Effects of Diabetic Complications on Health-Related Quality of Life Impairment in Vietnamese Patients with Type 2 Diabetes

Progress toward universal health coverage in Vietnam: Evidence on dispensing trends of diabetes medications from 2015 to 2021

AIMS

This study aims to investigate the trends in treatment coverage through dispensing diabetes medications in Vietnam from 2015 to 2021. The findings will serve to inform health policies to mitigate the health burden of Type 2 diabetes mellitus (T2DM).

METHODS

We collected information on major antidiabetic medicines from General Department of Vietnam Customs and payments for antidiabetics via the National Health Insurance Program. We applied ordinary least squares models, accounting for economic and health outcome characteristics, to estimate the association between the annual mass of medications and related factors.

RESULTS

Nationally, the total mass/doses of all antidiabetic drugs increased rapidly from 2015 to 2021, based on both databases. Metformin was the most frequently prescribed medicine, with the total mass increasing nearly threefold over the study period. Gliclazide, a Sulfonylureas drug, ranked second. In the multivariate regression analysis, a one-unit increase in adults with diabetes (in 1,000 s) was associated with 0.11 % (95 %CI = 0.0005; 0.0076) and 0.13 % (95%CI = 0.0007; 0.0242) higher mass of Metformin and Glimepiride, respectively.

CONCLUSION

Our data suggested that policies changes were related to significant increase in antidiabetic medication dispenses in Vietnam. The high treatment coverage indicates impressive progress in achieving universal health coverage in Vietnam, meeting the UN Sustainable Development Goal (SDG).

Health state utility values ranges across varying stages and severity of type 2 diabetes-related complications: A systematic review

INTRODUCTION

Health state utility values (HSUV) for Type 2 diabetes mellitus (T2DM) complications are useful in economic evaluations to determine cost effectiveness of an intervention. However, there is a lack of reference ranges for different severity and stages of individual complications. This study aimed to provide an overview of HSUV decrement ranges for common T2DM complications focusing on different severity and stages of complications.

METHOD

A systematic search was conducted in MEDLINE, SCOPUS, WEB OF SCIENCE. (Jan 2000 to April 2022). Included studies for HSUV estimates were from outpatient setting, regardless of treatment types, complication stages, regions and HRQoL instruments. Health Related Quality of Life (HRQoL) outcomes was to be presented as HSUV decrement values, adjusted according to social demographics and comorbidities. Adjusted HSUV decrements were extracted and compiled according to individual complications. After which, subsequently grouped into mild or severe category for comparison.

RESULTS

Searches identified 35 studies. The size of the study population ranged from 160 to 14,826. The HSUV decrement range was widest for cerebrovascular disease (stroke): -0.0060 to -0.0780 for mild stroke and -0.035 to -0.266 for severe stroke; retinopathy: mild (-0.005 to -0.0862), moderate (-0.0030 to -0.1845) and severe retinopathy (-0.023 to -0.2434); amputation: (-0.1050 to -0.2880). Different nature of complication severity defined in studies could be categorized into: those with acute nature, chronic with lasting effects, those with symptoms at early stage or those with repetitive frequency or episodes.

DISCUSSION

Overview of HSUV decrement ranges across different stages of each T2DM diabetes-related complications shows that chronic complications with lasting impact such as amputation, severe stroke with sequelae and severe retinopathy with blindness were generally associated with larger HSUV decrement range. Considerable heterogeneities exist across the studies. Promoting standardized complication definitions and identifying the most influential health state stages on HSUV decrements may assist researchers for future cost-effectiveness studies.

Interplay between Senescence and Macrophages in Diabetic Cardiomyopathy: A Review of the Potential Role of GDF-15 and Klotho

Type 2 diabetes mellitus (T2DM) is a critical health problem, with 700 million diagnoses expected worldwide by 2045. Uncontrolled high blood glucose levels can lead to serious complications, including diabetic cardiomyopathy (DCM). Diabetes induces cardiovascular aging and inflammation, increasing cardiomyopathy risk. DCM is characterized by structural and functional abnormalities in the heart. Growing evidence suggests that cellular senescence and macrophage-mediated inflammation participate in the pathogenesis and progression of DCM. Evidence indicates that growth differentiation factor-15 (GDF-15), a protein that belongs to the transforming growth factor-beta (TGF-β) superfamily, is associated with age-related diseases and exerts an anti-inflammatory role in various disease models. Although further evidence suggests that GDF-15 can preserve Klotho, a transmembrane antiaging protein, emerging research has elucidated the potential involvement of GDF-15 and Klotho in the interplay between macrophages-induced inflammation and cellular senescence in the context of DCM. This review explores the intricate relationship between senescence and macrophages in DCM while highlighting the possible contributions of GDF-15 and Klotho.

Diabetic Retinopathy and Quality of Life: A Systematic Review and Meta-Analysis

Importance

The association between diabetic retinopathy (DR) and quality of life (QoL) has not been thoroughly investigated.

Objective

To investigate the association between DR and both vision-related QoL (VRQoL) and general health-related QoL (HRQoL).

Data Sources

MEDLINE, EBSCO, Embase, and Web of Science were searched from their inception to April 2022.

Study Selection

Studies included adults with DR and a measure of QoL.

Data Extraction and Synthesis

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Two assumption-free meta-analyses were conducted. Analysis 1 included studies with participants without DR as the referent group to which QoL scores of participants with DR, grouped according to DR severity, were compared. Analysis 2 included all studies with participants with DR and a measure of QoL. QoL scores were pooled within categories of DR severity, and comparisons were made between these categories.

Main Outcome and Measures

QoL measured using HRQoL and VRQoL scales.

