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Nanditha A, Susairaj P, Satheesh K, Raghavan A, Snehalatha C, Ramachandran A. The rising prevalence of type 2 diabetes among the youth in southern India-An ancillary analysis of the Secular TRends in DiabEtes in India (STRiDE-I) study. J Diabetes 2024; 16:e13576. [PMID: 38923743 PMCID: PMC11200006 DOI: 10.1111/1753-0407.13576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND We studied the prevalence and incidence of type 2 diabetes (T2DM) and its associated risk factors in younger (20 and 39 years) and older individuals (≥40 years) over a 10-year period. METHODS Epidemiological surveys in 2006 (n = 7066) and 2016 (n = 9848) were conducted in similar urban and rural locations of southern India among people aged ≥20 years. Diagnosis of T2DM was made using World Health Organization criteria. Self-reported diabetes was verified from medical records. Age and gender standardized prevalence and incidence rates, percentage change in obesity, hypertension, and dyslipidemia were calculated. Prevalence ratios (PR) were calculated using Poisson regression analyses. Primary study was registered on www. CLINICALTRIALS gov. Identifier: NCT03490136. RESULTS In 10 years, the prevalence of T2DM increased in younger (7.8% vs. 4.5%, p < 0.0001) and older individuals (34% vs. 28.4%, p < 0.0001). After adjusting for age, family history of diabetes, and waist circumference, younger individuals showed a higher percentage increase in prevalence than the older group (PR = 1.36 [95% confidence interval [CI], 1.14-1.62], p = 0.001) versus (PR = 1.11 [95% CI, 1.02-1.20], p = 0.02). Increase in rates of obesity and dyslipidemia was also higher in the younger than in the older individuals. In 10 years, incidence of T2DM increased by 120% (1.1% vs. 0.5%, p < 0.0001) and 150% (5% vs. 2%, p < 0.0001) in the younger and older individuals, respectively. CONCLUSIONS Higher percentage increase in prevalence of T2DM was seen among younger individuals over a 10-year period. Obesity and family history of diabetes were shown to be the primary contributing factors for the rise in prevalence.
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Affiliation(s)
- Arun Nanditha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes HospitalsChennaiIndia
| | - Priscilla Susairaj
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes HospitalsChennaiIndia
| | | | - Arun Raghavan
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes HospitalsChennaiIndia
| | - Chamukuttan Snehalatha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes HospitalsChennaiIndia
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes HospitalsChennaiIndia
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Meshram II, Nagalla B, Rao Kodavanti M, Avula L, Ginnela Narsimhachary Veera B. Overweight/obesity, pre-diabetes, diabetes and its association with hypertension and other factors among rural adults (≥18 years) in India. Indian Heart J 2024; 76:182-191. [PMID: 38908547 PMCID: PMC11329029 DOI: 10.1016/j.ihj.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 03/26/2024] [Accepted: 06/12/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Non-communicable diseases are important causes of morbidity and mortality throughout the world. METHODS A community-based cross-sectional study conducted in 10 Indian states using multi-stage random sampling procedures. Information was collected on socio-economic and demographic particulars, anthropometric measurements such as height, weight and waist circumference, fasting blood glucose and blood pressure was measured. One day 24-h dietary recall was done for foods and nutrient intakes. Bivariate and multivariate step-wise logistic regression analyses was done. RESULTS The prevalence of overweight/obesity among rural adults was 23.4 % (95 % CI: 22.9-23.9), while age adjusted prevalence of pre-diabetes was 8.4 % (95 % CI: 8.1-8.7) and diabetes was 6.8, (95 % CI 6.7-7.1), respectively. The prevalence of diabetes was lowest in Uttar Pradesh, West Bengal and Odisha (3-4%) and higher in Kerala and Tamil Nadu (12-15 %). The odds of diabetes was 5.5 times more among elderly, 1.3 times higher among Christians and among high income groups, and 2 times among overweight (CI: 1.50-2.50), obese (CI: 1.61-2.76) and abdominal obesity (OR; 1.57; CI: 1.29-1.91) and 1.6 times more among hypertensives. The odds of diabetes were high among those consuming the lower tertiles of carbohydrates, pulses, milk and milk products and folic acid. CONCLUSION the age-adjusted prevalence of diabetes and pre-diabetes was 6.8 % and 8.4 % respectively and the odds of diabetes was high among elderly, among high socio-economic groups, overweight/obese subjects and among hypertensives. Also, knowledge about symptoms of diabetes was low. There is a need to improve awareness for early diagnosis and treatment for control of diabetes and hypertension.
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Affiliation(s)
- Indrapal I Meshram
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition, Hyderabad-500007, India.
| | - Balakrishna Nagalla
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition, Hyderabad-500007, India.
| | | | - Laxmaiah Avula
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition, Hyderabad-500007, India.
