Prevalence, awareness, treatment and control of diabetes mellitus among middle-aged and elderly people in a rural Chinese population: A cross-sectional study

[Evaluation of healthcare for patients with diabetes in primary care: A systematic review]

OBJECTIVE

Have the most current evidence in relation to the evaluation of medical healthcare for patients with diabetes in primary care.

METHOD

During the review process, we followed the recommendations to improve the publication of systematic reviews and meta-analyses and the preferred reporting points for PRISMA systematic reviews. The bibliographic search was carried out in Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, Scielo, MedLine/ PubMed, Cochrane databases and in the Google Scholar search engine, with free and controlled language, using the MeSh search terms: «Physicians, Primary Care», «Diabetes Mellitus, Type2». Eight selected articles were analyzed. The articles were selected based on their relevance, published in peer-reviewed academic journals and published between 2019 and 2023.

RESULTS

The main study tool represents interventions in knowledge and practice about the care of patients with diabetes among primary care physicians. The most important discussion topics extracted in the analyzed articles refer to knowledge, clinical inertia, patients' housing challenges, adherence intervention programs, and a self-care application for patients with diabetes.

CONCLUSIONS

The findings of this study indicate the need to improve medical health care through knowledge, attitudes and practices in primary care regarding patients with diabetes. In this way, it could be considered a useful tool to promote medical healthcare in primary care.

Dietary Potassium and Magnesium Intake with Risk of Type 2 Diabetes Mellitus Among Rural China: the Henan Rural Cohort Study

Previous studies exploring the relationship between dietary potassium and magnesium intake and the risk of type 2 diabetes mellitus (T2DM) have yielded inconsistent results and the lack evidence from rural China. Therefore, we aimed to investigate the association between dietary potassium and magnesium intake and the risk of T2DM in rural China. Data was collected from the Henan Rural Cohort Study in 2017. A validated semi-quantitative food frequency questionnaire assessed dietary potassium and magnesium intake. Logistic regression models were used to calculate odds ratio (ORs) and 95% confidence intervals (CIs) to evaluate the effect of dietary potassium, magnesium and the potassium-magnesium ratio on the risk of T2DM. A total of 38384 individuals were included in the study, and 3616 participants developed T2DM. Logistic regression analysis revealed that the OR (95% CI) of the highest versus dietary potassium and magnesium and potassium-magnesium ratio intakes were 0.67 (0.59, 0.75), 0.76 (0.67, 0.88), and 0.57 (0.50, 0.66), respectively, compared to the subjects with the lowest quartile of intakes. In addition, gender partially influences the relationship between dietary magnesium and T2DM prevalence (P-interaction = 0.042). The group with the highest dietary potassium and dietary magnesium intake had the lowest risk of T2DM, with an OR (95% CI) of 0.63 (0.51-0.77). Dietary potassium and magnesium intake are important modifiable risk factors for T2DM in rural China. Dietary potassium intake > 1.8g/day, dietary magnesium intake > 358.6mg/day and < 414.7mg/day and potassium-magnesium ratio >5.1 should be encouraged to prevent better and manage T2DM.

Disparity in Guideline-Based Antidiabetic Drugs Prescribing for Type 2 Diabetes Patients in Primary Healthcare Facilities Across China, 2017-2019

PURPOSE

The purpose of this study is to evaluate the pattern, appropriateness, and cost of antidiabetic drugs prescribed for patients with Type 2 diabetes at primary healthcare facilities (PHFs) in China.

METHODS

We collected outpatient-visit prescriptions from 363 PHFs in 31 cities covering eastern, central, and western regions of China. The visits of adult patients with Type 2 diabetes diagnosis were collected and classified the antidiabetic medication pattern of each patient use as recommended or non-recommended according to Chinese guidelines. We then calculated the proportion of guideline-recommended patterns and the average monthly cost for each pattern, overall and by region.

RESULTS

Of 33 519 prescriptions for Type 2 diabetes, most (73.9%) were for guideline-recommended antidiabetic treatments. The proportion of guideline-recommended prescriptions varied by region (eastern [75.9%], central [87.5%], and western [59.7%]). Metformin monotherapy was the most common guideline-recommended treatment in all three regions (eastern [20.1%], central [28.0%], and western [24.6%]). The most common non-guideline-recommended treatments were monotherapy of insulin (eastern [16.5%], central [5.1%], and western [25.7%]) and traditional Chinese antidiabetic medicines (eastern [5.6%], central [5.7%], and western [11.1%]). The average monthly costs were lower for guideline-recommended treatments compared to non-recommended treatments in all regions (eastern [13.6 ± 15.4 USD vs. 28.1 ± 22.0 USD], central [9.8 ± 10.9 USD vs. 28.7 ± 19.4 USD], and western [17.9 ± 21.4 USD vs. 30.3 ± 23.6 USD]).

CONCLUSIONS

The majority of patients with Type 2 diabetes received guideline-recommended antidiabetic medications at PHFs in China, with only half of the prescriptions containing guideline-recommended metformin. Utilization of guideline-recommended therapies differed across regions. Tailored interventions to promote evidence-based antidiabetic prescribing are urgently needed, especially in the undeveloped western region.

Network analysis combined with experimental assessment to explore the therapeutic mechanisms of New Shenqi Pills formula targeting mitochondria on senile diabetes mellitus

Background

The escalation of global population aging has accentuated the prominence of senile diabetes mellitus (SDM) as a consequential public health concern. Oxidative stress and chronic inflammatory cascades prevalent in individuals with senile diabetes significantly amplify disease progression and complication rates. Traditional Chinese Medicine (TCM) emerges as a pivotal player in enhancing blood sugar homeostasis and retarding complication onset in the clinical management of senile diabetes. Nonetheless, an evident research gap persists regarding the integration of TCM's renal tonification pharmacological mechanisms with experimental validation within the realm of senile diabetes therapeutics.

Aims

The objective of this study was to investigate the mechanisms of action of New Shenqi Pills (SQP) in the treatment of SDM and make an experimental assessment.

Methods

Network analysis is used to evaluate target pathways related to SQP and SDM. Mitochondrial-related genes were obtained from the MitoCarta3.0 database and intersected with the common target genes of the disease and drugs, then constructing a protein-protein interaction (PPI) network making use of the GeneMANIA database. Representative compounds in the SQP were quantitatively measured using high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) to ensure quality control and quantitative analysis of the compounds. A type 2 diabetes mice (C57BL/6) model was used to investigate the pharmacodynamics of SQP. The glucose lowering efficacy of SQP was assessed through various metrics including body weight and fasting blood glucose (FBG). To elucidate the modulatory effects of SQP on pancreatic beta cell function, we measured oral glucose tolerance test (OGTT), insulin histochemical staining and tunel apoptosis detection, then assessed the insulin-mediated phosphoinositide 3-kinase (PI3K)/protein kinase A (Akt)/glycogen synthase kinase-3β (GSK-3β) pathway in diabetic mice via Western blotting. Additionally, we observe the structural changes of the nucleus, cytoplasmic granules and mitochondria of pancreatic islet β cells.

Results

In this investigation, we identified a total of 1876 genes associated with senile diabetes, 278 targets of SQP, and 166 overlapping target genes, primarily enriched in pathways pertinent to oxidative stress response, peptide response, and oxygen level modulation. Moreover, an intersection analysis involving 1,136 human mitochondrial genes and comorbidity targets yielded 15 mitochondria-related therapeutic targets. Quality control assessments and quantitative analyses of SQP revealed the predominant presence of five compounds with elevated concentrations: Catalpol, Cinnamon Aldehyde, Rehmanthin D, Trigonelline, and Paeonol Phenol. Vivo experiments demonstrated notable findings. Relative to the control group, mice in the model group exhibited significant increases in body weight and fasting blood glucose levels, alongside decreased insulin secretion and heightened islet cell apoptosis. Moreover, β-cells nuclear condensation and mitochondrial cristae disappearance were observed, accompanied by reduced expression levels of p-GSK-3β protein in islet cells (p < 0.05 or p < 0.01). Conversely, treatment groups administered SQP and Rg displayed augmented expressions of the aforementioned protein markers (p < 0.05 or p < 0.01), alongside preserved mitochondrial cristae structure in islet β cells.

Conclusion

Our findings suggest that SQP can ameliorate diabetes by reducing islet cell apoptosis and resist oxidative stress. These insulin-mediated PI3K/AKT/GSK-3β pathway plays an important regulatory role in this process.

Optimal obesity- and lipid-related indices for predicting type 2 diabetes in middle-aged and elderly Chinese

To investigate the screening and predicting functions of obesity- and lipid-related indices for type 2 diabetes (T2D) in middle-aged and elderly Chinese, as well as the ideal predicted cut-off value. This study's data comes from the 2011 China Health and Retirement Longitudinal Study (CHARLS). A cross-sectional study design was used to investigate the relationship of T2D and 13 obesity- and lipid-related indices, including body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), lipid accumulation product (LAP), conicity index (CI), Chinese visceral adiposity index (CVAI), triglyceride- glucose index (TyG index) and its correlation index (TyG-BMI, TyG-WC, TyG-WHtR). The unadjusted and adjusted correlations between 13 indices and T2D were assessed using binary logistic regression analysis. The receiver operating characteristic curve (ROC) was used to determine the usefulness of anthropometric indices for screening for T2D and determining their cut‑off value, sensitivity, specificity, and area under the curve (AUC). The study comprised 9488 people aged 45 years or above in total, of whom 4354 (45.89%) were males and 5134 (54.11%) were females. Among them were 716 male cases of T2D (16.44%) and 870 female cases of T2D (16.95%). A total of 13 obesity- and lipid-related indices were independently associated with T2D risk after adjusted for confounding factors (P < 0.05). According to ROC analysis, the TyG index was the best predictor of T2D among males (AUC = 0.780, 95% CI 0.761, 0.799) and females (AUC = 0.782, 95% CI 0.764, 0.799). The AUC values of the 13 indicators were higher than 0.5, indicating that they have predictive values for T2D in middle-aged and elderly Chinese. The 13 obesity- and lipid-related indices can predict the risk of T2D in middle‑aged and elderly Chinese. Among 13 indicators, the TyG index is the best predictor of T2D in both males and females. TyG-WC, TyG-BMI, TyG-WHtR, LAP, and CVAI all outperformed BMI, WC, and WHtR in predicting T2D.

Knowledge level and health information-seeking behavior of people with diabetes in rural areas: a multicenter cross-sectional study

Introduction

There is a lack of research on the current level of diabetes knowledge and health information-seeking behaviors among patients with diabetes in rural areas of China's economically underdeveloped regions during COVID-19, as well as a lack of up-to-date evidence on glycemic control and the incidence of complications among rural patients with diabetes.