Results

A total of 93 articles were included: 79 in the meta-analyses and 14 in the narrative results. VRQoL was recorded in 54 studies, HRQoL in 26, and both in 13 studies. The most commonly used scales were the National Eye Institute 25-item Visual Function Questionnaire (VFQ-25) (n = 49) for VRQoL and the Short Form (SF) Health Survey (n = 18) for HRQoL. Thirty-five studies reported VFQ-25 composite scores. Analysis 1 consisted of 8 studies including 1138 participants with DR and 347 participants without DR. Compared with participants without DR, the composite VFQ-25 score was 3.8 (95% CI, 1.0-6.7) points lower in those with non-vision-threatening DR (NVTDR), 12.5 (95% CI, 8.5-16.5) lower in those with any DR, and 25.1 (95% CI, 22.8-27.2) lower in VTDR (P < .001 for trend). Analysis 2 consisted of 35 studies including 6351 participants with DR. The pooled mean VFQ-25 composite score was 91.8 (95% CI, 91.0-92.7) for participants with NVTDR, 77.6 (95% CI, 76.9-78.3) for any DR, and 73.2 (95% CI, 72.6-73.7) for VTDR (P < .001 for trend). HRQoL scores had weak or no associations with NVTDR and strong associations with VTDR.

Conclusions and Relevance

This study found that VRQoL declined with the presence and severity of DR. Interventions to reduce progression of DR at both early and more advanced stages could improve VRQoL.

Factors associated with quality of life among elderly patients with type 2 diabetes mellitus: the role of family caregivers

BACKGROUND

As a long-term chronic disease, Type 2 diabetes mellitus (T2DM) patients' quality of life is affected by both themselves and his/ her close relatives, requiring comprehensive support from family members to ensure that patients are able to manage disease. The objective of this study is to investigate the relationship between caregivers' sense of coherence, caregiver competence, and T2DM patients' quality of life, as well as to explore the factors affecting patients with T2DM patients.

METHODS

This investigation was a cross-sectional study. Between October 2022 and July 2023, 392 participant-caregiver dyads from two hospitals in Jinzhou City, Liaoning Province, were researched. Participants were investigated by General Characteristics Questionnaire, Modified Barthel Index (MBI), Diabetes Specific Quality of Life Scale (DSQLS), Sense of Coherence scale-13 (SOC-13), and Family Caregiver Task Inventory (FCTI). Data were statistically analyzed using SPSS 25. Univariate and multivariate linear regression analyses were used to identify the independent factors associated with the quality of life of elderly patients with T2DM.

RESULTS

The average score of T2DM quality of life was 61.14 (SD = 7.37), quality of life was negatively correlated with sense of coherence (r=-0.344, P<0.01) and positively correlated with caregiver competence (r = 0.522, P<0.01). Furthermore, we found that age, disease duration, activities of daily living scores, sense of coherence, and caregiver competence scores were the main predictors of quality of life (R2 = 0.375, P < 0.001).

CONCLUSIONS

This study found that high levels of sense of coherence and caregiver competence in family caregivers were associated with better quality of life for patients. Furthermore, we also found that good quality of life was also related to younger age, shorter disease duration, and less dependence. This study offers a feasible example for policymakers to improve the quality of life from the perspective of T2DM patients' family caregivers.

Real-world evidence on health-related quality of life in patients with type 2 diabetes mellitus using sulphonylureas: An analysis of the Joint Asia Diabetes Evaluation (JADE) Register

AIMS

To describe health-related quality of life (HRQoL) and identify associated factors in patients with type 2 diabetes mellitus (T2DM) treated with oral glucose-lowering drugs (OGLDs).

METHODS

This retrospective, cross-sectional analysis included adults with T2DM from 11 Asian countries/regions prospectively enrolled in the Joint Asian Diabetes Evaluation (JADE) Register (2007-2019) with available EuroQol-5D (EQ-5D-3L) data.

RESULTS

Of 47,895 included patients, 42,813 were treated with OGLDs + lifestyle modifications (LSM) and 5,082 with LSM only. Among those treated with OGLDs, 60% received sulphonylureas (SUs), of whom 47% received gliclazide. The OGLD + LSM group had a lower mean EQ-5D-3L index score than the LSM-only group (p < 0.001). The most affected EQ-5D-3L dimensions in OGLD + LSM-treated patients were pain/discomfort (26.2%) and anxiety/depression (22.6%). On multivariate analysis, good HRQoL was positively associated with male sex, education level, balanced diet and regular exercise, and negatively with complications/comorbidities, self-reported hypoglycaemia, smoking, HbA1c, age, body mass index and disease duration. Patients receiving gliclazide vs non-gliclazide SUs had lower HbA1c and better HRQoL in all dimensions (p < 0.001).

CONCLUSIONS

Demographic, physical and psychosocial-behavioural factors were associated with HRQoL in patients with T2DM. Our real-world data add to previous evidence that gliclazide is an effective OGLD, with most treated patients reporting good HRQoL. A plain language summary of this manuscript is available here.

The Role of Copper Intake in the Development and Management of Type 2 Diabetes: A Systematic Review

Diabetes mellitus is a worldwide public health issue with numerous complications. Several risk factors are associated with diabetes, mainly due to patients following an unhealthy lifestyle. Copper is a crucial trace element, with various physiological actions. Different intake levels of copper might contribute to diabetes development due to its dual action as both an anti- and pro-oxidant. Aim: Due to the inconclusive findings regarding the relationship between copper consumption and the management of diabetes, we decided to conduct this extensive systematic review. Up to this date, no similar study has been available in the literature. In this review, we used the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Relevant articles were identified by searching the electronic databases CINAHL, EMBASE and Medline from their respective index dates to September 2022 using keywords such as “Copper Intake” and “Type 2 Diabetes”. Any paper that has investigated copper exposure through supplementation or any other method that indicates copper intake in human subjects with type 2 diabetes and measures at least one of the outcomes of interest related to diabetes was included in this review. This review is comprised of 4 cross-sectional studies, 3 cohort studies, 2 RCTs, and 2 interventional studies. Two cohort studies found positive associations between copper intake and the risk of developing T2DM, while no significant association was found in the third study. Regarding diabetes outcomes in the four cross-sectional studies, two found inverse associations, one found a positive relationship, and one found no significant association. In interventional studies, all studies found a protective effect of copper, including the RCT, while one found no significant association. The results are inconsistent concerning the association between copper consumption and the likelihood of developing diabetes are inconsistent. Individuals should receive an adequate dietary amount of copper that is within the RDA levels (900 µg/day) to avoid copper deficiency or toxicity. Further studies, especially RCTs, are strongly needed to enable researchers to elucidate more robust conclusions regarding this association.

