes, including those not on insulin therapies. Different SMBG regimens should be followed based on factors such as diabetes type, treatment approach (diet, oral antidiabetic medication, or insulin), glycaemic control, available resources, and patient's level of education.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St. John’s Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rakesh Kumar Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | | | - Manash P. Baruah
- Department of Endocrinology, Excel Hospital, Guwahati, Assam, India
| | - Shehla Sheikh
- Department of Endocrinology, Nagpada-Mumbai Central, Mumbai, Maharashtra, India
| | - Tejal Lathia
- Department of Endocrinology, Apollo Hospitals and Fortis Hospital, Mumbai, Maharashtra, India
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Aravindakshan MR, Maity SK, Paul A, Chakrabarti P, Mandal C, Sarkar J. Distinct pathoclinical clusters among patients with uncontrolled type 2 diabetes: results from a prospective study in rural India. BMJ Open Diabetes Res Care 2022; 10:10/1/e002654. [PMID: 35144941 PMCID: PMC8845217 DOI: 10.1136/bmjdrc-2021-002654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/15/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Inadequate glycemic control among patients with type 2 diabetes mellitus (T2DM) poses an enormous challenge. Whether this uncontrolled T2DM population is a heterogenous mix of disease subtypes remains unknown. Identification of these subtypes would result in a customized T2DM management protocol thereby paving the way toward personalized therapy. RESEARCH DESIGN AND METHODS Electronic health records of 339 patients with uncontrolled T2DM patients followed up for a median period of 14 months were analyzed using Uniform Manifold Approximation and Projection followed by density-based spatial clustering of applications with noise. Baseline clinical features and final diagnoses with drug combinations were selected in the analysis. A 30 min oral glucose tolerance test was next performed for assessing the underlying insulin resistance and β cell dysfunction. RESULTS Three major clusters were identified. The first cluster characterized by recent onset T2DM had moderately preserved β cell function. The second cluster with a longer duration of T2DM and associated hypertension showed the best glycemic control with dual antidiabetic therapy. The third cluster with the longest history of T2DM and no history of hypertension had the worst glycemic control in spite of the highest percentage of patients on triple therapy (34.58%) and quadruple therapy (8.41%). CONCLUSIONS Uncontrolled T2DM comprises a heterogeneous population with respect to disease duration, presence of co-morbidities and β cell function without significant difference in insulin resistance. Stratifying them on the basis of pathoclinical features is the first step toward a personalized management in T2DM.
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Affiliation(s)
| | - Sujay Krishna Maity
- Department of Cell Biology and Physiology, Indian Institute of Chemical Biology CSIR, Kolkata, West Bengal, India
| | - Avishek Paul
- Department of Cell Biology and Physiology, Indian Institute of Chemical Biology CSIR, Kolkata, West Bengal, India
| | - Partha Chakrabarti
- Department of Cell Biology and Physiology, Indian Institute of Chemical Biology CSIR, Kolkata, West Bengal, India
- Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Chittaranjan Mandal
- Department of Computer Science & Engineering, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Jit Sarkar
- Department of Cell Biology and Physiology, Indian Institute of Chemical Biology CSIR, Kolkata, West Bengal, India
- Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
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Wungrath J, Autorn N. Effectiveness of Line application and telephone-based counseling to improve medication adherence: A randomized control trial study among uncontrolled type 2 diabetes patients. Health Promot Perspect 2022; 11:438-443. [PMID: 35079588 PMCID: PMC8767072 DOI: 10.34172/hpp.2021.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/11/2021] [Indexed: 11/09/2022] Open
Abstract
Background: More than 4.2 million cases of diabetes mellitus (DM) were reported in Thailand during 2019. Medication adherence is necessary to delay disease progression and prevent complications among uncontrolled type 2 DM patients. The objective of this research was to study how education via the Line application and telephone-based counseling impacted medication adherence knowledge by analyzing the behavior of uncontrolled type 2 diabetic patients. Methods: Uncontrolled type 2 DM patients in Doi Saket Hospital, Doi Saket district, Chiang Mai province, Thailand. were included in the study. The sample was divided into an experimental (n=30) and control group (n=30). Patients who met the inclusion criteria of having uncontrolled type 2 diabetes diagnosed by a physician for at least one year, capable of communicating in Thai, possessing a mobile phone with the Line application and able to partake in activities for eight weeks were recruited in the parallel-group randomized trial. The experimental group participated in the developed education program, while the control group received standard routine health education activities provided by their health care providers. The intervention was based on the 5Rs principle as right medicine, right dose, right route, right patient and right time and included activities via the Line application and telephone-based counseling. Participants were evaluated for their medication adherence knowledge and behavior. Results: After eight weeks of education through the Line application and telephone-based counseling, posttest mean scores of medication adherence knowledge of the experimental and control groups were 18.03 (SD=0.28) and 12.37 (SD=0.62), while posttest mean scores of medication adherence behavior of the experimental and control groups were 49.28 (SD=3.77) and 33.84 (SD=3.81), respectively. Results revealed that the experimental group had statistically significant (P <0.01) higher medication adherence knowledge and behavior mean scores. Conclusion: Education using the Line application and telephone-based counseling program improved medication adherence knowledge and behavior among uncontrolled type 2 DM patients. Other outcomes of social media interactions such as patient engagement, patient behavior and attitudes, and the efficacy of patient-health care provider communication levels are possible areas for future study.