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Guan Q, Zhu C, Zhang G, Wang J, Xiang H, Chen Y, Cui H. Association of land urbanization and type 2 diabetes mellitus prevalence and mediation of greenness and physical activity in Chinese adults. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 337:122579. [PMID: 37741540 DOI: 10.1016/j.envpol.2023.122579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 09/25/2023]
Abstract
The prevalence of type 2 diabetes (T2D) is higher in urban than in rural areas. Limited information is available on the association between T2D and Land urbanization (LU) while LU influences not only greenness and Particulate Matter 2.5 (PM2.5) but also inhabitant behavior. We aimed to explore the association between the LU level and T2D prevalence, as well as whether greenness, PM2.5, or conscious physical activity mediated any of the observed associations. This study encompassed 27,633 adult participants from Shandong Province who completed the sixth National Health Service Survey in 2018. Ambient LU exposure was estimated by spatial characteristics, including the existing impervious surface area (ISA), road density (RD), and annual night light (NL). Exposures were estimated using satellite images and OpenStreetMap, with 1000 m used as the main analysis buffer. Two-level logistic regression models were used to investigate the association between the LU metrics and T2D. Additionally, we explored potential mechanisms of the association through mediation analysis. The prevalence of T2D among participants was 5.14%, with average exposures to ISA_1000m of 1.441 km2, RD_1000m of 3.856 km/km2, and NL_1000m of 9.821 nW/cm2/sr. Higher levels of LU exposure were associated with higher T2D ORs [for each interquartile of ISA_1000m, RD_1000m, and NL_1000m, the adjusted OR (95% CI) for the T2D prevalence were 1.29 (1.19-1.4), 1.25 (1.15-1.36), and 1.25 (1.15-1.36), respectively]. This relationship persisted in several sensitivity analyses including use of different buffer sizes. We observed stronger associations among participants younger than 65 years or in men. Greenness mediated a 20.78%-65.36% of the estimated associations, conscious physical activity mediated a 10.35%-15.85%, while PM2.5 mediated insignificantly. These results suggest a deleterious association between higher levels of LU and T2D among adult residents in a developing country. Greenness and conscious physical activity mediate the association.
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Affiliation(s)
- Qing Guan
- State Key Laboratory of Information Engineering in Surveying, Mapping, and Remote Sensing, Wuhan University, Wuhan 430079, China.
| | - Chunyang Zhu
- State Key Laboratory of Information Engineering in Surveying, Mapping, and Remote Sensing, Wuhan University, Wuhan 430079, China.
| | - Guo Zhang
- State Key Laboratory of Information Engineering in Surveying, Mapping, and Remote Sensing, Wuhan University, Wuhan 430079, China.
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan 430072, China.
| | - Hao Xiang
- Department of Global Health, School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan, China.
| | - Yujia Chen
- State Key Laboratory of Information Engineering in Surveying, Mapping, and Remote Sensing, Wuhan University, Wuhan 430079, China.
| | - Hao Cui
- State Key Laboratory of Information Engineering in Surveying, Mapping, and Remote Sensing, Wuhan University, Wuhan 430079, China.
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Kundu S, Sharma P, Singh S, Kumar P. District-level heterogeneity in overweight or obesity among women of reproductive age: A geo-spatial analysis in India. PLoS One 2023; 18:e0290020. [PMID: 37590188 PMCID: PMC10434895 DOI: 10.1371/journal.pone.0290020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/01/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Globally by 2030, 38% of the world's population would be overweight, and another 20% would be obese. This has led to rising concerns regarding how swiftly and substantially the world is moving towards this epidemic of "globesity". India too is facing an increased burden of overweight and obese population. The changing dietary patterns are significantly associated with the increasing prevalence of overweight/obesity and related complications, especially among women. Hence, the present study aims to observe the spatial patterns of overweight or obesity among women in reproductive age group in India and factors associated with it. METHODS The study analyzed data from a cross-sectional nationwide household survey, i.e. National Family Health Survey (NFHS-4), 2015-16. The primary outcome variable of this study was overweight/obesity among reproductive-age women, which was measured through the body mass index (BMI) of the women. Bivariate and multivariate logistic regression analysis was used to analyze the data. Additionally, for spatial analysis in terms of overweight/obesity among women in India, univariate and bivariate Moran's I index measurements were used along with the usage of spatial regression models. RESULTS The value of spatial-autocorrelation for overweight or obese was 0.64, which depicts the moderately high prevalence of the overweight/obesity coverage over districts of India. The overall prevalence overweight/obesity among women in India is around 25% and higher proportion of women from urban areas (37.8%), and non-poor (33.4%) economic group reported to be overweight or obese. From spatial lag model, the lag coefficient was found to be 0.28, implying that a change in the prevalence of overweight/obesity among women in a certain district may statistically lag the prevalence of overweight/obesity by 28% in the neighbouring districts. There were significantly high clustering of overweight/obese women and non-poor wealth quintiles in 132 districts, mainly from states of Punjab, Haryana, Gujarat, Maharashtra, Kerala, Tamil Nadu, Karnataka and Andhra Pradesh. Additionally, there was high-high clustering of overweight/obese women and those who ever had caesarean in 82 districts, mostly from Kerala, Tamil Nadu, Andhra Pradesh and Karnataka. CONCLUSION The spatial patterns on the prevalence of overweight and obesity in India show that the women belonging to the southern states' districts are more overweight or obese in comparison to other states. The determinants like older age, higher education, urban residence, higher economic status are the key factors contributing to the prevalence of overweight or obesity among women in the reproductive age group. The study concludes and recommends an urgent need of interventions catering to urban women belonging to higher socio-economic status, to reduce the risks of health consequences due to overweight and obesity.
