Prevalence, Awareness, Treatment and Control of Diabetes Mellitus in a Chinese Population

The worldwide trend in diabetes awareness, treatment, and control from 1985 to 2022: a systematic review and meta-analysis of 233 population-representative studies

Background

With the rapid increase in the prevalence of DM, studies on the awareness, treatment, and control of this condition are essential. Therefore, this study aimed to review the literature and pool the awareness, treatment, and control of diabetes at the global, regional, and national levels.

Methods

In this systematic review and meta-analysis, several databases, including MEDLINE/PubMed, Institute of Scientific Information (ISI), Scopus, and Google Scholar, were searched using appropriate keywords up to June 2022. Observational studies investigating the awareness, treatment, and control of glucose levels among diabetic individuals were included. Awareness, treatment, and control were defined as the proportion of participants who were aware of their diabetes condition, treated pharmacologically, and achieved adequate glucose control, respectively. Two investigators independently conducted the study selection, data extraction, and quality assessment. Heterogeneity among studies was calculated using Chi-square, and a random-effect meta-analysis was used to pool the rates.

Results

A total of 233 studies published between 1985 and 2022 met the inclusion criteria. The included studies had a combined population of 12,537,968. The pooled awareness of DM was 60% (95%CI: 56-63) and ranged from 41% (25-57) in low-income countries to 68% (64-72) in high-income countries, with no significant trend observed over the assessed periods at the global level. The pooled treatment of DM globally was 45% (42-48) and varied from 37% (31-43) in lower-middle-income countries to 53% (47-59) in high-income countries, showing variation over the examined time period. Before 2000, the proportion of adequate DM control was 16% (12-20), which significantly improved and reached 22% (19-25) after 2010. The pooled awareness, treatment, and control of DM were higher in females, high-income countries, and urban areas compared to males, upper and lower-middle-income countries, and rural areas, respectively. The older adults population had higher awareness and treatment rates than the adult population, but their DM control did not differ significantly.

Conclusion

Despite the high level of awareness and treatment among the diabetic population, treatment success (control) is considerably low, particularly in low-income countries and rural areas. It is crucial to improve awareness, treatment, and control by strengthening the primary care system in all countries.

The urban-rural disparities and factors associated with the utilization of public health services among diabetes patients in China

BACKGROUND

Basic public health services for diabetes play an essential role in controlling glycemia in patients with diabetes. This study was conducted to understand the urban-rural disparities in the utilization of basic public health services for people with diabetes and the factors influencing them.

METHODS

The data were obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS) with 2976 diabetes patients. Chi-square tests were used to examine the disparities in the utilization of diabetes physical examination and health education between urban and rural areas. Logistic regression was performed to explore the factors associated with the utilization of diabetes public health services.

RESULTS

Among all participants, 8.4% used diabetes physical examination in the past year, and 28.4% used diabetes health education services. A significant association with age (OR = 0.64, 95% CI:0.49-0.85; P < 0.05) was found between patients' use of health education services. Compared with diabetes patients living in an urban area, diabetes patients living in a rural area used less diabetes health education. (χ2= 92.39, P < 0.05). Patients' self-reported health status (OR = 2.04, CI:1.24-3.35; P < 0.05) and the use of glucose control (OR = 9.33, CI:6.61-13.16; P < 0.05) were significantly positively associated with the utilization of diabetes physical examination. Patients with higher education levels were more likely to use various kinds of health education services than their peers with lower education levels (OR = 1.64, CI:1.21-2.22; P < 0.05).

CONCLUSION

Overall, urban-rural disparities in the utilization of public health services existed. Vulnerable with diabetes, such as those in rural areas, are less available to use diabetes public health services. Providing convenient health service infrastructure facilitates the utilization of basic public health services for diabetes in older patients with diabetes, especially in rural areas.

Socio-economic inequalities in undiagnosed, untreated, and uncontrolled diabetes mellitus in Bangladesh: is there a gender difference?

OBJECTIVES

We aimed to determine: (1) the prevalence and socio-economic distribution of undiagnosed, untreated, and uncontrolled diabetes mellitus (DM); (2) the relationship between socio-economic status (SES) and undiagnosed, untreated, and uncontrolled DM; and (3) if this relationship is mediated by gender.

STUDY DESIGN

Cross-sectional nationally representative household-based survey.

METHODS

We used data from the Bangladesh Demographic Health Survey from 2017 to 18. Our findings were based on the responses of 12,144 individuals aged 18 years and older. As a measure of SES, we focused on standard of living (hereinafter referred to as wealth). The study's outcome variables were prevalence of total (diagnosed + undiagnosed), undiagnosed, untreated, and uncontrolled DM. We used three regression-based approaches-adjusted odds ratio, relative inequality index, and slope inequality index-to assess different aspects of SES differences in the prevalence of total, undiagnosed, untreated, and uncontrolled DM. We used logistic regression analysis to look at the adjusted association between SES and the outcomes after gender stratification to see whether gender status moderates the association between SES and the targeted outcomes.

RESULTS

In our sample analysis, the age-adjusted prevalence of total, undiagnosed, untreated, and uncontrolled DM was 9.1%, 61.4%, 64.7%, and 72.1%, respectively. Females had a higher prevalence of DM and undiagnosed, untreated, and uncontrolled DM than males. When compared to people in the poor SES group, people in the rich and middle SES groups had 2.60 times (95% confidence interval [CI] 2.05-3.29) and 1.47 times (95% CI 1.18-1.83) higher chance of developing DM. When compared to individuals in the poor SES group, those in the rich SES groups were 0.50 (95% CI 0.33-0.77) and 0.55 times (95% CI 0.36-0.85) less likely to have undiagnosed and untreated DM.

CONCLUSIONS

In Bangladesh, rich SES groups were more likely than poor SES groups to have DM, whereas poor SES groups with DM were less likely than rich SES groups to be aware of their disease and obtain treatment. The government and other concerned parties are urged by this study to pay more attention to developing suitable policy measures to reduce the risk of DM, particularly among rich SES groups, as well as targeted efforts to screen for and diagnose DM in socio-economically disadvantaged groups.

