Age-related differences in diabetes care outcomes in Korea: a retrospective cohort study

Management goal achievements of diabetes care in Iran: study profile and main findings of DiaCare survey

Aim

This paper presented the methodology and main findings of a population-based survey to determine diabetes care status among type 2 diabetic subjects in Iran. The current study assessed treatment goal achievements in type 2 diabetics, diabetes care service utilization, prevalence of diabetes complications, and psychological effects of diabetes in a representative sample of Iranian population in urban and rural areas.

Materials and Methods

This nationwide study was conducted between 2018 and 2020 as the observational survey entitled "Diabetes Care (DiaCare)". We studied a representative sample of participants with type 2 diabetes, aged 35-75 years, living in urban and rural areas in all thirty- one provinces of Iran. Data were collected by an interviewer in a form of a questionnaire that includes demographic and socioeconomic status, family and drug history, lifestyle, and self-reported psychological status according to a Patient's Health Questionnaire (PHQ). Management goal achievements, diabetes care service utilization, diabetes complications and psychological effects of diabetes were also assessed. Physical measurements were measured based on standard protocol. Fasting blood glucose (FBG), HbA1c, lipid profile, and also urine albumin to creatinine ratio were obtained from all participants of the study.

Results

Overall, 13,334 people with type 2 diabetes in 31 provinces of Iran completed the survey (response rate: 99.6%). In total 13,321 participants, 6683(50.17%) women and 6638(49.83%) men were included in our analysis. Thirteen recruited patients refused after the consenting process and did not respond. The mean age (SD) of total participants was 54.86 ± 9.44 years and 71.50% were from the urban areas. 13.66% of diabetic patients had achieved the triple target of management [controlled HbA1c, blood pressure, and Low-Density Lipoprotein-Cholesterol (LDL-C)] in the whole country. While 28.74% of people had controlled HbA1c and 33.40% of them had controlled FBG. Diabetic subjects living in rural areas had less controlled HbA1c (23.93 vs. 29.48), controlled FBG (29.50 vs. 34.20) and controlled triple targets (10.45 vs. 14.32) than those living in urban areas. Diabetic neuropathy and diabetic foot were more common in women than men, while end-stage of renal disease (ESRD) was more common in men than women.

Conclusions

This population-based study provided representative information about diabetes care in Iran. The high prevalence of diabetes and low proportion of diabetes control in Iran implies that it is necessary to identify factors associated with poor treatment goal achievements. Besides, general improvements in management and care of diabetes are mandatory.

Population segmentation of type 2 diabetes mellitus patients and its clinical applications - a scoping review

Background

Population segmentation permits the division of a heterogeneous population into relatively homogenous subgroups. This scoping review aims to summarize the clinical applications of data driven and expert driven population segmentation among Type 2 diabetes mellitus (T2DM) patients.

Methods

The literature search was conducted in Medline®, Embase®, Scopus® and PsycInfo®. Articles which utilized expert-based or data-driven population segmentation methodologies for evaluation of outcomes among T2DM patients were included. Population segmentation variables were grouped into five domains (socio-demographic, diabetes related, non-diabetes medical related, psychiatric / psychological and health system related variables). A framework for PopulAtion Segmentation Study design for T2DM patients (PASS-T2DM) was proposed.

Results

Of 155,124 articles screened, 148 articles were included. Expert driven population segmentation approach was most commonly used, of which judgemental splitting was the main strategy employed (n = 111, 75.0%). Cluster based analyses (n = 37, 25.0%) was the main data driven population segmentation strategies utilized. Socio-demographic (n = 66, 44.6%), diabetes related (n = 54, 36.5%) and non-diabetes medical related (n = 18, 12.2%) were the most used domains. Specifically, patients’ race, age, Hba1c related parameters and depression / anxiety related variables were most frequently used. Health grouping/profiling (n = 71, 48%), assessment of diabetes related complications (n = 57, 38.5%) and non-diabetes metabolic derangements (n = 42, 28.4%) were the most frequent population segmentation objectives of the studies.

Conclusions

Population segmentation has a wide range of clinical applications for evaluating clinical outcomes among T2DM patients. More studies are required to identify the optimal set of population segmentation framework for T2DM patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01209-w.

Prevalence of Type 1 and Type 2 Diabetes-Related Complications and Their Association With Determinants Identified in Canada's Survey on Living With Chronic Diseases-Diabetes Component

OBJECTIVES

In this study, we estimated the prevalence of diabetes-related complications and the factors associated with them in Canadian patients with diabetes.

METHODS

Data from the 2011 Survey on Living with Chronic Diseases in Canada---Diabetes Component (SLCDC-DM-2011) were used to calculate the weighted prevalence of 16 diabetes-related complications. A multivariable, sex-stratified logistic regression model was used to examine the association between each diabetes-related complication and select determinants.

RESULTS

Among Canadian patients who self-reported having diabetes, 80.26% reported having at least 1 type of diabetes-related complication. The most frequently reported complications were high blood pressure (54.65%), cataracts (29.52%) and poor circulation (21.68%). Male patients were more associated to have at least 1 complication if they had an inappropriate body mass index (odds ratio [OR], 2.94; 95% confidence interval [CI], 1.39 to 6.23) and had a high level of glycated hemoglobin (OR, 2.32; 95% CI, 1.05 to 5.13), were older (OR, 6.92; 95% CI, 1.82 to 24.74) and had diabetes for a longer period of time (OR, 3.42; 95% CI, 1.71 to 6.85). Among the female patients, a longer duration diabetes was found to have a significant association with complications (OR, 2.00; 95% CI, 1.05 to 3.81).