Health-related quality of life and its determinants among patients with diabetes mellitus: a multicentre cross-sectional study in Northwest Ethiopia

OBJECTIVES

This study assessed the health-related quality of life (HRQoL) and its determinants in patients with diabetes.

DESIGN AND SETTING

An institutional-based multicentre prospective cross-sectional study design was conducted in diabetes follow-up clinics of selected hospitals in Northwest Ethiopia from April to July 2022.

PARTICIPANTS

All eligible adult patients with diabetes at the selected facilities.

MAIN OUTCOME MEASURES

HRQoL was measured using EuroQol 5-dimensions 5-levels (EQ-5D-5L) and the EuroQol-Visual Analogue Scales (EQ-VAS) instruments. A lower EQ-5D-5L utility mean score for each dimension and/or an overall lower utility score of EQ-5D-5L and EQ-VAS scores are intended to show poor HRQoL. Linear regression analysis was used to identify the association of HRQoL and other variables.

RESULTS

Out of the 422 samples approached, 402 (95.3%) participated in the study. Most of the participants (>85%) reported having moderate-to-severe problems in all five EQ dimensions. The overall EQ-5D-5L utility and EQ-VAS scores were 0.56 (±0.11) and 56.7 (±10.1), respectively. A higher body mass index (BMI) (p < 0.001), a higher number of medications (p = 0.037), a high level of blood glucose (p < 0.001), the presence of comorbidities and/or complications (p = 0.031), hypoglycaemia (p = 0.043) and taking insulin (p < 0.001) were associated with worsened HRQoL, whereas practicing self-monitoring of blood glucose (p = 0.002) and taking aspirin (p = 0.008) had a significant association with increased HRQoL.

CONCLUSION

This study concluded that the HRQoL of patients was compromised in all five measuring dimensions. The EQ-5D-5L utility and EQ-VAS scores were far lower than other findings. Clinical and medication-related variables, such as a higher BMI, a higher number of medications, the presence of comorbidities and/or complications, hypoglycaemia and insulin use were associated with poor HRQoL in patients with diabetes. As a result, interventions should be individualised and focused on determinant factors.

Health-related Quality of Life among Type 2 Diabetes Patients in Southern Province of Saudi Arabia using WHOQOL-BREF: A Cross-section Study

BACKGROUND

Quality of life has become a more important health outcome with advancements in medical therapies and disease management, leading to better lives for people in general, particularly those living with chronic diseases. Diabetes has a direct impact on the physical, psychological, and social aspects of personal health. This study aimed to determine healthrelated quality of life (HRQOL) and its predictors in patients with type 2 diabetes.

METHODS

A cross-sectional study was carried out on 420 patients with type 2 diabetes who presented to primary healthcare centers in Samtah Town, Saudi Arabia, from March 2017 to February 2018. The HRQOL of the study participants was determined using the World Health Organization Quality of Life-BREF. Multi-level linear regression was employed to ascertain the factors associated with HRQOL among patients with type 2 diabetes.

RESULTS

Female sex was significantly associated with higher HbA1c, anxiety, depression, and stress scores and a lower HRQL in the physical, psychological, and environmental health subscales than males (P<0.001). All subscales of HRQOL were significantly lower in the > 50 years age group. When compared to those with low levels of education (illiterate, primary, or elementary school), patients with secondary and bachelor's degrees had significantly higher HRQOL in all subscales (P<0.001). In addition, there were significant differences in glycemic control and HRQL with a longer duration of diabetes, the presence of one or more diabetes complications, and the presence of comorbid hypertension (P<0.001). However, no significant differences in the Depression Anxiety and Stress Scale (DASS) index were observed with a longer duration of diabetes and the presence of comorbid hypertension. Patients with diabetes on combined therapy and healthy diet and exercise showed significantly higher HRQOL on physical functioning (P<0.001).

CONCLUSION

Type 2 diabetes was significantly associated with impaired health-related quality of life and mental health among study participants. Females appeared to have worse quality of life and mental health than males. Age, duration of diabetes, comorbid hypertension, diabetes complications, and level of education were significantly associated with lower HRQOL and mental health scores. Healthy diet and exercise, when combined with hypoglycemic and insulin therapy, were found to improve HRQOL and mental health among patients with diabetes. Scales based on a broad definition of health, such as the WHOQOL-BREF, are appropriate for use in primary care settings and can enhance patient management and care.

Predicting Factors of Health-Related Quality of Life Among Adults With Type 2 Diabetes: A Systematic Review

Introduction

One of the most important outcomes of diabetes care and treatment is an improvement in patients' health-related quality of life (HRQoL).

Objective

This study aimed to review the empirical evidence regarding the predictors of HRQoL among adults with type 2 diabetes mellitus (T2DM).

Methods

To find all English-language articles published between 2012 and 2022, a comprehensive literature search was conducted using ProQuest, Scopus, PubMed, Science Direct, and CORE. Cross-sectional studies were the focus of this analysis. Search terms included "type 2 diabetes" OR "T2DM" AND "health-related quality of life" OR "HRQoL" AND ("predicting factors" OR "influencing factors" OR "associated factors"). The original search yielded a total of 1,089 studies, from which 35 met the review's inclusion criteria. The systematic review protocol was registered with PROSPERO CRD42023431229.

Results

The final analysis comprised 24,346 people with type 2 diabetes and used data from 35 cross-sectional studies conducted during the preceding decade. Socio-demographic factors (age, marital status, gender, monthly income, education, area of residence, and religiosity), patient-centered factors (diabetes knowledge and self-efficacy), disease characteristics (comorbidities, duration of diabetes, and insulin treatment), self-management behaviors (physical activity, medication adherence, and frequent glucose checks), and family support were found to be predictors of HRQoL.

Conclusion

A diabetes program to enhance the HRQoL among people with T2DM is highly encouraged to address these factors, which can be focused on promoting self-management behaviors, diabetes distress management, and encourage family support.

