Identifying persons at risk for developing type 2 diabetes in a concentrated population of high risk ethnicities in Canada using a risk assessment questionnaire and point-of-care capillary blood HbA1c measurement

Cost-effectiveness of community diabetes screening: Application of Akaike information criterion in rural communities of Nigeria

Background

The prevalence of diabetes mellitus (DM) is increasing globally, and this requires several approaches to screening. There are reports of alternative indices for prediction of DM, besides fasting blood glucose (FBG) level. This study, investigated the ability of combination of biochemical and anthropometric parameters and orodental disease indicators (ODIs) to generate models for DM prediction, using Akaike information criterion (AIC) to substantiate health economics of diabetes screening.

Methods

Four hundred and thirty-three subjects were enrolled in the study in Ndokwa communities, Delta State, Nigeria, and their glycaemic status was determined, using the CardioChek analyser^® and previous data from the Prediabetes and Cardiovascular Complications Study were also used. The cost of screening for diabetes (NGN 300 = $0.72) in a not-for-profit organization/hospital was used as basis to calculate the health economics of number of individuals with DM in 1,000 participants. Data on the subjects' anthropometric, biochemical and ODI parameters were used to generate different models, using R statistical software (version 4.0.0). The different models were evaluated for their AIC values. Lowest AIC was considered as best model. Microsoft Excel software (version 2020) was used in preliminary analysis.

Result

The cost of identifying <2 new subjects with hyperglycemia, in 1,000 people was ≥NGN 300,000 ($ 716). A total of 4,125 models were generated. AIC modeling indicates FBG test as the best model (AIC = 4), and the least being combination of random blood sugar + waist circumference + hip circumference (AIC ≈ 34). Models containing ODI parameters had AIC values >34, hence considered as not recommendable.

Conclusion

The cost of general screening for diabetes in rural communities may appear high and burdensome in terms of health economics. However, the use of prediction models involving AIC is of value in terms of cost-benefit and cost-effectiveness to the healthcare consumers, which favors health economics.

NDSP 09: Risk Assessment of Pakistani Individual for Diabetes (RAPID) - Findings from Second National Diabetes Survey of Pakistan (NDSP) 2016-2017

OBJECTIVE

To elucidate the effectiveness of Risk Assessment of Pakistani individuals with diabetes (RAPID) tool in epidemiological and population-based second National Diabetes Survey of Pakistan (NDSP) 2016-2017 for identifying risk of developing type 2 diabetes.

METHODOLOGY

This observational study was a sub-analysis of the second National Diabetes Survey of Pakistan (NDSP) 2016-2017 conducted from February 2016 to August 2017 in all four provinces of Pakistan. Ethical approval was obtained from National Bioethics Committee Pakistan. RAPID score, a validated and published scoring scale to assess risk of diabetes, originally developed from community-based surveys was used. The risk score is assessed by parameters namely: age, waist circumference, and positive family history of diabetes. Subjects with score greater ≥4 were considered at risk of diabetes.

RESULTS

A total of 4904 individuals were assessed (2205 males and 2699 females). Mean age of participants was 41.8±14.2 years. Positive family history of diabetes was seen in 1379 (28.1%) people. According to RAPID score 1268 (25.9%) individuals scored ≥4 and were at risk of diabetes. OGTT status of people at risk of diabetes according to RAPID score showed that 18.1% people with diabetes and 29.2% were prediabetic. Whereas, OGTT status of people not at risk of diabetes showed that only 7.6% people with diabetes, 20% were prediabetic.

CONCLUSION

A simple diabetes risk score can be used for identification of high-risk individuals for diabetes so that timely intervention can be implemented. Community-based awareness programs are needed to educate people regarding healthy lifestyle in order to reduce risk of diabetes.

Type 2 Diabetes Risk Among University Students in Malaysia

BACKGROUND

Type 2 diabetes (T2D) is a preventable condition. Targeting those who are at risk of getting this disease is essential.

OBJECTIVE

To examine T2D risk among university students in Malaysia and determine its relationship with socio-demographic characteristics and physical activity.

METHODS

The study was conducted cross-sectionally on 390 students selected using quota sampling method from 13 faculties in Universiti Kebangsaan Malaysia. A short form of the International Physical Activity Questionnaire and Finnish Diabetes Risk Score were used to measure the physical activity and T2D risk.

RESULTS

The T2D risk was found to be low (M = 5.23, SD = 3.32) with more than two-third of the student population at the low risk level while a significant proportion of 23.8%, 5.6% and 0.3% having slightly elevated, moderate and high risk respectively. The T2D risk was significantly related to their age (rho = 0.197, p < 0.000), gender (U = 12641, p = 0.011), ethnic group (Χ2 = 18.86, p < 0.000), marital status (Χ2 = 6.597, p = 0.037), residence (U = 10345, p = 0.008), academic year (Χ2 = 14.24, p = 0.007) and physical activity (rho = -0.205, p < 0.000 and Χ2 = 13.515, p = 0.001). Of these, only age (β=0.130) and physical activity (β=-0.159) remained significant in the regression analysis.

