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Kordi Z, Khosravi A, Fotouhi A. Depression and self-care in diabetes; adjustment for misclassification bias: application of predictive weighting method. BMC Public Health 2023; 23:2540. [PMID: 38114954 PMCID: PMC10729342 DOI: 10.1186/s12889-023-17412-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the association between depression and self-care in diabetic patients potentially influenced by biases in depression measurement using weighting the positive and negative predictive values. METHODS In this cross-sectional study, 1050 patients informedly consented to participate in the study. Using a WHO-5 well-being index, the participants were examined for depressive mood as exposure. The sensitivity and specificity of this index in a systematic review study were 0.86 and 0.81, respectively. Self-care (that is outcome) was assessed using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. To correct the misclassification bias of exposure, the predictive weighting method was used in the multivariable logistic regression model adjusted for covariates. Bootstrap sample with replacement and simulation was used to deal with random error. RESULTS The mean age of patients was 42.8 ± 7.5 years. In this study, 70.1% of diabetic patients (n = 720) were depressed based on the questionnaire score and only 52.7% (n = 541) of them had appropriate self-care behaviors. Our study revealed a close relationship between self-care and covariates such as gender, depression, having comorbidities, abdominal obesity, economic status and education. The odds ratio of the association between depressive mood and lack of self-care in primary multivariable logistic regression was 2.21 (95% CI: 1.62-3.00, p < 0.001) and after misclassification bias adjusting, it was equal to 3.4 (95% CI: 1.7-6.6, p < 0.001). The OR percentage of bias was - 0.55. CONCLUSION After adjusting for depression misclassification bias and random error, the observed association between depression and self-care was stronger. According to our findings, psychiatric interventions, and counseling and education along with self-care interventions are necessary for these patients. Special attention should be paid to male, low economic classes, less educated and those having a history of comorbidities along with psychological assessment when improving the care and progress of treatment in diabetic patients is expected. Future studies are needed to clarify the role of other psychological disorders on self-care of diabetics.
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Affiliation(s)
- Zahra Kordi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Vice-chancellery for Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ahmad Khosravi
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran.
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Ekpor E, Akyirem S, Adade Duodu P. Prevalence and associated factors of overweight and obesity among persons with type 2 diabetes in Africa: a systematic review and meta-analysis. Ann Med 2023; 55:696-713. [PMID: 36821504 PMCID: PMC9970251 DOI: 10.1080/07853890.2023.2182909] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Type 2 diabetes and obesity are serious public health concerns globally and a growing burden in Africa. Both conditions have serious repercussions on health when they co-occur, yet the extent of their co-occurrence in Africa remains unknown. Therefore, this review aimed to identify the prevalence and associated factors of overweight and obesity among persons with type 2 diabetes in Africa. METHOD A systematic search was conducted on PubMed, MEDLINE, Embase, African Index Medicus (AIM), and African Journals Online (AJOL) for observational studies that reported the prevalence of overweight and/or obesity among type 2 diabetes patients in Africa. The prevalence data from individual studies were aggregated through a random-effects meta-analysis. The I2 statistic was used to evaluate between-studies heterogeneity, while subgroup analysis and mixed-effects meta-regression were performed to identify sources of heterogeneity. We assessed publication bias using funnel plots and Egger's test. This review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. RESULTS Of 1753 records retrieved, 80 articles were eligible for this review, with 74 cross-sectional studies included in the meta-analysis. The pooled prevalence of overweight and obesity was 35.6% and 25.6% respectively, while the overall prevalence of both overweight and obesity was 61.4%. Also, the pooled prevalence of both overweight and obesity across the five geographical areas in Africa ranged from 56.9% in East Africa to 88.5% in Southern Africa. Nineteen factors were significantly associated with overweight and obesity among patients with type 2 diabetes. CONCLUSION The high prevalence of overweight and obesity among patients with type 2 diabetes is a significant public health concern that transcends geographical boundaries within Africa. The findings from this review highlight the need for innovative weight management interventions that are tailored to the cultural context of the African setting.KEY MESSAGESThere was a high prevalence of overweight and obesity among the type 2 diabetes patients.Nineteen factors were identified to be significantly associated with overweight and obesity among type 2 diabetes patients.Only 12 out of the 80 included studies primarily focused on the prevalence of overweight and/or obesity which reflects a dearth of interest in this topic.