Type 2 diabetes and atrial fibrillation could cause transient ischemic attack

Diabetes mellitus (DM) is still one of the common chronic problems not only in rural but also the urban cities. While the regulation of blood sugar metabolism is one of the target points, living with DM can trammel primary care physicians. 64 years old female patient who was diagnosed with DM and hypertension for at least 5 years has attended the surgery for nuisance and dysuria. Bacteriuria has detected and blood sugar was 550 mg/dl WBC= 12,48 CRP: 7 HbA1C: 10,4 % Her neurologic examination was normal except she has got urinary incontinence. She was hospitalized with a diagnosis of DM, HT, and cystitis. Metformin 2x1gr, 1x 40 mg, ceftriaxone 2x1gr, and insulin glargine were ordered. Diabetic patient education has been performed. During follow-up, her blood sugar regulation has been settled but she complained of palpitation, ECG has been performed and diagnosed as AF (atrial fibrillation). Her blood pressure was 120/80 and metoprolol infusion was made. INR: 1,44 sec PT=17sn creatine=0,9 mg/dl. Control ECG was at sinus rhythm. While she was in time of recovery, internal medicine consultation has performed and she was planned to discharge. She complained about "could not talk". In her neurologic examination, her left arm has lost strength (3/5) and she could hear and understand what was told but couldn't speak. She was transferred to another health center for detection and treatment as pre-diagnose of Transient Ischemic Attack (TIA). DM never walks alone. At primary health care centers physicians should be aware of chronic conditions as well as the new onset problems to manage.

Investigating patients' preferences for new anti-diabetic drugs to inform public health insurance coverage decisions: a discrete choice experiment in China

Background

Diabetes is a major public health concern with a considerable impact on healthcare expenditures. Deciding on health insurance coverage for new drugs that meet patient needs is a challenge facing policymakers. Our study aimed to assess patients’ preferences for public health insurance coverage of new anti-diabetic drugs in China.

Methods

We identified six attributes of new anti-diabetic drugs and used the Bayesian-efficient design to generate choice sets for a discrete choice experiment (DCE). The DCE was conducted in consecutive samples of type 2 diabetes patients in Jiangsu Province. The mixed logit regression model was applied to estimate patient-reported preferences for each attribute. The interaction model was used to investigate preference heterogeneity.

Results

Data from 639 patients were available for analysis. On average, the most valued attribute was the improvement in health-related quality of life (HRQoL) (β = 1.383, p < 0.001), followed by positive effects on extending life years (β = 0.787, p < 0.001), and well-controlled glycated haemoglobin (β = 0.724, p < 0.001). The out-of-pocket cost was a negative predictor of their preferences (β = -0.138, p < 0.001). Elderly patients showed stronger preferences for drugs with a lower incidence of serious side effects (p < 0.01) and less out-of-pocket costs (p < 0.01). Patients with diabetes complications favored more in the length of extended life (p < 0.01), improvement in HRQoL (p < 0.05), and less out-of-pocket costs (p < 0.001).

Conclusion

The new anti-diabetic drugs with significant clinical effectiveness and long-term health benefits should become the priority for public health insurance. The findings also highlight the value of accounting for preference heterogeneity in insurance policy-making.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14244-z.

Bioactive functional collagen-oxidized pullulan scaffold loaded with polydatin for treating chronic wounds

Prolonged inflammation, elevated matrix metalloproteinases, hypoxia, decreased vascularization, increased oxidative stress, and bacterial infection are typical signs of chronic non-healing diabetic wounds. Any agent that improves one or all factors could offer enhanced opportunities for better healing of diabetic wounds. In this study, a polyphenol (polydatin) incorporated collagen scaffold was prepared using a biocompatible crosslinker, oxidized pullulan (Col-OxP3-Po), to treat diabetic wounds. The scaffolds were characterized using SEM, FTIR, antioxidant activity, in vitro and in vivo wound healing assay, gene expression, and immunohistopathological studies. Polydatin incorporated scaffold exhibited 75 % antioxidant activity, hemostatic and erythrocyte adhesion properties. FTIR results proved the incorporation of polydatin in the Col-OxP3-Po scaffold. They were also non-toxic to the 3 T3 fibroblasts with a viability of 93 % and good cell attachment. In vivo, normal and diabetic wound healing studies showed that the Col-OxP3-Po scaffold treated group healed on days 16 and 21. The histological and immunohistochemistry analyses of the granulation tissues showed improved epithelialization, angiogenesis and enhanced collagen deposition by modulating TGF-β3 and MMP - 9 gene expressions favorable for better healing. Thus, this scaffold could be a newer treatment strategy for chronic non-healing wounds.

Prediction models of diabetes complications: a scoping review

BACKGROUND

Diabetes often places a large burden on people with diabetes (hereafter 'patients') and the society, that is, in part attributable to its complications. However, evidence from models predicting diabetes complications in patients remains unclear. With the collaboration of patient partners, we aimed to describe existing prediction models of physical and mental health complications of diabetes.

METHODS

Building on existing frameworks, we systematically searched for studies in Ovid-Medline and Embase. We included studies describing prognostic prediction models that used data from patients with pre-diabetes or any type of diabetes, published between 2000 and 2020. Independent reviewers screened articles, extracted data and narratively synthesised findings using established reporting standards.

RESULTS

Overall, 78 studies reported 260 risk prediction models of cardiovascular complications (n=42 studies), mortality (n=16), kidney complications (n=14), eye complications (n=10), hypoglycaemia (n=8), nerve complications (n=3), cancer (n=2), fracture (n=2) and dementia (n=1). Prevalent complications deemed important by patients such as amputation and mental health were poorly or not at all represented. Studies primarily analysed data from older people with type 2 diabetes (n=54), with little focus on pre-diabetes (n=0), type 1 diabetes (n=8), younger (n=1) and racialised people (n=10). Per complication, predictors vary substantially between models. Studies with details of calibration and discrimination mostly exhibited good model performance.

CONCLUSION

This rigorous knowledge synthesis provides evidence of gaps in the landscape of diabetes complication prediction models. Future studies should address unmet needs for analyses of complications n> and among patient groups currently under-represented in the literature and should consistently report relevant statistics. SCOPING REVIEW REGISTRATION: https://osf.io/fjubt/.