Prevalence, awareness, treatment and control of type 2 diabetes and its determinants among Mongolians in China: a cross-sectional analysis of IMAGINS 2015-2020

OBJECTIVES

This study aims to estimate the prevalence, awareness, treatment and control rates of type 2 diabetes (T2D) and pre-diabetes as well as to identify its associated factors among Mongolians living in the Inner Mongolia Autonomous Region, China.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

This sample included 11 361 Mongolian participants from the Inner Mongolian Healthy Aging Intervention Study, a population-based screening project consisting of 141 255 adults aged above 35 years in Inner Mongolia from 2015 to 31 December 2020.

OUTCOME MEASURES

The prevalence and 95% CIs of T2D and pre-diabetes were calculated. Factors associated with the prevalence, awareness, treatment and control of T2D were explored by a binomial logistic regression.

RESULTS

A total of 17.2% (95% CI 16.5% to 17.9%) of the sample had T2D, of whom 34.0% (95% CI 31.9% to 36.1%) were aware of their diagnosis, 24.7% (95% CI 22.8% to 26.6%) were taking prescribed antidiabetic medications, 6.7% (95% CI 5.6% to 7.8%) had achieved control and 27.5% (95 % CI 26.7% to 28.3%) had pre-diabetes. The prevalence of T2D increased with increasing age, male, lower education level, smoking, obesity and a history of hypertension or dyslipidaemia (all p<0.05).

CONCLUSIONS

T2D is highly prevalent, with suboptimal awareness, treatment and control rates, and an escalating health challenge among the Mongolian population. Broad-based strategies, including diabetes prevention education, better screening and affordable treatment, should be implemented to raise awareness, treatment and control rates of T2D in Inner Mongolia.

Franco O. Prevalence, awareness, treatment, and control of type 2 diabetes mellitus among the adult residents of tehran: Tehran Cohort Study

BACKGROUND

The prevalence of type 2 diabetes mellitus has increased in the past decades. We investigated the prevalence of diabetes and its awareness, treatment, and control among adult residents of Tehran.

METHODS

We used the recruitment phase data of the Tehran Cohort study, enrolling a random sample of adult residents of Tehran aged ≥35 years. Diabetes was defined as self-report, current use of glucose-lowering medications, and/or fasting plasma glucose (FPG) ≥126mg/dl. Impaired fasting glucose (IFG) was defined as an FPG of 100-125mg/dl. Awareness was defined as diabetes self-report, treatment as receiving glucose-lowering medications, and glycemic control as FPG <126mg/dl. The age- and sex-weighted estimates were calculated using the 2016 national census. Logistic regression models were used to determine the factors associated with diabetes awareness, treatment, and control.

RESULTS

A total of 8151 participants were included. Age- and sex-weighted prevalence of diabetes mellitus and IFG were 16.7% (95% CI: 15.1-18.4) and 25.1% (95% CI: 23.1-27.1), respectively. Diabetes was more prevalent in the eastern and central districts of Tehran. Advanced age (OR per 1-year increase: 1.026, 95% CI: 1.021-1.030), male sex (OR: 1.716, 95% CI: 1.543-1.909), higher BMI levels (OR for BMI ≥35 vs. <20 kg/m²: 4.852, 95% CI: 3.365-6.998), pre-existing hypertension (OR: 1.552, 95% CI: 1.378-1.747), dyslipidemia (OR: 1.692, 95% CI: 1.521-1.883), and chronic kidney disease (OR: 1.650, 95% CI: 1.019-2.673) were associated with an increased odds of diabetes mellitus. On the contrary, diabetes mellitus was less likely in current tobacco (OR: 0.872, 95% CI: 0.765-0.994) and alcohol users (OR: 0.836, 95% CI: 0.703-0.994) compared to non-users. Among diabetic individuals, 82.8% were aware of their condition, 71.9% received treatment, and 31.7% of treated patients had adequate glycemic control. Advanced age and pre-existing comorbidities, including hypertension and dyslipidemia, were associated with higher diabetes awareness and treatment. Furthermore, advanced age, higher levels of education, and female sex were determinants of better glycemic control among treated diabetic participants.

CONCLUSION

There is a high prevalence of diabetes and IFG among adult residents of Tehran. Additionally, more than two-thirds of treated diabetics living in Tehran remain uncontrolled.

The Relationship between Dietary Patterns and High Blood Glucose among Adults Based on Structural Equation Modelling

The aim of this study was to examine the association between dietary patterns and high blood glucose in Jiangsu province of China by using structural equation modelling (SEqM). Methods: Participants in this cross-sectional study were recruited through the 2015 Chinese Adult Chronic Disease and Nutrition Surveillance Program in Jiangsu province using a multistage stratified cluster random sampling method. Dietary patterns were defined by exploratory factor analysis (EFA). Confirmatory factor analysis (CFA) was used to test the fitness of EFA. SEqM was used to investigate the association between dietary patterns and high blood glucose. Results: After exclusion, 3137 participants with complete information were analysed for this study. The prevalence of high blood glucose was 9.3% and 8.1% in males and females, respectively. Two dietary patterns: the modern dietary pattern (i.e., high in red meats and its products, vegetables, seafood, condiments, fungi and algae, main grains and poultry; low in other grains, tubers and preserves), and the fruit−milk dietary pattern (i.e., high in milk and its products, fruits, eggs, nuts and seeds and pastry snacks, but low in vegetable oils) were established. Modern dietary pattern was found to be positively associated with high blood glucose in adults in Jiangsu province (multivariate logistic regression: OR = 1.561, 95% CI: 1.025~2.379; SEqM: β = 0.127, p < 0.05). Conclusion: The modern dietary pattern—high intake of red meats—was significantly associated with high blood glucose among adults in Jiangsu province of China, while the fruit−milk dietary pattern was not significantly associated with high blood glucose.

Time to Diagnosis and Treatment of Diabetes Mellitus among Korean Adults with Hyperglycemia: Using a Community-Based Cohort Study

OBJECTIVES

To identify the time from hyperglycemia to diabetes mellitus (DM) diagnosis and treatment, the risk factors for diabetes development, and the prevalence of comorbidities/complications in patients > 40 years of age.

METHODS

This secondary data analysis study used data from the Korean Genome and Epidemiology Study. The participants comprised 186 patients who did not have diabetes at baseline, but developed hyperglycemia at the first follow-up. The average and median periods until DM diagnosis and treatment were calculated using Kaplan-Meier survival analysis.