Objectives

To investigate the prevalence of glycemic control and complications among patients with diabetes in rural areas, to explore the current status and correlation of diabetes knowledge level and health information-seeking behavior, and to analyze the factors affecting diabetes knowledge level.

Methods

From January 2022 to July 2022, we conducted a screening on diabetic complications and a questionnaire survey among 2,178 patients with diabetes in 15 county hospitals in rural areas of Guangxi Zhuang Autonomous Region. The patients' knowledge level and health information-seeking behavior were investigated. Spearman correlation analysis was used to assess the correlation between diabetes knowledge and health information-seeking behavior. Multiple linear regression analysis was used to test how demographic information and health information-seeking behavior influenced the level of diabetes knowledge.

Results

Of 2,178 patients with diabetes in rural areas, 1,684 (77.32%) had poor glycemic control, and the prevalence of diabetic complications was estimated to be 72.13%. Patients with diabetes had poor diabetes knowledge and health information-seeking behavior, and there is a strong positive correlation between them. Diabetes knowledge level was influenced by per capita household disposable income, occupational status, gender, age, ethnicity, family history of diabetes, insulin use, glycated hemoglobin, education level, number of complications and health information-seeking behavior.

Conclusion

Patients with diabetes in rural areas have poor glycemic control and a high incidence of diabetic complications. Patients with diabetes in rural areas have poor knowledge and inadequate health information-seeking behavior. Systematic and standardized education should be provided to improve patients' diabetes knowledge and thus improve their self-management ability.

A systematic review on reporting quality of economic evaluations for negotiated glucose-lowering drugs in China national reimbursement drug list

BACKGROUND

This study aimed to examine the reporting quality of existing economic evaluations for negotiated glucose-lowering drugs (GLDs) included in China National Reimbursement Drug List (NRDL) using the Consolidated Health Economic Evaluation Reporting Standards 2013 (CHEERS 2013).

METHODS

We performed a systematic literature research through 7 databases to identify published economic evaluations for GLDs included in the China NRDL up to March 2021. Reporting quality of identified studies was assessed by two independent reviewers based on the CHEERS checklist. The Kruskal-Wallis test and Mann-Whitney U test were performed to examine the association between reporting quality and characteristics of the identified studies.

RESULTS

We have identified 24 studies, which evaluated six GLDs types. The average score rate of the included studies was 77.41% (SD:13.23%, Range 47.62%-91.67%). Among all the required reporting items, characterizing heterogeneity (score rate = 4.17%) was the least satisfied item. Among six parts of CHEERS, results part scored least at 0.55 (score rate = 54.79%) because of the incompleteness of characterizing uncertainty. Results from the Kruskal-Wallis test and Mann-Whitney U test showed that model choice, journal type, type of economic evaluations, and study perspective were associated with the reporting quality of the studies.

CONCLUSIONS

There remains room to improve the reporting quality of economic evaluations for GLDs in NRDL. Checklists such as CHEERS should be widely used to improve the reporting quality of economic researches in China.

Dysregulation of miR-25-3p in Diabetic Nephropathy and Its Role in Inflammatory Response

To investigate the expression level of miR-25-3p in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN), and its effect on proliferation, apoptosis and inflammatory response of mesangial cells cultured with high glucose. Blood samples of all clinical subjects were collected for RT-qPCR analysis to detect serum miR-25-3p levels. Human mesangial cells (HMCs) cultured with high glucose were used to construct DN model in vitro. MTT assay, flow cytometry and ELISA were used to evaluate the effects of miR-25-3p on the proliferation, apoptosis, and inflammatory response of DN cell models. Serum miR-25-3p was decreased in both T2DM group and DN group, but more in DN group. Serum miR-25-3p was positively correlated with eGFR and negatively correlated with UAER. The expression of miR-25-3p was reduced in HMCs induced by high glucose. Transfection of miR-25-3p mimic could significantly up-regulate the miR-25-3p level in HMCs. Besides, high glucose culture resulted in abnormal proliferation of HMCs, reduced apoptotic cells, and increased inflammation. The addition of miR-25-3p mimic significantly inhibited cell proliferation and promoted cell apoptosis and reduced the production of inflammatory factors. The abnormal reduction of serum miR-25-3p in DN indicates that it may be a potential biomarker for clinical diagnosis of DN. In in vitro experiments, miR-25-3p was involved in the progression of DN by regulating cell proliferation, apoptosis, and inflammatory response.

An observational study to evaluate the awareness of drug treatment, prescription pattern, adverse drug reactions, and adherence in patients of major depressive disorder

Aims

Due to the paucity of studies in and out of India that dealt with treatment awareness of major depressive disorder (MDD), we decided to assess the awareness of MDD patients, and since adherence and awareness are linked to each other, we assessed adherence too. Prescription pattern studies identify changes in prescriptions due to poor initial response or adverse drug reactions (ADRs), which may result in dose reduction or switching medications and delay remission. Therefore, the study assessed the ADR pattern.

Methodology

A cross-sectional questionnaire-based study was carried out on 200 MDD patients with treatment records for at least 3 months after getting approval from the Institutional Ethics Committee and consent from the patients. The data obtained were entered in Microsoft Excel and analyzed using descriptive statistics.

Results

The mean age was 44.65 ± 12.02 years, and females were 70%. Maximum patients (98%) were aware of the consequence of stopping the drugs suddenly, and only 12.5% were aware of the onset of response to treatment. Escitalopram was the most common antidepressant prescribed (43.77%), and 67 ADRs out of 136 were attributable to it. Weakness and fatigue were the most common ADRs. The majority (97) of the ADRs were possibly related to antidepressants, and 65% of patients showed optimal adherence to medications.

Conclusions

This study sheds light on the treatment awareness and adherence of MDD patients in India and highlights the need for educating patients about treatment response. It also emphasizes the importance of monitoring ADRs and adjusting prescription patterns accordingly to improve treatment outcomes.

Diabetes, hypertension, and other cardiovascular disease risk factors among adults in an urban underprivileged community in Bangalore city, India

Aim

Diabetes and hypertension are major risk factors of cardiovascular disease, which is known to be the leading cause of global mortality in the world today. Studies have shown that the prevalence of these risk factors is on the rise, with the burden of diabetes alone increasing by 80% in the last two decades. Complications of diabetes and hypertension result in huge public health challenges for the country and catastrophic medical expenditures for families among the urban poor. Our study aims to estimate the prevalence of diabetes, hypertension, and other cardiovascular risk factors among adults in an urban underprivileged community of Bengaluru city.

Objectives and Methods

A cross-sectional study was conducted over a period of 6 months where 2245 individuals aged 30 or older were interviewed using a structured interviewer-administered questionnaire used to capture sociodemographic details that assessed modifiable risk factors for diabetes and hypertension. Inclusion criteria for diabetes were considered if the random blood sugar reading was ≥200 mg/dL, whereas a diagnosis of hypertension was taken into consideration if the systolic blood pressure reading was ≥140 mmHg and/or diastolic blood pressure was ≥90 mmHg.

Results

Among the 2245 participants that took part in the study, 15.5% were diabetics and 17.2% were hypertensive. There was a strong association of diabetes among consumers of alcohol, with more than one-third having a high prevalence of the disease (odds ratio (OR): 2.09, 95% confidence interval (95% CI): 1.1-3.9). More than half the population were consumers of junk food; the prevalence of diabetes in this group was 1.35 times higher than that in their counterparts (OR: 1.35, 95% CI: 1.0-1.8). A significant association of diabetes was also seen among those identified with central obesity (OR: 1.83, 95% CI: 1.4-2.5). One-third of the population who consumed alcohol were found to be diagnosed with hypertension (OR: 3.08, 95% CI: 1.6-5.9), and one-fifth of individuals who were regular consumers of junk food had a higher prevalence of hypertension (OR: 1.41, 95% CI: 1.1-1.8). A higher prevalence of hypertension was also seen among individuals with central obesity or a body mass index (BMI) of >30 (OR: 1.59, 95% CI: 1.2-2.1; OR: 1.92, 95% CI: 1.4-2.6).

Conclusion

The findings from our study conducted in an urban underprivileged area of Bengaluru city shed light on the significant associations between diabetes and hypertension and various demographic and lifestyle factors. Specifically, male gender and lower educational status were found to have a significant association with diabetes, whereas being unmarried and having a high BMI status were strongly linked to hypertension. In addition, the study revealed that elderly individuals, alcohol consumers, junk food eaters, and those with central obesity demonstrated an increased risk for both diabetes and hypertension. By identifying these risk factors, targeted interventions can be developed to address the unique challenges faced by this vulnerable section of society. Strategies can be designed to raise awareness, encourage healthier lifestyle choices, and improve access to healthcare services to effectively prevent and manage diabetes and hypertension in this community.

Factors of Influence on Diabetes Awareness in Older People With Chronic Obstructive Pulmonary Disease Comorbid With Type 2 Diabetes Mellitus

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD) and has been associated with an increased risk of mortality in this population.

PURPOSE

This study was designed to investigate the predictive factors of diabetes awareness (DA), including diabetes knowledge (DK), and diabetes care behaviors (DCB) among older people with both COPD and T2DM.

METHODS

This was a cross-sectional descriptive correlation study. One hundred thirty-three older-age patients with COPD comorbid with T2DM receiving treatment at a chest hospital were enrolled as participants. Both DK and DCB were utilized to measure DA. The Diabetes Knowledge Questionnaire was utilized to measure DK, and the Summary of Diabetes Self-Care Activities was used to evaluate DCB.

RESULTS

The average glycated hemoglobin (HbA1c) was 7.68% ( SD = 1.55%), with 74 (55.6%) participants having a level > 7%. The average DA was 46.46% ( SD = 13.34%), the average DK was 53.42% ( SD = 18.91%), and the average DCB was 39.50% ( SD = 16.66%). In terms of demographic variables, age, diabetes education, diabetes shared care, and HbA1c were all significantly associated with DA, DK, and DCB (all p s < .05). The overall variance in DA was significantly explained by diabetes education and HbA1c (all p s < .05). The overall variance in DK was significantly explained by age, diabetes education, and HbA1c. The overall variance in DCB was significantly explained by diabetes education and HbA1c (all p s < .05).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Our study findings indicate that older adult patients with COPD comorbid with T2DM are at elevated risks of poor glycemic control and low DA. Healthcare professionals should be aware of these issues and develop appropriate DA plans to prevent poor glycemic control in this population. Providing accurate information on diabetes to older adults with COPD comorbid with T2DM is important to improving their DK and promoting better DCB.