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Affiliation(s)
- Emmanuel Ekpor
- School of Nursing, University of Ghana, Legon, Ghana.,St. Martins de Porres Hospital, Eikwe, Ghana
| | - Samuel Akyirem
- Yale School of Nursing, Yale University, New Haven, CT, USA
| | - Precious Adade Duodu
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, England, UK
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Al-Ozairi A, Taghadom E, Irshad M, Al-Ozairi E. Association Between Depression, Diabetes Self-Care Activity and Glycemic Control in an Arab Population with Type 2 Diabetes. Diabetes Metab Syndr Obes 2023; 16:321-329. [PMID: 36777315 PMCID: PMC9911899 DOI: 10.2147/dmso.s377166] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/20/2023] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Poor self-care behavior and depression are associated with worse glycemic control, but the relationship between these variables is poorly reported. The present study aimed to describe self-care behaviors and explore the association between depression, self-care and glycemic control in people with type 2 diabetes in an Arab population. PATIENTS AND METHODS This study recruited 446 patients with type-2 diabetes from an outpatient clinic in Kuwait and completed assessments of diabetes self-care using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire and depression using the Patients Health Questionnaire-9 (PHQ-9) scales. Multiple linear regression models were used to determine the associations between depression, self-care behaviors and glycemic control. RESULTS Self-care behaviors were highest for medication taking (92.9%), an average for foot care (61.4%), blood glucose testing (60%) and healthy diet (55.7%), and lowest for exercise (27.1%). Depression, poor self-care activities and poor HbA1c levels were inter-correlated in univariate analysis (p< 0.03). In regression analysis, following healthful eating (B= -0.27, p< 0.001), general eating plan (B= -0.21, p= 0.01), more space carbohydrates evenly throughout the day (B= - 0.17, p= 0.03) and exercise at least 30 minutes (B= -0.17, p= 0.02) behaviors were associated with better HbA1c levels. However, depression was associated with poor scores of following a general eating plan (B= -0.20, p= 0.03), space carbohydrates evenly throughout the day (B= -0.21, p= 0.05), and exercising at least 30 minutes (B= -0.24, p= 0.03) behaviors. Depression scores were also associated with poor HbA1c levels (B= 0.32, p= 0.03). However, this association no longer persists after mutual adjustment with following a healthy diet (B= 0.14, p= 0.38) and exercise (B = 0.26, p = 0.08) behaviors. CONCLUSION Self-care activity was less than fifty percent in people with type 2 diabetes and higher activity was associated with better glycemic control. However, depression adversely affects self-care behaviors. To maintain and achieve glycemic control, diabetes educators might motivate people with type 2 diabetes to enhance their self-care activities, particularly those with depression symptoms and poor compliance with self-care activities.