Zingiber officinale ameliorates diabetic nephropathy and hepatotoxicity in rats by preventing tissue injury and controlling liver/kidney function

BACKGROUND: Chronic hyperglycemia results in decrease glucose metabolism leading to nephropathy, hepatotoxicity and neuropathy. Diabetic complications are regarded globally as one of the leading cause of disability and mortality. OBJECTIVE: The study aims to evaluate the role of Zingiber officinale (ZO) on diabetic nephropathy and hepatotoxicity in rats. METHODS: Thirty diabetic rats and six non-diabetic rats were distributed into six groups (n = 6). Group 1 & 2 (nondiabetic and diabetic) received distilled water at 1 ml/kg. Groups 3–5 received (12.5, 25& 50) mg/kg of ZO respectively while group 6 received 100 mg/kg metformin. All treatments lasted for 28 days and rats were euthanized on day 29. Biochemical parameters, kidney and liver histology were evaluated. RESULTS: No significant change (P >  0.05) was noticed in blood glucose and creatinine levels of diabetic rats treated with 25 mg/kg ZO compared to control. The liver of 25 mg/kg ZO treated diabetic rats showed mild distortion of hepatocytes while kidneys of ZO treated diabetic rats showed mild distortion of renal tubules with few collagen deposits and intact Bowman’s capsule. CONCLUSIONS: ZO ameliorates diabetic complications by regulating biochemical parameters and preventing renal tubules and hepatocytes damage in rats.

Health-related quality of life of patients with type 2 diabetes mellitus at a tertiary care hospital in Ethiopia

Background

Type 2 diabetes mellitus (T2DM) and its treatment impact patients’ physical health as well as emotional and social wellbeing. This study aimed to assess health-related quality of life (HRQoL) and associated factors among patients with T2DM at a tertiary care hospital in Ethiopia.

Methods

A face-to-face cross-sectional survey was conducted among patients with T2DM at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. We collected data using a validated Amharic version of the 5-level EuroQoL-5 dimensions (EQ-5D-5L) questionnaire. Descriptive statistics were used to present patient characteristics. Kruskal-Wallis and Mann-Whitney U tests were performed to explore differences in the median scores of EQ-5D-5L utility and visual analog scale (EQ-VAS). Multivariable Tobit regression models were used to identify predictors of HRQoL. Utility scores were calculated using disutility weights of the Ethiopian general population. Statistical significance was determined at p < 0.05.

Results

A total of 360 patients with T2DM participated. Mean (SD) age was 64.43(10.61) years. Reported health problems were mostly in the pain/discomfort (67.3%) dimension followed by mobility (60.5%), whereas the usual activities domain (34.1%) was the least health problem being reported. The median (IQR) EQ-5D-5L utility and EQ-VAS scores were 0.95 (0.88–0.96) and 80 (75.0–85.0), respectively. In multivariable Tobit regression models older age, having poor glycemic control, longer duration of diabetes, insulin usage, obesity, and having diabetes-related complications were significant negative predictors of HRQoL.

Conclusions

Overall, patients with T2DM had lower HRQoL than the general population, which was attributed to being older age, longer duration of diabetes, insulin use, obesity, inadequate glycemic control, and diabetes-related complications. The utility index we generated can be used in future economic evaluations to inform decisions about alternative interventions and resource allocation.

Factors Associated with Quality of Life in Patients with Type 2 Diabetes of South Benin: A Cross-Sectional Study

Background: Type 2 diabetes (T2D) adversely affects health-related quality of life (QoL). However, little is known about the QoL of diabetic patients in Benin, where the disease is a growing concern. Thus, this study aims to assess the QoL and its associated factors among T2D patients in Cotonou, southern Benin. Methods: A total of 300 T2D patients (age > 18 years) were enrolled, and the diabetes-specific quality of life (DQoL) and Natividad self-care behaviors’ (SCB) instruments were used for data collection. DQoL scores were calculated, and factors associated with DQoL explored using logistic regression. Results: The mean of patients’ DQoL was 38.1 ± 4.1, with 43% having low QoL. In terms of DQoL, 56.3% reported a high diabetes impact, followed by low life satisfaction (53%) and high worry about diabetes (32.7%). In the logistic regression analysis, education, marital status, occupation, family history of diabetes, complications, and social support were associated with DQoL. SCB factors, including healthy eating, problem-solving, coping strategies, and risk reduction, were significant predictors of DQoL. Conclusions: Patients’ empowerment, starting with self-management education, is essential to improve the QoL of T2D patients in Cotonou. However, the programs need to target low education, low socioeconomic status, low social support, and overweight patients.

Dual-strategy biosensing of glucose based on multifunctional CuWO4 nanoparticles

The multifunctional CuWO4 NPs were prepared and exhibit large specific surface area, good conductivity and excellent peroxidase-like activity, which was exploited for electrochemical and colorimetric dual-strategy biosensing of glucose.

Health Utilities in Patients with Type 2 Diabetes in Taiwan

We aimed to measure health utilities in patients with diabetes mellitus (DM) in Taiwan and to estimate the impact of common DM-related complications and adverse effects (AEs) on health utilities. The present study was a cross-sectional survey of DM patients at a metropolitan hospital. Respondents’ health-related quality of life (HRQoL) was assessed by the EQ-5D-5L, and ordinary least-squares (OLS) regression was used to estimate the impact of self-reported DM-related complications and AEs on health utilities after controlling for age, gender, and duration of DM. A total of 506 eligible adults with type 2 DM (T2DM) were enrolled. The EQ-5D index values in our study sample ranged from −0.13 to 1, with a mean ± standard deviation of 0.88 ± 0.20. As indicated by the negative regression coefficients, the presence of any complication or AE was associated with lower EQ-5D index values, and the greatest impact on the score was made by amputation (−0.276), followed by stroke (−0.211), and blindness (−0.203). In conclusion, the present study elicited health utilities in patients with T2DM in Taiwan using the EQ-5D-5L. These estimated utility decrements provided essential data for future DM cost–utility analyses that are needed as a result of the increasing prevalence and health expenditures of DM.