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Affiliation(s)
- Jukkrit Wungrath
- Faculty of Public Health, Chiang Mai University, Chiang Mai 50200, Thailand
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Sabharwal M, Misra A, Ghosh A, Chopra G. Efficacy of Digitally Supported and Real-Time Self-Monitoring of Blood Glucose-Driven Counseling in Patients with Type 2 Diabetes Mellitus: A Real-World, Retrospective Study in North India. Diabetes Metab Syndr Obes 2022; 15:23-33. [PMID: 35023937 PMCID: PMC8743499 DOI: 10.2147/dmso.s345785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/16/2021] [Indexed: 04/20/2023] Open
Abstract
PURPOSE Poor glycemic control is prevalent in patients with type 2 diabetes mellitus (T2DM) in India. This study aims to understand the effectiveness of a smartphone-connected glucometer, real-time feedback, and contextualized counseling on glycemic control and hypoglycemic episodes in T2DM patients. METHODS This retrospective, multicenter study reviewed the medical records of T2DM patients belonging to several cities of north India, who were digitally engaged with a smartphone-connected glucometer and who had received at least one counseling session between September 2019 and July 2020. Intervention included self-monitoring of blood glucose (SMBG) using a smartphone-connected glucometer enabled with real-time transmission of information to certified diabetes educators (CDE) and their corresponding counseling based on SMBG findings. RESULTS Of 7111 adult T2DM patients included in this study, majority (75%) of the patients received a single session of counseling, and the remaining patients received 2 (16.7%), 3 (5%), 4 (2%), or ≥5 (1.3%) sessions. The mean age of the patients was 51.6 years, and the majority (77.9%) were males. Digital monitoring of BG and counseling with CDE significantly reduced the mean fasting (by 9.6%), pre-prandial (by 9.9%), and post-prandial (by 9.2%) BG values in 53%, 52%, and 54% of patients, respectively. The majority (81.4%) of patients showed no hypoglycemic episode (≤70 mg/dL) post-counseling. The hypoglycemia episodes observed with FBG, pre-prandial, and post-prandial BG values were reduced significantly by 58.5%, 48.1%, and 61.8%, respectively, post-counseling. CONCLUSION Digitally supported and real-time SMBG-driven counselling was effective in glycemic control and reduction of hypoglycemic episodes in T2DM patients in India. Moreover, reduction in hypoglycemia may be due to back end real-time support of CDE intervention.