Nationwide survey of physicians' familiarity and awareness of diabetes guidelines in China: a cross-sectional study

OBJECTIVE

This study aims to investigate physicians' familiarity and awareness of four diabetes guidelines and their practice of the recommendations outlined in these guidelines.

DESIGN

A cross-sectional study.

SETTING

An online questionnaire survey was conducted among physicians affiliated with the Specialist Committee for Primary Diabetes Care of China Association of Chinese Medicine, using the snowball sampling method to ensure a broader representation of physicians.

PARTICIPANTS

1150 physicians from 192 cities across 30 provinces in China provided complete data.

RESULTS

Tertiary care hospital physicians (TCPs) exhibited the highest familiarity with the Guideline for the Prevention and Treatment of Type 2 Diabetes Mellitus in China (91.3%), followed by the National Guidelines for the Prevention and Control of Diabetes in Primary Care (76.8%), the Standards of Medical Care in Diabetes (72.2%) and the Guidelines for Prevention and Treatment of Diabetes in Chinese Medicine (63.8%). Primary care practitioners (PCPs) exhibited familiarity with these four guidelines at about 50% or less. Self-reported reference to modern diabetes guidelines by physicians is more frequent than traditional Chinese medicine (TCM) diabetes guidelines, with rates at 73.2% and 33.8%, respectively. Approximately 90% of physicians provided instructions on self-monitoring of blood glucose to their patients with diabetes. Less than one-third of physicians referred patients to a specialised nutritionist. In terms of health education management, TCPs reported having a diabetes health management team at the rate of 75.7%, followed by secondary care hospital physicians at 57.0% and PCPs at 27.5%. Furthermore, approximately 40% of physicians did not fully grasp hypoglycaemia characteristics.

CONCLUSIONS

Familiarity and awareness of the screening guidelines varied among physicians in different hospital settings. Importantly, significant discrepancies were observed between physicians' awareness and their self-reported reference to modern medicine guidelines and TCM guidelines. It is essential to consistently provide education and training on diabetes management for all physicians, particularly PCPs.

Diabetes care cascade and their predictors in young and middle-aged population in India: evidence from the National Family Health Survey (2019-21)

Purpose

Weak care cascade of diabetes from the time of screening, diagnosis, treatment initiation and attainment of optimal glycemic control is a public health challenge particularly in resource limited settings. We aimed to assess the diabetes care cascade in India and its determinants in the 15-49 age group.

Methods

We conducted a secondary data analysis of the National Family Health Survey (NFHS-5, 2019-2021), a nationally representative cross-sectional survey, including a total of 724,115 women and 101,839 men with mean (SD) age 30.6 (9.9) years.

Results

The prevalence of self-reported Diabetes Mellitus (DM) in the sample was 2.14% (n = 14,116, 95% CI: 2.06, 2.21) of which 55.13% (n = 6990, 95% CI: 53.37, 56.88) were currently undergoing anti-diabetes therapy. The net prevalence of DM including both old and new cases detected on screening was 2.9%. Poor glycemic control was observed in 52.43% (n = 3506, 95% CI: 50.69, 54.16) of patients with DM on anti-diabetes therapy. Patients from the richest wealth quintile (aOR = 5.17, 95% CI: 1.93, 13.84) had significantly higher odds of accessing private health facilities, while female patients with DM were less likely to be on anti-diabetes therapy.

Conclusion

The prevalence of self-reported DM in India has increased from 1.7% (NFHS-4, 2015-16) to 2.1% (NFHS-5, 2019-21) while more than half of existing patients continue to remain undiagnosed. Consequently, diabetes care cascade have major lacunae at every stage from screening to diagnosis, initiation of effective treatment, and achievement of safe blood glucose levels.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01263-9.

Diabetes knowledge predicts HbA1c levels of people with type 2 diabetes mellitus in rural China: a ten-month follow-up study

Improving diabetes self-management (DSM) is facing real-world challenges among people with type 2 diabetes mellitus (T2DM) who have a low education level in resource-limited areas. This study aimed to investigate whether diabetes knowledge could predict glycemic levels in people with T2DM in rural China. This analytical cross-sectional study recruited 321 people with T2DM from eight villages by purposive sampling at baseline. After 10 months, 206 patients completed the follow-up survey and HbA1c tests, with a response rate of 64.17% (206/321). Multiple regression analysis was employed to explore the correlation between diabetes knowledge and HbA1c levels. The patient's diabetes knowledge was significantly negatively correlated with HbA1c levels before and after controlling for covariates in both hierarchical multiple regression and multiple logistic regression (p < 0.01). In addition, other influencing factors, including sex, age, marital status, employment status, income, and HbA1c levels at baseline, were also identified. Diabetes knowledge could predict HbA1c levels significantly among patients with low education levels in rural China. Therefore, interventions on improving diabetes knowledge need to be strengthened for patients in rural China so that they can improve their health outcomes and reduce the disease burden.

The relationship between psychological resilience and quality of life among the Chinese diabetes patients: the mediating role of stigma and the moderating role of empowerment

BACKGROUND

Although some factors, such as stigma and empowerment, influence the complex relationship between psychological resilience and quality of life, few studies have explored similar psychological mechanisms among patients with diabetes. Therefore, this study explored the mediating role of stigma and the moderating role of empowerment in the psychological mechanisms by which psychological resilience affects quality of life.

METHODS

From June to September 2022, data were collected by multi-stage stratified sampling and random number table method. Firstly, six tertiary hospitals in Wuhu were numbered and then selected using the random number table method, resulting in the First Affiliated Hospital of Wannan Medical College being selected. Secondly, two departments were randomly selected from this hospital: endocrinology and geriatrics. Thirdly, survey points were set up in each department, and T2DM patients were randomly selected for questionnaire surveys. In addition, we used the Connor-Davidson Elasticity Scale (CD-RISC) to measure the psychological resilience of patients, and used the Stigma Scale for Chronic Illness (SSCI) to measure stigma. Empowerment was measured by the Diabetes Empowerment Scale (DES). Quality of Life was assessed by the Diabetes Quality of Life Scale (DQoL). We used SPSS (version 21) and PROCESS (version 4.1) for data analysis.

RESULTS

(1) Psychological resilience was negatively correlated with stigma and quality of life, and positively correlated with empowerment. Stigma was positively associated with empowerment and quality of life. Empowerment was negatively correlated with quality of life. (2) The mediation analysis showed that psychological resilience had a direct predictive effect on the quality of life, and stigma partially mediated the relationship; Empowerment moderates the first half of "PR → stigma → quality of life"; Empowerment moderates the latter part of "PR → stigma → quality of life."

CONCLUSIONS

Under the mediating effect of stigma, psychological resilience can improve quality of life. Empowerment has a moderating effect on the relationship between psychological resilience and stigma, and it also has a moderating effect on the relationship between stigma and quality of life. These results facilitate the understanding of the relationship mechanisms between psychological resilience and quality of life.

The role of family support in diabetes self-management among rural adult patients

AIMS AND OBJECTIVES

This study aimed to investigate the role of the family in supporting diabetes self-management and explore the possible mechanisms between family and diabetes self-management among rural patients in China.

BACKGROUND

The prevalence of Type 2 diabetes mellitus (T2DM) is growing rapidly in rural areas of China, where healthcare resources remain relatively poor and family members play an important role in chronic disease self-management.

DESIGN

This was a multicentre cross-sectional study.

METHODS

A total of 276 adults with T2DM were recruited from nine county hospitals in China. Diabetes self-management, family support, family function, and family self-efficacy were evaluated using the mature scales. A theoretical model was built based on the social learning family model and previous studies and then verified using a structural equation model. The STROBE statement was used to standardise the study procedure.

RESULTS

Family support and general family factors, including family function and self-efficacy, were positively correlated with diabetes self-management. Family support fully mediates the relationship between family function and diabetes self-management and partially mediates the relationship between family self-efficacy and diabetes self-management. The model explained 41% of the variability in diabetes self-management and had a good model fit.

CONCLUSION

General family factors can explain nearly half of the change in diabetes self-management in rural areas of China, while family support is a mediator between general family factors and diabetes self-management. Family self-efficacy, a potential intervention point of family based diabetes self-management education, can be improved by building special lessons for family members.

RELEVANCE TO CLINICAL PRACTICE

This study emphasises the role of family in diabetes self-management and proposes suggestions for diabetes self-management intervention among patients with T2DM in rural areas of China.

PATIENT OR PUBLIC CONTRIBUTION

Patients and their family members completed the questionnaire which was used for data collection.

The Mediation Effect of Attitude on the Association Between Knowledge and Self-Management Behaviors in Chinese Patients With Diabetes

Objective: This study aims to investigate the level of knowledge, attitude and self-management behaviors of diabetic patients, to explore the mediating role of attitude in the relationship between knowledge and self-management behaviors. Methods: 900 diabetes patients were randomly selected from the eastern, central and western regions of Shandong Province, China, and recovered 863 valid questionnaires. Path analysis was used to examine the mediating role of attitude in the relationship between knowledge and self-management behaviors in patients with diabetes. Results: The mean score (SD) of the diabetes self-management questionnaire (DSMQ) in this study was 35.01 (6.87). The direct effect value of knowledge level on self-management behaviors was 0.357, accounting for 62.09% of the total effect. The indirect effect value of knowledge on self-management behaviors through attitude was 0.218, accounting for 37.91%. Conclusion: Level of knowledge has a significant direct impact on self-management behaviors and an indirect impact on self-management behaviors through attitude. Therefore, it is necessary to strengthen health education on diabetes to improve awareness, ameliorate attitudes toward diabetes, and change self-management behaviors.

Digital Health Solutions for Community-Based Control of Diabetes During COVID-19 Pandemic: A Scoping Review of Implementation Outcomes

BACKGROUND

The COVID-19 pandemic has added to the pre-existing challenges of diabetes management in many countries. It has accelerated the wider use of digital health solutions which have tremendous potential to improve health outcomes for people with diabetes. However, little is known about the attributes and the implementation of these solutions.

OBJECTIVE

To identify and describe digital health solutions for community-based diabetes management and to highlight their key implementation outcomes.

METHODS

We searched Ovid Medline, CINAHL, Embase, PsycINFO, and Web of Science for relevant articles. A purposive search was also used to identify grey literature. Articles that described digital health solutions that aimed to improve community-based diabetes management were included in this review. We applied a thematic synthesis of evidence to describe the characteristics of digital health solutions, and to summarize their key implementation outcomes.