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Affiliation(s)
- Abdullah Al-Ozairi
- Department of Psychiatry, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Etab Taghadom
- Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
- Dasman Diabetes Institute, Dasman, Kuwait
| | | | - Ebaa Al-Ozairi
- Dasman Diabetes Institute, Dasman, Kuwait
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Correspondence: Ebaa Al-Ozairi, Dasman Diabetes Institute, PO Box 1180, Dasman, 15462, Kuwait, Email
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Fina Lubaki JP, Omole OB, Francis JM. Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis. Diabetol Metab Syndr 2022; 14:134. [PMID: 36127712 PMCID: PMC9487067 DOI: 10.1186/s13098-022-00902-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is an increased burden of diabetes globally including in sub-Saharan Africa. The literature shows that glycaemic control among type 2 diabetes patients is poor in most countries in sub-Saharan Africa. Understanding the factors influencing glycaemic control in this region is therefore important to develop interventions to optimize glycaemic control. We carried out a systematic review to determine the prevalence and factors associated with glycaemic control in sub-Saharan Africa to inform the development of a glycaemic control framework in the Democratic Republic of the Congo. METHODS We searched five databases (African Index Medicus, Africa-Wide Information, Global Health, PubMed, and Web of Science) using the following search terms: type-2 diabetes, glycaemic control, and sub-Saharan Africa. Only peer-reviewed articles from January 2012 to May 2022 were eligible for this review. Two reviewers, independently, selected articles, assessed their methodological quality using Joanna Briggs checklists, and extracted data. A meta-analysis was performed to estimate the prevalence of glycaemic control. Factors associated with glycaemic control were presented as a narrative synthesis due to heterogeneity as assessed by the I2. RESULTS A total of 74 studies, involving 21,133 participants were included in the review. The pooled prevalence of good glycaemic control was 30% (95% CI:27.6-32.9). The glycaemic control prevalence ranged from 10-60%. Younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family history of diabetes, longer duration of diabetes, pill burden, treatment regimen, side effects, use of statins or antihypertensives, alcohol consumption, smoking, presence of comorbidities/complications, and poor management were associated with poor glycaemic control. On the other hand, positive perceived family support, adequate coping strategies, high diabetes health literacy, dietary adherence, exercise practice, attendance to follow-up, and medication adherence were associated with good glycaemic control. CONCLUSION Suboptimal glycaemic control is pervasive among patients with type-2 diabetes in sub-Saharan Africa and poses a significant public health challenge. While urgent interventions are required to optimize glycaemic control in this region, these should consider sociodemographic, lifestyle, clinical, and treatment-related factors. This systematic review and meta-analysis protocol is registered in PROSPERO under CRD 42021237941.
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Affiliation(s)
- Jean-Pierre Fina Lubaki
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Family Medicine and Primary Care, Protestant University of Congo, Kinshasa, Democratic Republic of the Congo.
| | - Olufemi Babatunde Omole
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
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Dinh Le T, Huy Duong H, Thi Nguyen L, Phi Thi Nguyen N, Tien Nguyen S, Van Ngo M. The Relationship Between Depression and Multifactorial Control and Microvascular Complications in Vietnamese with Type 2 Diabetes Mellitus Aged 30-60 Years. Diabetes Metab Syndr Obes 2022; 15:1185-1195. [PMID: 35464259 PMCID: PMC9031987 DOI: 10.2147/dmso.s354443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/01/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Depression is a common mental disorder in people with type 2 diabetes mellitus (T2DM). Depression and T2DM have a reciprocal interaction through many factors, of which the most important is the multifactorial control and microvascular complications of T2DM. AIM This research aims to determine the rate of depression and the association between depression and multifactorial control and microvascular complications in patients with T2DM aged 30-60 years in Vietnam. METHODS A cross-sectional and descriptive study was conducted on 231 outpatients with T2DM at Bach Mai hospital, Hanoi, Vietnam. Depression severity was measured with the Patient Health Questionnaire-9 (PHQ-9). RESULTS The rate of depression in patients with T2DM aged 30-60 years was 16.9% (in which, the rate of mild depression was 15.2% and moderate depression was 1.7%; no serious depression). The prevalence of depression was higher in female patients than in male patients (p = 0.049). There is a statistically significant difference in the rate of depression by age, duration of diabetes, and treatment method for type 2 diabetes. Poor HbA1c control and microvascular complications increase the risk of depression (OR = 2.37; 95% CI 1.11-5.02, p = 0.033 and OR = 2.62; 95% CI 1.15-5.93, p = 0.027, respectively). When the multivariate analysis was performed, it was shown that sex, treatment for glycemic control, and microvascular complications had a statistically significant influence on PHQ-9 score. CONCLUSION In Vietnam, there are 16.9% of patients with T2DM aged 30-60 years suffer from depression. Poor HbA1c control, the presence of microvascular complications, and without antihyperglycemic treatment increase the risk of developing depression.