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Affiliation(s)
- Mudit Sabharwal
- BeatO, Health Arx Technologies Pvt. Ltd., New Delhi, India
- Correspondence: Mudit Sabharwal Email
| | - Anoop Misra
- Fortis C-DOC Hospital, Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Amerta Ghosh
- Fortis C-DOC Hospital, Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Gautam Chopra
- BeatO, Health Arx Technologies Pvt. Ltd., New Delhi, India
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Joy T, Najeeb S, Sreedevi A, Vijayakumar K. Glycemic control and its determinants among people with type 2 diabetes mellitus in Ernakulam district, Kerala. Indian J Public Health 2022; 66:S80-S86. [DOI: 10.4103/ijph.ijph_1104_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abhyankar M, Das A, Wangnoo S, Chawla R, Shaikh A, Bantwal G, Kalra P, Jaggi S, Prasad A, Sarda P. Expert consensus on triple combination of glimepiride, metformin, and voglibose usage in patients with type 2 diabetes mellitus in Indian settings. JOURNAL OF DIABETOLOGY 2022. [DOI: 10.4103/jod.jod_118_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Das AK, Kalra S, Joshi S, Mithal A, Kumar K M P, Unnikrishnan AG, Thacker H, Sethi B, Chowdhury S, Ghosh R, Krishnan S, Nair A, Mohanasundaram S, Menon SK, Salvi V, Chodankar D, Thaker S, Trivedi C, Wangnoo SK, Zargar AH, Rais N. One-year trends from the LANDMARC trial: A 3-year, pan-India, prospective, longitudinal study on the management and real-world outcomes of type 2 diabetes mellitus. Endocrinol Diabetes Metab 2022; 5:e00316. [PMID: 34856077 PMCID: PMC8754240 DOI: 10.1002/edm2.316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 11/01/2021] [Accepted: 10/24/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction Longitudinal data on management and progression of type 2 diabetes mellitus (T2DM) in India are scarce. LANDMARC (CTRI/2017/05/008452), first‐of‐its‐kind, pan‐India, prospective, observational study aimed to evaluate real‐world patterns and management of T2DM over 3 years. Methods Adults (≥25 to ≤60 years old at T2DM diagnosis; diabetes duration ≥2 years at enrolment; controlled/uncontrolled on ≥2 anti‐diabetic agents) were enrolled. The first‐year trends for glycaemic control, therapy and diabetic complications, including those from metropolitan and non‐metropolitan cities are reported here. Results Of 6236 enrolled participants, 5654 completed 1 year in the study. Although the overall mean glycated haemoglobin (HbA1c) improved by 0.5% (baseline: 8.1%) at 1 year, only 20% of the participants achieved HbA1c <7%. Participants from metropolitan and non‐ metropolitan cities showed similar decrease in glycaemic levels (mean change in HbA1c: −0.5% vs. −0.5%; p = .8613). Among diabetic complications, neuropathy was the predominant complication (815/6236, 13.1% participants). Microvascular complications (neuropathy, nephropathy and retinopathy) were significantly (p < .0001) higher in non‐metropolitan than metropolitan cities. Hypertension (2623/6236, 78.2%) and dyslipidaemia (1696/6236, 50.6%) continued to be the most commonly reported cardiovascular risks at 1 year. After 1 year, majority of the participants were taking only oral anti‐diabetic drugs (OADs) (baseline: 4642/6236 [74.4%]; 1 year: 4045/6013 [67.3%]), while the proportion of those taking insulin along with OADs increased (baseline: 1498/6236 [24.0%] vs. 1 year: 1844/6013 [30.7%]). Biguanides and sulfonylureas were the most used OADs. The highest increase in use was seen for dipeptidyl peptidase‐IV inhibitors (baseline: 3047/6236 [48.9%]; 1 year: 3529/6013 [58.7%]). Improvement in all glycaemic parameters was significantly (p < .0001) higher in the insulin vs. the insulin‐naïve subgroups; in the insulin‐naïve subgroup, no statistical difference was noted in those who received >3 vs. ≤3 OADs. Conclusions First‐year trends of the LANDMARC study offer insights into real‐world disease progression, suggesting the need for controlling risk factors and timely treatment intensification in people with T2DM.