RESULTS

Of the 186 participants, 57.0% were men and 35.5% were 40-49 years old. The average time to DM diagnosis and treatment was 10.87 years and 11.34 years, respectively. The risk factors for the duration of DM were current smoking, body mass index (BMI), fasting blood sugar (FBS), and postprandial 2-hour glucose (PP2). The risk factors for the duration of diabetes treatment were current smoking, hypertension, BMI, FBS, and PP2. The development of one or more comorbidities or diabetes complications was identified at the time of DM diagnosis (36.5%) and DM treatment (41.4%).

CONCLUSIONS

As diabetes complications occur at the time of DM, and early treatment can impact the development of diabetes complications or mortality, it is necessary to establish a referral program so that participants presenting with high blood sugar levels in the screening program can be diagnosed and treated in a timely manner.

Prevalence, awareness and control of type 2 diabetes mellitus and risk factors in Chinese elderly population

Background

Type 2 diabetes mellitus is an expanding global public health issue, especially in developing countries. This study aimed to investigate the prevalence, awareness and control rate of type 2 diabetes mellitus, and assess its risk factors in elderly Chinese individuals.

Methods

The health screening data of 376,702 individuals aged ≥ 65 years in Wuhan, China, were collected to analyse the prevalence, awareness, and control rates of diabetes. Indices, including fasting plasma glucose and other biochemical indicators, were measured for all participants using standard methods at the central laboratory. Multilevel logistic regression analysis was performed to assess the key determinants of the prevalence, awareness, and control rates of diabetes.

Results

The prevalence, awareness, and control rates of diabetes in the Chinese individuals aged ≥ 65 years were 18.80%, 77.14%, and 41.33%, respectively. There were statistically significant differences in the prevalence, awareness, and control rates by gender. Factors associated with diabetes prevalence were age, body mass index (BMI), and central obesity; while those associated with awareness and control were gender, education level, marital status, physical activity, alcohol consumption, BMI, and central obesity.

Conclusions

Diabetes is an important public health problem in the elderly in China. The awareness and control rates have improved, but overall remained poor. Therefore, effective measures to raise awareness and control the rates of diabetes should be undertaken to circumvent the growing disease burden in elderly Chinese people.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13759-9.

Prevalence, Awareness, Treatment, and Control of Hypertension and Diabetes: Results From Two State-Wide STEPS Survey in Punjab and Haryana, India

Background

India which is home to more than one sixth of the world's population, accounts for more than two thirds of total deaths due to non-communicable diseases (NCD). Out of this, hypertension and diabetes are the most common NCDs. Awareness, treatment, and control of hypertension and diabetes remains a major challenge despite various national programs being run to curb the rising burden NCDs. In order to fill the knowledge gap, awareness, treatment, and control of diabetes and hypertension were studied by using data from the STEPS survey among the adult population in two major northern Indian states of Punjab and Haryana.

Methods

Two state-wide NCD risk factors surveys were conducted using WHO STEPS methodology among 5,127 individuals in Punjab and 5,078 individuals in Haryana aged 18-69 years in the year 2014-15 and 2016-18. Standardized questionnaire was used to determine the behavioral risk factors in step one followed by anthropometric measurements for physical risk factors in step two and in the third step serum and urine samples were collected for biochemical risk factors.

Results

The prevalence of hypertension in Punjab was 40.1% while that in Haryana was 26.2%. In Punjab, only 48.3% of the hypertensive were aware of their condition, 30.9% were on treatment while only 18.3% of the cases were controlled. While in Haryana 33.4% of the respondents were aware of their condition, 26.3% are on treatment while only 12% of the cases were controlled. Similarly, the prevalence of diabetes was 14.3 and 15.1% in Punjab and Haryana, respectively. In Punjab 34.2% of diabetics were aware of their condition, 28.2% were on treatment while only 14.2% of the cases were controlled. The awareness and control rates in Haryana were similar to that in Punjab. 29.5% of the respondents were aware of their condition, 22.4% were on treatment while only 13.8% of the cases of diabetes were controlled. Family history of diabetes and hypertension was found to be associated with higher odds of being aware, on treatment and controlled blood glucose and blood pressure levels in both Punjab and Haryana.

Discussion

Hypertension and diabetes are a major public health problem in Punjab and Haryana and awareness, treatment and control rates are low which require specific interventions with a focus on access to treatment, regular follow up for better control. There is an urgent need to effectively implement the existing national NCD programmes in these states in India.

Awareness, Treatment, and Control of Diabetes in Bangladesh: Evidence from the Bangladesh Demographic and Health Survey 2017/18

BACKGROUND

The prevalence of diabetes is increasing in Bangladesh from ∼5% in 2001 to ∼13% in 2017/18 (∼8.4 million cases). The prevalence of undiagnosed diabetes was also found to be higher at 6% in 2017/18. However, very little is known about the management of diabetes assessed by diabetes awareness, treatment, and control. We aimed to estimate the age-standardised prevalence of awareness, treatment, and control of diabetes and its associated factors.

METHODS

Cross-sectional data from 1,174 Bangladeshi adults aged 18 years and older available from the most recent nationally representative Bangladesh Demographic and Health Survey (BDHS) 2017-18 were analysed. Outcomes were age-standardised prevalence of awareness, treatment, and control of diabetes, estimated using the direct standardisation. Multilevel mixed-effects Poisson regression models were used to identify factors associated with awareness, treatment, and control of diabetes.

RESULTS

Of the respondents we analysed, 30.9% (95% CI, 28.2-33.6) were aware that they had the condition, and 28.2% (95% CI, 25.6-30.7) were receiving treatment. Among those treated for diabetes, 26.5% (95% CI, 19.5-33.5) had controlled diabetes. The prevalence of diabetes awareness, treatment, and control was lower in men than women. Factors positively associated with awareness and treatment were increasing age and hypertension, while factors negatively associated with awareness and treatment were being men and lower education. Factors associated with poor control were secondary education and residing in Rajshahi and Rangpur divisions.