RESULTS

We included 15 articles that reported digital health solutions that primarily focused on community-based diabetes management. Nine of the 15 innovations involved were mobile applications and/or web-based platforms, and five were based on social media platforms. The majority of the digital health solutions were used for diabetes education and support. High engagement, utilization, and satisfaction rates with digital health solutions were observed. The use of digital health solutions was also associated with improvement in self-management, taking medication, and reduction in glycated hemoglobin (HbA1c) levels.

CONCLUSION

COVID-19 triggered digital health solutions have tremendous potential to improve health outcomes for people with diabetes. Further studies are needed to evaluate the sustainability and scale-up of these solutions.

Rural-urban differentials of prevalence and lifestyle determinants of pre-diabetes and diabetes among the elderly in southwest China

BACKGROUND

Diabetes has become a major public health problem in China. A better understanding of diabetes determinants and urban-rural differences is essential to crafting targeted diabetes prevention measures for the elderly living in both urban and rural areas. This study aimed to compare rural-urban differentials in prevalence and lifestyle determinants of pre-diabetes and diabetes among the elderly in southwest China.

METHODS

A cross-sectional health interview and examination survey was conducted among individuals aged ≥ 60 years in both a rural and urban area of China. Anthropometric measurements, including height, weight, and waist circumference, as well as blood pressure and fasting blood glucose measurements were taken. Associated risk factors for pre-diabetes and diabetes were evaluated using multivariate logistic regression analysis.

RESULTS

In total, 1,624 urban residents and 1,601 rural residents consented to participate in the study. The urban prevalence of pre-diabetes and diabetes (46.8% and 24.7%, respectively), was higher than the rural prevalence (23.4% and 11.0%, respectively, P<0.01). Urban elderly participants had markedly higher prevalence of obesity, central obesity, and physical inactivity than their rural counterparts (15.3%, 76.0%, and 9.2% vs. 4.6%, 45.6%, and 6.1%, P<0.01). In contrast, rural elderly adults had higher prevalence of smoking than urban ones (23.2% vs. 17.2%, P<0.01). Obese (OR 1.71, 95% CI 1.27-2.30 vs. OR 1.73, 95% CI 1.30-3.28) and centrally obese participants (OR 1.59, 95% CI 1.18-2.15 vs. OR 1.83, 95% CI 1.32-2.54) were more likely to suffer from diabetes in both urban and rural regions. Furthermore, urban current smokers had a higher probability of suffering from diabetes (OR 1.58, 95% CI 1.11-2.25), while hypertension was positively associated with the prevalence of diabetes in the rural area (OR 2.13, 95% CI 1.54-2.95). Obese participants in the rural area were more likely to suffer from pre-diabetes (OR 2.50, 95% CI 1.53-4.08), while physical inactivity was positively associated with prevalence of pre-diabetes in the urban area (OR 1.95, 95% CI 1.37-2.80).

CONCLUSION

Pre-diabetes and diabetes are more prevalent among urban older adults than their rural counterparts in southwest China. The identified rural-urban differentials of lifestyle factors have significant impacts on prevalence of pre-diabetes and diabetes. Thus, tailored lifestyle interventions are needed to improve diabetes prevention and management among the elderly in southwest China.

Development and validation of the diabetic self-management scale based on information-motivation-behavioral skills theory

Background

Self-management is important for the blood sugar control of middle-aged and elderly Type 2 diabetes mellitus (T2DM) patients, of which diet, exercise, and drug compliance are the most common components. The Information-Motivation-Behavioral Skills Model (IMB) has been widely used in health behavior management and intervention.

Objective

The purpose of this study is to develop and validate the Diabetic Self-Management Scale (DSMS) based on the IMB model.

Methods

Self-report survey data was collected from middle-aged and elderly T2DM patients in Zhongmu City, Henan Province, China in November 2021 using convenience sampling. The original DSMS was developed through a literature review and summary of previous similar scales using an inductive approach. Item modification was finished by a panel of specialists. Exploratory factor analysis and confirmatory factor analysis were used to evaluate the reliability, convergent validity, discriminant validity, and criterion validity of DSMS.

Results

Four hundred and sixty nine T2DM patients completed the questionnaire survey. The final DSMS consists of 22 items with three dimensions, including information (five items), motivation (eight items), and behavior skills (nine items). The results of simple factor analysis showed that the KMO value was 0.839, Bartlett spherical test 2 = 3254.872, P < 0.001. The results of confirmatory factor analysis showed that 2/df = 2.261, RMSEA = 0.073, CFI = 0.937, TLI = 0.930, and SRMR = 0.096. The standardized factor loadings of 22 DSMS items were all above 0.6, and the CR values of 3 dimensions were all higher than 0.9. In addition, DSMS also showed good discriminant and criterion validity.

Conclusion

The 22-item DSMS has good reliability and validity, and can be used to make diabetic self-management assessment regarding diet, physical activity, and medication among middle-aged and elderly Chinese T2DM patients. DSMS is of moderate length and easy to understand. It can be promoted in China in the future to understand the self-management status of middle-aged and elderly T2DM patients in China.

Exposure to Polybrominated Diphenyl Ethers and Phthalates in China: A Disease Burden and Cost Analysis

Increasing evidence indicates that endocrine-disrupting chemicals (EDCs) cause a variety of adverse health outcomes and contribute to substantial disease burden. This study summarized the exposure status of polybrominated diphenyl ethers (PBDEs) and phthalates (PAEs) in China and evaluated the disease burden attributable to PBDEs and PAEs in 2015. The results showed that PBDE and PAE concentrations were higher in coastal areas. The disease burden attributable to PBDEs was 0.77 million cases, and the economic costs were CNY 18.92 billion. Meanwhile, 3.02 million individuals suffered from diseases attributable to PAEs, and the economic costs were CNY 49.20 billion. The economic burden caused by PBDEs and PAEs accounted for 0.28% and 0.72% of China's Gross Domestic Product (GDP) in 2015, respectively. When comparing China's results from 2010, it was determined that the GDP ratio of economic costs caused by PAEs in 2015 (0.72%) was lower than in 2010 (1.42%). Finally, compared with the results of the European Union and North America, the GDP ratios of economic costs caused by PAEs in 2015 were 0.19% in Canada (lower than China), 0.29% in the United States (lower than China), and 1.44% in the European Union (higher than China). This study provides important reference values for China's health governance, and further research should be conducted in the future.

Association between glycemic control and albuminuria among Peruvian adults with diabetes mellitus 2: a cross-sectional analytical study

BACKGROUND

Albuminuria is a risk factor for microvascular and macrovascular complications in the diabetic population. However, few studies have correlated poor glycemic control and albuminuria prevalence in Hispanic populations.

OBJECTIVE

To evaluate the association between glycemic control and albuminuria among Peruvian adults with type 2 diabetes mellitus (T2DM).

DESIGN AND SETTING

Cross-sectional analytical study among adults with T2DM in Lima, Peru.

METHODS

We included adults over 18 years old who were in a clinical follow-up program at a private clinic in Lima in 2018. Poor glycemic control was defined as a serum value of glycosylated hemoglobin A1C (HbA1C) ≥ 7%. Albuminuria was defined as albumin values &gt; 30 mg/dl in the first morning urine. We generated generalized linear regression models from the Poisson family with robust variance. We calculated the crude and adjusted prevalence ratios (PRs) with their 95% confidence interval (CI).

RESULTS

We analyzed 907 participants of median age 58 years (interquartile range, IQR 49 to 66), and 62.8% were males. The prevalence of poor glycemic control was 39.8%, and the prevalence of albuminuria was 22.7%. The prevalences of albuminuria in groups with poor glycemic control and adequate glycemic control were 32.7% and 16.1%, respectively. In the adjusted regression analysis, we found a statistically significant association between poor glycemic control and albuminuria (annual percentage rate, aPR = 1.70; 95% CI: 1.28-2.27).

CONCLUSIONS

The prevalence of poor glycemic control and albuminuria was high in our study population. Moreover, Peruvian T2DM adults with poor glycemic control were more likely to have albuminuria.

Influence of Information-Based Continuous Care on Disease Control and Treatment Compliance of Elderly Diabetic Patients

Background

The incidence of diabetes is increasing year by year. For elderly diabetic patients, poor blood glucose control and worsening immune function greatly increase the risk of complications, which will seriously affect their quality of life.

Purpose

This paper primarily clarifies the influence of information-based continuous care on disease control and treatment compliance of elderly diabetic patients.

Methods

From December 2018 to December 2021, 106 elderly diabetic patients were selected, and their clinical data were retrospectively studied. Patients were grouped according to the type of care they received: an observation group (OG) comprising 56 cases receiving information-based continuous care and a control group (CG) including 50 cases treated with routine nursing. The two cohorts of patients were compared regarding disease control, treatment compliance, glucose and lipid metabolism (GLM), and self-management.

Results

After analysis, it was found that the disease control and treatment compliance were statistically higher in OG compared with CG. OG also showed significantly reduced fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG), total cholesterol (TC), and triglyceride (TG) after nursing that were all lower compared with CG. In terms of self-management, OG outperformed CG in diet, exercise, blood glucose monitoring, and adherence to medical regimens.

Conclusions

Information-based continuous care has beneficial effects on disease control and treatment compliance of elderly diabetic patients and can help control blood sugar and optimize patients' self-management level, with high clinical promotion value.

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.

Pre-diabetes, Diabetes Mellitus and Related Cardio-metabolic Risk Factors in the Southern Coastal Region of Iran Middle-aged and Elderly Population; Bandare-Kong Cohort Study

Background: To evaluate the prevalence of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG), and its cardio-metabolic risk factors in the southern Iranian adult population. Methods: This is a population-based cross-sectional survey on 3944 middle-aged and elderly adults (35–70 years) from Bandare-Kong. The participants were recruited from 2016 to 2018 and the first phase data of the Bandare-Kong Cohort as a part of the PERSIAN Cohort were used for analysis. Results: Among the 3944 included adults, the age-adjusted prevalence of T2DM and IFG was 17.40% and 20.61%, respectively. Mean FPG was higher among those older than 55 years, females, rural residents, current cigarette smokers, hypertriglyceridemia, hypercholesterolemia, unemployed and low educational level in subjects with diabetes and pre-diabetes. T2DM and IFG were more prevalent in women and men, respectively. Also, those with higher waist circumference (WC), higher body mass index (BMI), lower educational levels, rural residents, former cigarette smokers, hypertension (HTN), hypercholesterolemia, hypertriglyceridemia and age older 45 years, had a higher T2DM and IFG prevalence. Multivariable regression analysis showed that older age, higher WC, HTN and hypertriglyceridemia and living in rural regions were statistically significant predictors of T2DM and pre-diabetes while BMI≥25 kg/m2 was the only significant risk factor for IFG. Conclusion: The current study illustrated that T2DM and IFG have a high prevalence among the middle-aged and elderly adult Iranian population, particularly in rural dwellers. Hence, prevention strategies should be implemented to reduce diabetes and pre-diabetes, especially in rural areas.