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Affiliation(s)
- Ashok K Das
- Pondicherry Institute of Medical Sciences, Puducherry, India
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Rahul A, Chintha S, Anish TS, Prajitha KC, Indu PS. Effectiveness of a Non-pharmacological Intervention to Control Diabetes Mellitus in a Primary Care Setting in Kerala: A Cluster-Randomized Controlled Trial. Front Public Health 2021; 9:747065. [PMID: 34869163 PMCID: PMC8636158 DOI: 10.3389/fpubh.2021.747065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite being the first Indian state with a dedicated Non-Communicable Disease (NCD) program, glycemic control among a large proportion of patients is low in Kerala. This study tries to find evidence for a standardized non-pharmacological strategy delivered through Junior Public Health Nurses (JPHNs) in achieving and maintaining glycemic control among diabetic patients registered with NCD clinics of primary health care settings. Design: A cluster randomized controlled trial was conducted among adult patients with Diabetes Mellitus attending NCD clinics of primary care settings of South Kerala, India. JPHNs of the intervention group received additional module-based training while standard management continued in the control group. Sequence generation was done by random permuted blocks method and a cluster of 12 patients was selected from each of the 11 settings by computer-generated random numbers. Patients were followed up for 6 months with monthly monitoring of Fasting Blood Sugar (FBS), Post-Prandial Blood Sugar (PPBS), blood pressure, Body Mass Index (BMI), and health-related behaviors. Knowledge and skills/practice of JPHNs were also evaluated. Analysis of Covariance was done to study the final outcome adjusting for the baseline values and a model for glycemic control was predicted using multilevel modeling. Results: We analyzed 72 participants in the intervention group and 60 participants in the control group according to the intention-to-treat principle. The intervention was associated with a significant reduction in FBS (p < 0.001) and PPBS (p < 0.001) adjusting for the baseline values. The achievement of glycemic control was 1.5 (95% CI: 1.05-2.3) times better with intervention and they showed a better trend of maintenance of glycemic control (FBS, p = 0.003 and PPBS, p = 0.039). Adjusting for clustering and the baseline values, the intervention showed a significant effect on FBS (B = -3.1, SE = 0.57; p < 0.001) and PPBS (B = -0.81, SE = 0.3; p < 0.001) with time. Drug adherence score (p < 0.001), hours of physical activity (p < 0.001), BMI (p = 0.002), fruit intake (p = 0.004), and green leafy vegetable intake (p = 0.01) were the major predictors of FBS control. The practice/skills score of the JPHNs significantly improved with intervention (p < 0.001) adjusting for baseline values. Conclusion: A well-designed health worker intervention package incorporated into the existing health system can translate into attitude change and skill development in the health workers which can reflect in the improvement of glycemic control among the patients. Trial registration: [URL: http://www.ctri.nic.in], identifier [CTRI/2017/11/010622].
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Affiliation(s)
- Arya Rahul
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, India
| | - Sujatha Chintha
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, India
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Xiang AS, Szwarcbard N, Gasevic D, Earnest A, Pease A, Andrikopoulos S, Wischer N, Davis W, Zoungas S. Trends in glycaemic control and drug use in males and females with type 2 diabetes: Results of the Australian National Diabetes Audit from 2013 to 2019. Diabetes Obes Metab 2021; 23:2603-2613. [PMID: 34338406 DOI: 10.1111/dom.14506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022]
Abstract
AIM To investigate temporal changes in glycaemic control and the use of antihyperglycaemic therapies in females and males with type 2 diabetes from 2013 to 2019. METHODS Data from adult patients with type 2 diabetes (n = 11 930; 44.9% females, mean [SD] age of 62.9 [12.9] years) were analysed from the 2013 to 2019 biennial cross-sectional Australian National Diabetes Audit. RESULTS Mean HbA1c remained similar throughout the years examined and between the sexes (7.8%-8.3%, 62-67 mmol/mol; P > .05). The number of antihyperglycaemic agents used by both sexes increased from 2013 to 2019 (P < .001), with more agents used by males (P = .014). From 2013 to 2019, there were increasing proportions of both sexes using dipeptidyl peptidase-4 inhibitors (females: 11.7%-25.7%, P = .045; males: 11.6%-29.5%, P = .036) and glucagon-like peptide-1 receptor agonists (females: 5.9%-15.3%; males: 4.9%-11.1%; P = .043 for both). Sodium-glucose co-transporter-2 inhibitors were not available in 2013; however, their use increased substantially from 2015 to 2019 in both females (4.9%-26.3%, P = .013) and males (4.7%-32.2%, P = .019). CONCLUSIONS From 2013 to 2019, mean HbA1c levels remained unchanged despite a concurrent increase in the number of antihyperglycaemic medications used. Overall, there was a trend towards preferencing newer agents with some differences in treatment regimens relating to sex and renal function.