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Affiliation(s)
- Tuan Dinh Le
- Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
- Department of Rheumatology and Endocrinology,Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
- Correspondence: Tuan Dinh Le, Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, 160 Phung Hung Street, Phuc La Ward, Ha Dong District, Hanoi City, Vietnam, Tel +840388166078, Email
| | - Hoang Huy Duong
- Department of Neurology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
- Hoang Huy Duong, Department of Neurology, Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Ky Ba Ward, Thai Binh, Vietnam, Tel +84 912675919, Email
| | - Ly Thi Nguyen
- Department of Internal Medicine, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
- Postgraduate Student, Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Nga Phi Thi Nguyen
- Department of Rheumatology and Endocrinology,Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Son Tien Nguyen
- Department of Rheumatology and Endocrinology,Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Manh Van Ngo
- Postgraduate Training Management Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
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Otieno FC, Mikhail T, Acharya K, Muga J, Ngugi N, Njenga E. Suboptimal glycemic control and prevalence of diabetes-related complications in Kenyan population with diabetes: cohort analysis of the seventh wave of the International Diabetes Management Practices Study (IDMPS). ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Yang H, Cao Q, Xiong X, Zhao P, Shen D, Zhang Y, Zhang N. Fluoxetine regulates glucose and lipid metabolism via the PI3K‑AKT signaling pathway in diabetic rats. Mol Med Rep 2020; 22:3073-3080. [PMID: 32945450 PMCID: PMC7453494 DOI: 10.3892/mmr.2020.11416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 11/01/2018] [Indexed: 12/02/2022] Open
Abstract
Diabetes mellitus poses a major threat towards global heath due to a lack of effective treatment. Fluoxetine hydrochloride, a selective 5-hydroxytryptamine reuptake inhibitor, is the most commonly used antidepressant in clinical therapy; however, the potential molecular mechanisms of fluoxetine in diabetes remain unknown. In the present study, reduced glucose, total cholesterol and triglyceride levels and lipid metabolism, as well as upregulated proliferator-activated receptor γ, fatty acid synthase and lipoprotein lipase, and downregulated sterol regulatory element-binding protein 1-c were detected in rats with streptozotocin (STZ)-induced diabetes following treatment with fluoxetine. Furthermore, fluoxetine significantly inhibited the expression levels of glucose metabolism-associated proteins in liver tissues, including glycogen synthase kinase 3β (GSK-3β), glucose-6 phosphatase catalytic subunit (G6PC), phosphoenolpyruvate carboxykinase (PEPCK) and forkhead box protein O1 (FOXO1). In addition, fluoxetine treatment notably attenuated morphological liver damage in rats with STZ-induced diabetes. Additionally, fluoxetine could inhibit the phosphatidylinositol 3-kinase-protein kinase B (PI3K-AKT) signaling pathway, whereas LY294002, a specific inhibitor of PI3K, suppressed the function of PI3K-AKT signaling and suppressed the expression levels of glucose metabolism-associated proteins, including GSK-3β, G6PC, PEPCK and FOXO1 in BRL-3A cells. The results of the present study revealed that fluoxetine may regulate glucose and lipid metabolism via the PI3K-AKT signaling pathway in diabetic rats.