Acacia jacquemontii ethyl acetate extract reduces hyperglycemia and pro-inflammatory markers while increasing endogenous antioxidant potential in alloxan-induced diabetic rats

Acacia jacquemontii possess has numerous traditional therapeutic uses. The rationale of this study was to investigate the role of Acacia jacquemontii ethyl acetate extract (AJEAE) in the downregulation of hyperglycemia. The current study was performed in two parts, in vitro, through characterization (high-performance liquid chromatography), estimation of total phenolic content, total flavonoid content, antioxidant (2,2-diphenyl-1-picrylhydrazylassay), and α-amylase inhibitory activities of the studied extract, and in vivo using Wistar rats in which animals were divided into five groups NC, DC, GL, AJEAE 250 mg/kg, and AJEAE 500 mg/kg. The effects of AJEAE on fasting plasma glucose, plasma insulin, HOMA-IR, oral glucose tolerance test, glycated hemoglobin (HBA1c), lipid profile, inflammatory cytokines (Interleukin-6, tumor necrosis factor-alpha), and oxidative stress markers (lipid peroxidation, nitic oxide, superoxide dismutase, catalase, glutathione peroxidase) were evaluated. Our findings confirmed the presence of quercetin, kaempferol, gallic acid, vanillic acid, syringic acid, M-coumaric acid, sinapic acid, chlorogenic acid, cinnamic acid, and ferulic acid in AJEAE. Total flavonoid and phenolic contents in AJEAE were 83.83 mg GAE/g and 77.06 mg QE/g, respectively. Significant inhibition of DPPH (69.470%/1 mg/ml) and α-amylase (71.8%/1 mg/ml) activities were exhibited by AJEAE. Alloxan-injected rats showed marked hyperglycemia and hypoinsulinemia, and increased inflammatory marker levels as compared to normal control (p < 0.001). Additionally, raised levels of triglyceride (139.7 ± 2.771), total cholesterol (198.7 ± 1.856), very low-density lipoprotein (33.43 ± 0.2728), low-density lipoprotein (155.5 ± 2.754), lipid peroxidation, and nitric oxide (p < 0.001) and decreased levels of high-density lipoprotein (17.20 ± 0.1732), superoxide dismutase, catalase, and glutathione peroxidase were observed in diabetic rats (p < 0.001). AJEAE significantly (p < 0.05) improved the aforementioned parameters and the protective efficacy was comparable to glibenclamide. Histopathological findings also evidenced the anti-hyperglycemic properties of AJEAE through regeneration of pancreatic β cells. Conclusively, our findings demonstrated the antihyperglycemic, antihyperlipidemic, antioxidant, anti-inflammatory, and pancreatic beta β cell regenerative properties of AJEAE against alloxan-induced diabetes.

Combined Effects of Obesity and Dyslipidaemia on the Prevalence of Diabetes Amongst Adults Aged ≥45 Years: Evidence from a Nationally Representative Cross-Sectional Study

Objectives: This study aimed to explore the combined effects of different types of obesity and dyslipidaemia on the prevalence of diabetes in middle-aged and elderly residents. Methods: Data were obtained from the 2015 China Health and Retirement Longitudinal Studydatabase, and 5023 valid participants were included after excluding those with missing data. A Chi-square test was used to test the difference in the prevalence of diabetes between the groups. Binary logistic regression was used to analyse the relationship between different types of obesity combined with dyslipidaemia and the prevalence of diabetes. Results: Multivariate logistic regression analysis showed that, compared with those with a body mass index <24/ortholiposis, the subgroup with systemic obesity/dyslipidaemia had 4.37 times the risk of diabetes (OR = 4.37, 95% CI = 2.36−8.10, p < 0.001). In addition, compared with those with a normal waist circumference (WC)/ortholiposis, the subgroup with abdominal obesity/dyslipidaemia had 3.58 times the risk of diabetes (OR = 3.58, 95% CI = 2.49−5.13, p < 0.001). Conclusions: The coexistence of obesity and dyslipidaemia can significantly increase the risk of diabetes, suggesting that the strict control of weight, WC and lipid level is beneficial to the prevention of diabetes.

Review of the Chinese Landscape in Phase I Clinical Trials for Noncancer Innovative Drugs Over 2015 to 2020

In recent years, the research and development (R&D) of innovative drugs in China has been dramatically accelerated. And the early clinical study is crucial for drug R&D. However, little is known involving the change of phase I trials for noncancer drugs. We retrieved the data of phase I clinical trials for noncancer innovative drugs on the Registration and Information Disclosure Platform for Drug Clinical Studies on the Center for Drug Evaluation. The number of clinical trials proliferating in recent years and the average annual growth rates of chemical and biological drugs were 55.5% and 42.1%, respectively. Most trials were distributed in Beijing, Shanghai, and other developed coastal cities. Moreover, the clinical trials of innovative drugs in China were focused on the digestive and endocrine systems, whereas the pediatric and orphan drugs were scarce. Based on the data assessment, this work provided comprehensive analysis and suggestions about Chinese drug R&D. Significant advancement has been made in mainland China with the implementation of available policies and the emergence of advanced technologies. Though shortcomings, including uneven geographic distribution and lack of pediatric and orphan drugs, still exist, we believe progress will continue to be made in mainland China.

Blood Glucose Response of a Low-Carbohydrate Oral Nutritional Supplement with Isomaltulose and Soluble Dietary Fiber in Individuals with Prediabetes: A Randomized, Single-Blind Crossover Trial

A high-energy-type oral dietary supplement (ONS), with a low proportion of available carbohydrate (LC-ONS), which contains a slowly digestible carbohydrate, isomaltulose, and is fortified with soluble dietary fiber, was newly developed for individuals with diabetes or prediabetes. This study aimed to evaluate the impact of LC-ONS on blood glucose levels after ingestion in individuals with prediabetes. A single-blind, randomized crossover clinical trial was performed on 20 individuals with prediabetes. After overnight fasting, all subjects ingested one serving (200 kcal/125 mL) of either LC-ONS (40% energy proportion of available carbohydrates) or standard ONS (ST-ONS, 54% energy proportion of available carbohydrates) on two separate days. The incremental area under the curve of blood glucose levels for 120 min was significantly lower after LC-ONS ingestion compared to ST-ONS (2207 ± 391 mg/dL·min (least mean square value ± standard error) and 3735 ± 391 mg/dL·min, respectively; p < 0.001). The LC-ONS showed significantly lower blood glucose levels than the ST-ONS at all time points, except at baseline. Similarly, the incremental area under the curve of plasma insulin was significantly lower after LC-ONS ingestion. These results suggest that LC-ONS is useful as an ONS for energy supply in individuals with postprandial hyperglycemia.

Effects of continuous subcutaneous insulin infusion on the microstructures, mechanical properties and bone mineral compositions of lumbar spines in type 2 diabetic rats

BACKGROUND

Continuous subcutaneous insulin infusion (CSII) for the treatment of type 2 diabetes (T2D) can improve the structure and strength of femur of rats, but the effect of CSII treatment on the lumbar spine of T2D rats is unknown. The purpose of this study is to investigate the effects of CSII on the microstructure, multi-scale mechanical properties and bone mineral composition of the lumbar spine in T2D rats.

METHODS

Seventy 6-week-old male Sprague-Dawley (SD) rats were divided into two batches, each including Control, T2D, CSII and Placebo groups, and the duration of insulin treatment was 4-week and 8-week, respectively. At the end of the experiment, the rats were sacrificed to take their lumbar spine. Microstructure, bone mineral composition and nanoscopic-mesoscopic-apparentand-macroscopic mechanical properties were evaluated through micro-computed tomography (micro-CT), Raman spectroscopy, nanoindentation test, nonlinear finite element analysis and compression test.

RESULTS

It was found that 4 weeks later, T2D significantly decreased trabecular thickness (Tb.Th), nanoscopic-apparent and partial mesoscopic mechanical parameters of lumbar spine (P < 0.05), and significantly increased bone mineral composition parameters of cortical bone (P < 0.05). It was shown that CSII significantly improved nanoscopic-apparent mechanical parameters (P < 0.05). In addition, 8 weeks later, T2D significantly decreased bone mineral density (BMD), bone volume fraction (BV/TV) and macroscopic mechanical parameters (P < 0.05), and significantly increased bone mineral composition parameters of cancellous bone (P < 0.05). CSII treatment significantly improved partial mesoscopic-macroscopic mechanical parameters and some cortical bone mineral composition parameters (P < 0.05).

CONCLUSIONS

CSII treatment can significantly improve the nanoscopic-mesoscopic-apparent-macroscopic mechanical properties of the lumbar spine in T2D rats, as well as the bone structure and bone mineral composition of the lumbar vertebrae, but it will take longer treatment time to restore the normal level. In addition, T2D and CSII treatment affected bone mineral composition of cortical bone earlier than cancellous bone of lumbar spine in rat. Our study can provide evidence for clinical prevention and treatment of T2D-related bone diseases.

Vitamin D is Positively Associated with Bone Mineral Density Muscle Mass and Negatively with Insulin Resistance in Senile Diabetes Mellitus

Objective

To explore the correlations between vitamin D level and bone mineral density (BMD), insulin resistance (HOMA-IR), and muscle mass in patients with senile type 2 diabetes mellitus (T2DM).

Methods

Totally, 80 patients with senile T2DM admitted to China-Japan Friendship Hospital from Jan 2020 to Oct 2021 were enrolled and assigned to the 25 (OH)D-deficiency group (n = 35) or 25(OH)D-normal group (n = 45) according to serum 25(OH)D level. BMD and HOMA-IR in the femur neck and muscle masses of upper and lower limbs were compared between the two groups, and Pearson's correlation analysis was performed to determine the relations between 25(OH)D and BMD, HOMA-IR, and muscle masses of upper and lower limbs.

Results

No notable difference was found between the two groups in general data including age, gender, diabetes duration, BMI, HBA 1c, and fasting insulin (all P > 0.05). Compared with the 25(OH)D-normal group, the 25 (OH)D-deficiency group showed a notably lower BMD in the femur neck, notably lower muscle masses of upper and lower limbs, and a notably higher HOMA-IR level (all P < 0.05). The Pearson's correlation analysis revealed positive associations between 25(OH)D and BMD and muscle masses of upper and lower limbs in patients with senile T2DM and a negative correlation between 25(OH)D and HOMA-IR (all P < 0.05).