CONCLUSIONS

This study provides evidence of poor management of diabetes in Bangladesh, especially in men. Less than one-third of the people with diabetes were aware of their condition. Just over one-fourth of the people with diabetes were on treatment, and among those who were treated only one-fourth had controlled diabetes. Interventions targeting younger people, in particular men and those with lower education, are urgently needed. Government policies that address structural factors including the cost of diabetes care and that strengthen diabetes management programmes within primary healthcare in Bangladesh are urgently needed.

Trends in cardiovascular risk factors and treatment goals in patients with diabetes in Singapore-analysis of the SingHealth Diabetes Registry

Background

Asian populations are at high risk of diabetes and related vascular complications. We examined risk factor control, preventive care, and disparities in these trends among adults with diabetes in Singapore.

Methods

The sample included 209,930 adults with diabetes aged≥18 years from a multi-institutional SingHealth Diabetes Registry between 2013 and 2019 in Singapore. We performed logistic generalized estimating equations (GEEs) regression analysis and used linear mixed effect modeling to evaluate the temporal trends.

Results

Between 2013 and 2019, the unadjusted control rates of glycated hemoglobin (4.8%, 95%CI (4.4 to 5.1) and low-density lipoprotein cholesterol (LDL-C) (11.5%, 95%CI (11.1 to 11.8)) improved, but blood pressure (BP) control worsened (systolic BP (SBP)/diastolic BP (DBP) <140/90 mmHg: -6.6%, 95%CI (-7.0 to -6.2)). These trends persisted after accounting for the demographics including age, gender, ethnicity, and housing type. The 10-year adjusted risk for coronary heart disease (CHD) (3.4%, 95% (3.3 to 3.5)) and stroke (10.4%, 95% CI (10.3 to 10.5)) increased. In 2019, the control rates of glycated hemoglobin, BP (SBP/DBP<140/90 mmHg), LDL-C, each, and all three risk factors together, accounted for 51.5%, 67.7%, 72.2%, and 24.4%, respectively.

Conclusions

Trends in risk factor control improved for glycated hemoglobin and LDL-C, but worsened for BP among diabetic adults in Singapore from 2013 to 2019. Control rates for all risk factors remain inadequate.

Vietnamese Version of the General Medication Adherence Scale (GMAS): Translation, Adaptation, and Validation

Background: We aimed to translate, cross-culturally adapt, and validate the General Medication Adherence Scale (GMAS) into Vietnamese. Methods: We followed the guidelines of Beaton et al. during the translation and adaptation process. In Stage I, two translators translated the GMAS to Vietnamese. Stage II involved synthesizing the two translations. Stage III featured a back translation. Stage IV included an expert committee review and the creation of the pre-final version of the GMAS, and in stage V, pilot testing was conducted on 42 Vietnamese patients with type 2 diabetes. The psychometric validation process evaluated the reliability and validity of the questionnaire. The internal consistency and test–retest reliability were assessed by Cronbach’s alpha and Spearman’s correlation coefficients. The construct validity was determined by an association examination between the levels of adherence and patient characteristics. The content validity was based on the opinion and assessment score by the expert committee. The Vietnamese version of the GMAS was created, including 11 items divided into three domains. There was a good equivalence between the English and the Vietnamese versions of the GMAS in all four criteria. Results: One hundred and seventy-seven patients were participating in the psychometric validation process. Cronbach’s alpha was acceptable for all questionnaire items (0.817). Spearman’s correlation coefficient of the test–retest reliability was acceptable for the GMAS (0.879). There are significant correlations between medication adherence levels and occupation, income, and the Beliefs about Medicines Questionnaire (BMQ) score regarding construct validity. Conclusions: The Vietnamese version of GMAS can be considered a reliable and valid tool for assessing medication adherence in Vietnamese patients.

Level of and Related Factors to Diabetes Awareness among Diabetic Adults by Gender: Based on Data from the Korean National Health and Nutrition Examination Survey

PURPOSE

This study aimed to determine the level of awareness about diabetes mellitus (DM) and identify the associated factors among diabetic adults in Korea by sex, using data from most recent nationwide representative survey.

METHODS

Secondary data analysis was conducted using data obtained from the Korean National Health and Nutrition Examination Survey VII (2016-2018). In total, 2,026 participants (1,049 men, 977 women) aged ≥30 years with DM were included. Data were analyzed using a complex sample analysis considering the combined sampling weight for 3 years. Odds ratios and 95% confidence intervals were calculated using stepwise multiple logistic regression analysis to identify the association between DM awareness (DA) and sociodemographic and health-related factors.

RESULTS

Researchers observed that 60.2% of men and 68.4% of women had DA. DA levels in both men and women were higher in those who were older, less educated, had normal weight, had hypertension and/or dyslipidemia, and had a family history of DM than in their counterparts. Having undergone a health screening in the past 2 years was associated with DA levels in men, whereas glycated hemoglobin levels of 5.7-6.4% were associated with higher DA levels in women.

CONCLUSION

The level of DA is unsatisfactory. Although the DA level is slightly higher in women than in men, it needs to be improved regardless of gender. Most of the factors associated with DA levels are similar in both men and women. Nurses in the community setting should provide health education, conduct campaigns, and promote referral to medical services by targeting the high-risk groups with lower DA identified in this study.

Strong Association of Waist Circumference (WC), Body Mass Index (BMI), Waist-to-Height Ratio (WHtR), and Waist-to-Hip Ratio (WHR) with Diabetes: A Population-Based Cross-Sectional Study in Jilin Province, China

BACKGROUNDS

The prevalence of diabetes has increased with the increase of obesity, and finding indicators to predict diabetes risk has become an urgent need. The purpose of this study is to compare the correlation between four anthropometric indices and the prevalence of diabetes.

METHODS

A total of 4052 participants aged 40 years and above were selected in Dehui City, Jilin Province, using a multistage stratified whole group sampling method. Face-to-face interviews and physical examinations were conducted. Multivariate logistic analysis was used. The values of BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were divided into quartiles (Q1: <25%; Q2: ~25%; Q3: ~50%; and Q4: ~75%). The median of each quartile was used for a linear trend test.