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Affiliation(s)
- Sampurna Kundu
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, Delhi, India
| | - Pratima Sharma
- School of Health System Studies, Tata Institute of Social Sciences, Mumbai, India
| | - Shivani Singh
- Specialist- Monitoring and Evaluation, India Health Action Trust (IHAT), Lucknow, India
| | - Pradeep Kumar
- Specialist- Monitoring and Evaluation, India Health Action Trust (IHAT), Lucknow, India
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Mumu SJ, Stanaway FF, Merom D. Rural-to-urban migration, socio-economic status and cardiovascular diseases risk factors among Bangladeshi adults: A nationwide population based survey. Front Public Health 2023; 11:860927. [PMID: 37089482 PMCID: PMC10116049 DOI: 10.3389/fpubh.2023.860927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/13/2023] [Indexed: 04/25/2023] Open
Abstract
Background Rural-to-urban migration is one of the key drivers of urbanization in Bangladesh and may impact on cardiovascular diseases (CVD) risk due to lifestyle changes. This study examined whether CVD risk factors were associated with migration to and duration of urban life, considering socio-economic indicators. Methods A total of 27,792 participants (18-59 years) from the 2006 Bangladesh cross-sectional Urban Health Survey were included in the analyses of whom 14,167 (M: 7,278; W: 6,889) were non-migrant urban residents and 13,625 (M: 6,413; W: 7,212) were rural-to-urban migrants. Gender-specific prevalence of CVD risk factors were estimated for urban and migrant groups. Multivariate logistic regression models were used to test the association between each CVD risk by education and wealth within each study group and their possible effect modification. An analysis on the rural-to-urban migrant subgroup only was conducted to examine the association between each CVD risk factor and length of urban stay adjusted for demographic and socio-economic indicators. Results Compared to urban residents, migrants had significantly lower prevalence of overweight/obesity for both genders. Hypertension was higher among urban women while alcohol/illicit drug use was higher among urban men. Mental health disorders were higher among migrants than urban residents for both genders and no difference were noted for diabetes or cigarette smoking prevalence. In both study groups and genders, the risk of overweight/obesity, hypertension and diabetes increased with increasing education and wealth whereas for mental health disorders, alcohol/illicit drug use, cigarette and bidi smoking the reverse was found. Differences in BMI between migrant and urban women were attenuated with increased education levels (p = 0.014 for interaction). Consistent increasing pattern of risk was observed with longer duration of urban stay; in migrant men for obesity (OR = 1.67), smoking (OR = 1.67) and alcohol/illicit drug use (OR = 2.86), and for obesity and mental health disorder among migrant women. Conclusions Migrants had high proportion of CVD risk factors which were influenced by education, wealth and duration of urban stay.
