Current smoking and type 2 diabetes among patients in selected Indian Health Service clinics, 1998-2003

Epidemiology of Type 2 Diabetes in Indigenous Communities in the United States

PURPOSE OF REVIEW

The present review focuses on the epidemiology of type 2 diabetes (T2D) in Indigenous communities in the continental United States (U.S.)-including disease prevention and management-and discusses special considerations in conducting research with Indigenous communities.

RECENT FINDINGS

Previous studies have reported the disparately high prevalence of diabetes, especially T2D, among Indigenous peoples in the U.S. The high prevalence and incidence of early-onset T2D in Indigenous youth relative to that of all youth in the U.S. population pose challenges to the prevention of complications of diabetes. Behavioral, dietary, lifestyle, and genetic factors associated with T2D in Indigenous communities are often investigated. More limited is the discussion of the historical and ongoing consequences of colonization and displacement that impact the aforementioned risk factors. Future research is necessary to assess community-specific needs with respect to diabetes prevention and management across the diversity of Indigenous communities in the U.S.

Burden of increased blood glucose due to modifiable risk factors among men in India

BACKGROUND AND AIMS

Worldwide, many diabetes cases are occurring mainly due to lifestyle risk factors. Hence, to quantify and compare the attributable burden of key modifiable risk factors associated with increased Blood Glucose (BG) among Indian states and districts.

METHODS

The study used the National Family Health Survey (2015-16) data to estimate Population Attributable Risk (PAR) for increased BG (>140 mg/dl) among men aged 15-54 years in 640 districts of 36 States/Union Territories (UTs), India. We have considered three key modifiable factors such as high Body Mass Index (BMI), use of tobacco and alcohol. Population Attributable Risk techniques were employed to address the attributable burden of increased blood glucose due to modifiable risk factors.

RESULTS

Substantial variations were found in the burden of increased BG due to high BMI, alcohol and tobacco use in India. The overall burden of increased BG due to high BMI, tobacco and alcohol in India was 28.5%, 2.1% and 6.4%, respectively. Regional variations in BG were found in high BMI, tobacco and alcohol consumption groups. The high burden of increased BG related to the above key modifiable risk factors mostly seen in North-Eastern' districts due to alcohol, Southern and Northern' districts was due to high BMI. However, the higher burden due to tobacco was reported in Central, Eastern and North-Eastern' districts.

CONCLUSION

Three modifiable risk factors are contributing significantly to increased BG among men. Since there are regional differences in their contributions, state/district, specific targeted interventions may be necessary to control increased BG among men in India.

Associations of history of mental illness with smoking and vaping among university students aged 18-24 years in New Zealand: Results of a 2018 national cross-sectional survey

OBJECTIVE

Data on associations of history of mental illness (HMI) with smoking and vaping in New Zealand (NZ) are lacking. This study examines these associations in university students aged 18-24 years.

METHODS

Data came from a 2018 national cross-sectional study of university students and included information on demographic characteristics, smoking, vaping and participant health in the previous 12-months. χ² tests compared patterns of smoking and vaping, and logistic regression assessed associations of HMI with smoking and vaping, controlling for age, gender and ethnicity. An HMI was defined as a diagnosis/treatment for depression, anxiety/nervous disorder, or other mental health condition in the previous 12-months.

RESULTS

The sample comprised 1293 students: 61.3% aged 18-20; 62.8% female; 7.8% Māori, 92.2% non-Māori, and 18.5% reported an HMI. Smoking: 49.7% (95% CI 47.0-52.5) reported ever, 10.5% (8.9-12.3) current and 5.0% (3.9-6.4) daily smoking. Vaping: 38.7% (36.0-41.4) reported ever, 6.3% (5.1-7.8) current and 1.9% (1.3-2.8) daily vaping. Participants with HMI were significantly more likely to smoke: ever (64.9% vs 46.3%, p < .001), current (15.1% vs 9.5%, p = .011) and daily (7.5% vs 4.5%, p = .050), and vape: ever (49.4% vs 36.3%, p < .001) and current (9.2% vs 5.7%, p = .044) than participants without HMI. The model containing all predictors of HMI was significant, χ² (5, N = 1293) = 24.09, p < .001. Gender (OR 0.54, (0.4-0.75)), current smoking (OR 1.82, (1.19-2.78)) and current vaping (OR 1.73, (1.02-2.93)) made unique significant contributions to the model.