RESULTS

For all four body fat-measuring indices of body mass index (adjusted OR: 3.300, 95% CI: 2.370, 4.595), WC (adjusted OR: 5.131, 95% CI: 3.433, 7.669), WHR (adjusted OR: 3.327, 95% CI: 2.386, 4.638), and WHtR (adjusted OR: 5.959, 95% CI: 3.922, 9.054), patients in the highest quartile were more likely to have diabetes than those in the lowest quartile. The areas under the curve of WHtR, WC, WHR, and BMI for diabetes were 0.683, 0.669, 0.654, and 0.629, respectively. In female participants, the areas under the curve of the waist-height ratio and WC were 0.710 (95% CI: 0.679-0.741) and 0.701 (95% CI: 0.670-0.732), respectively.

CONCLUSIONS

The WC and WHtR were more closely related to diabetes than BMI and WHR among study participants ≥ 40 years of age, especially in females.

A cross-sectional study on diabetes epidemiology among people aged 40 years and above in Shenyang, China

This study aimed at understanding the diabetic prevalence, awareness, treatment and control rates and their influencing factors among people aged ≥ 40 years in Shenyang, China. A face-to-face cross-sectional epidemiological survey was conducted on the respondents using the national unified questionnaire. A total of 3922 respondents were enrolled, including 609 cases of diabetes. The diabetic prevalence rate was 15.5%, and was higher in rural areas than that in urban areas (17.7% vs. 14.2%, p = 0.004), while no difference was observed between men and women (14.8% vs. 16.1%, p = 0.242). Advanced age, hypertension and dyslipidemia were the diabetes influencing factors. Among the 609 respondents with diabetes, the diabetic awareness and treatment rates, and the control rate of fasting plasma glucose were 82.3%, 36.6% and 17.1%, respectively. In different age groups, the diabetic awareness rate was higher in men than that in women, and the treatment rate was higher in women than that in men. The diabetic patients, who consumed fruit for ≥ 5 days a week, accounted for 16.3%, and their diabetic treatment (28.1%) and control rates (44.1%) were lower. Shenyang people aged ≥ 40 years have higher diabetic prevalence and awareness rates, and lower diabetic treatment and control rates. Finally, it is necessary to enhance awareness and education about diabetes, to improve its treatment and control rates.

Health Literacy and Blood Glucose Level in Transitional Albania

Aim: Our aim was to assess the independent association between blood glucose level and health literacy (HL) adjusting for many socio-demographic characteristics and body mass index (BMI) in an adult population in Albania, a transitional country in the South Eastern Europe.

Methods: A cross-sectional study was carried out in Tirana in 2012–2014 including a population-based sample of 1,154 individuals aged ≥18 years (57% women; mean age: 45.5 ± 16.4 years; response rate: 88.6%). HL was assessed by use of HLS-EU-Q instrument. Blood glucose level was measured in a fasting state by use of rapid finger stick method. Information on socio-demographic characteristics was collected, and BMI was calculated based on measurement of height and weight in all participants. General Linear Model (GLM) and binary logistic regression were used to assess the independent association of blood glucose level and HL adjusting for all socio-demographic factors and BMI.

Results: One-third of participants had pre-diabetes (100–125.9 mg/dl) and further 11% had diabetes (≥126 mg/dl) based on the measured blood glucose level. In fully-adjusted GLM, mean blood glucose level was significantly lower among individuals with excellent HL compared with their counterparts with inadequate HL (99.3 vs. 106.0, respectively). Furthermore, the odds for the presence of diabetes in the group of study participants whose HL was “inadequate” were 2.6 times higher (95% CI = 1.3–5.4) compared to those whose HL was “excellent.”

Conclusion: We obtained evidence of a strong and significant inverse relationship between measured blood glucose level and HL, independent of many socio-demographic characteristics and measured BMI in a population-based study in a country of the Western Balkans.

Evaluating the treatment and control of modifiable cardiovascular disease risk factors among patients with diabetes in the Inner Mongolia, China: A cross-sectional study

Reducing the risk of diabetes has been a great public health challenge in China. In this study, we aimed to estimate the treatment and control of FPG (fasting blood plasma glucose) as well as the other main modifiable cardiovascular disease (CVD) risk factors in patients with diabetes and to identify those characteristics associated with the treatment and control of diabetes, hypertension, and low-density lipoprotein cholesterol (LDL-C). Between 2015 and 2017, participants aged 35 to 75 years from Inner Mongolia in northern China were recruited. A total 13,644 participants with diabetes were enrolled in this study. We calculated rates and 95% confidence intervals for treatment and control of FPG, blood pressure, and LDL-C. We performed multivariate logistic regression to identify characteristics associated with the treatment and control of diabetes as well as hypertension and LDL-C. Overall, the treatment rates of diabetes, hypertension, and dyslipidemia were 30.76%, 50.75%, and 9.17%, respectively. Control rates of FPG, blood pressure, and LDL-C were 4.73%, 4.86%, and 57.83%, respectively. Patients who were younger, Mongol ethnicity and rural residents were less likely to be treated and controlled for diabetes and hypertension. Patients insured by NCMS (new rural cooperative medical scheme) were less likely to be treated and achieve the treatment target of blood pressure. Patients having prior CVD were more likely to be treated and have controlled FPG and blood pressure. Substantial efforts are urgently needed to improve the treatment and control of these modifiable CVD risk factors among patients with diabetes in Inner Mongolia.

Epidemiology of diabetes mellitus, pre-diabetes, undiagnosed and uncontrolled diabetes in Central Iran: results from Yazd health study

Background

Over the past few decades, the prevalence of Diabetes Mellitus (DM) has risen rapidly in Iran and other low and middle-income countries. We investigated the prevalence of DM, pre-diabetes, undiagnosed and uncontrolled diabetes and its relationship with some associated socioeconomic factors in the Yazd Greater Area in Iran.

Methods

Yazd Health Study is a longitudinal study conducted to determine the prevalence of non-communicable disease and related risk factors. In a two-step cluster sampling, 10,000 adults aged 20–69 years (200 clusters) were selected. In the recruitment phase, DM was considered if the patients had been either diagnosed DM by a physician or had fasting blood glucose ≥ 126 mg/dL. Chi square test was used for categorical variables to evaluate the differences and logistic regression model was applied to determine the predictors of diabetes.. P-value < 0.05 considered statistically significant.

