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Ambaye AS, Mengiste FY, Demise N, Derseh MT, Abebe A, Yayehrad AT, Endalifer BL. Prevalence of Hypoglycemia and Its Determinants Among Diabetes Patients on Insulin Treatment at Tepi General Hospital, Southwest, Ethiopia. Patient Prefer Adherence 2024; 18:1151-1161. [PMID: 38868670 PMCID: PMC11168415 DOI: 10.2147/ppa.s458091] [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: 03/06/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024] Open
Abstract
Background Hypoglycemia occurs when the blood sugar levels are too low. In severe cases, hypoglycemia may give to seizures, coma, and sometimes death. The prevalence of hypoglycemia among patients with diabetes is likely underreported and undocumented. Methods An institutional-based cross-sectional study was conducted among 336 study participants at the Tepi General Hospital in Southwest Ethiopia. A binary logistic regression model was used to determine the association between the prevalence of hypoglycemia and the factors associated with it. After a bivariate analysis, variables with a p value of < 0.25 were selected as a candidate for multivariable analysis. An odds ratio with a 95% CI was considered to indicate a significant association. Results With 95% CI (52.48-62.25) the prevalence of hypoglycemia was determined as 57.44%. Nearly 11% of the patients encounter severe hypoglycemia. Female patients had three times higher odds of experiencing hypoglycemia (aOR=3, 95% CI: 2.10, 6.39). Those with no formal education had 1.5 times higher odds of experiencing hypoglycemia (aOR = 1.5, 95% CI: 1.08, 5.45). Patients with type 1 diabetes were 3.4 times more likely to experience hypoglycemia (aOR = 3.4, 95% CI: 1.87, 7.50). Those who had been diagnosed before 10 years (aOR = 1.3, 95% CI: 1.02, 3.21) were more likely to have hypoglycemia. Furthermore, patients who consumed alcohol were 3.0 times more likely to have a history of hypoglycemia (aOR = 3.0, 95% CI: 2.03, 6.43). Conclusion The magnitude of hypoglycemia among patients with diabetes is determined to be considerable with more than half of the participants encountered hypoglycemia. There is a strong relationship between the occurrence of hypoglycemia and sex, type of diabetes, time since diagnosis, alcohol status, and education status. Therefore, all concerned parties must pay close attention to lessen the prevalence of hypoglycemia and address the problems based on the primary contributing factors.
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Affiliation(s)
- Abyou Seyfu Ambaye
- Departement of Pharmacy, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Fiseha Yirgu Mengiste
- Departement of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Netsanet Demise
- Departement of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Manaye Tamrie Derseh
- Departement of Pharmacy, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Abinet Abebe
- Departement of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | | | - Bedilu Linger Endalifer
- Departement of Pharmacy, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
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Alshowair A, Altamimi S, Alruhaimi FA, Alshahrani S, Alsuwailem F, Alkhaldi M, Abdalla H, Alkhuraiji FH, Alaqeel MS, Almureef SS, Alhawasy S, Abdel-Azeem A. Cost-Savings Associated with Multi-Disciplinary Team Approach for Reducing Macrovascular and Microvascular Complications in Patients with Type 2 Diabetes: A Predictive Model. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:211-223. [PMID: 38596283 PMCID: PMC11001564 DOI: 10.2147/ceor.s451739] [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: 11/25/2023] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Purpose This study aims to predict the expected cost savings associated with implementing a multidisciplinary team (MDT) approach to reduce macrovascular and microvascular complications among patients with type 2 diabetes mellitus (T2DM). Methods This economic evaluation study was conducted in Riyadh First Health Cluster, Saudi Arabia as a predictive model conceptualized by the authors based on models used in previous studies, particularly the CORE Diabetes Model. Our model was designed based on 1) the level of glycemic control among 24,755 T2DM patients served by MDTs; 2) the expected incidence of diabetes-related complications without intervention; 3) the predicted risk reduction of developing diabetes-related complications with MDTs. Costs of complications and cost savings were then calculated and expressed as mean incremental annual cost savings adjusted for a 1% reduction in HbA1c, and a 10 mmHg reduction in systolic blood pressure (SBP). Results Along with the expected reduction in all diabetes-related complications, the average incremental cost savings per diabetic patient is predicted to be ($38,878) with approximately ($11,108) in the year of complication onset and ($27,770) over the subsequent post-index 10-years. On adjustment of cost savings, the average incremental cost savings are predicted to be ($22,869) for each 1% reduction in HbA1c per diabetic patient and ($27,770) for every 10 mmHg reduction in SBP per diabetic patient. Conclusion MDT as a model of care is effective in glycemic control among T2DM patients with a predicted significant reduction of all diabetes-related complications and in turn, a predicted significant cost savings.