Conclusions

The serum 25(OH)D decreases notably in patients with senile T2DM, and higher serum 25(OH)D level may improve insulin resistance, limb muscle masses, and bone density and thus maintain bone health.

Anaemia and associated factors among older adults in an urban district in China: a large-scale cross-sectional study

OBJECTIVE

Anaemia leads to poor health outcomes in older adults; however, most current research in China has focused on younger adults. This study aimed to investigate the prevalence of anaemia and its associated factors in older adults in an urban district in China.

DESIGN

A cross-sectional study.

SETTING

An urbanised region, Shenzhen, China.

PARTICIPANTS

A total of 121 981 participants aged ≥65 years were recruited at local community health service centres in Shenzhen from January to December 2018.

PRIMARY OUTCOMES

The prevalence of anaemia was analysed and potential associated factors were evaluated.

RESULTS

The mean haemoglobin level was 136.40±16.66 g/L and the prevalence of anaemia was 15.43%. The prevalences of mild, moderate and severe anaemia were 12.24%, 2.94% and 0.25%, respectively. Anaemia was positively associated with older age, being underweight (adjusted OR (AOR) 2.06, 95% CI 1.93 to 2.20), diabetes (AOR 1.23, 95% CI 1.19 to 1.28) and chronic kidney disease (AOR 1.41, 95% CI 1.36 to 1.46), and inversely with higher education level, current-smoker (AOR 0.84, 95% CI 0.78 to 0.89), non-habitual drinker (AOR 0.86, 95% CI 0.81 to 0.92), habitual drinker (AOR 0.81, 95% CI 0.75 to 0.87), overweight (AOR 0.67, 95% CI 0.64 to 0.70), obesity (AOR 0.57, 95% CI 0.53 to 0.61), central obesity (AOR 0.86, 95% CI 0.82 to 0.89), hypertension (AOR 0.86, 95% CI 0.83 to 0.89) and dyslipidaemia (AOR 0.81, 95% CI 0.78 to 0.84).

CONCLUSION

Anaemia is prevalent among people aged 65 years and older in China. Screening of high-risk populations and treatment of senile anaemia should be a top priority in Shenzhen, and should be listed as important public health intervention measures for implementation.

Joint associations of fresh fruit intake and physical activity with glycaemic control among adult patients with diabetes: a cross-sectional study

OBJECTIVE

To investigate the joint associations of fresh fruit intake and physical activity with glycaemic control in adult patients with diabetes mellitus (DM).

DESIGN

It was an observational study involving adult patients with DM through a face-to-face questionnaire survey, physical measurements and laboratory examinations. Data were analysed by introducing a generalised linear mixed model, and a significant difference was set at p<0.05.

SETTING

Nanjing, Jiangsu, China.

PARTICIPANTS

A total of 5663 adult patients with DM from the 2017 Nanjing Chronic Disease and Risk Factor Surveillance were recruited.

RESULTS

Based on the food frequency questionnaire, fresh fruit intake was classified as 'not eat', '1~99 g/day' and '≥100 g/day'. Physical activity level was calculated based on the data of Global Physical Activity Questionnaire and classified into insufficient physical activity (<600 MET-min/week) and sufficient physical activity (≥600 MET-min/week). The likelihood of glycaemic control in adult patients with DM with fresh fruit intake ≥100 g/day was 37.8% (OR: 1.378; 95% CI: 1.209 to 1.571) higher than those with fresh fruit intake <100 g/day, which was 26% (OR: 1.260; 95% CI: 1.124 to 1.412) higher in adult patients with DM with sufficient physical activity than those with insufficient physical activity. Adult patients with DM with fresh fruit intake ≥100 g/day and sufficient physical activity presented the greatest likelihood of glycaemic control (OR: 1.758; 95% CI: 1.471 to 2.102) compared with those with both fresh fruit intake <100 g/day and insufficient physical activity.

CONCLUSIONS

Fresh fruit intake ≥100 g/day combined with sufficient physical activity is associated with a significantly higher likelihood of glycaemic control in adult patients with DM.

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.

Mortality and Years of Life Lost in Diabetes Mellitus and Its Subcategories in China and Its Provinces, 2005-2020

OBJECTIVES

To analyze diabetes mellitus (DM) mortality and years of life lost (YLL) in different years and different subgroups at the national and regional levels in China from 2005 to 2020.

METHODS

We estimated mortality and YLL of DM and its subcategories for 31 provinces in China during 2005-2020 using multisource data from the National Mortality Surveillance System (NMSS).

RESULTS

The age standardized mortality rate (ASMR) of DM increased from 12.18 per 100,000 in 2005 to 13.62 per 100,000 in 2020, which was an increase of 11.86%. The ASMR of type 2 diabetes mellitus (T2DM) was much higher than that of type 1 diabetes mellitus (T1DM). The ASMR of T1DM remained stable, but the rate of T2DM increased, and the increase in male patients was higher than that in their female counterparts. At the same time, the burden of premature death was highest in the group ≥ 80 years old, and ASMR increased from 236.02 per 100,000 in 2005 to 358.86 per 100,000 in 2020. In 2005, the eastern region had the highest ASMR of DM, but the western region's ASMR grew faster and eventually became the highest in 2020. In addition, the YLL rate in the eastern region showed a downward trend; however, in the middle and western regions the YLL rate continued to rise, with that of the western region rapidly increasing.

CONCLUSION

A dramatically upward trend in DM deaths can be seen in China from 2005 to 2020. DM remains a chronic disease in urgent need of prevention and control, especially in the elderly and people in less-affluent provinces. We must put forward more targeted policies to effectively allocate medical resources and focus on high-risk groups to reduce the premature-mortality burden of DM and its subcategories.

Factors associated with treatment and control of hypertension among elderly adults in Shenzhen, China: a large-scale cross-sectional study

OBJECTIVE

Hypertension has become the leading cause of death worldwide. Data on hypertension management among Shenzhen elderly are sparse. Our study aims to investigate treated and controlled hypertension in Shenzhen elderly, and identify relevant predictors.

DESIGN

A cross-sectional study.

SETTING

Communities in Shenzhen, Guangdong, China.

PARTICIPANTS

A cross-sectional study was conducted. We employed a convenience sampling method to select participants; 124 007 participants aged 65 years and older were recruited from January to December 2018 at local community health centres in Shenzhen.

MAIN OUTCOME MEASURES

Data on treatment, control and influencing factors of hypertension were obtained from a standard questionnaire, physical measurements and biochemical analyses.

RESULTS

Prevalence of hypertension was 55.8% among the sample population. Among this group of hypertensive patients, those undergoing hypertension treatment and those with hypertension under control were 54.4% and 32.3%, respectively. Employing multivariate analysis, significant associations were found between treatment and older age, junior high school education and above (OR=1.25, p＜0.05), being widowed rather than being married or cohabiting (OR=1.28, p＜0.05), engaging in physical activity (OR=1.14, p＜0.05), ex-smoker (OR=1.19, p＜0.05), habitual drinker (OR=0.72, p＜0.05), history of cardiovascular disease (CVD) (OR=2.20, p＜0.05) and comorbidities, with a higher probability for those with obesity (OR=1.89, p＜0.05), central obesity (OR=1.10, p＜0.05), diabetes (OR=1.49, p＜0.05) or dyslipidaemia (OR=1.20, p＜0.05). Male sex (OR=0.91, p＜0.05), junior high school education and above (OR=1.28, p＜0.05), engaging in physical activity (OR=1.06, p＜0.05), history of CVD (OR=1.82, p＜0.05) and individuals who had diabetes (OR=1.52, p＜0.05) or dyslipidaemia (OR=1.05, p＜0.05) were associated with increased likelihood of control. Aged 80 years and older (OR=0.93, p＜0.05), habitual drinker (OR=0.73, p＜0.05) and central obesity (OR=0.94, p＜0.05) were negatively associated with control of hypertension.

CONCLUSIONS

We found a high prevalence of hypertension, but a low prevalence of treatment and control among Shenzhen elderly.

Early DMO: a predictor of poor outcomes following cataract surgery in diabetic patients. The DICAT-II study

BACKGROUND

The prospective DIabetes and CATaract Study II (DICAT II) was performed to characterise the risks of cataract surgery to the retinae of patients with early diabetic macular oedema (E-DMO).

METHODS

DICAT II was a prospective, comparative, multicentre, observational study involving six Italian clinics. Patients were aged ≥55 years, had type 1 or 2 diabetes with spectral-domain optical coherence tomography evidence of ESASO classification Early DMO. Group 1 eyes (78 eyes, 78 patients) underwent phacoemulsification-based cataract surgery. Group 2 eyes (65 eyes, 65 patients) had E-DMO and either clear media or had undergone uncomplicated cataract surgery ≥1 year previously. Central subfield thickness (CST) and best-corrected visual acuity (BCVA) were assessed in both groups.

RESULTS

The negative impact of surgery on CST was evident after the first postoperative week; CST peaked during the first month, then rapidly decreased. CST worsening ≥10 µm was observed in 63/78 eyes (80.7%) and 29/65 eyes (44.6%) in Groups 1 and 2, respectively (p < 0.0001). CST worsening of ≥50 µm was observed in 51 eyes (65.4%) and 10 eyes (15.4%) in Groups 1 and 2, respectively (p < 0.0001). Mean CST worsening was lower in Group 2 than in Group 1 (38.6 ± 30.4 µm vs 85.5 ± 55.3 µm, p < 0.0001) with a lower BCVA loss (-2.6 ± 3.5 letters vs -8.2 ± 6.2 letters, p < 0.0001). Higher glycaemic levels and HBA1c levels were significantly associated with the risk of >50 μm CST worsening in eyes from both groups.

CONCLUSION

Early DMO is associated with poorer outcomes after cataract surgery and requires close pre- and postoperative monitoring.

Two-year impact of an educational intervention in primary care on blood glucose control and diabetes knowledge among patients with type 2 diabetes mellitus: a study in rural China

Background: Type 2 diabetes mellitus is increasing in rural China and should be managed in primary health care, but knowledge is lacking. Educational interventions have been implemented but not followed up long-term.

Objective: The study aimed to assess the long-term impact of an educational intervention on patients’ diabetes knowledge and fasting blood glucose (FBG) level, and whether these outcomes differed between two rural counties.

Methods: The study was nested in an educational intervention project in primary health care in Jiangsu province. Patients with type 2 diabetes mellitus from Huaiyin county and Gaochun county were randomly divided into an intervention group receiving an educational intervention and follow-up visits, and a control group with standard care. Questionnaires and medical records, including FBG level and diabetes knowledge score, were compared, at baseline in 2015 and two follow-ups, in 2016, and 2017, respectively. A paired t-test and two mixed-effects linear regression models were used.