CONCLUSIONS

The prevalence of smoking and vaping were significantly higher in students with HMI, and there were strong associations between HMI and smoking and vaping.

Diabetes prevalence by HbA1c and oral glucose tolerance test among HIV-infected and uninfected Tanzanian adults

BACKGROUND

The burden of diabetes is increasing in sub-Saharan Africa, including among people living with HIV. We assessed the prevalence of diabetes and the roles of HIV, antiretroviral therapy (ART) and traditional risk factors among adults in Tanzania.

METHODS

We analysed diabetes-relevant baseline data from 1,947 adult participants in the CICADA study in Mwanza, Tanzania: 655 HIV-uninfected, 956 HIV-infected ART-naïve, and 336 HIV-infected persons on ART. WHO guidelines for haemoglobin A1c (HbA1c) and oral glucose tolerance test (OGTT) were used to define diabetes and prediabetes. Risk factors were evaluated using multinomial logistic regression analysis. Relative risk ratios (RRR) were generated comparing participants with diabetes and prediabetes against the reference of those with no diabetes.

RESULTS

Mean age was 41 (SD 12) years; 59% were women. The prevalence of diabetes was 13% by HbA1c and 6% by OGTT, with partial overlap among participants identified by the two tests. Relative to HIV-uninfected, HIV-infected ART-naïve persons had increased relative risks of diabetes (HbA1c: RRR = 1.95, 95% CI 1.25-3.03; OGTT: RRR = 1.90, 95% CI 0.96-3.73) and prediabetes (HbA1c: RRR = 2.89, 95% CI 1.93-4.34; OGTT: RRR = 1.61, 95% CI 1.22-2.13). HIV-infected participants on ART showed increased risk of prediabetes (RRR 1.80, 95% CI 1.09, 2.94) by HbA1c, but not diabetes. CD4 count < 200 cell/μL at recruitment increased risk and physical activity decreased risk of diabetes by both HbA1c and OGTT.

CONCLUSIONS

The prevalence of diabetes was high, especially among HIV-infected ART-naïve adults. Being more physically active was associated with lower risk of diabetes. HbA1c and OGTT identified different participants as having diabetes or prediabetes. Overall, the finding of high burden of diabetes among HIV-infected persons suggests that health systems should consider integrating diabetes screening and treatment in HIV clinics to optimize the care of HIV patients and improve their health outcomes.

Perceptions and Prevalence of Alcohol and Cigarette Use Among American Indian Adults With Type 2 Diabetes

IN BRIEF This study examined community perceptions and prevalence of alcohol use and cigarette smoking among American Indian adults with type 2 diabetes. Results revealed normative rates and perceptions of smoking and negative views and low rates of alcohol use. Participants reported high levels of household indoor smoking and comorbid high-risk drinking and smoking. The high smoking rate among the adult American Indians in this study is especially problematic given the increased risk of cardiovascular problems related to both smoking and type 2 diabetes. The results underscore the importance of considering substance use behaviors and beliefs as a component of overall health and well-being for people with diabetes.

Proximate determinants of tuberculosis in Indigenous peoples worldwide: a systematic review

BACKGROUND

Indigenous peoples worldwide carry a disproportionate tuberculosis burden. There is an increasing awareness of the effect of social determinants and proximate determinants such as alcohol use, overcrowding, type 1 and type 2 diabetes, substance misuse, HIV, food insecurity and malnutrition, and smoking on the burden of tuberculosis. We aimed to understand the potential contribution of such determinants to tuberculosis in Indigenous peoples and to document steps taken to address them.