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Affiliation(s)
- Abdulmajeed Alshowair
- Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Saleh Altamimi
- Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Faisal A Alruhaimi
- Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Saad Alshahrani
- Academic and Training Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Fatima Alsuwailem
- Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Mona Alkhaldi
- Health Administration Office, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Haiam Abdalla
- Model of Care, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | | | - Montaser Saad Alaqeel
- Financial Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | | | - Salman Alhawasy
- Reporting Department, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Amro Abdel-Azeem
- Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine Zagazig University, Zagazig, Egypt
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Paudel G, Vandelanotte C, Dahal PK, Biswas T, Yadav UN, Sugishita T, Rawal L. Self-care behaviours among people with type 2 diabetes mellitus in South Asia: A systematic review and meta-analysis. J Glob Health 2022; 12:04056. [PMID: 35916498 PMCID: PMC9346342 DOI: 10.7189/jogh.12.04056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The burden of Type 2 Diabetes Mellitus (T2DM) in South Asian countries is increasing rapidly. Self-care behaviour plays a vital role in managing T2DM and preventing complications. Research on self-care behaviours among people with T2DM has been widely conducted in South Asian countries, but there are no systematic reviews that assess self-care behaviour among people with T2DM in South Asia. This study systematically assessed the studies reporting self-care behaviours among people with T2DM in South-Asia. Methods Adhering to the PRISMA guidelines, we searched six bibliographic databases (Scopus, PubMed, CINAHL, Embase, Web of Science, and PsychInfo) to identify the relevant articles published between January 2000 through March 2022. Eligibility criteria included all observational and cross-sectional studies reporting on the prevalence of self-care behaviours (ie, diet, physical activity, medication adherence, blood glucose monitoring, and foot care) conducted in South Asian countries among people with T2DM. Results The database search returned 1567 articles. After deduplication (n = 758) and review of full-text articles (n = 192), 92 studies met inclusion criteria and were included. Forward and backward reference checks were performed on included studies, which resulted in an additional 18 articles. The pooled prevalence of adherence to blood glucose monitoring was 65% (95% CI = 49-80); 64% for medication adherence (95% CI = 53-74); 53% for physical activity (95% CI = 39-66); 48% for diet (95% CI = 38-58); 42% for foot care (95% CI = 30-54). About a quarter of people with T2DM consumed alcohol (25.2%, IQR = 13.8%-38.1%) and were using tobacco products (18.6%, IQR = 10.6%-23.8%). Conclusions Our findings suggest that the prevalence of self-care behaviours among people with T2DM in South Asia is low. This shows an urgent need to thoroughly investigate the barriers to the practising of self-care and design and implement interventions to improve diabetes self-care behaviour among people with T2DM in South Asia.
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Affiliation(s)
- Grish Paudel
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia
| | - Corneel Vandelanotte
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, Australia
| | - Padam K Dahal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia
| | - Tuhin Biswas
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - Uday N Yadav
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Tomohiko Sugishita
- Section of Global Health, Division of Public Health, Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia.,Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, Australia.,Translational Health Research Institute (THRI), Western Sydney University, Sydney Australia
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Ahmedani MY, Basit A, Zia S, Hasan I, Masroor Q, Shaikh A, Khan J, Iqbal W. Evidence-based risk factors for major complications during Ramadan fasting in people with diabetes grouped under IDF-DAR risk categories. Diabetes Res Clin Pract 2022; 185:109234. [PMID: 35124097 DOI: 10.1016/j.diabres.2022.109234] [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: 09/15/2021] [Revised: 01/22/2022] [Accepted: 01/31/2022] [Indexed: 11/20/2022]
Abstract
AIM To identify evidence-based risk factors for major complications during Ramadan fasting in people with diabetes grouped under IDF-DAR risk categories. METHODS This prospective observational multicenter study was conducted by Baqai Institute of Diabetology and Endocrinology (BIDE) between April-June 2019. People with diabetes having intention to fast during Ramadan were recruited. Demographic data collection along with risk categorization was done during pre-Ramadan visit. Structured education was given on one- to-one basis to each of the study participants. Assessment of complications was done during post Ramadan visit. RESULTS A total of 1045 people with diabetes participated with near equal gender distribution. Two thirds of study population was grouped into very high- and high-risk categories. Frequencies of major hypoglycemia, major hyperglycemia, hospitalization & need to break the fast were 4.4%, 10.8%, 0.8% & 3.1% respectively. On multivariate analysis, the risk factors found for major hypoglycemia during Ramadan were male gender, use of sedatives & antidepressants & having type1 diabetes mellitus, history of DKA/HHS during last 3 months for major hyperglycemia, major hypoglycemia & hospitalization for breaking of fast while older age, acute illness, and major hypoglycemia were identified factors for hospitalization. CONCLUSION In this prospective study evidence-based risk factors for fasting related major complications were identified in people with diabetes. It is imperative to recognize these factors during pre-Ramadan risk assessment visit.