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Affiliation(s)
- Shirin Jahan Mumu
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
- School of Health Sciences, Torrens University Australia, Sydney, NSW, Australia
- *Correspondence: Shirin Jahan Mumu
| | - Fiona F. Stanaway
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Dafna Merom
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
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Susarla G, Rizza AN, Li A, Han S, Khan R, Chan W, Lains I, Apivatthakakul A, Brustoski K, Khetan V, Raman R, Igo RP, Iyengar SK, Mathavan S, Sobrin L. Younger Age and Albuminuria are Associated with Proliferative Diabetic Retinopathy and Diabetic Macular Edema in the South Indian GeNetics of DiAbeTic Retinopathy (SIGNATR) Study. Curr Eye Res 2022; 47:1389-1396. [PMID: 35815717 PMCID: PMC9637383 DOI: 10.1080/02713683.2022.2091148] [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: 04/08/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/03/2022]
Abstract
Purpose: The purpose of the South Indian GeNetics of DiAbeTic Retinopathy (SIGNATR) Study is to identify non-genetic and genetic risk factors associated with diabetic retinopathy (DR). This report examines the non-genetic risk factors for DR in South Indian patients.Methods: Participants with South Indian ancestry and type 2 diabetes (T2D) were included from two sources: the Sankara Nethralaya Diabetic Retinopathy and Molecular Genetics Study (SN-DREAMS) and prospective recruitment at Sankara Nethralaya affiliates. Fundus photography and optical coherence tomography (OCT) were obtained on participants. Fundus images were graded for DR severity and OCTs were graded for center-involved diabetic macular edema (ciDME). Multivariate analyses were performed using stepwise logistic regression to assess effects of the demographic and clinical factors on proliferative DR (PDR) and DME.Results: Among the 2941 participants with DR grading, participants with PDR were more likely to be younger [odds ratio (OR)=0.95], men (OR = 1.83), have a longer duration of diabetes (OR = 1.10), have a higher hemoglobin A1c (OR = 1.12), have albuminuria (OR = 5.83), have hypertension (OR = 1.69), have a higher HDL (OR = 1.02) and a lower total cholesterol (OR = 0.99) (all p < 0.05). Among the 483 participants with gradable OCT scans, participants who had ciDME were more likely to be younger (OR = 0.97), men (OR = 2.80), have a longer duration of diabetes (OR = 1.06), have lower triglycerides (OR = 0.99), and have albuminuria (OR = 3.12) (all p < 0.05).Conclusions: Younger age, male sex, longer duration of diabetes, higher HbA1c, and presence of albuminuria were identified as risk factors for PDR and DME in a South Indian population with T2D.
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Affiliation(s)
- Gayatri Susarla
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - A N Rizza
- Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ashley Li
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Samuel Han
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Rehana Khan
- Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Weilin Chan
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Ines Lains
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Atitaya Apivatthakakul
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Kim Brustoski
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Vikas Khetan
- Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rajiv Raman
- Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Robert P Igo
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Sudha K Iyengar
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | - Lucia Sobrin
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Wismayer R, Kiwanuka J, Wabinga H, Odida M. Risk Factors for Colorectal Adenocarcinoma in an Indigenous Population in East Africa. Cancer Manag Res 2022; 14:2657-2669. [PMID: 36097505 PMCID: PMC9464000 DOI: 10.2147/cmar.s381479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/31/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The incidence of colorectal cancer (CRC) is increasing in East Africa. Changes in lifestyle and dietary changes, particularly alcohol consumption, smoking, and consumption of cooked meats with a reduction in fibre in the diet may be responsible. The objective of our study was to determine the risk factors responsible for CRC in Uganda. Methods We recruited 129 participants with histologically proven colorectal adenocarcinoma and 258 control participants from four specialized hospitals in central Uganda from 2019 to 2021. Controls were block matched for age (±5 years) and sex of the case participants. The risk factor variables included; area of residence, tribe, body mass index (BMI), smoking, alcohol consumption and family history of gastrointestinal cancer. We used conditional or ordinal logistic regression to obtain crude and adjusted odds ratios for risk factors associated with CRC. Results In bivariate analysis, case participants were more likely to be associated with urban residence (cOR:62.11; p<0.001); family history of GI cancer (cOR: 14.34; p=0.001); past smokers (cOR: 2.10; p=0.080); past alcohol drinkers (cOR: 2.35; p=0.012); current alcohol drinkers (cOR: 3.55; p<0.001); high BMI 25–29.9 kg/m2 (cOR: 2.49; p<0.001); and high BMI ≥30kg/m2 (cOR: 2.37; p=0.012). In the multivariate analysis, urban residence (aOR: 82.79; p<0.001), family history of GI cancer (aOR: 61.09; p<0.001) and past smoking (aOR: 4.73; p=0.036) were independently associated with a higher risk of developing CRC. Conclusion A family history of gastrointestinal cancer was a risk factor for CRC. While population-based CRC screening may not be feasible in low income-countries, targeted CRC screening for first-degree relatives with CRC should be considered in East Africa. Molecular genetic studies need to be carried out to determine the role of hereditary factors in our population. Prevention strategies should be adopted to avoid smoking in our population which was associated with an increased risk of CRC.