METHODS

We did a systematic review using seven databases (MEDLINE, Embase, CINAHL, Global Health, BIOSIS Previews, Web of Science, and the Cochrane Library). We identified English language articles published from Jan 1, 1980, to Dec 20, 2017, reporting the prevalence of proximate determinants of tuberculosis and preventive programmes targeting these determinants in Indigenous communities worldwide. We included any randomised controlled trials, controlled studies, cohort studies, cross-sectional studies, case reports, and qualitative research. Exclusion criteria were articles in languages other than English, full text not available, population was not Indigenous, focused exclusively on children or older people, and studies that focused on pharmacological interventions.

FINDINGS

Of 34 255 articles identified, 475 were eligible for inclusion. Most studies confirmed a higher prevalence of proximate determinants in Indigenous communities than in the general population. Diabetes was more frequent in Indigenous communities within high-income countries versus in low-income countries. The prevalence of alcohol use was generally similar to that among non-Indigenous groups, although patterns of drinking often differed. Smoking prevalence and smokeless tobacco consumption were commonly higher in Indigenous groups than in non-Indigenous groups. Food insecurity was highly prevalent in most Indigenous communities evaluated. Substance use was more frequent in Indigenous inhabitants of high-income countries than of low-income countries, with wide variation across Indigenous communities. The literature pertaining to HIV, crowding, and housing conditions among Indigenous peoples was too scant to draw firm conclusions. Preventive programmes that are culturally appropriate targeting these determinants appear feasible, although their effectiveness is largely unproven.

INTERPRETATION

Indigenous peoples were generally reported to have a higher prevalence of several proximate determinants of tuberculosis than non-Indigenous peoples, with wide variation across Indigenous communities. These findings emphasise the need for community-led, culturally appropriate strategies to address smoking, food insecurity, and diabetes in Indigenous populations as important public health goals in their own right, and also to reduce the burden of tuberculosis.

FUNDING

Canadian Institutes of Health Research.

Costs of smoking and policy strategies for California American Indian communities

The cost of smoking has been explored for residents of the U.S. living in several states. Recent evidence has indicated that the prevalence and cost of smoking are associated with racial and ethnic groups. This study provides information on tobacco prevention and control for American Indians (AI) (American Indians refers to American Indians and Alaska Natives throughout this article. Where we use the term California tribe we specifically mean persons who are members of Indigenous tribes geographically located in the geographic area now known as the state of California.) and examines the relative impact of smoking by using behavioral and demographic characteristics in order to predict the economic cost on AIs. The analysis suggests that AIs smoke more frequently than other Californians, which results in higher health care costs, as well as morbidity and mortality due to high levels of tobacco related chronic disease. Based on these factors we urge tribes to exercise their sovereignty as governments and implement local tobacco control policy strategies. We call for public health action by community leaders in Indian country and nationwide. We must act now to protect future generations.

An accurate risk score for estimation 5-year risk of type 2 diabetes based on a health screening population in Taiwan

This study aimed to provide the epidemiological model evaluating the risk of developing type 2 diabetes (T2DM) in Taiwan periodic health-check population. We derived risk functions using multivariate Cox regression in a random half of the sample. Rules based on these risk functions were evaluated in another half. Model coefficients were used to assign each variable a score. 73,961 subjects aged 35-74, were included and followed up with a median 3.15 years. Six predictive models (PMs) were developed. PM1 contained simple clinical information, while PM2 contained fasting plasma glucose (FPG) based on PM1, and PM3 further added variables indicating lipid level, liver and kidney. PM4 only included FPG. The capability of published ARIC score model was also evaluated. Eventually we considered score defined nine predictors by PM2. The area under the ROC curve (AUC) was 0.848 (95% CI, 0.829-0.868) predicting diabetes within 5 years, and also had adequate performance in validation subsample (AUC=0.833, 95% CI, 0.811-0.855). The 5-year T2DM probability can be calculated by: 1-0.9743960037 exp((score points -15.0281284)). We concluded that this diabetes risk score, derived from clinical information combined with FPG is a simple, effective tool to identify individuals at high risk for undiagnosed T2DM.