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Affiliation(s)
- Muhammad Yakoob Ahmedani
- Professor of Medicine, Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.
| | - Abdul Basit
- Professor of Medicine, Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.
| | - Shagufta Zia
- Family Medicine Specialist, AIMS Sugar Hospital, Peshawar, Pakistan.
| | - Imran Hasan
- Specialist Endocrinologist, Lahore General Hospital, Lahore, Pakistan
| | - Qazi Masroor
- Consultant Physician, Bahawal Victoria Hospital, Bahawalpur, Pakistan
| | - Abrar Shaikh
- Professor and Head Department of Medicine, Ghulam Mohammed Mahar Medical College Teachings Hospital, Sukkur, Pakistan
| | - Jehangir Khan
- Professor of Medicine, Abbottabad International Medical College, Abbottabad, Pakistan
| | - Waheed Iqbal
- Professor of Medicine, Mohtarma Benazir Bhutto Shaheed Medical College (MBBSMC), AJK, Pakistan
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Kant R, Yadav P, Pratti M, Barnwal S. Hypoglycemia: Elucidating its circadian propensity and recovery time based on clinical parameters. CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:29-37. [PMID: 35178205 PMCID: PMC8797821 DOI: 10.22088/cjim.13.1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/15/2021] [Accepted: 02/24/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND Hypoglycemia is frequently associated with insulin therapy in diabetic patients; it leads to many short and long-term complications and even death if not addressed in time. This study was undertaken to observe the circadian propensity of hypoglycemia and its recovery time based on type 2 diabetes mellitus patients' clinical parameters. METHODS We included type 2 diabetes mellitus (DM) hospitalized patients with the exclusion of patients suffering from critical illness. Data were collected for a period of three months (September to November 2019). RESULTS A total of 120 patients were included, comprising 60% males and 40% females. Approximately 55% of patients had hypoglycemic episodes at around 12 am- 6 am. The most common comorbidity present in these patients was hypertension (43.3%, P=0.931). Anemia (OR-3.765, CI-1.350-5.500, P=0.011), retinopathy (OR 6.066, CI-2.031-8.113, P=0.001), and duration of DM (OR-6.266, CI-2.209-7.774, P=0.001) were significantly associated with the recovery time of hypoglycemia, around 50±14.14min in the elderly population of age 60-70. People with BMI 22.5- 27.5 Kg/m2 took around 45.66 ± 19.37 min to recover after treatment. CONCLUSION Time taken to recover from hypoglycemic episodes vary with age and BMI. Associated comorbidities such as anemia, retinopathy, and DM duration had a significant bearing on the time taken to recover from hypoglycemia. Recovery time was directly proportional to BMI, a new finding that needs further molecular level evaluation. Circadian propensity of hypoglycemia in these patients have been identified in the early morning hours of the day.