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Affiliation(s)
- Richard Wismayer
- Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda.,Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda.,Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Julius Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Michael Odida
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.,Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Shivashankar R, Singh K, Kondal D, Gupta R, Perel P, Kapoor D, Jindal D, Mohan S, Pradeepa R, Jarhyan P, Srinivasapura Venkateshmurthy N, Tandon N, Mohan V, Venkat Narayan KM, Prabhakaran D, Ali MK. Cardiovascular Health in India - a Report Card from Three Urban and Rural Surveys of 22,144 Adults. Glob Heart 2022; 17:52. [PMID: 36051326 PMCID: PMC9354560 DOI: 10.5334/gh.1137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background Markers of ideal cardiovascular health (CVH) predict cardiovascular events. We estimated the prevalence of ideal CVH markers in two levels of cities and villages in India. Methods We did pooled analysis of individual-level data from three cross sectional surveys of adults ≥ 30 years over 2010-14 (CARRS: Centre for cArdiometabolic Risk Reduction in South Asia; UDAY and Solan Surveillance Study) representing metropolitan cities; smaller cities and rural areas in diverse locations of India. We defined ideal CVH using modified American Heart Association recommendations: not smoking, ≥ 5 servings of fruits and vegetables (F&V), high physical activity (PA), body mass index (BMI) <25 Kg/m2, blood pressure (BP) <120/80 mm Hg, fasting plasma glucose (FPG) <100 mg/dl, and total cholesterol (TC) <200 mg/dL. We estimated (1) age-and sex-standardized prevalence of ideal CVH and (2) prevalence of good (≥6 markers), moderate (4-5), and poor CVH (≤3) adjusted for age, sex, education, and stratified by setting and asset tertiles. Results Of the total 22,144 participants, the prevalence of ideal CVH markers were: not smoking (76.7% [95% CI 76.1, 77.2]), consumed ≥5 F&V (4.2% [3.9, 4.5]), high PA (67.5% [66.8, 68.2]), optimum BMI (59.6% [58.9, 60.3]), ideal BP (34.5% [33.9, 35.2]), FPG (65.8% [65.1, 66.5]) and TC (65.4% [64.7, 66.1]). The mean number of ideal CVH metrics was 3.7(95% CI: 3.7, 3.8). Adjusted prevalence of good, moderate, and poor CVH, varied across settings: metropolitan (3.9%, 41.0%, and 55.1%), smaller cities (7.8%, 49.2%, and 43%), and rural (10.4%, 60.9%, and 28.7%) and across asset tertiles: Low (11.0%, 55.9%, 33.1%), Middle (6.3%, 52.2%, 41.5%), and High (5.0%, 46.4%, 48.7%), respectively. Conclusion Achievement of ideal CVH varied, with higher prevalence in rural and lower asset tertiles. Multi-sectoral and targeted policy and program actions are needed to improve CVH in diverse contexts in India.
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Affiliation(s)
- Roopa Shivashankar
- Indian Council of Medical Research (ICMR), New Delhi, IN
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
| | - Kalpana Singh
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Hamad Medical Corporation, Doha, QA
| | - Dimple Kondal
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
| | - Ruby Gupta
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Deksha Kapoor
- All India Institute of Medical Sciences (AIIMS), New Delhi, IN
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK
| | - Devraj Jindal
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
| | - Sailesh Mohan
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
- Deakin University, Melbourne, AUS
| | | | | | | | - Nikhil Tandon
- All India Institute of Medical Sciences (AIIMS), New Delhi, IN
| | | | - K. M. Venkat Narayan
- Rollins School of Public Health & Emory Global Diabetes Research Center, Emory University, Atlanta, US
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
- Rollins School of Public Health, Emory University, Atlanta, US
| | - Mohammed K. Ali
- Rollins School of Public Health & Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, US
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Kumar P, Mangla S, Kundu S. Inequalities in overweight and obesity among reproductive age group women in India: evidence from National Family Health Survey (2015-16). BMC Womens Health 2022; 22:205. [PMID: 35655261 PMCID: PMC9161460 DOI: 10.1186/s12905-022-01786-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background In developing nations like India, fertility and mortality have decreased, and diseases related to lifestyle have become more common. Females in India are more prone to being overweight and obese than their male counterparts, more specifically in affluent families than the poor ones. Understanding the overweight and obesity trend may help develop feasible public health interventions to reduce the burden of obesity and associated adverse health outcomes. Methods The study utilizes the fourth round of the National Family Health Survey (NFHS-4), 2015–16. Descriptive statistics, bivariate and multivariate analysis was used to check the significant relationship between overweight and obesity, and other background characteristics. Income-related inequality in overweight and obesity among women was quantified by the concentration index and the concentration curve. Further, Wagstaff decomposition analysis was done to decompose the concentration index, into the contributions of each factor to the income-related inequalities. Results Overweight & obesity among women had a significant positive association with their age and educational level. The odds of overweight and obesity were 57% more likely among women who ever had any caesarean births than those who did not [AOR: 1.57; CI: 1.53–1.62]. The likelihood of overweight and obesity was 4.31 times more likely among women who belonged to richest [AOR: 5.84; CI: 5.61–6.08] wealth quintile, than those who belonged to poor wealth quintile. Women who ever terminated the pregnancy had 20% higher risk of overweight and obesity than those who did not [AOR: 1.20; CI: 1.17–1.22]. The concentration of overweight and obesity among women was mostly in rich households of all the Indian states and union territories. Among the geographical regions of India, the highest inequality was witnessed in Eastern India (0.41), followed by Central India (0.36). Conclusion The study results also reveal a huge proportion of women belonging to the BMI categories of non-normal, which is a concern and can increase the risks of developing non-communicable diseases. Hence, the study concludes and recommends an urgent need of interventions catering to urban women belonging to higher socio-economic status which can reduce the risks of health consequences due to overweight and obesity. Development nutrition-specific as well as sensitive interventions can be done for mobilization of local resources that addresses the multiple issues under which a woman is overweight or obese.