Inhibition of Advanced Glycation End Product Formation in Rat Tail Tendons by Polydatin and p-Coumaric acid: an In Vitro Study

Advanced glycation end products (AGEs) formed through non-enzymatic glycosylation between a protein and sugar molecule are highly harmful to the human body. In hyperglycemic patients, AGE formation is more due to high glucose circulating in the blood, causing inter and intra molecular cross-linking of collagen leading to reduction of collagen elasticity. This cross-linked collagen develops resistance to matrix metalloproteinases leading to impaired collagen turnover. The aim of this work is to determine the anti-glycation effects of polydatin and p-coumaric acid in preventing collagen cross-linking by incubating rat tail tendons (RTTs) as collagen source in high glucose concentration (50 mM) for a week. The RTTs were then characterized for tensile strength, cross-linking efficiency, circular dichroism spectrometry, collagen, glucose, and aldehyde contents. Electrophoresis was carried out to evaluate the level of cross-linking in collagen and the results confirmed the ability of the drugs in preventing complex intermolecular cross-link formation induced by non-enzymatic glycosylation. CD data showed alteration in the secondary structure of collagen where AGE formation had occurred. More collagen was extracted by pepsin from RTTs treated with glucose alone (6.88 mg/10 mg tendon) when compared with drug-treated groups (4.25, 2.56 mg/10 mg tendon for polydatin and p-coumaric acid, respectively). Tensile strength (20.66% and 18.95%), cross-linking percentage (32.5% and 29.84%), and glucose content (2.3 and 1.8 mg/100 mg) of drug-treated groups were similar to the positive control (19.07%, 30.13%, and 2.61 mg/100 mg) thus proving the anti-glycation potential of the drugs. Hence, both polydatin and p-coumaric acid could play a pivotal role in preventing AGE formation.

Valuing health states of people with type 2 diabetes: Analyses of the nationwide representative linked databases

AIMS/INTRODUCTION

To estimate preference-based measures of health-related quality of life associated with sociodemographic and clinical characteristics in type 2 diabetes patients.

MATERIALS AND METHODS

Individuals with EuroQol-5 dimensions-3 levels data were identified from Taiwan's National Health Interview Survey in 2009 and 2013. Status of diabetes, comorbidities, complications and treatments were ascertained through data linkage to Taiwan's National Health Insurance Research Database. Multivariable ordinary least squares, Tobit and median regression analyses were used to estimate the coefficients that represented independent impacts of patients' characteristics on health-related quality of life.

RESULTS

The mean health utility score for 2,104 participants was 0.838. Being female, aging, divorced/widowed, never worked or underweight, or having a lower monthly household income, injectable glucose-lowering therapy, comorbid connective tissue disease or depression were associated with lower health utilities. Having an amputation led to the largest reduction by 0.288 in health utilities, followed by debilitating stroke (0.266), heart failure (0.237), other coronary heart disease (0.185), kidney dialysis/transplant (0.148), coronary revascularizations (0.093), transient ischemic attack/stroke (0.078), diabetic neuropathy (0.062), polyneuropathy (0.055) and other neuropathy (0.043).

CONCLUSIONS

Major vascular complications, connective tissue disease and depression are associated with considerably worse health-related quality of life. These health utility estimates can facilitate health economic evaluations to determine cost-effective strategies for diabetes management.

Health State Utility Values for Type 2 Diabetes and Related Complications in East and Southeast Asia: A Systematic Review and Meta-Analysis

OBJECTIVES

East and Southeast Asia has the greatest burden of diabetes in the world. We sought to derive a reference set of utility values for type 2 diabetes without complication and disutility (utility decrement) values for important diabetes-related complications to better inform economic evaluation.

METHODS

A systematic review to identify utility values for diabetes and related complications reported in East and Southeast Asia. We searched MEDLINE (OVID) from inception to May 26, 2020 for utility values elicited using direct and indirect methods. Identified studies were assessed for quality based on the National Institute of Health and Care Excellence guidelines. Utility and disutility estimates were pooled by meta-analyses with subgroup analyses to evaluate differences by nationality and valuation instrument. (PROSPERO: CRD42020191075).

RESULTS

We identified 17 studies for the systematic review from a total of 13 035 studies in the initial search, of which 13 studies met the quality criteria for inclusion in the meta-analyses. The pooled utility value for diabetes without complication was 0.88 (95% CI 0.83-0.93), with the pooled utility decrement for associated complications ranged from 0.00 (for excess BMI) to 0.18 (for amputation). The utility values were consistently more conservative than previous estimates derived in Western populations. Utility decrements were comparable for SF-6D and EQ-5D valuation instruments and for Chinese and other Asian groups.

CONCLUSIONS

A reference set of pooled disutility and utility values for type 2 diabetes and its complications in East and Southeast Asian populations yielded more conservative estimates than Western populations.

Estimating Utility Values for Health States of DFU Patients Using EQ-5D-5L and cTTO

Health-state utility values of diabetic foot ulcer (DFU) patients are necessary for clinical praxis and economic modeling. The purpose of this study was to estimate utility values in DFU patients using the EuroQol-5-dimension-5-level (EQ-5D-5L) and composite time trade-off (cTTO). The EQ-5D-5L and cTTO were used for estimating utility values. Data were collected from 228 patients referred to the largest governmental diabetes center in the South of Iran, Yazd province. When appropriate, independent sample t-test or analysis of variance test was used to test the difference in the utility values in each of the demographic and clinical characteristics of the patients. Finally, the BetaMix was used to identify predictors of the utility values. The means of EQ-5D-5L and cTTO values were 0.55(SD 0.21) and 0.67(SD 0.23), respectively. Anxiety and pain were the most common problems reported by the patients. The difference between the mean EQ-5D-5L values was significant for age, grade of ulcer, number of comorbidities, and having complications. In addition, variables of gender, age, grade of ulcer, and having complications were significant predictors of the EQ-5D-5L. The difference between the mean cTTO values was significant for age, employment status, grade of ulcer, number of comorbidities, and having complications. Moreover, variables of gender, age, grade of ulcer, number of comorbidities, and developing complications were significant predictors of cTTO. The current study provided estimates of utility values for DFU patients for clinical praxis and economic modeling. These estimates, similar to utilities reported in other studies, were low. Identifying strategies to decrease anxiety/depression and pain in patients is important to improve the utility values.

Effects of a health education technology program on long-term glycemic control and self-management ability of adults with type 2 diabetes: A randomized controlled trial

AIMS

This study aimed to explore the effects of a health technology education program on long-term glycemic control and the self-management ability of adults with type 2 diabetes (T2D).