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Affiliation(s)
- Angie S Xiang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Naomi Szwarcbard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anthony Pease
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
| | - Sof Andrikopoulos
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Australian Diabetes Society, Sydney, New South Wales, Australia
| | - Natalie Wischer
- National Association of Diabetes Centres, Sydney, New South Wales, Australia
| | - Wendy Davis
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
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Gupta AP, Chakraborty PP, Halder R, Sahoo A, Roy K. Post-usual meal C-peptide as a reliable and practical alternative to C-peptide following glucagon or standardized mixed-meal for β-cell reserve: a comparative study between three stimulatory methods in different types of diabetes. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00987-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Saboo B, Agarwal S, Gupta S, Makkar B, Panneerselvam A, Sahoo AK, Ramchandani GD, Das S, Erande S, Kadam Y, Abhyankar MV, Revankar S. REAL-world evidence of risk factors and comorbidities in YOUNG Indian adults with type 2 diabetes mellitus: A REAL YOUNG (diabetes) study. J Family Med Prim Care 2021; 10:3444-3452. [PMID: 34760771 PMCID: PMC8565132 DOI: 10.4103/jfmpc.jfmpc_2010_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/01/2021] [Indexed: 11/04/2022] Open
Abstract
Objective To assess the clinical characteristics, risk factors, and comorbidities associated with type 2 diabetes mellitus (T2DM) in young adult patients. Methods This is a retrospective, multicentric real-world study that included young adults (18-45 years) with T2DM. Primary information including demographics, medical and family history, biochemical measures (pre-and post-prandial blood glucose levels, glycosylated hemoglobin [HbA1c] and blood pressure, and lipid parameters) smoking and drinking habits were collected retrospectively from the medical records of the respective hospitals/clinics. Data were analyzed using descriptive and appropriate comparative statistics. Results A total of 22,921 patients from 623 sites were included. The median age was 37.0 years and the majority were men (61.6%). The proportion of patients from the age group >35-≤45 years was 62.7%. Among all patients, 46.9% had only T2DM; however, 53.1% of patients had T2DM with other comorbidities (T2DM with hypertension, dyslipidemia, and both). The majority of patients had elevated body mass index (BMI) (overweight, 46.6%; and obese, 22.9%). Family history of T2DM (68.1%) was most common in overall population. Sedentary lifestyle (63.1%), alcohol consumption (38.9%), and regular smoking (23.1%) were the most common associations in patients with T2DM with dyslipidemia and hypertension. Uncontrolled HbA1c level (≥7%) were observed in 79.2% of patients. The level of HbA1c was significantly increased with the duration of T2DM and sedentary lifestyle (p < 0.001). Conclusion Higher BMI, family history of T2DM, sedentary lifestyle, alcohol consumption, and smoking were the most common risk facors, while hypertension and dyslipidemia were the most prevalent comorbidities associated with T2DM in young Indian adults.
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Affiliation(s)
- Banshi Saboo
- Department of Diabetology, Diabetes Care and Hormone Clinic, Ambawadi, Ahmedabad, Gujarat, India
| | - Sanjay Agarwal
- Department of Internal Medicine, Dr. Sanjay Agarwal's Aegle Clinic, City, Pune, Maharashtra, India
| | - Sunil Gupta
- Department of Diabetology, Sunil's Diabetes Care Research Centre, Nagpur, Maharashtra, India
| | - Brij Makkar
- Department of Diabetology, Dr. Makkar's Diabetes and Obesity Centre, Delhi, India
| | - A Panneerselvam
- Department of Diabetology, Aruna Diabetes Centre, Chennai, Tamil Nadu, India
| | - Abhay Kumar Sahoo
- Department of Endocrinology, IMS and SUM Hospital, Bhubaneshwar, Odisha, India
| | - G D Ramchandani
- Ramachandani Diabetes Care and Research Centre, Kota, Rajasthan, India
| | - Sambit Das
- Department of Endocrinology, Endeavour Clinics, Bhubaneswar, Odisha, India
| | - Suhas Erande
- Department of Diabetology, Akshay Hospital and Diabetic Speciality Centre and Insulin Pump Centre, Pune, Maharashtra, India
| | - Yogesh Kadam
- Department of Diabetology, Poona Diabetes Centre, Pune, Maharashtra, India
| | - Mahesh V Abhyankar
- Department of Scientific Services, Scientific Services, USV Private Limited, Mumbai, Maharashtra, India
| | - Santosh Revankar
- Department of Scientific Services, Scientific Services, USV Private Limited, Mumbai, Maharashtra, India
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Wang J, Li J, Wen C, Liu Y, Ma H. Predictors of poor glycemic control among type 2 diabetes mellitus patients treated with antidiabetic medications: A cross-sectional study in China. Medicine (Baltimore) 2021; 100:e27677. [PMID: 34713865 PMCID: PMC8556014 DOI: 10.1097/md.0000000000027677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/15/2021] [Indexed: 01/05/2023] Open
Abstract