CONCLUSIONS

Our findings suggest that socioeconomic factors, including marital status, income and education, have a significant association with most types of complications. Our findings also confirm that low levels of physical activity and high levels of glycated hemoglobin were major determinants in many diabetes-related complications.

Utility of Geriatric Syndrome Indicators for Predicting Subsequent Health Care Utilization in Older Adults in Taiwan

BACKGROUND

The predictive utility of both individual and combined indicators of geriatric syndromes on subsequent emergency use and hospitalization is not clear.

METHODS

Nationally representative data on adults aged 65+ (N = 2345) (with 1148 male, 1197 female) in Taiwan were analyzed. The receiver operating characteristic (ROC) curve examined the diagnostic accuracy of the combined effects of geriatric syndromes on predicting health care utilization in three years. Negative binomial regressions identified the individual effect of each indicator with the control of sociodemographic and baseline health status.

RESULTS

The combined indicators of geriatric syndromes predicted future hospitalization of old-old (75+ yrs) diabetes patients, with area under the curve (AUC) = 0.709, 95% confidence interval (CI) = 0.635⁻0.782, and young-old patients (65-74 yrs) with mild cognitive impairment (AUC = 0.727, 95% CI = 0.610⁻0.845 for hospitalization and AUC = 0.770, 95% CI = 0.664⁻0.877 for emergency visits). As for individual indicators, while incontinence was the indicator having the most influence on hospitalization (incidence rate ratio (IRR) = 1.81, 95% CI = 1.21⁻2.72) and emergency visits (IRR = 1.78, 95% CI = 1.23⁻2.59) for general older adults (65+), and for old-old emergency visits, especially (IRR = 2.21, 95% CI = 1.39⁻3.49), falls was the most prominent indicator of hospitalization for young-old (65-74) adults (IRR = 1.61, 95% CI = 1.13⁻2.28). In addition, pain was another significant indicator for predicting future hospitalization of old-old diabetes patients (IRR = 1.61, 95% CI= 1.07⁻2.44).

CONCLUSIONS

Combined indicators of geriatric syndromes effectively predict hospitalization in old-old (75+ yrs) diabetes patients and hospitalization and emergency visits in young-old (65⁻74 yrs) patients with cognitive impairment. Incontinence, falls, and pain were the most predictive independent geriatric assessment indicators.

Cohort profile: the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) in Korea

PURPOSE

The National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) is a cohort of participants who participated in health screening programmes provided by the NHIS in the Republic of Korea. The NHIS constructed the NHIS-HEALS cohort database in 2015. The purpose of this cohort is to offer relevant and useful data for health researchers, especially in the field of non-communicable diseases and health risk factors, and policy-maker.

PARTICIPANTS

To construct the NHIS-HEALS database, a sample cohort was first selected from the 2002 and 2003 health screening participants, who were aged between 40 and 79 in 2002 and followed up through 2013. This cohort included 514 866 health screening participants who comprised a random selection of 10% of all health screening participants in 2002 and 2003.

FINDINGS TO DATE

The age-standardised prevalence of anaemia, diabetes mellitus, hypertension, obesity, hypercholesterolaemia and abnormal urine protein were 9.8%, 8.2%, 35.6%, 2.7%, 14.2% and 2.0%, respectively. The age-standardised mortality rate for the first 2 years (through 2004) was 442.0 per 100 000 person-years, while the rate for 10 years (through 2012) was 865.9 per 100 000 person-years. The most common cause of death was malignant neoplasm in both sexes (364.1 per 100 000 person-years for men, 128.3 per 100 000 person-years for women).

FUTURE PLANS

This database can be used to study the risk factors of non-communicable diseases and dental health problems, which are important health issues that have not yet been fully investigated. The cohort will be maintained and continuously updated by the NHIS.

Age differences in diabetes-related complications and glycemic control

BACKGROUND

This study aimed to examine the associations of age with the presence of complications and glycemic control in the Northwest of Iran.

METHODS

A total of 649 people with diabetes who were >25 years old and had a caring record in diabetes clinics in two Northwestern provinces of Iran during 2014-15, were recruited in this cross-sectional study. General information including demographic, socioeconomic status and lifestyle factors were collected by trained interviewers. Clinical information was retrieved from clinic's record. Univariate and multivariate logistic regression were performed to assess the predictors of diabetes outcome of interest as well as to clarify the role of age in relation to these outcomes.

RESULTS

Compared to the age group of ≤49, the middle age group (50-59) and the older age group (60 years of age and older) were less likely to report poor glycemic control (OR fully adjusted = 0.49 95% CI: 0.28-0.86 and (OR = 0.44 95% CI: 0.24-0.80), respectively. Additionally, poor glycemic control was associated with income level, disease duration, hypercholesterolemia, high level of LDL and hypertension. In contrast, age was associated with the highest percentage of complications. People with duration of >7 years of disease record were 6 times more likely to have complications (OR_adj = 5.98 95% CI: 2.35-15.22).

CONCLUSION

Although the prevalence of complications was higher among the older diabetic patients, they had a better glycemic control. The influential factors were variably associated with the two diabetes-related outcomes; therefore, a more comprehensive risk profiles assessment is needed for glycemic control.