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Affiliation(s)
- Hailong Yang
- Department of Clinical Psychology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Qiuyun Cao
- Department of Clinical Psychology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical College, Nanjing, Jiangsu 210000, P.R. China
| | - Xiaolu Xiong
- Department of Endocrinology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical College, Nanjing, Jiangsu 210000, P.R. China
| | - Peng Zhao
- Department of Clinical Psychology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical College, Nanjing, Jiangsu 210000, P.R. China
| | - Diwen Shen
- Department of Clinical Psychology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical College, Nanjing, Jiangsu 210000, P.R. China
| | - Yuzhe Zhang
- Department of Clinical Psychology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical College, Nanjing, Jiangsu 210000, P.R. China
| | - Ning Zhang
- Department of Clinical Psychology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
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Achila OO, Ghebretinsae M, Kidane A, Simon M, Makonen S, Rezene Y. Factors Associated with Poor Glycemic and Lipid Levels in Ambulatory Diabetes Mellitus Type 2 Patients in Asmara, Eritrea: A Cross-Sectional Study. J Diabetes Res 2020; 2020:5901569. [PMID: 32090121 PMCID: PMC7008274 DOI: 10.1155/2020/5901569] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/19/2019] [Accepted: 01/08/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE There is a dearth of relevant research on the rapidly evolving epidemic of diabetes mellitus (particularly Type 2 diabetes mellitus) in sub-Saharan Africa. To address some of these issues in the Eritrean context, we conducted a cross-sectional study on glycemic and lipid profiles and associated risk factors. METHODS A total of 309 patients with diabetes mellitus on regular follow-up at the Diabetic and Hypertensive Department at Halibet Regional Referral Hospital, Asmara, were enrolled for the study. Data on specific clinical chemistry and anthropomorphic parameters was collected. Chi-squared (χ 2) test or Fischer's exact test was used to evaluate the relationship between specific variables. Multivariate logistic regression (backward: conditional) was undertaken to identify the factors associated with increased odds of suboptimal values in glucose and specific lipid panel subfractions. RESULTS High proportions of patients (76.7%) had suboptimal levels of HbA1c with a mean ± SD of 8.6% ± 1.36, respectively. In multivariate regression analysis, the likelihood of HbA1c ≥ 7% was higher in patients with abnormal WHR (AOR = 3.01, 95% CI, 3.01 (1.15-7.92 = 0.024)) and in patients without hypertension (AOR = 1.97, 95% CI (1.06-3.56), p = 0.021). A unit reduction in eGFR was also associated with HbA1c ≥ 7% (AOR = 0.99, 95% CI (0.98-1 = 0.031)). In a separate analysis, the data shows that 80.9% of the patients had dyslipidemia. In particular, 62.1% of the patients had TC ≥ 200 mg/dL (risk factors: sex, hypertension, and HbA1c concentration), 81.6% had LDL-C ≥ 100 mg/dL (risk factors: sex and hypertension), 56.3% had TG ≥ 150 (risk factors: sex, HbA1c, and waist circumference), 62.8% had abnormal HDL-C (risk factors: waist circumference), 78.3% had non-HDL < 130 mg/dL (risk factors: duration of disease, reduced estimated glomerular filtration rate, and HbA1c), and 45.3% had abnormal TG/HDL (risk factors: sex, age of patient, FPG, and waist circumference). CONCLUSIONS The quality of care, as measured by glycemic and specific lipid targets, in this setting is suboptimal. Therefore, there is an urgent need for simultaneous improvements in both indicators. This will require evidence-based optimization of pharmacological and lifestyle interventions. Therefore, additional studies, preferably longitudinal studies with long follow-up, are required on multiple aspects of DM.