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Affiliation(s)
- Pradeep Kumar
- International Institute of Population Sciences, Deonar, Mumbai, 400088, India
| | - Sherry Mangla
- International Institute of Population Sciences, Deonar, Mumbai, 400088, India
| | - Sampurna Kundu
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, Delhi, 110067, India.
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Nanditha A, Susairaj P, Raghavan A, Vinitha R, Satheesh K, Nair DR, Jeyaraj S, Snehalatha C, Ramachandran A. Concordance in incidence of diabetes among persons with prediabetes detected using either oral glucose tolerance test or glycated haemoglobin. Prim Care Diabetes 2022; 16:440-444. [PMID: 35337771 DOI: 10.1016/j.pcd.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 10/18/2022]
Abstract
AIMS To study the concordance in the incidence of type 2 diabetes (T2DM) between cohorts with prediabetes, selected either by oral glucose tolerance test (OGTT) or glycosylated haemoglobin (HbA1c) at two years in a real world situation. METHODS Two cohorts with impaired glucose tolerance (IGT) were selected from the non-interventional arm of the Indian diabetes prevention programmes; a group selected by using OGTT (Cohort 1, n = 498), another selected based on the HbA1c criterion (Cohort 2, n = 504). Clinical and biochemical data collected for 24 months at 6 monthly intervals were used in assessing the cumulative incidence of T2DM using the respective diagnostic criteria. Intra and inter group comparisons were analysed using appropriate statistical tests. A multiple logistic regression analysis was used to identify the variables significantly associated with the incidence of diabetes. RESULTS Incidence of diabetes in both cohorts were similar at 12 and 24 months with either of the two criteria (25.3% with glucose and 27.5% with HbA1c, p = 0.41 at 24 months). The multivariate analysis confirmed the results. Only baseline waist circumference was positively associated with the incidence. CONCLUSION Both OGTT and HbA1c have similar utility and validity in identifying persons with IGT. Persons identified with either of the criterion had similar incidence of T2DM among Asian Indians.
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Affiliation(s)
- Arun Nanditha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Priscilla Susairaj
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Arun Raghavan
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ramachandran Vinitha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Krishnamoorthy Satheesh
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Dhruv Rajesh Nair
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Santhosh Jeyaraj
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Chamukuttan Snehalatha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
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Lin CC, Ou HY, Hsu HY, Cheng KP, Hsieh TJ, Yeh CH, Su FC, Kuo LC. Beyond Sarcopenia: older adults with type II diabetes mellitus tend to experience an elevated risk of poor dynamic balance-a case-control study. BMC Geriatr 2022; 22:138. [PMID: 35177026 PMCID: PMC8855561 DOI: 10.1186/s12877-022-02826-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background People with type 2 diabetes mellitus (T2DM) tend to be vulnerable to geriatric syndromes such as sarcopenia and frailty. Reduced physical activity also accompanies sarcopenia and frailty, which is generally typical of patients with T2DM. However, a comprehensive assessment of physical fitness in patients with T2DM has seldom been carried out and verified. This study is thus an attempt to determine the associations among sarcopenia, frailty, and the SFT in diabetic patients and non-diabetic controls to provide a more comprehensive understanding of such associations in future evaluations of T2DM in older individuals. Methods Sarcopenia, frailty, and the senior fitness test (SFT) were compared between 78 older men with T2DM (66.5 ± 9.0 years) and 48 age-matched normoglycemic controls (65.8 ± 5.3 years) in this case–control study. The skeletal muscle index (SMI), grip strength, and 4-m walk test were employed to assess for sarcopenia. Frailty was evaluated using the Study of Osteoporotic Fractures index (SOF). The SFT comprises five components, including body composition, muscle strength, flexibility, balance, and aerobic endurance. Results The risk level of sarcopenia was significantly higher (p < 0.05) in the T2DM group as compared to the control group. No significant difference between-group differences were found in SMI and grip strength in the T2DM and control groups. However, the T2DM group showed a significant decrease in gait speed (p < 0.01) in comparison with the control group, as well as significant increases in frailty (p < 0.01) and depression (p < 0.05). With respect to the SFT, obvious elevation in BMI, significant declines in extremity muscle strength (elbow extensor, knee flexor, hip abductor, hip flexor, sit to stand), static/dynamic balance (single leg stand: p < 0.05; up-and-go: p < 0.01) and aerobic endurance (2-min step: p < 0.01; 6-min walk: p < 0.01) were found in the T2DM group. Furthermore, the SOF (OR = 2.638, 95% CI = 1.333–5.221), BMI (OR = 1.193, 95% CI = 1.041–1.368) and up-and-go (OR = 2.089, 95% CI = 1.400–3.117) were found to be positively and significantly associated with T2DM. Conclusions The findings of this study indicated the importance of countering frailty and maintaining physical fitness, especially dynamic balance, during the early physical deterioration taking place in diabetic patients.