Results

Of the 9965 individuals recruited, the crude self-reported prevalence of DM was 14.1% (95% CI: 13.4–14.7). The prevalence was higher in women than men (15.6 vs.12.4%), significantly. The age-standardized prevalence of DM was 8%. The prevalence was 14.9% in Yazd local people and 8.6% in those residents migrated from other provinces (P < 0.0001). We showed a significant association between DM prevalence and age, education, marital status, unemployment, insurance status, and positive family history (P < 0.0001). The prevalence of DM diagnosed by phycisians was 16.1% in participants (age-standardized prevalence: 8.3%). The subset analysis showed that 4.8% of patients were not aware of their disease. The prevalence of pre-diabetes was 25.8%. Of those with diabetes, 58.3% were not adequately controlled, which is not statistically significant with socio-economic status.

Conclusion

The current study showed a high prevalence of DM in Yazd Greater Area which is closely related to some socio-demographic factors. The high prevalence of pre-diabetes is alarming. Effective strategies for DM prevention should be introduced. The majority of people with diabetes are aware, but half of them are not controlled. The ineffective care plan currently in use, should be reviewed. Patients needs to be encouraged to improve their lifestyle. Active follow-up of patients is recommended to ensure continuity of care.

Screening for pulmonary tuberculosis in high-risk groups of diabetic patients

BACKGROUND

The double burden of diabetes mellitus (DM) and tuberculosis (TB) has attracted increasing attention, because DM not only increases the risk of active TB but also affects treatment outcomes. Screening for TB among diabetic patients has been recommended, but requires real-world evidence by considering its cost-effectiveness, cost-utility ratio, and cost-benefit ratio.

METHODS

A screening program was conducted in Jiangyin City of Jiangsu Province, China. A total of 14 869 diabetic patients received regular physical examinations for three consecutive years and were followed for the diagnosis of TB. The cost of screening and the effectiveness, utility, and social benefits attributed to the program were evaluated. In addition, a matched case-control study was conducted and the nomogram was used to identify high-risk groups that could be the target population for screening.

RESULTS

Among the 14 869 diabetic patients who participated in this screening program, 22 were diagnosed with TB, resulting in an incremental cost-effectiveness ratio (ICER) of 83 910 CNY per disability-adjusted life-year (DALY) gained and a cost-benefit ratio of 0.50. If the screening program was limited to high-risk diabetic patients by considering body mass index (BMI), fasting blood glucose (FBG), and triglycerides, the ICER decreased to 34 303 CNY per DALY gained and the cost-benefit ratio increased to 1.22.

CONCLUSIONS

Screening for TB using regular chest X-ray examinations is feasible but not economical in areas with a low incidence of TB. It is recommended that diabetic patients with a low BMI, high FBG, and low triglycerides are selected as subjects for TB screening.

Study protocol for the road to hierarchical diabetes management at primary care (ROADMAP) study in China: a cluster randomised controlled trial

INTRODUCTION

Diabetes management in primary care remains suboptimal in China, despite its inclusion in the essential public health service (EPHS). We aimed to evaluate the effectiveness of a mobile health (mHealth) based and three-tiered diabetes management system in diverse Chinese contexts.

METHODS AND ANALYSIS

This is a cluster randomised controlled trial, named road to hierarchical diabetes management at primary care (ROADMAP). 19 008 patients with type 2 diabetes (T2D) were recruited from primary care clinics in 864 communities across 144 counties/districts of 24 provinces. Eligible participants were adult patients diagnosed with T2D and registered for diabetes management in communities. Patients within the same communities (clusters) were randomly allocated into the intervention or control arm for 1 year in a 2:1 ratio. The control arm patients received usual care as EPHS packaged: at least four blood glucose (BG) and blood pressure (BP) tests, and lifestyle and medication instruction, yearly, from primary care providers. The intervention arm patients received at least two BG and one BP tests, monthly, and lifestyle and treatment instruction from a three-tiered contracted team. A mHealth platform, Graded ROADMAP, enabled test results uploading and sharing, and patient referral within the team. The intervention participants will be further divided into basic or intensive intervention group according to whether they were actively using the Your Doctor App. The primary outcome is the BG control rate with glycated haemoglobin (HbA1c)<7.0%. Secondary outcomes include control rates and changes of ABC (HbA1c, BP and low-density lipoprotein cholesterol) and fasting BG, hypoglycaemia episodes and health-related quality of life (EuroQol (EQ-5D)).

ETHICS AND DISSEMINATION

The trial has been approved by the Institutional Review Board at Shanghai Sixth People's Hospital. Findings on the intervention effectiveness will be disseminated through peer-reviewed journals, conference presentations and other relevant mechanisms.

TRIAL REGISTRATION NUMBER

ChiCTR-IOC-17011325.

Trends in the prevalence and management of diabetes in Korea: 2007-2017

OBJECTIVES

This study analyzed Korea National Health and Nutrition Examination Survey data from 2007 to 2017 to assess trends in the prevalence, treatment, and control of diabetes in Korean adults ≥30 years of age.

METHODS

Prevalent diabetes was defined as a fasting plasma glucose level ≥126 mg/dL, self-reported use of anti-diabetic treatment (insulin or oral anti-diabetic drugs), or diabetes diagnosis by a physician. Target levels were defined as glycosylated hemoglobin <6.5% or <7.0%, blood pressure <130/80 mmHg, and total cholesterol <200 mg/dL. All survey waves were age-standardized to the 2005 Korean census population.

RESULTS

Diabetes prevalence increased from 9.6% in 2007-2009 to 10.8% in 2016-2017 (p<0.001). Impaired fasting glucose prevalence significantly increased in both genders and almost every age group. Diabetes awareness and glycemic control did not show an increasing trend; however, the treatment rate and proportion of people diagnosed with diabetes achieving target blood pressure and total cholesterol levels improved from 57.2% to 63.5% (p=0.008), from 41.1% to 53.2% (p<0.001), and from 65.0% to 78.0% (p<0.001), respectively.

CONCLUSIONS

From 2007 to 2017, the prevalence of diabetes increased moderately in Korea, whereas the diabetes treatment rate and the proportion of people diagnosed with diabetes achieving target blood pressure and total cholesterol levels improved. However, awareness of diabetes and glycemic control require significant improvements. A national-level action plan is required to raise awareness about diabetes and prediabetes, with the goal of improving glycemic control and minimizing the occurrence of adverse health outcomes.