Results: The diabetes knowledge score increased in the intervention group in 2016 and in 2017, compared with 2015. The FBG level decreased in 2016 compared with 2015 in the intervention and control groups. Comparing data in 2015 and 2017, there was no significant change in FBG level in the intervention or control group, but the diabetes knowledge score increased in the intervention group both in 2016 and 2017. A significant association between FBG level and the interaction of time and group, suggesting a long-term effect, was only found in Gaochun county in 2017.

Conclusion: The educational intervention improved the diabetes knowledge score in the intervention group, while no significant improvement was found in the control group in both year 2016 and 2017. Meanwhile, the intervention had a positive impact on FBG level in the intervention group in 2017. Patients in Gaochun county had better improvement in both diabetes knowledge and controlling FBG level, compared with Huaiyin county.

Prevalence, awareness, treatment, and control of diabetes mellitus by depressive symptom severity: a cross-sectional analysis of NHANES 2011-2016

INTRODUCTION

Despite extensive studies on the relationship between diabetes mellitus (DM) and depression, the associations of depressive symptom severity with prevalence, awareness, treatment, and control of diabetes remain unclear. We aimed to investigate changes in these outcomes of diabetes as depressive symptoms aggravate.

RESEARCH DESIGN AND METHODS

We conducted a cross-sectional analysis of 14 328 participants in the 2011-2016 National Health and Nutrition Examination Survey. Participants were classified into depressive symptom groups of none, mild, moderate, moderately severe, and severe depending on their Patient Health Questionnaire-9 scores. Multivariate logistic regression analyses were conducted in three models adjusted for expanding confounders to evaluate the associations between severity of depressive symptoms and prevalence, awareness, treatment, and control of DM.

RESULTS

As depressive symptom severity worsened, both prevalence and awareness of DM increased regardless of models (p value for trend <0.01 in all models for prevalence and awareness; adjusted OR (aOR) 2.14, 95% CI 1.29 to 3.56 for prevalence in the severe group, model 1; aOR 2.43, 95% CI 1.27 to 4.64 for awareness in the moderately severe group, model 1). Notwithstanding higher awareness of diabetes in the moderately severe and severe groups (84.5% and 86.2%, respectively, vs 71.3% in the none group), these groups were treated less (aOR 0.25, 95% CI 0.11 to 0.55 in the severe group, model 3) or inadequately controlled (aOR 0.51, 95% CI 0.27 to 0.98 in the moderately severe group, model 3).

CONCLUSIONS

The gap between patients' higher awareness and lower treatment rate or control of diabetes among individuals with severe depressive symptoms highlights the unmet needs for postdiagnostic multidisciplinary care for patients with comorbid depression and DM.

Prevalence and risk factors of diabetes among adults aged 45 years or older in China: A national cross-sectional study

Background

Although there is preponderance of literature on disease burden of diabetes in developed countries, limited investigations have been conducted in less developed regions including China. This study aimed to explore the current prevalence and risk factors for diabetes, pre‐diabetes, awareness, treatment and control of diabetes in China.

Methods

We included 12,458 adults from the China Health and Retirement Longitudinal Study. We estimated prevalence of diabetes and pre‐diabetes in the overall sample and by socio‐demographics. Bivariate associations of diabetes, pre‐diabetes, awareness, control and treatment of diabetes with health and function measures were evaluated by chi‐squared test and multivariate logistic regression analysis.

Results

We found that the prevalence of diabetes and pre‐diabetes was 13.21% and 25.16%. The prevalence of diabetes increased with advanced age (12.37%, 15.98% and 16.52% among persons who were 45 to 55, 55 to 65 and ≥65 years old, respectively), educational background (14.52%, 15.52% and 15.58% among persons who were illiterate, had primary education and had secondary or above education) and weight (8.18%, 17.05% and 22.54% among persons with a body mass index of 18.5 to 24.9, 25.0 to 29.9 and ≥30.0, respectively). The prevalence of diabetes was higher among urban residents than among rural residents (19.04% vs. 12.85%). We also observed that aged between 55 and 65 years, obesity, history of hypertension and coronary heart disease, and inactivity were significant risk factors of awareness of diabetes.

Conclusion

Our results indicated that diabetes is high prevalent in adults aged 45 years or above in China. The potentially modifiable risk factors should be further studied to develop interventions and strategies aimed at prevention and treatment of diabetes among middle‐aged and older Chinese adults.

Prevalence of Prediabetes and Type-2 Diabetes Mellitus in Cricket Players: Multi-Cricket Clubs Cross Sectional Study

Background & Objectives:

Sports activities are highly beneficial for improving the human health and reducing the risk of diseases. This cross sectional study aimed to investigate the prevalence of prediabetes and Type-2 diabetes mellitus in cricket players compared to population based non-elite athlete control subjects.

Methods:

The present matched cross sectional study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia during the period October 2019 to February 2020. Initially, 700 volunteer males, (300) cricket players and (400) population based non-elite athlete control subjects were interviewed. After socio-demographic and medical history, (200) nonsmoker cricket players and (300) nonsmoker control subjects were recruited. The age of cricket players was 34 (32-37) years, weight 81 (76-84) kg, height 1.79 (1.74-1.84) meters, and body mass index (BMI) was 25.09 (23.66-26.76) kg/m². The cricket players have been playing cricket for 4 (3-4) hours per day; 3.50 (3-4) days per week; for the total period of 24 (12-36) months. American Diabetes Association (ADA) based criteria on Glycated Hemoglobin (HbA1c) was used to investigate the prediabetes and Type-2 diabetes mellitus.

Results:

In cricket players, the prevalence of prediabetes was 23 (11.5%) and Type-2 diabetes mellitus (T2DM) was 7 (3.5%) compared to population based matched non-elite athlete control subjects the prediabetes was 73 (24.34%) and T2DM was 63 (21.1%) (p=0.001). Among cricket players, there was a 6-folds decrease in T2DM compared to control subjects.

Conclusions:

The cricket sports activities decrease the prevalence of prediabetes and Type-2 diabetes mellitus (T2DM) among the cricket players compared to population based matched non-elite athlete control subjects. The study findings demonstrate the urgent need for promoting sports activities, more cricket grounds as a physiological preventive strategy against the global growing diabetes epidemic.

Evaluating Awareness and Practices Towards Diabetes and Diabetic Retinopathy in Adult Patients Attending the Eye Clinic in a Tertiary Academic Hospital in Jordan

Aim and Background

Awareness of diabetes mellitus (DM) and its complications, particularly diabetic retinopathy (DR), is one of the main factors of early detection and improved management. This study aims to assess the level of awareness of DM type 2 complications in a cohort of Jordanian patients, with special emphasis on DR.

Methods

A total of 176 consecutive patients with DM type 2 attending the ophthalmology clinic at Jordan University Hospital were included in the study. Each participant responded to a questionnaire which assessed their awareness and behaviors towards DM type 2 and DR.

Results

A total of 176 individuals with diabetes responded to the invitation to participate. They were 93 (52.8%) males and 83 (47.2%) females. Mean age (±SEM) for the study population was 60.6 (±0.82) years. Of all participants, 93.8% were aware that diabetes can affect the eyes. Only 4.5% reported that DR could occur without symptoms and/or loss of vision. Symptoms affecting the eyes were the main cause behind attending the ophthalmology clinic in 60.8% of the cases. The awareness score of participants for DM and DR ranged from 4 to 15 out of 20 with a mean score of 11.4/20. Statistically significant relationships of awareness mean score were observed with gender, educational level, employment status, insurance status, Hemoglobin (Hb) A1c level, and dyslipidemia as a co-morbidity (p<0.05). Binary logistic regression revealed disease duration and HbA1c as the main predictive factors of having DR.

Conclusion

Among this cohort of Jordanian individuals with diabetes, awareness towards DM and DR was relatively low, and patient practices did not correlate with perceived awareness. Awareness scores correlated with HbA1c readings and higher educational levels among other variables. Emphasis on communication strategies and patient education is essential in establishing efficient screening programs and effective strategies to curtail visual impairment and other complications of the diabetes pandemic.

Prevalence of Prediabetes and Type 2 Diabetes Mellitus in Football Players: A Novel Multi Football Clubs Cross Sectional Study

Sports offer great benefits, improving health and reducing the risk of illnesses. This study’s aim was to investigate the prevalence of prediabetes and type 2 diabetes mellitus in football players compared to population based non-elite athlete control subjects. Initially 1100 male volunteers, (550) football players, and (550) population based non-elite athlete control subjects were interviewed. After socio-demographic and medical history analysis, 756 (378) nonsmoker male football players and (378) nonsmoker male control subjects were recruited. The control subjects were not involved in regular sports activities such as football, volleyball, badminton, cricket, hockey, and swimming. Participants with a known history of anemia, blood diseases, diabetes mellitus, and malignancy were excluded from the study. The mean age of football players was 31.80 ± 5.46 years, Body Mass Index (BMI) was 26.40 ± 2.08 (kg/m²), and the mean age of control subjects was 32.32 ± 4.37 years, and BMI was 26.66 ± 1.87 (kg/m²). The selected football players have been playing football for about 2 h a day, 3 days per week, and so the total mean duration of playing football was 1.08 years. American Diabetes Association (ADA) based criteria on Glycated Hemoglobin (HbA1c) was used to investigate prediabetes and type 2 diabetes mellitus. In football players the prevalence of prediabetes was 30 (7.93%) and type 2 diabetes mellitus (T2DM) was 6 (1.59%) compared to population based matched non-elite athlete control subjects where the prediabetes was 71 (18.78%) and T2DM was 89 (23.54%) (p = 0.001). Among football players there was a 7-fold decrease in T2DM compared to control subjects. Football recreational activities markedly reduce the prevalence of prediabetes and T2DM. The study findings demonstrate the benefits of football and other such sport activities and emphasize the urgent need for promoting football based physical activities as a physiological preventive strategy against the globally growing diabetes epidemic.

Cost-effectiveness of the Da Qing diabetes prevention program: A modelling study

Objective

The Da Qing Diabetes Prevention program (DQDP) was a randomized lifestyle modification intervention conducted in 1986 for the prevention and control of type 2 diabetes in individuals with impaired glucose tolerance. The current study estimated long-term cost-effectiveness of the program based on the health utilities from the Chinese population.