METHODS

The study was a randomized controlled trial with repeated measures design. The experimental group (n = 53) received a novel health technologies education program plus focus groups and routine shared care, the control group (n = 55) received routine shared care. Glycosylated hemoglobin (HbA1c) level and self-management ability were the primary and secondary outcomes. Subject self-management ability was evaluated using the Chinese version of Perceived Diabetes Self-Management Scale (PDSMS). A linear mixed-effect model for repeated measures was used to analyze changes in HbA1c level and self-management ability after controlling for pretest effects.

RESULTS

The mean HbA1c levels in the experimental group decreased by 0.692% (7.564 mmol/mol) and 0.671% (7.332 mmol/mol) at 3 and 6 months after the intervention (p < 0.05) while the mean increase in the PDSMS scores at 3 and 6 months after the intervention were significantly higher than those in the control group (p < 0.05).

CONCLUSION

The health technology education program was more effective than routine shared care alone in lowering HbA1c and increasing self-management ability in T2D patients.

The association between diabetic complications and health-related quality of life in patients with type 2 diabetes: a cross-sectional study from Iran

INTRODUCTION

This study aimed to investigate the health-related quality of life (HRQoL) of type 2 diabetic patients and its relationship with the complications of diabetes in Farashband County, Fars, Iran.

METHODS

Data of this cross-sectional study were collected by a researcher-made demographic questionnaire, EuroQol-5 Dimensions questionnaire (EQ-5D) and Visual Analog Scale (VAS) and also from patient records. Multivariate regression model was used to investigate the net effect of diabetes complications on HRQoL after controlling for other independent variables.

RESULTS

A total of 685 patients with a mean age of 58.36 and a disease duration of 7.64 years participated in the study. The mean EQ-5D and EQ-VAS scores of all patients were 0.64 and 56.53, respectively. The HRQoL dimensions in which the largest portions of the population had problems were Pain/Discomfort (77.23%) and Anxiety/Depression (63.50%). Among the studied diabetic patients, women, divorcees, and widows were more likely to report problems in all dimensions of HRQoL, and people without complications, people with university degrees, and employed people were more likely to report fewer problems in these dimensions (P < 0.05). After controlling for the effect of all independent variables in the multivariate regression model, a significant negative relationship was found between diabetes complications and EQ-5D: β =  - 0.149 (95% CI - 0.186, - 0.112) and EQ-VAS: β =  - 6.697 (95% CI - 9.947, - 3.747). This indicates that for each additional diabetic complication, 0.149 and 6.697 units of EQ-5D Index and EQ-VAS were reduced, respectively.

CONCLUSION

This study indicated that type 2 diabetic patients in the studied region, especially those with complications, suffer from poor HRQoL. Therefore, more attention should be paid to the main determinants of HRQoL when adopting policies for diabetes management in order to ultimately improve the HRQoL of these patients.

High blood glucose levels are associated with fibrosis/cirrhosis progression in chronic hepatitis C

Chronic hepatitis C (CHC) leads eventually to liver fibrosis, advanced hepatic disease and related deaths. Therefore, it is very important to assess clinical risk factors associated with rapid CHC and hepatic fibrosis progression. Former studies reported diabetes mellitus synergistic interactions with other host factors to fibrosis progression. Here, we aimed to evaluate the association between elevated blood glucose levels and CHC progression according to METAVIR system in patients chronically infected with HCV-genotype 4 and to evaluate the correlation between elevated glucose levels and liver- and viral-related biochemical parameters. A total of 160 patients with CHC (80 with liver fibrosis and 80 with cirrhosis) and 40 healthy volunteers, negative for HCV, were included. Our results revealed that cirrhotic patients had high (P = .0001) fasting (169.1 ± 50.2 mg/dL), postprandial (208 (123-320) mg/dL), and random (176.8 ± 51 mg/dL) glucose levels compared to patients with liver fibrosis (105.0 ± 32, 120 (105-135), and 113.5 ± 35 mg/dL, respectively). Mean serum fasting, postprandial and random glucose levels were significantly (P = .0001) increased with an increase in fibrosis stages, F1< F2< F3< F4. Blood glucose levels were also significantly (P < .05) correlated with liver disease related biological parameters and HCV-Ab titer. In conclusion, our results highlighted the fibrogenic impact of elevated glucose levels on CHC patients.

Depressive Symptoms among Patients with Diabetes in Qatar: Frequency and Potential Determinants

Background: Diabetes is a highly prevalent chronic disease that is associated with major complications. Findings regarding risk of depression among patients with diabetes are controversial. This study aimed to determine the prevalence and determinants of depressive symptoms among Qatari patients with type 2 diabetes. Methods: This cross-sectional study was based on Qatar Biobank (QBB) data of 2448 Qatari adults with diabetes aged 21–60 years old. Data regarding age, gender, education, income, body mass index (BMI), medication use, glycated hemoglobin (HbA1c) were retrieved. Patients’ responses to the Patient Health Questionnaire-9 (PHQ-9) were also obtained. Data analyses was performed using STATA 16, and statistical significance was considered at a p-value of <0.05. Results: Of the 2448 participants, 15.4% (n = 378) had self-reported depressive symptoms. Depressive symptoms were frequent among females (69.6%), smokers (15.9%), and participants with a higher level of education (47.1%). Average age of participants who reported depressive symptoms was significantly less that among participants without depressive symptoms (44.8 vs. 52.9 years). Qatari women with diabetes seem to be at higher risk of depression when compared to men (OR = 1.819, 95% CI: 1.42–2.33); The odds of reporting depressive symptoms were 35% higher among patients with more advanced educational qualifications (OR = 1.351, 95% CI: 1.00, 1.82). Smokers were twice as likely to report depressive symptoms as their non-smoking counterparts. There was no significant relationship between depression and poor glycemic control, physical activity, BMI, or insulin use. Conclusions: In summary, the study results suggest that several sociodemographic factors, such as age, gender, and level of education were associated with the risk of depressive symptoms among Qataris with diabetes.