CONCLUSION

The findings call for a radical change in the nursing practice to target the amendable factors that are significant in order to prevent the progression of the risk towards type 2 diabetes.

The Efficacy of New Chinese Diabetes Risk Score in Screening Undiagnosed Type 2 Diabetes and Prediabetes: A Community-Based Cross-Sectional Study in Eastern China

The New Chinese Diabetes Risk Score (NCDRS) is one of the recommended tools for screening undiagnosed type 2 diabetes in China. However, its performance in detecting undiagnosed diabetes needs to be verified in different community populations. Also, it is unknown whether NCDRS can be used in detecting prediabetes. In the present study, we aimed to evaluate the performance of NCDRS in detecting undiagnosed diabetes and prediabetes among the community residents in eastern China. We applied NCDRS in 7675 community residents aged 18-65 years old in Jiangsu Province. The results showed that the participants with undiagnosed diabetes reported the highest NCDRS value, followed by those with prediabetes (P < 0.001). The best cut-off points of NCDRS for detecting undiagnosed diabetes and prediabetes were 27 (with a sensitivity of 78.0% and a specificity of 57.7%) and 27 (with a sensitivity of 66.0% and a specificity of 62.9%). The AUCs of NCDRS for identifying undiagnosed diabetes and prediabetes were 0.749 (95% CI: 0.739~0.759) and 0.694 (95% CI: 0.683~0.705). These results demonstrate the excellent performance of NCDRS in screening undiagnosed diabetes in the community population in eastern China and further provide evidence for using NCDRS in detecting prediabetes.

Prevalence and Associated Risk Factors of Diabetes in the African Immigrant Population of Sacramento County, California

Purpose

The purpose of this study was to determine the prevalence and associated risk factors of diabetes in the African immigrant population in Sacramento County, California.

Methods

A cross-sectional study was conducted in Sacramento County, California, from June to August 2018. The convenience sample included 126 African immigrants aged 21 years and older. Sociodemographic and clinical characteristics were collected. Hemoglobin A1C (A1C) level, blood pressure, height, and weight were measured per standard methods. Data were analyzed using descriptive statistics and χ2 test at value of P < .05.

Results

Of 126 adult individuals included in this study, 32 (25.4%) had diabetes, of whom 25 (19.8%) were previously diagnosed and 7 (5.6%) represented new cases of diabetes. Also, 36 (28.6%) had prediabetes, of whom 24 (19.1%) had previously been told they had prediabetes and 12 (9.5%) represented new cases of prediabetes. Diabetes and prediabetes were significantly higher among participants in the age group of 36 to 60 years, married, employed full-time, and those with hypertension, high blood cholesterol, and participating in 0 to 2 days per week of moderate physical activities. Only one-fifth of all participants with previously known diabetes or previously on treatment had a good glycemic control status.

Conclusions

The present study found a high prevalence of prediabetes, diabetes, and multiple risk factors of diabetes in the African immigrant population, as well as a poor glycemic control among those with diabetes, calling for urgent attention. Strategies aimed to improving a healthy lifestyle in the African immigrant population are necessary to reduce the burden of diabetes.

Aerobic Exercise Training Modalities and Prediabetes Risk Reduction

PURPOSE

Prediabetes is linked to several modifiable risk factors, in particular, physical activity participation. The optimal prescription for physical activity remains uncertain. This pilot study aimed to investigate the effectiveness of continuous moderate intensity (CON) versus high-intensity interval training (HIIT) in persons with prediabetes. Outcome measures included glycated hemoglobin (A1C), body composition, musculoskeletal and aerobic fitness.

METHODS

Participants (n = 35) were recruited and screened using a questionnaire plus capillary blood point-of-care A1C analysis. After baseline screening/exclusions, 21 participants were randomly assigned to either HIIT or CON training three times per week for 12 wk. All participants also undertook resistance training two times per week. A1C, an oral glucose tolerance test, select measures of physical and physiological fitness were assessed at baseline and follow-up.

RESULTS

There were no significant differences in improvements in select metabolic indicators to training between CON and HIT groups. Pooled participant data showed a mean reduction in A1C of 0.5% (95% confidence interval [CI] = 0.3%-0.7%), whereas β-cell function (%β) improved by 28.9% (95% CI = 16.5%-39.2%) and insulin sensitivity (%S) decreased by 34.8 (95% CI = 57.8%-11.8), as assessed by the Homeostatic Model Assessment. Significant reductions in waist circumference of 4.5 cm (P < 0.001) and a 20% (P < 0.001) improvement in aerobic fitness were also observed in both training groups.

CONCLUSION

The completion of a 12-wk exercise program involving both resistance training and either HIIT or CON training results in improved glycemic control, visceral adiposity, and aerobic fitness in persons with prediabetes.