Awareness, prevalence, treatment, and control of type 2 diabetes in a semi-urban area of Nepal: Findings from a cross-sectional study conducted as a part of COBIN-D trial

BACKGROUND

Type 2 diabetes is an escalating public health problem in Nepal. The current study aims to assess the prevalence, associated factors, awareness, treatment, and control of type 2 diabetes in a semi-urban area of Nepal.

METHODS

A population-based cross-sectional survey was conducted including 2,310 adults aged 25 years or above from a semi-urban area of Lekhnath Municipality of Nepal, during October 2016 to April 2017 using the World Health Organization (WHO) STEPS approach. Data on demographics, behavioral risk factors, blood pressure, anthropometric measurements (weight, height, waist and hip circumference), and fasting blood glucose were collected by face-to-face interviews during a door-to-door visit. Participants were considered to have type 2 diabetes if they had previously been diagnosed by a physician and/or were on antidiabetic medications and/or had fasting blood glucose ≥ 7.0 mmol/L. Participants were classified as being aware of their diabetes conditions if they had earlier been told that they had type 2 diabetes. Treatment of diabetes among those aware was if participants received any kind of medication treatment or counseling, and control of diabetes among those treated was defined as fasting blood glucose level was <7.0 mmol/L. Odds Ratio (OR) with 95% Confidence Interval (CI) was used to determine the strength of association.

RESULTS

The prevalence of type 2 diabetes was 11.7% (95% CI: 10.5-13.1). Among type 2 diabetes participants, 65% were aware of their disease, 94% of those who were aware received treatment, and 21% of the treated subjects had their diabetes under control. Factors significantly associated with type 2 diabetes were older age (OR = 3.2 for age group 45-54 years, OR = 3.8 for age group 55-64 years), Janajati ethnicity (OR = 1.4), abdominal obesity (OR = 2.3), being overweight or obese (OR = 1.4), and hypertension (OR = 2.0), while protective factors included being a female (OR = 0.4), medium physical activity (OR = 0.3), high physical activity (OR = 0.2), and not having family history of diabetes (OR = 0.3).

CONCLUSIONS

The study revealed a high prevalence of type 2 diabetes among adults. Older age, male gender, Janajati ethnicity, abdominal obesity, overweight or obesity, hypertension, low physical activity, and family history of diabetes were associated with type 2 diabetes. Immediate public health and individual measures are warranted to reduce further burden of type 2 diabetes.

Prevalence and risk factors for diabetes and impaired fasting glucose in Northeast China: Results from the 2016 China National Stroke Screening Survey

AIMS

To explore the current prevalence and risk factors for diabetes and impaired fasting glucose in Northeast China.

METHODS

This study adopted the multistage stratified random cluster sampling method to obtain a representative sample of adults aged 40 years or older in Dehui City, Jilin Province, Northeast China. Diabetes and impaired fasting glucose were defined according to the 1999 World Health Organization criteria.

RESULTS

A total of 4052 participants were included, with prevalence of diabetes in Northeast China of 11.2% (95% confidence interval [CI], 10.1-12.4%); that of diagnosed, 5.9% (95% CI, 5.1-6.8%); and that of impaired fasting glucose, 6.9% (95% CI, 6.0-8.0%). Among them, 52.9% were aware of their condition, 47.7% were receiving antidiabetic medication, and 75.9% had their diabetes controlled. Rural residents were more likely to have diabetes but were less inclined to be aware of and report antidiabetic treatment and to have their diabetes controlled than urban residents.

CONCLUSION

Diabetes and impaired fasting glucose were highly prevalent among adults in Northeast China. However, awareness and treatment rates remained relatively low compared with those of developed countries. Health policymakers should put more basic medical and healthcare into rural areas in the future.

Association between household physical activity level and type 2 diabetes among urban males in northern China

OBJECTIVES

Physical activity contributes to preventing type 2 diabetes (T2D). Doing housework is an unstructured mild-intensity physical activity. We aimed to investigate the association between household physical activity level (HPAL) and T2D in urban Chinese men.

STUDY DESIGN

This is a cross-sectional study.

METHODS

This study contained 13,862 male adults aged 35-78 (48.4 ± 7.1) years. According to the self-reported time (hours/day [h/d]) spent on housework, they were stratified into three levels: 0 h/d, >0-2 h/d, and >2 h/d. The association of HPAL with T2D was investigated by logistic regression analysis.

RESULTS

The odds ratios (ORs) for T2D across increasing categories of HPAL were 1.00 (reference), 0.80 (95% confidence interval [CI] 0.72-0.89), and 0.60 (95% CI 0.51-0.70), respectively (P for trend <0.001), after adjusting for confounding factors. Further adjustment for waist circumference or body mass index (BMI) had a minimal impact on these ORs. The inverse association of HPAL with T2D was persistent in subgroup analyses based on age, hypertension, family history of diabetes, smoking, BMI, waist circumstance, and fasting plasma glucose level.

CONCLUSION

Our findings indicated that HPAL was inversely associated with the risk of T2D among urban males in northern China. This implied that household physical activity may contribute to long-term glucose control. Well-designed longitudinal studies are required to improve our understanding of this association.

Identification of Family Factors That Affect Self-Management Behaviors Among Patients With Type 2 Diabetes: A Qualitative Descriptive Study in Chinese Communities

INTRODUCTION

In the past 30 years, the prevalence of diabetes in China has increased from 0.67% to 11.6%. Self-management behaviors (SMBs) are significant to improve health outcomes for diabetics. However, little is known about self-management experiences of Chinese diabetic patients. The purpose of this study was to explore family factors affecting SMBs.

METHODOLOGY

A qualitative descriptive study was used. Purposive samples were recruited from Chinese communities. Semistructured interviews were conducted, and audio-recordings transcripts were analyzed using content analysis methods.

RESULTS

Twenty participants were interviewed, including 8 with well-controlled HbA1c while 12 were poorly controlled. Facilitators that promote patients' SMBs were responsibility toward children and commitment to spouse; barriers that hinder patients' SMBs were family experiences about starvation, seeking harmony-eating in a big family, living in an "empty nest," and family financial burden.

DISCUSSION

This study provides insight into SMBs of Chinese diabetic patients. Professionals can develop tailored interventions in a Chinese cultural context according to patients' perceptions of family responsibility, early experience, activities, and resources.

