Evaluation of a risk factor scoring model in screening for undiagnosed diabetes in China population

A systematic review of diabetes risk assessment tools in sub-Saharan Africa

Objectives

To systematically review all current studies on diabetes risk assessment tools used in SSA to diagnose diabetes in symptomatic and asymptomatic patients.

Methods

Tools were identified through a systematic search of PubMed, Ovid, Google Scholar, and the Cochrane Library for articles published from January 2010 to January 2020. The search included articles reporting the use of diabetes risk assessment tool to detect individuals with type 2 diabetes in SSA. A standardized protocol was used for data extraction (registry #177726).

Results

Of the 825 articles identified, 39 articles met the inclusion criteria, and three articles reported tools used in SSA population but developed for the Western population. None was validated in SSA population. All but three articles were observational studies (136 and 58,657 study participants aged between the ages of 15 and 85 years). The Finnish Medical Association risk tool, World Health Organization (WHO) STEPS instrument, General Practice Physical Activity Questionnaire (GPPAQ), Rapid Eating and Activity Assessment for Patients (REAP), and an anthropometric tool were the most frequently used non-invasive tools in SSA. The accuracy of the tools was measured using sensitivity, specificity, or area under the receiver operating curve. The anthropometric predictor variables identified included age, body mass index, waist circumference, positive family of diabetes, and activity levels.

Conclusions

This systematic review demonstrated a paucity of validated diabetes risk assessment tools for SSA. There remains a need for the development and validation of a tool for the rapid identification of diabetes for targeted interventions.

Prevalence of Undiagnosed Diabetes in 2004 and 2012: Evidence From the English Longitudinal Study of Aging

BACKGROUND

In light of recent publicity campaigns to raise awareness of diabetes, we investigated changes in the prevalence of diabetes and undiagnosed diabetes in adults age 50 and older in England between 2004 and 2012, and explored risk factors for undiagnosed diabetes.

METHOD

In total, 7666 and 7729 individuals were from Wave 2 (2004-2005, mean age 66.6) and Wave 6 (2012-2013, mean age 67.6) of the English Longitudinal Study of Ageing. Diagnosed diabetes was defined as either self-reported diabetes or taking diabetic medications. Undiagnosed diabetes was defined as not self-reporting diabetes and not taking diabetic medications, but having a glycated hemoglobin measurement ≥48 mmol/mol (6.5%).

RESULTS

There were increases in both diagnosed diabetes (7.7%-11.5%) and undiagnosed diabetes (2.4%-3.4%) between 2004 and 2012. However, a small decrease in the proportion of people with diabetes who were unaware of this condition (24.5%-23.1%, p < .05) was observed. Only men aged 50-74 showed a stable prevalence of undiagnosed diabetes, with better recognition of diabetes. Age, non-white ethnicity, manual social class, higher diastolic blood pressure, and cholesterol level were factors associated with higher risks of undiagnosed diabetes, whereas greater depressive symptoms were related to lower risks.

CONCLUSION

This study suggests that the greater awareness of diabetes in the population of England has not resulted in a decline in undiagnosed cases between 2004 and 2012. A greater focus on people from lower socioeconomic groups and those with cardiometabolic risk factors may help early diagnosis of diabetes for older adults.

Performance of Risk Assessment Models for Prevalent or Undiagnosed Type 2 Diabetes Mellitus in a Multi-Ethnic Population-The Helius Study

Background:

Most risk assessment models for type 2 diabetes (T2DM) have been developed in Caucasians and Asians; little is known about their performance in other ethnic groups.

Objective(s):

We aimed to identify existing models for the risk of prevalent or undiagnosed T2DM and externally validate them in a multi-ethnic population currently living in the Netherlands.