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Affiliation(s)
- Chih-Chun Lin
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Horng-Yih Ou
- Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiu-Yun Hsu
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Pi Cheng
- Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tai-Jung Hsieh
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan
| | - Chien-Hsien Yeh
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Chin Su
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.,Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Li-Chieh Kuo
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan. .,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan.
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Trends in the diabetes incidence and mortality in India from 1990 to 2019: a joinpoint and age-period-cohort analysis. J Diabetes Metab Disord 2021; 20:1725-1740. [PMID: 34900822 DOI: 10.1007/s40200-021-00834-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/12/2021] [Indexed: 10/20/2022]
Abstract
Introduction Globally, a metabolic disorder like Diabetes is considered as one of the largest global health issues, as it accounts for the majority of the disease burden and happens to be one of the leading causes of mortality as well as reduced life expectancy across the world. As in 2019, India is home to the second-largest number (77 million) of Diabetic adults and the number of people affected has been increasing rapidly over the years. Termed as "the diabetes capital of the world," with every fifth diabetic in the world being an Indian, there is an urgent need to address many critically significant challenges posed by Diabetes in India, like, increasing prevalence among young people in urban areas, less awareness among people, high cost of disease management, limited healthcare facilities, suboptimal diabetes control etc. In Indian context, not enough attempts have been made to observe and understand the long-term pattern of diabetes incidence and mortality. This study aims to provide deep insights into the recent trends of diabetes incidence and mortality in India from 1990 to 2019. Materials and methods This is an observational study based on the most recent data from the Global Burden of Disease (GBD) Study 2019. We extracted numbers, age-specific and age-standardized incidence and mortality rates of diabetes (from 1990 to 2019) from the Global Health Data Exchange. The average annual percentage changes in incidence and mortality were analysed by joinpoint regression analysis; the net age, period, and cohort effects on the incidence and mortality were estimated by age-period-cohort analysis. Results During the study period, age-standardized incidence and mortality rates of diabetes in India experienced an upsurge in numbers, the incidence rate increased from 199.14 to 317.02, and consequently, mortality increased from 22.30 to 27.35 per 100,000 population. The joinpoint regression analysis showed that the age-standardized incidence significantly rose by 1.63 % (95 % CI: 1.57 %, 1.69 %) in Indian males and 1.56 % in Indian females (95 % CI: 1.49 %, 1.63 %) from 1990 to 2019. On the other hand, the age-standardized mortality rates rose by 0.77 % (95 % CI: 0.24 %, 1.31 %) in Indian males and 0.57 % (95 % CI: -0.54 %, 1.70 %) in Indian females. For age-specific rates, incidence increased in most age groups, with exception of age groups 5-9, 70-74, 75-79 and 80-84 in male, and age groups 5-9, 75-79 and 80-84 in female. Mortality in male saw a decreasing trend till age group 20-24, whereas in female, the rate decreased till age group 35-39. The age effect on incidence showed no obvious changes with advancing age, but the mortality significantly increased with advancing age; period effect showed that both incidence and mortality increased with advancing time period; cohort effect on diabetes incidence and mortality decreased from earlier birth cohorts to more recent birth cohorts, while incidence showed no material changes from 1975 to 1979 to 2000-2004 birth cohort. Conclusions Mortality of diabetes decreased in younger age groups but increased in older age groups; however, Incidence increased in most age groups for both male and female. The net age or period effect showed an unfavourable trend while the net cohort effect presented a favourable trend. Aging was likely to drive a continued increase in the mortality of diabetes. Timely population-level interventions aiming for health education, lifestyle modification with special emphasis on the promotion of physical activity and healthy diet should be conducted, especially for male and earlier birth cohorts at high risk of diabetes.