Prevalence, Awareness and Associated Risk Factors of Diabetes among Adults in Xi'an, China

The study aimed to investigate the prevalence, awareness, treatment and glycaemic control of diabetes and its associated risk factors among adults in Xi’an, China. We collected data among participants aged 18 years or older through a self-developed questionnaire and an additional health examination. A total of 8150 participants were included, with an overall prevalence of diabetes of 8.0%. Among 655 participants with diabetes, 52.5% were aware they had diabetes, 48.1% took antidiabetic treatment, and 19.1% had their fasting blood glucose level at less than 7.0 mmol/l. Older age, lower educational level, higher body mass index, larger waist circumference, having an unhealthy diet and having more comorbidities were positively associated with the risk of diabetes. Participants who were older, who had higher education and who had more comorbidities were more aware that they had diabetes. Being older age, having higher education and having more comorbidities were also factors for better treatment. Participants who were older were more likely to have their glucose level controlled. The prevalence of diabetes among adults in Xi’an is high, with suboptimal awareness, treatment, and glycaemic control rates. Comprehensive integrated strategies based on risk factors should be implemented to improve the prevention and glycaemic control of diabetes.

Familial History of Diabetes is Associated with Poor Glycaemic Control in Type 2 Diabetics: A Cross-sectional Study

To investigate the association of familial history (FH) of diabetes with the glycaemic control status of patients with type 2 diabetes (T2D), a cross-sectional study using stratified cluster sampling was conducted with 20,340 diabetic patients in Jiangsu, China. In total, 21.3% of the subjects reported a FH of diabetes. Patients with a FH of diabetes showed a higher risk of poor glycaemic control (59.7%) than those without a diabetic FH (49.8%), with an odds ratio (OR) of 1.366 (P < 0.001). Glycaemic control status did not significantly differ between the T2D patients with parental FH and those with sibling FH. Compared with patients with paternal FH, patients with maternal FH had a higher risk of poor glycaemic control (OR = 1.611, P = 0.013). Stratified analyses showed that a FH of diabetes was significantly associated with poor glycaemic control among T2D patients with a low education level (P < 0.05). In the <60 years old, overweight, and low level of physical activity groups, patients with a maternal history of diabetes showed a higher risk of poor glycaemic control than those without a FH (P < 0.05). In conclusion, FH of diabetes, especially a maternal history, had an independently adverse effect on the glycaemic control of T2D patients.

Evaluation of hemoglobin A1c measurement from filter paper using high-performance liquid chromatography and immunoturbidimetric assay

Glycated hemoglobin (HbA_1c) measurement from whole blood (WB) samples is inconvenient for epidemic surveillance and self-monitoring of glycemic level. We evaluated HbA_1c measurement from WB blotted on filter paper (FP), which can be easily transported to central laboratories, with high-performance liquid chromatography (HPLC) and immunoturbidimetric assay (ITA). WB was applied to Whatman filter paper. By using HPLC and WB samples as reference methods, these FP samples were evaluated on HPLC and ITA. Inter- and intra-assay variation, WB vs. FP agreement and sample stability at 20-25 °C and -70 °C were assessed by statistical analysis. Results showed that the coefficient of variation (CV, %) of FP samples for HPLC and ITA were 0.44-1.02% and 1.47-2.72%, respectively (intra-assay); 2.13-3.56% and 3.21-4.82%, respectively (inter-assay). The correlation of WB HPLC with FP analyzed using HPLC and ITA are both significant (p < 0.001). Sample stability showed that FP method up to 5 days at 20-25 °C and 5 weeks at -70 °C is accurate and reproducible. In conclusion, FP samples analyzed by HPLC and ITA can both provide an alternative to WB for HbA_1c measurement, supporting the use of FP method in epidemic surveillance and healthcare units.

The Dynamics of Type 2 Diabetes Mellitus Prevalence and Management Rates among Rural Population in Henan Province, China

The aim of this study was to estimate the dynamics of type 2 diabetes mellitus (T2DM) prevalence and management rates based on a rural cohort study in Henan Province of China. The rural prospective study was conducted for 20194 Chinese population ≥18 years in 2007-2008 and followed during 2013-2014. A total of 14009 individuals were recruited for the prospective analysis ultimately. Over 5.74 years of follow-up, the age-standardized prevalence, awareness, treatment, and control of T2DM increased from 6.18%, 44.41%, 34.39%, and 19.08% at baseline to 7.87%, 59.64%, 52.17%, and 26.52% at follow-up in total population, respectively. Similar changes were found in men and women except the age-standardized control in men. The four parameters of T2DM were higher among various factors at follow-up than those at baseline. There was no statistical difference in awareness (P = 0.089) and treatment (P = 0.257) in the newly diagnosed T2DM compared with the rates at baseline. The current study indicated that the prevalence, awareness, treatment, and control of T2DM displayed chronological increasing trends while the awareness, treatment, and control of T2DM were still disproportionally low in central China. More works are needed urgently to popularize public health education and improve the quality of medical care in T2DM.

Situation of Diabetes and Related Disease Surveillance in Rural Areas of Jilin Province, Northeast China

Background: Several studies have investigated the prevalence and awareness of diabetes mellitus (DM) in China, but little is known about the situation of DM in the northeastern rural areas. Our present study investigated the prevalence, awareness and associated characteristics of DM in rural areas of Jilin Province, aiming to suggest more efforts for the prevention and control of DM. Methods: A multistage stratified random cluster sampling design was used in this cross-sectional study which took place in 2012. Data were collected by face-to-face interviews and physical examinations. Rao-Scott Chi-square test, t test and multivariate logistic regression analysis were used. Results: The estimated prevalence of DM in rural areas of Jilin province was 7.2%. DM was positively associated with age, Body mass index (BMI), hypotension, dyslipidemia and was high in participants with a family history of diabetes and those who exercise frequently, but low for high education level and married participants. 69.0% participants with DM were aware of their diabetes status, 88.2% of whom received treatment and 34.4% of whom had received treatment controlled their DM status. Conclusions: We observed a high prevalence and low awareness status of DM among the rural residents in Jilin Province, but the rate of effective control in those who have received treatment was considerable. The low rate of disease surveillance should draw health authority’s attention.