Community-Based Culturally Preferred Physical Activity Intervention Targeting Populations at High Risk for Type 2 Diabetes: Results and Implications

OBJECTIVES

In Canada, an ageing population, obesity rates and high risk among certain ethnocultural populations are driving diabetes prevalence. Given the burden associated with type 2 diabetes and its link to modifiable risk factors, this study aimed to implement culturally preferred physical activities at the community level, targeting individuals at high risk for type 2 diabetes. Glycated hemoglobin (A1C) levels were used to detect potential improvements in glycemic control.

METHODS

Participants were screened for diabetes risk using a questionnaire and capillary point-of-care A1C blood testing. Participants were offered community-based physical activity classes 2 to 3 times per week for 6 months. A subset of participants (n=84) provided additional measurements.

RESULTS

In total, 718 subjects were reached during recruitment. Substantial participant dropout took place, and 487 participants were exposed to the intervention. Among those who participated in the physical activity and provided follow up, mean A1C levels were reduced by 0.17 (p=0.002) after 3 months (n=84) and by 0.06 (p=0.35; n=49) after 6 months. The homeostatic model assessment (HOMA-beta) showed a significant improvement of 23.6% after 3 months (n=20; p=0.03) and 45.2% after 6 months (n=12; p=0.02). Resting systolic blood pressure and diastolic blood pressure plus combined hand-grip strength improved after 6 months (n=12).

CONCLUSIONS

Implementation of this community-based, culturally preferred physical activity program presented several challenges and was associated with significant participant dropout. After considering participant dropout, the relatively small group who participated and provided follow-up measures showed improvements various physiologic measures. Despite efforts to enhance accessibility, it appears that several barriers to physical activity participation remain and need to be explored to enhance the success of future programs.

Automatic laboratory-based strategy to improve the diagnosis of type 2 diabetes in primary care

Introduction

To study the pre-design and success of a strategy based on the addition of hemoglobin A1c (HbA1c) in the blood samples of certain primary care patients to detect new cases of type 2 diabetes.

Materials and methods

In a first step, we retrospectively calculated the number of HbA1c that would have been measured in one year if HbA1c would have been processed, according to the guidelines of the American Diabetes Association (ADA). Based on those results we decided to prospectively measure HbA1c in every primary care patient above 45 years, with no HbA1c in the previous 3 years, and glucose concentration between 5.6-6.9 mmol/L, during an 18 months period. We calculated the number of HbA1c that were automatically added by the LIS based on our strategy, we evaluated the medical record of such subjects to confirm whether type 2 diabetes was finally confirmed, and we calculated the cost of our intervention.

Results

In a first stage, according to the guidelines, Hb1Ac should have been added to the blood samples of 13,085 patients, resulting in a cost of 14,973€. In the prospective study, the laboratory added Hb1Ac to 2092 patients, leading to an expense of 2393€. 314 patients had an HbA1c value ≥ 6.5% (48 mmol/mol). 82 were finally diagnosed as type 2 diabetes; 28 thanks to our strategy, with an individual cost of 85.4€; and 54 due to the request of HbA1c by the general practitioners (GPs), with a cost of 47.5€.

Conclusion

The automatic laboratory-based strategy detected patients with type 2 diabetes in primary care, at a cost of 85.4€ per new case.

Point-of-care capillary HbA1c measurement in the emergency department: a useful tool to detect unrecognized and uncontrolled diabetes

Background

Inpatient hyperglycaemia and diabetes mellitus (DM) are common and are associated with an increased risk of complications and mortality. The severity of hyperglycaemia determines the rate of complications in patients treated in the emergency department (ED). Our aim was to examine whether determination of the capillary haemoglobin A1c (HbA1c) is a reliable method for detecting unknown diabetes and poor glycaemic control in the ED.

Methods

A prospective observational study was conducted in adult (>18 years) patients treated in a single-centre ED. We compared the results of HbA1c levels measured by Bio-Rad in2it point-of-care device on a capillary blood sample and by the hospital laboratory.

Results

A total of 187 ED patients with an average age of 57.1 ± 19.2 years were studied. The mean HbA1c value was 5.78 ± 1.26 % by capillary POC testing and 6.10 ± 1.12 % by the hospital laboratory (correlation = 0.712, P < 0.001). A total of 17.1 % of cases had a prior diagnosis of DM. The diagnosis of DM (plasma glucose > 126 mg/dL and/or HbA1c > 6.5 %) was made in ten (5.4 %) additional cases (prior undiagnosed DM) for a total prior DM prevalence of 22.5 % (95 % CI 16.4–28.5 %). Capillary HbA1c detected 11 additional cases of unknown DM (5.9 %). A capillary HbA1c value greater than 6 % has a sensitivity of 85.7 % and specificity of 85.3 % for the screening of DM.

Conclusions

Determination of the capillary HbA1c in the ED is a reliable, fast, and simple system for the screening of unknown or uncontrolled DM.