Methods:

A literature search to identify risk assessment models for prevalent or undiagnosed T2DM was performed in PubMed until December 2017. We validated these models in 4,547 Dutch, 3,035 South Asian Surinamese, 4,119 African Surinamese, 2,326 Ghanaian, 3,598 Turkish, and 3,894 Moroccan origin participants from the HELIUS (Healthy LIfe in an Urban Setting) cohort study performed in Amsterdam. Model performance was assessed in terms of discrimination (C-statistic) and calibration (Hosmer-Lemeshow test). We identified 25 studies containing 29 models for prevalent or undiagnosed T2DM. C-statistics varied between 0.77–0.92 in Dutch, 0.66–0.83 in South Asian Surinamese, 0.70–0.82 in African Surinamese, 0.61–0.81 in Ghanaian, 0.69–0.86 in Turkish, and 0.69–0.87 in the Moroccan populations. The C-statistics were generally lower among the South Asian Surinamese, African Surinamese, and Ghanaian populations and highest among the Dutch. Calibration was poor (Hosmer-Lemeshow p < 0.05) for all models except one.

Conclusions:

Generally, risk models for prevalent or undiagnosed T2DM show moderate to good discriminatory ability in different ethnic populations living in the Netherlands, but poor calibration. Therefore, these models should be recalibrated before use in clinical practice and should be adapted to the situation of the population they are intended to be used in.

Effects of exercise training combined with psychological intervention compared to exercise training alone in prediabetes subjects

BACKGROUND

Prior research has confirmed the efficacy of exercise training (ET) in patients with prediabetes. However, whether the effectiveness of a combination of exercise and psychological intervention (EP) is better than ET alone in prediabetes in terms of physiological function, psychological status and glycometabolism has rarely been investigated.

METHODS

Forty newly diagnosed prediabetes patients (65.3 ± 8.1 years) took part in the study. Subjects were divided into a pure ET group and a combined EP group. Interventions were conducted in 40-50-min sessions twice weekly for 32 weeks. Physiological, psychological and biochemical indicator measurements were taken after pre-, mid- and post-interventions, respectively.

RESULTS

The main finding confirmed a significant improvement in systolic blood pressure, diastolic blood pressure (DBP) and heart rate, high-density lipoprotein, fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) from pre- to mid- and post-test differentially in both groups (P < 0.05) by post hoc analyses. The EP group has a greater magnitude of improvement of DBP than the ET group. Significant differences were observed in FPG at mid-intervention and total cholesterol at post-intervention between the ET and EP groups. Self-Rating Anxiety Scale (SAS) scores of EP group were significantly less than ET group after post-intervention.

CONCLUSION

Our results suggest that EP might be a promising method lead to more apparent long-term effects on glycometabolism and psychological status for prediabetes patients. Other domains were improved by both interventions, but no typical pattern could be identified. Its underlying mechanisms need further study, and directions for future research are suggested.

Cardiovascular diseases and risk factors among Chinese immigrants

The aim of this study is to identify the prevalence of cardiovascular disease (CVD) and major CVD risk factors, including diabetes, hypertension, dyslipidemia, obesity and smoking among Chinese immigrants by a systematic review of studies from various countries. PubMed and the China National Knowledge Infrastructure databases were searched for studies of the prevalence of major CVDs and risk factors, and of CVD mortality among Chinese immigrants. The search identified 386 papers, 16 of which met the inclusion criteria for this review. In mainland China, there is a pattern of high stroke prevalence but low coronary heart disease (CHD) prevalence. Among Chinese immigrants, there is a much lower prevalence and mortality of stroke, but a higher prevalence and mortality of CHD, even though these are lower than the rates in immigrants of other ethnicities in the host country. The prevalence of CVD risk factors is also markedly different in immigrants. Compared with mainland Chinese, Chinese immigrants have a higher prevalence of diabetes and hypertension, higher serum cholesterol, poorer dietary patterns, and higher prevalence of obesity and smoking. Thus, the epidemiological pattern of CVD among Chinese immigrants changes compared with resident mainland Chinese. The less healthy environmental factor after immigration may be a major trigger in the adverse CVD status of Chinese immigrants. It is important for policy-makers to pay more attention to specific minority immigrant groups, and to implement more effective preventive measures to improve the health of immigrant populations.