Methods

A Markov Monte Carlo model was developed to estimate the impact of the intervention from the healthcare system perspective. The analysis was run over 30-year and lifetime periods and costs were estimated respectively as health management service costs. Baseline characteristics and intervention effects were assessed from the DQDP. Utilities and costs were generated from relevant literature. The outcome measures were program cost per quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio (ICER) of the intervention. Sensitivity analyses and threshold analyses were performed.

Results

Using a 30-year horizon, the intervention strategy was cost-saving and was associated with better health outcomes (increase of 0.74 QALYs per intervention participant). Using a lifetime horizon, the intervention strategy was cost-saving and was associated with additional 1.44 QALYs. Sensitivity analyses showed that the overall ICER was most strongly influenced by the hazard ratio of cardiovascular disease event.

Conclusions

The Da Qing lifestyle intervention in a Chinese population with impaired glucose tolerance is likely to translate into substantial economic value. It is cost-saving over a 30-year time and lifetime frame.

Associations of TG/HDL Ratio with the Risk of Prediabetes and Diabetes in Chinese Adults: A Chinese Population Cohort Study Based on Open Data

BACKGROUND

In the global chronic diseases, type 2 diabetes shows a significant upward trend, and there are more people before prediabetes (impaired glucose tolerance). Many patients with impaired glucose tolerance and undiagnosed diabetes do not know that their glucose metabolism system has been in a state of disorder. Every year, about 5% to 10% of prediabetics develop diabetes. One of the important achieving factors may be the increase in blood lipids. However, it is not clear whether the triglyceride/high-density lipoprotein ratio is associated with impaired glucose tolerance and diabetes in the Chinese population. Therefore, we investigated the relationship between triglyceride/high-density lipoprotein and impaired glucose tolerance and diabetes in the Chinese population.

METHODS

We conducted a retrospective cohort study using data from the health screening program. The study included 116,855 participants from 32 locations in China, all of whom were adults over 20. Participants measured fasting blood glucose levels at each visit and collected information about their diabetes history. Impaired glucose tolerance was diagnosed as fasting blood glucose ≥6.00 mmol and self-reported diabetes mellitus. The patient was measured on the date of diagnosis or on his last visit (whichever comes first).

RESULTS

The results showed that, after adjusting the potential confounding factors, the ratio of TG/HDL was positively correlated with the occurrence of prediabetes and diabetes, and there was a saturation effect. The inflection points were 1.04 and 1.33, respectively. The effect value and 95% confidence interval before and after the inflection point of impaired glucose tolerance patients were 1.57 and (1.42, 1.73) and 1.03 and (1.01, 1.05), respectively. The effect value and 95% confidence interval before and after the inflection point in patients with diabetes were 2.07 and (1.80, 2.39) and 1.08 and (1.04, 1.12).

Burden of Diabetes and Prediabetes in Nepal: A Systematic Review and Meta-Analysis

BACKGROUND

Unhealthy behaviors, such as energy-dense food choices and a sedentary lifestyle, both of which are established risk factors for diabetes, are common and increasing among Nepalese adults. Previous studies have reported a wide variation in the prevalence of prediabetes and diabetes in Nepal, and thus a more reliable pooled estimate is needed. Furthermore, Nepal underwent federalization in 2015, and the province-specific prevalence, which is necessary for the de novo provincial government to formulate local health policies, is lacking. This study aims to provide a comprehensive summary of the current literature on various aspects of diabetes in Nepal, i.e., the prevalence of prediabetes and diabetes as well as of the awareness, treatment, and control of diabetes in Nepal.

METHODS

This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched three electronic databases-PubMed, Scopus, and Web of Science-using a comprehensive search strategy to identify eligible studies published up to April 2, 2020. Data on prevalence estimates of prediabetes and diabetes were extracted and pooled in a meta-analysis using a random effect model. Subgroup analyses and meta-regression were conducted to assess heterogeneity across the studies. The quality of included studies was assessed using the New Castle-Ottawa scale.

RESULTS

We included 14 eligible studies that comprised a total of 44,129 participants and 3517 diabetes cases. Half of the included studies had good quality. Overall, the prevalence of prediabetes and diabetes was 9.2% (95% CI 6.6-12.6%) and 8.5% (95% CI 6.9-10.4%), respectively. Among the participants with diabetes, only 52.7% (95% CI 41.7-63.4%) were aware of their diabetes status, and 45.3% (95% CI 31.6-59.8%) were taking antidiabetic medications. Nearly one-third of those under antidiabetic treatment (36.7%; 95% CI 21.3-53.3%) had their blood glucose under control. The prevalence of prediabetes and diabetes gradually increased with increasing age and was more prevalent among males and urban residents. There was a wide variation in diabetes prevalence across the provinces in Nepal, the lowest 2% in Province 6 to the highest 10% in Province 3 and Province 4.

CONCLUSIONS

The prevalence of prediabetes and diabetes was high in Nepal, while its awareness, treatment, and control were low. Our findings call for urgent nationwide public health action in Nepal.

Prediction of Type 2 Diabetes Risk and Its Effect Evaluation Based on the XGBoost Model

In view of the harm of diabetes to the population, we have introduced an ensemble learning algorithm—EXtreme Gradient Boosting (XGBoost) to predict the risk of type 2 diabetes and compared it with Support Vector Machines (SVM), the Random Forest (RF) and K-Nearest Neighbor (K-NN) algorithm in order to improve the prediction effect of existing models. The combination of convenient sampling and snowball sampling in Xicheng District, Beijing was used to conduct a questionnaire survey on the personal data, eating habits, exercise status and family medical history of 380 middle-aged and elderly people. Then, we trained the models and obtained the disease risk index for each sample with 10-fold cross-validation. Experiments were made to compare the commonly used machine learning algorithms mentioned above and we found that XGBoost had the best prediction effect, with an average accuracy of 0.8909 and the area under the receiver’s working characteristic curve (AUC) was 0.9182. Therefore, due to the superiority of its architecture, XGBoost has more outstanding prediction accuracy and generalization ability than existing algorithms in predicting the risk of type 2 diabetes, which is conducive to the intelligent prevention and control of diabetes in the future.

Prevalence, treatment, control of type 2 diabetes and the risk factors among elderly people in Shenzhen: results from the urban Chinese population

Background

Type 2 diabetes is regarded as one of the major public health problems worldwide. We aim to investigate the prevalence, treatment, and control rate in the Chinese urban population aged 65 years or older and also identified associated risk factors.

Methods

One hundred twenty-four thousand seven participants aged 65 years old and older were recruited from January 2018 through December 2018 at local community health service centers in Shenzhen. Fasting plasma glucose, as well as other biochemical indicators, were measured by standard methods. The analysis of multivariate logistic regression was applied to assess associated risk factors of type 2 diabetes.

Results

Approximately 22.5% of elderly urban Chinese residents had diabetes. Among people with diabetes, 54.8% received medical treatment. Only 34.4% of those who were treated had their glycemic controlled. The prevalence of T2D increased with increasing age before 80 years old, male, inadequate active physical activity, drinking, previous history of CVD, higher BMI, central obesity, and hypertension.

Conclusions

Our findings suggested that attention should be paid to the prevention and control of T2D in Chinese urban elderly population. The health policy department should develop effective strategies aimed at improving health care management of T2D in elderly adults.

The Nexus between Workplace Exposure for Wood, Welding, Motor Mechanic, and Oil Refinery Workers and the Prevalence of Prediabetes and Type 2 Diabetes Mellitus

Workplace exposure in various occupational and industrial sectors is an emerging health concern worldwide. This study aimed to investigate the nexus between workplace exposure for wood, welding, motor mechanic, and oil refinery workers and the prevalence of prediabetes and type 2 diabetes mellitus. Initially, 2500 male volunteers who were wood, welding, motor mechanic, and oil refinery workers were interviewed. After an examination of their demographics and medical history, 1408 non-smoking wood (158), welding (560), motor mechanic (272), and oil refinery workers (217), along with 201 control subjects, were selected. The participants' mean age was 36.59 ± 0.29 years and the mean body mass index was 26.14 ± 0.11 kg/m². The selected industry workers had been exposed to their respective wood, welding, motor mechanic, and oil refinery workplaces for 8 h per day, six days per week. The American Diabetic Association (ADA)-based glycated hemoglobin (HbA1c) criterion was used to diagnose prediabetes and type 2 diabetes mellitus. Subjects with an HbA1c of less than 5.7% were regarded as non-diabetics, subjects with an HbA1c of 5.7%-6.4% were considered prediabetics, and subjects with an HbA1c of more than 6.4% were considered diabetics. In wood industry workers, the prevalence of prediabetes (PD) was 64 (40.50%) and in type 2 diabetes mellitus (T2DM), it was 21 (13.29%); in welding workers, the prevalence of prediabetes was 261 (46.60%), and for T2DM, it was 90 (16.07%); in motor mechanic workers, the prevalence of prediabetes was 110 (40.44%), and for T2DM, it was 126 (46.32%); and in oil refinery workers, the prevalence of prediabetes was 80 (36.86%), and for T2DM, it was 35 (16.12%). However; the combined prevalence of prediabetes and T2DM among wood, welding, motor mechanic, and oil refinery workers was 421 (34.79%) and 515 (42.66%), respectively. The prevalence of prediabetes and T2DM among workers increased with the duration of working exposure in the wood, welding, motor mechanic, and oil refinery industries. A one-year working exposure in these industries caused an increase of 0.03% in HbA1c. Workplace exposure in wood, welding, motor mechanic, and oil refinery industries increased the risk of prevalence of prediabetes and T2DM among the workers and affected the diabetes etiology.

Shifting the Care of Type 2 Diabetes Mellitus from Hospital to Primary Health Care Institutions through an Educational Intervention for Health Care Professionals: An Example from Rural China

This study assessed the impact of an educational intervention on the knowledge, attitudes, and practice regarding Type 2 Diabetes Mellitus (T2DM) of Primary Health Care (PHC) professionals, as well as on the types of T2DM care services which they were able to provide. The intervention was carried out in collaboration with county hospitals. The study was conducted from 2015 to 2016 among 241 health care professionals in 18 township health centers and 55 village clinics in three counties in Jiangsu Province, randomly divided into an intervention group and a control group. Participants in the intervention group received professional skills training sessions and team communication and were involved in regular meetings. The control group followed the routine work plan. At one-year follow up, the diabetes knowledge score, practice score, and attitudes score were significantly higher in the intervention group than in the control group. A significantly higher proportion of health care professionals in the intervention group was able to provide services compared with the control group, for all types of services, except T2DM emergency treatment. The intervention among health care professionals in PHC had a positive impact on their professional diabetes skills, knowledge, attitudes, practices, and types of services they were able to provide, at one-year follow-up.