Health-related quality of life and associated factors among patients with type II diabetes mellitus: A study in the family medicine center (FMC) of Agricultural General Hospital in Hanoi, Vietnam

The current study aimed to examine the health-related quality of life (HRQoL) and to identify its related factors amongst adult patients with type 2 diabetes mellitus (T2DM). This cross-sectional study recruited randomly 519 patients diagnosed with T2DM for at least 6 months in the Family medicine center (FMC) of Agricultural General Hospital in Hanoi, Vietnam. The Short Form 36 (SF-36) health survey was used to measure their HRQoL. The female patients had lower physical and mental scores than the male patients. Patients with older age, comorbidity, and insulin treatment were more likely to have lower HRQoL. Meanwhile, educational attainment and having frequent exercise were positively associated with HRQoL.

Comparing the incidence of major cardiovascular events and severe microvascular complications in patients with type 2 diabetes mellitus: A systematic review and meta-analysis

BACKGROUND

Type 2 diabetes mellitus (T2DM) causes both macrovascular and microvascular complications. However, currently, selection of glycemic measures and their thresholds to diagnose T2DM, and efficacy outcomes in evaluation of anti-diabetic drugs is predominantly informed by the relation of T2DM to microvascular complications. We can be severely mistaken on T2DM by neglecting macrovascular complications which are generally more severe, if they also occur more commonly than microvascular complications.

AIM

To compare the incidence of major cardiovascular events (MACEs) and severe microvascular complications (SMICs) in T2DM patients.

METHODS

MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from inception to September 2017. Cohort studies or trials of T2DM patients aged 18 years or older that reported incidence of both MACEs and SMICs were included. MACEs were defined as nonfatal myocardial infarction and stroke, and cardiovascular death, while SMICs included serious retinopathy, nephropathy and diabetic disorder. The relative risk (RR) was estimated as the incidence of MACEs divided by that of SMICs in same patients and combined with meta-analysis in a random-effect model.

RESULTS

Twelve studies with a total of 16 cohorts and 387376 patients were included, and the combined RR was 2.02 (95%CI: 1.46–2.79). The higher incidence of MACEs remained in various subgroup and sensitivity analyses.

CONCLUSION

Patients with T2DM are much more likely to develop MACEs than SMICs. By taking more serious consequences and relatively higher incidence into consideration, macrovascular complications deserve more emphasis in developing the diagnostic criteria of T2DM and in evaluating the efficacy of anti-diabetic drugs.

Health-related quality of life and its associated factors in patients with type 2 diabetes mellitus

Background:

Assessing the health-related quality of life in patients with type 2 diabetes mellitus is important for evaluation of treatment outcome. The purpose of this study was to evaluate the health-related quality of life in type 2 diabetes mellitus patients and its related factors in Yazd.

Methods:

Data were gathered by using the EuroQoL-five-dimension-5 level instrument as well as using medical records of 734 outpatients with type 2 diabetes mellitus who were referred to the largest governmental diabetes center in South of Iran, Yazd province. When appropriate, the Kruskal–Wallis test or the Wilcoxon test was used to test the difference in the health-related quality-of-life scores in each factor. Finally, the adjusted limited dependent variable mixture model was developed to investigate factors associated with health-related quality-of-life scores.

Results:

The mean and median of the EuroQoL-five-dimension-5 level index values of 717 patients who completed the questionnaires were 0.75 ± 0.006 and 0.72 ± 0.20, respectively, and those of the Visual Analogue Scale scores were 69.25 ± 0.63 and 75 ± 30, respectively. The mean scores for health-related quality of life were significantly higher for employed, educated, single, and male patients, as well as patients without comorbidities, diabetes-related complications, and hemoglobin A1c level >7%. Adjusted limited dependent variable mixture model showed that gender, age, marital status, and diabetes-related complications are significant independent predictors of EuroQoL-five-dimension-5 level index value.

Conclusion:

The mean scores for health-related quality of life in patients with type 2 diabetes mellitus were moderate in this study, and this finding is consistent with health-related quality-of-life scores reported in other studies conducted in the Middle East region. Therefore, health-related quality of life should be the most important consideration in the management of patients. In parallel, some factors, especially gender, should be considered to improve health-related quality of life.

Class 3 Obesity in a Multidisciplinary Metabolic Weight Management Program: The Effect of Preexisting Type 2 Diabetes on 6-Month Weight Loss

INTRODUCTION

Class 3 obesity (BMI ≥ 40 kg/m²) is a growing health problem worldwide associated with considerable comorbidity including Type 2 diabetes mellitus (T2DM). The multidisciplinary medical management of obesity can be difficult in T2DM due to potential weight gain from medications including sulphonylureas and insulin. However, newer weight-neutral/losing diabetes medications can aid additional weight loss. The aim of this study was to compare weight loss outcomes of patients with and without T2DM, and in patients with T2DM, to compare diabetes outcomes and change in medications at 6 months.

METHODS

All patients entering a multidisciplinary weight management metabolic program in a publicly funded hospital clinic in Sydney between March 2018 and March 2019, with BMI ≥ 40 kg/m² and aged ≥18 years were included. Data was collected from patient clinical and electronic notes at baseline and 6 months.

RESULTS

Of the 180 patients who entered the program, 53.3% had T2DM at baseline. There was no difference in percentage weight loss in those with or without T2DM (4.2 ± 4.9% vs. 3.6 ± 4.7%, p = 0.35). Additionally, T2DM patients benefited from a 0.47% reduction in HbA1c (p < 0.01) and a reduction in the number of medications from baseline to 6 months (1.8 ± 1.0/patient vs. 1.0 ± 1.2/patient, p < 0.001). T2DM patients who started on weigh-neutral/losing medications in the program lost more weight than those started on weight-gaining medications (7.7 ± 5.3% vs. 2.4 ± 3.8%, p = 0.015).

CONCLUSIONS

Patients with class 3 obesity had significant weight loss at 6 months in this program. Patients with T2DM at baseline had comparable weight loss at 6 months, a significant improvement in glycaemic control, and a reduction in diabetes medication load. Additionally, patients with T2DM who were started on weight-neutral/losing medications lost significantly more weight than those started on weight-gaining medications, and these medications should be preferentially used in class 3 obesity and comorbid T2DM.