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Affiliation(s)
- Oliver Okoth Achila
- Department of Clinical Laboratory Sciences, Orotta College of Medicine and Health Sciences, Eritrea
| | - Millen Ghebretinsae
- Department of Clinical Laboratory Services, Asmara College of Health Sciences (ACHS), Eritrea
| | - Abraham Kidane
- Department of Clinical Laboratory Services, Asmara College of Health Sciences (ACHS), Eritrea
| | - Michael Simon
- Department of Clinical Laboratory Services, Asmara College of Health Sciences (ACHS), Eritrea
| | - Shewit Makonen
- Department of Clinical Laboratory Services, Asmara College of Health Sciences (ACHS), Eritrea
| | - Yohannes Rezene
- Department of Clinical Laboratory Services, Asmara College of Health Sciences (ACHS), Eritrea
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Salinero-Fort MA, Gómez-Campelo P, San Andrés-Rebollo FJ, Cárdenas-Valladolid J, Abánades-Herranz JC, Carrillo de Santa Pau E, Chico-Moraleja RM, Beamud-Victoria D, de Miguel-Yanes JM, Jimenez-Garcia R, López-de-Andres A, Ramallo-Fariña Y, De Burgos-Lunar C. Prevalence of depression in patients with type 2 diabetes mellitus in Spain (the DIADEMA Study) : results from the MADIABETES cohort. BMJ Open 2018; 8:e020768. [PMID: 30249627 PMCID: PMC6157517 DOI: 10.1136/bmjopen-2017-020768] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of depression in patients diagnosed with type 2 diabetes mellitus (T2DM), and to identify sociodemographic, clinical and psychological factors associated with depression in this population. Additionally, we examine the annual incidence rate of depression among patients with T2DM. METHODS We performed a large prospective cohort study of patients with T2DM from the Madrid Diabetes Study. The first recruitment drive included 3443 patients. The second recruitment drive included 727 new patients. Data have been collected since 2007 (baseline visit) and annually during the follow-up period (since 2008). RESULTS Depression was prevalent in 20.03% of patients (n=592; 95% CI 18.6% to 21.5%) and was associated with previous personal history of depression (OR 6.482; 95% CI 5.138 to 8.178), mental health status below mean (OR 1.423; 95% CI 1.452 to 2.577), neuropathy (OR 1.951; 95% CI 1.423 to 2.674), fair or poor self-reported health status (OR 1.509; 95% CI 1.209 to 1.882), treatment with oral antidiabetic agents plus insulin (OR 1.802; 95% CI 1.364 to 2.380), female gender (OR 1.333; 95% CI 1.009 to 1.761) and blood cholesterol level (OR 1.005; 95% CI 1.002 to 1.009). The variables inversely associated with depression were: being in employment (OR 0.595; 95% CI 0.397 to 0.894), low physical activity (OR 0.552; 95% CI 0.408 to 0.746), systolic blood pressure (OR 0.982; 95% CI 0.971 to 0.992) and social support (OR 0.978; 95% CI 0.963 to 0.993). In patients without depression at baseline, the incidence of depression after 1 year of follow-up was 1.20% (95% CI 1.11% to 2.81%). CONCLUSIONS Depression is very prevalent among patients with T2DM and is associated with several key diabetes-related outcomes. Our results suggest that previous mental status, self-reported health status, gender and several diabetes-related complications are associated with differences in the degree of depression. These findings should alert practitioners to the importance of detecting depression in patients with T2DM.
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Affiliation(s)
- Miguel Angel Salinero-Fort
- Subdirección General de Investigación Sanitaria, Consejería de Sanidad, Madrid, Spain
- Nodo Madrid, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - P Gómez-Campelo
- Grupo Respuesta Inmune Innata. Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
- Centro de Ciencias de la Salud San Rafael, Universidad Antonio de Nebrija, Madrid, Spain
| | | | - Juan Cárdenas-Valladolid
- Gerencia Adjunta de Planificación y Calidad, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | | | | | - Rosa M Chico-Moraleja
- Servicio de Ortopedia y Traumatología, Hospital Central de la Defensa, Madrid, Spain
| | | | | | | | - Ana López-de-Andres
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Yolanda Ramallo-Fariña
- Nodo Madrid, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Carmen De Burgos-Lunar
- Nodo Madrid, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain
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Silver B, Ramaiya K, Andrew SB, Fredrick O, Bajaj S, Kalra S, Charlotte BM, Claudine K, Makhoba A. EADSG Guidelines: Insulin Therapy in Diabetes. Diabetes Ther 2018; 9:449-492. [PMID: 29508275 PMCID: PMC6104264 DOI: 10.1007/s13300-018-0384-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Indexed: 01/25/2023] Open
Abstract