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Affiliation(s)
- Ravi Kant
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Poonam Yadav
- Center of Excellence in Nursing Education and Research, All India Institute of Medical Sciences, Rishikesh, India
| | - Madhuri Pratti
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Shruti Barnwal
- Department of Dermatology, Govt. Doon Medical College, Dehradun, India
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Durai V, Samya V, Akila GV, Shriraam V, Jasmine A, Muthuthandavan AR, Gayathri T, Mahadevan S. Self-care practices and factors influencing self-care among type 2 diabetes mellitus patients in a rural health center in South India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:151. [PMID: 34222526 PMCID: PMC8224494 DOI: 10.4103/jehp.jehp_269_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/20/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Self-care for diabetes is very important in preventing complications of diabetes and also improving quality of life. This study aims to find the various self-care practices of type 2 diabetes patients who are being treated at a rural health center of a medical college and the factors influencing self-care. MATERIALS AND METHODS This is a hospital-based cross-sectional study. Type 2 diabetes patients registered and receiving treatment from the noncommunicable disease clinic of a rural health center were administered a pretested questionnaire, developed based on different diabetes self-care questionnaires making changes as appropriate and including most aspects of self-care practices. The proportion of compliant was then cross-tabulated with background characteristics and their glycated hemoglobin (HbA1c) levels. SPSS version 16.0 was used for the analysis. RESULTS Among 390 patients with a mean age 56 years, 25.5% adhered to at least four dietary modifications, 46% were physically active, and 57% had good compliance to drugs; hypoglycemia prevention practices ranged from 21% to 51%. Except for avoiding barefoot walking (90%), other foot-care practices were followed by only a quarter of them. Among ever users, 69.2%, 64.3%, and 29.4% have quit smoking, alcohol, and tobacco use, respectively. Adherence to dietary modifications and drug compliance were associated with a lower HbA1c level of ≤7 g% (P < 0.05). CONCLUSION In this study, the compliance to physical activity or medications is much better than dietary changes and foot-care practices. Focused education programs and monitoring during follow-up visits will improve self-care in the less adhered to aspects. Those who are adherent to dietary modifications and drugs have better glycemic control.
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Affiliation(s)
- Vanitha Durai
- Department of Community Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - V. Samya
- Department of Community Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - G. V. Akila
- Department of Community Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Vanishree Shriraam
- Department of Community Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Aliya Jasmine
- Department of Community Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Anitha Rani Muthuthandavan
- Department of Community Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - T. Gayathri
- Department of Community Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Shriraam Mahadevan
- Department of Endocrinology and Metabolism, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Yosef T. Hypoglycemia Among Type 1 Diabetes Patients After Insulin Use in Southwest Ethiopia. Front Endocrinol (Lausanne) 2021; 12:684570. [PMID: 34690922 PMCID: PMC8531583 DOI: 10.3389/fendo.2021.684570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/03/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Glycemic control is a valuable goal for people with diabetes; however, the greatest challenge to achieving tight glycemic control is hypoglycemia. Hypoglycemic events are probably common in type 1 diabetes; however, little is known about hypoglycemia in Ethiopia. Therefore, this study aimed to assess the prevalence and the associated factors of hypoglycemia among type 1 diabetes (T1D) patients after insulin use at Metu Karl Referral Hospital in southwest Ethiopia. MATERIALS AND METHODS A hospital-based cross-sectional study was conducted among 242 T1D patients at Metu Karl Referral Hospital in southwest Ethiopia. The prevalence of hypoglycemia was assessed by a structured questionnaire through a face-to-face interview in which all the possible symptoms of hypoglycemia were included. If the patients reported that they had experienced the symptoms at least two times in a month and the symptoms were relieved upon consuming sugar/candy/honey, such cases were considered to have had a hypoglycemic episode. Binary logistic regression analysis was done to identify the factors associated with the occurrence of hypoglycemia. RESULTS Out of 242 T1D patients interviewed, 114 (47.1%) had self-reported hypoglycemia. The most reported symptom of hypoglycemia was sweating (91.7%), followed by dizziness and hunger and nausea with a prevalence of 24.8 and 14.5%, respectively. The study also found that educational level with reading and writing skills up to primary level [adjusted odds ratio, AOR = 0.41; 95% confidence interval, CI (0.19-0.88)] and secondary level and above [AOR = 0.32, 95% CI (0.14-0.70)], poor knowledge of diabetes [AOR = 2.26, 95% CI (1.06-4.84)], good knowledge of insulin self-administration [AOR = 0.54, 95% CI (0.30-0.99)], and duration of insulin use ≥5 years [AOR = 3.93, 95% CI (1.44-10.7)] were factors associated with hypoglycemia. CONCLUSIONS The prevalence of hypoglycemia was found remarkable. We can conclude that hypoglycemia is of public health importance among T1D patients. Since the study assesses hypoglycemia after insulin injection, this prevalence may be due to the poor practice of insulin injection. Therefore, imparting education on the proper technique of insulin administration should be considered at each follow-up visit.
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Affiliation(s)
- Tewodros Yosef
- *Correspondence: Tewodros Yosef, ; orcid.org/0000-0002-3173-6753
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