This study aimed to clarify of the predictors of poor glycemic control in type 2 diabetes mellitus (T2DM) patients treated with antidiabetic medications in China.This study was a retrospective, cross-sectional study based on SuValue database. T2DM patients aged 18 years or older performing glycosylated hemoglobin A1c (HbA1c) examinations from January 1st, 2018 to December 31st, 2018 were included and have been treated with antidiabetic medications for at least 6 months. HbA1c < 7.0% was defined as adequate glycemic control. Multivariate analysis was performed for the factors associated with poor glycemic control.A total of 13972 T2DM patients were included in this study. The adequate glycemic control rate was 44.04% (n = 6153). In the multivariate analysis, predictors of poor glycemic control include longer T2DM duration (5-10 years vs <5 years and >10 years vs <5 years, odds ratio [OR] = 1.499 and 1.581, P < .001 and P = .008), myocardial infarction (OR = 1.141, P = .041), diabetic neuropathy (OR = 1.409, P < .001), secondary hospital (OR = 1.877, P < .001), underdeveloped regions (OR = 1.786, P < .001), insulin only (OR = 3.912, P < .001), combination of oral antidiabetic agents and/or insulin use (P < .001).In conclusion, longer T2DM duration, secondary hospital, myocardial infarction, diabetic neuropathy, undeveloped regions and use of polypharmacy and insulin were associated with poor glycemic control among T2DM patients treated with antidiabetic medications. Patient education and training of health care providers may be short-term strategy to achieve adequate glycemic control.
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Affiliation(s)
- Jingqing Wang
- Department of Endocrinology, The Third People's Hospital of Datong, Datong, China
| | - Jie Li
- Department of Endocrinology, The Third People's Hospital of Datong, Datong, China
| | - Chendong Wen
- Department of Endocrinology, The Third People's Hospital of Datong, Datong, China
| | - Yan Liu
- Department of Endocrinology, The Third People's Hospital of Datong, Datong, China
| | - Hongshan Ma
- Department of Cardiology, The Third People's Hospital of Datong, Datong, China
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Nguyen TH, Truong HV, Vi MT, Taxis K, Nguyen T, Nguyen KT. Vietnamese Version of the General Medication Adherence Scale (GMAS): Translation, Adaptation, and Validation. Healthcare (Basel) 2021; 9:healthcare9111471. [PMID: 34828516 PMCID: PMC8623004 DOI: 10.3390/healthcare9111471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 01/02/2023] Open
Abstract
Background: We aimed to translate, cross-culturally adapt, and validate the General Medication Adherence Scale (GMAS) into Vietnamese. Methods: We followed the guidelines of Beaton et al. during the translation and adaptation process. In Stage I, two translators translated the GMAS to Vietnamese. Stage II involved synthesizing the two translations. Stage III featured a back translation. Stage IV included an expert committee review and the creation of the pre-final version of the GMAS, and in stage V, pilot testing was conducted on 42 Vietnamese patients with type 2 diabetes. The psychometric validation process evaluated the reliability and validity of the questionnaire. The internal consistency and test–retest reliability were assessed by Cronbach’s alpha and Spearman’s correlation coefficients. The construct validity was determined by an association examination between the levels of adherence and patient characteristics. The content validity was based on the opinion and assessment score by the expert committee. The Vietnamese version of the GMAS was created, including 11 items divided into three domains. There was a good equivalence between the English and the Vietnamese versions of the GMAS in all four criteria. Results: One hundred and seventy-seven patients were participating in the psychometric validation process. Cronbach’s alpha was acceptable for all questionnaire items (0.817). Spearman’s correlation coefficient of the test–retest reliability was acceptable for the GMAS (0.879). There are significant correlations between medication adherence levels and occupation, income, and the Beliefs about Medicines Questionnaire (BMQ) score regarding construct validity. Conclusions: The Vietnamese version of GMAS can be considered a reliable and valid tool for assessing medication adherence in Vietnamese patients.
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Affiliation(s)
- Thao Huong Nguyen
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam; (T.H.N.); (H.V.T.)
| | - Hoa Van Truong
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam; (T.H.N.); (H.V.T.)
| | - Mai Tuyet Vi
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam;
| | - Katja Taxis
- Groningen Research Institute of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands;
| | - Thang Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam;
- Correspondence: (T.N.); (K.T.N.)
| | - Kien Trung Nguyen
- Department of Physiology, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
- Correspondence: (T.N.); (K.T.N.)
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Prevalent vascular complications in people with diabetes: a multicentre observational cohort study. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-01010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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