A diagnosis of diabetes or hyperglycemia should be confirmed prior to ordering, dispensing, or administering insulin (A). Insulin is the primary treatment in all patients with type 1 diabetes mellitus (T1DM) (A). Typically, patients with T1DM will require initiation with multiple daily injections at the time of diagnosis. This is usually short-acting insulin or rapid-acting insulin analogue given 0 to 15 min before meals together with one or more daily separate injections of intermediate or long-acting insulin. Two or three premixed insulin injections per day may be used (A). The target glycated hemoglobin A1c (HbA1c) for all children with T1DM, including preschool children, is recommended to be < 7.5% (< 58 mmol/mol). The target is chosen aiming at minimizing hyperglycemia, severe hypoglycemia, hypoglycemic unawareness, and reducing the likelihood of development of long-term complications (B). For patients prone to glycemic variability, glycemic control is best evaluated by a combination of results with self-monitoring of blood glucose (SMBG) (B). Indications for exogenous insulin therapy in patients with type 2 diabetes mellitus (T2DM) include acute illness or surgery, pregnancy, glucose toxicity, contraindications to or failure to achieve goals with oral antidiabetic medications, and a need for flexible therapy (B). In T2DM patients, with regards to achieving glycemic goals, insulin is considered alone or in combination with oral agents when HbA1c is ≥ 7.5% (≥ 58 mmol/mol); and is essential for treatment in those with HbA1c ≥ 10% (≥ 86 mmol/mol), when diet, physical activity, and other antihyperglycemic agents have been optimally used (B). The preferred method of insulin initiation in T2DM is to begin by adding a long-acting (basal) insulin or once-daily premixed/co-formulation insulin or twice-daily premixed insulin, alone or in combination with glucagon-like peptide-1 receptor agonist (GLP-1 RA) or in combination with other oral antidiabetic drugs (OADs) (B). If the desired glucose targets are not met, rapid-acting or short-acting (bolus or prandial) insulin can be added at mealtime to control the expected postprandial raise in glucose. An insulin regimen should be adopted and individualized but should, to the extent possible, closely resemble a natural physiologic state and avoid, to the extent possible, wide fluctuating glucose levels (C). Blood glucose monitoring is an integral part of effective insulin therapy and should not be omitted in the patient's care plan. Fasting plasma glucose (FPG) values should be used to titrate basal insulin, whereas both FPG and postprandial glucose (PPG) values should be used to titrate mealtime insulin (B). Metformin combined with insulin is associated with decreased weight gain, lower insulin dose, and less hypoglycemia when compared with insulin alone (C). Oral medications should not be abruptly discontinued when starting insulin therapy because of the risk of rebound hyperglycemia (D). Analogue insulin is as effective as human insulin but is associated with less postprandial hyperglycemia and delayed hypoglycemia (B). The shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular (IM) injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them (A). Many patients in East Africa reuse syringes for various reasons, including financial. This is not recommended by the manufacturer and there is an association between needle reuse and lipohypertrophy. However, patients who reuse needles should not be subjected to alarming claims of excessive morbidity from this practice (A). Health care authorities and planners should be alerted to the risks associated with syringe or pen needles 6 mm or longer in children (A).
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Affiliation(s)
- Bahendeka Silver
- MKPGMS-Uganda Martyrs University | St. Francis Hospital, Nsambya, Kampala, Uganda.
| | - Kaushik Ramaiya
- Shree Hindu Mandal Hospital, Chusi Street, Dar es Salaam, Tanzania
| | - Swai Babu Andrew
- Muhimbili University College of Health Sciences, United Nations Road, Dar es Salaam, Tanzania
| | - Otieno Fredrick
- Department of Clinical Medicine and Therapeutics School of Medicine, College of Health Science, University of Nairobi, Nairobi, Kenya
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, George Town, Allahabad, India
| | - Sanjay Kalra
- Bharti Research Institute of Diabetes and Endocrinology, Sector 12, PO Box 132001, Karnal, Haryana, India
| | - Bavuma M Charlotte
- University of Rwanda, College of Medicine and Health Science, Kigali University Teaching Hospital, Kigali, Rwanda
| | - Karigire Claudine
- Department of Internal Medicine, Rwanda Military Hospital, Kigali, Rwanda
| | - Anthony Makhoba
- MKPGMS-Uganda Martyrs University | St. Francis Hospital, Nsambya, Kampala, Uganda
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