Application and applicability of non-invasive risk models for predicting undiagnosed prevalent diabetes in Africa: A systematic literature search

BACKGROUND AND PURPOSE

Prediction algorithms are increasingly advocated in diabetes screening strategies, particularly in developing countries. We conducted a systematic review to assess the application and applicability of existing non-invasive prevalent diabetes risk models to populations within Africa.

DESIGN

systematic review data sources A systematic search of English literatures in Medline via PubMed from 1999 until June, 2014. Study selection Included studies had to report on the development, validation or implementation of a model that was primarily constructed to predict prevalent undiagnosed diabetes using non-laboratory based predictors.

DATA EXTRACTION

Data were extracted on the type of statistical model, type and range of predictors in the model, performance measures in both internal and external validation, and whether the model was developed from, validated or implemented in an African population.

RESULTS

Twenty-three studies reporting on non-invasive prevalent diabetes models were identified. Ten from Europe (some with multiethnic populations), nine models were developed among Asian population, two from the USA and two from the Middle-East. The c-statistics for these models ranged from 0.65 to 0.88 in the development studies, and from 0.63 to 0.80 in the validation studies. Twenty models were validated, and none in Africa. Among predictors commonly included in models, parental/family history of diabetes and personal history of hypertension appear to be more prone to measurement errors in the African context.

CONCLUSION

Existing prevalent diabetes prediction models have not been applied to African populations, and issues with the measurement of key predictors make their applicability likely inaccurate.

Type 2 Diabetes Mellitus Screening and Risk Factors Using Decision Tree: Results of Data Mining

Objectives:

The aim of this study was to examine a predictive model using features related to the diabetes type 2 risk factors.

Methods:

The data were obtained from a database in a diabetes control system in Tabriz, Iran. The data included all people referred for diabetes screening between 2009 and 2011. The features considered as “Inputs” were: age, sex, systolic and diastolic blood pressure, family history of diabetes, and body mass index (BMI). Moreover, we used diagnosis as “Class”. We applied the “Decision Tree” technique and “J48” algorithm in the WEKA (3.6.10 version) software to develop the model.

Results:

After data preprocessing and preparation, we used 22,398 records for data mining. The model precision to identify patients was 0.717. The age factor was placed in the root node of the tree as a result of higher information gain. The ROC curve indicates the model function in identification of patients and those individuals who are healthy. The curve indicates high capability of the model, especially in identification of the healthy persons.

Conclusions:

We developed a model using the decision tree for screening T2DM which did not require laboratory tests for T2DM diagnosis.

Comparison of the effects of acute and chronic psychological stress on metabolic features in rats

This study was aimed to compare the effects of acute and chronic psychological stress on metabolic factors. Forty-two male Wistar rats were divided into control and stressed groups. Stress was applied by a communication box acutely (1 d) and chronically (15 and 30 d). Blood sampling was carried out by retro-orbital-puncture method. The plasma levels of glucose, cholesterol, triglyceride, insulin, and corticosterone were measured. In addition, feed and water intake, latency to eat and drink, adrenal and body weights were determined. Acute and chronic psychological stress did not significantly change basal plasma corticosterone levels. However, immediately (1 min) after acute exposure to stress, plasma corticosterone level increased compared to that before stress exposure. Acute stress increased plasma insulin levels significantly. Fifteen days of stress exposure resulted in plasma glucose increase. Chronic stress significantly increased feed intake, latency to eat, and adrenal weight compared to acute stress. The body weights of both control and stressed groups increased markedly during the experiment. Homeostasis model assessment of insulin resistance (HOMA-IR) index did not change significantly in the stressed group. In conclusion, application of acute and chronic psychological stress leads to different metabolic and/or behavioral changes but the metabolic changes resulting from acute exposure to stress seem to be more pronounced.