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Enayatrad M, Yavari P, Vahedi H, Mahdavi S, Etemad K, Khodakarim S. Urbanization Levels and Its Association with Prevalence of Risk Factors and Colorectal Cancer Incidence. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:2317-2325. [PMID: 35223607 PMCID: PMC8826346 DOI: 10.18502/ijph.v50i11.7588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Colorectal cancer is one of the most common cancers in the world. This study aimed to determine the relationship between risk factors and the incidence of colorectal cancer in Urbanization levels in Iran. METHODS This was a population-based study. Urbanization levels were determined using the census data of the Statistical Center in 2012. Data on risk factors for colorectal cancer were obtained from the information provided by the Iranian Non-Communicable Disease Control Center and the incidence of colorectal cancer from the data from the National Cancer Registry System. Negative binomial regression analysis was used to determine the relationship between colorectal cancer risk factors and urbanization levels with colorectal cancer incidence. For statistical analysis, SPSS and Stata software were used. A significant level of P≤0.05 was considered. RESULTS The relationship between urbanization levels and risk factors with the incidence of colorectal cancer, nutrition Status, tobacco use, and body mass index were not significant. There was a significant relationship between physical activity and incidence at different levels and between levels of urbanization and incidence rate, indicating a lower incidence rate of colorectal cancer at lower levels of urbanization. CONCLUSION Colorectal cancer incidence is higher at higher levels of urbanization than lower levels. The difference between regions in terms of urbanization can have in flounce on access to facilities, health service, and counseling opportunities to modify the risk factors and access to proper screening and follow-up care.
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Affiliation(s)
- Mostafa Enayatrad
- Clinical Research Development Unit, Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Parvin Yavari
- Cancer Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Health & Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Vahedi
- Department of Clinical Sciences, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Sepideh Mahdavi
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Koorosh Etemad
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Khodakarim
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ubani BC, Young E, Ekrikpo UE, Agbonrofo-Eboigbe G, Nga CN, Unachukwu CN. Pre-diabetes and it’s predictors in Abia State, Eastern Nigeria. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-01007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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15
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Nanditha A, Susairaj P, Raghavan A, Satheesh K, Vinitha R, Snehalatha C, Ramachandran A. Secular trends in cardiovascular risk factors among urban and rural populations in Tamil Nadu, India - An ancillary analysis of the STRiDE-I study. Diabetes Res Clin Pract 2021; 178:108930. [PMID: 34216682 DOI: 10.1016/j.diabres.2021.108930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 06/01/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022]
Abstract
AIMS To study changes in cardiovascular (CV) risk factors; hypertension (HTN), dysglycaemia (DG) and dyslipidaemia (DL) and their interrelationship, in urban and rural Southern India, in a decade. METHODS Epidemiological data of a city (Chennai, n = 2192(2006), n = 3850(2016)) and peri-urban villages (Panruti, n = 2584 (2006), n = 2468 (2016)) among persons aged ≥ 20 years in 2006 and in 2016 were analysed. Age-standardized prevalence, prevalence ratios and interrelationships of HTN, DG and DL and effect of time in years, age, gender and obesity were calculated using Poisson regression analyses. RESULTS Response rates in urban and rural areas were 86.5% and 87.6% respectively. Mean age, general obesity (GO), abdominal obesity (AO), total calories and carbohydrate intake increased in both populations (p < 0.0001). Rural population had lower BMI than the urban but had higher AO, particularly among women. Physical activity decreased only in the urban population. HTN increased in urban population; in both, proportion of known HTN decreased, DG and DL increased. CONCLUSIONS In both populations, GO, AO, DG and DL increased; AO and DL were more common among rural women. HTN did not increase in the rural population. The risk factors increased rapidly even in rural areas projecting the impact of urbanisation on the CV burden.
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Affiliation(s)
- Arun Nanditha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Priscilla Susairaj
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Arun Raghavan
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Krishnamoorthy Satheesh
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ramachandran Vinitha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Chamukuttan Snehalatha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
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Verma AK, Goyal Y, Bhatt D, Dev K, Alsahli MA, Rahmani AH, Almatroudi A. A Compendium of Perspectives on Diabetes: A Challenge for Sustainable Health in the Modern Era. Diabetes Metab Syndr Obes 2021; 14:2775-2787. [PMID: 34168477 PMCID: PMC8216699 DOI: 10.2147/dmso.s304751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
Diabetes is a chronic illness. Hyperglycemia is the characteristic of this disorder. Diabetes is a global crisis which affects the economy and health of all nations. Over the last decades, the number of individuals living with diabetes has significantly increased worldwide. Asia is a key epicenter of the emerging diabetes epidemic, with China and India the two nations having the highest number of diabetic people. Economic development, modernization, unhealthy diet, population aging, and sedentary lifestyles are the major factors responsible for the increasing diabetes epidemic. Diabetes is associated with several complications, and cardiovascular disease is the most important cause of morbidity and mortality among people with diabetes. These life-threatening problems can be prevented or delayed by proper management of diabetes. Lifestyle modification is an important factor to decrease the diabetes risk. The frequency of diabetic complications will rise if there is a lack of cost-effective and sustainable interventions. Hence, prevention of diabetes and its complications such as diabetic retinopathy and cardiovascular disease should be a crucial part of all future health-related public policies among all nations. This review summarizes current epidemiological aspects of diabetes in the world along with its complications, preventive measures, and treatment.
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Affiliation(s)
- Amit K Verma
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Yamini Goyal
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Deepti Bhatt
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Kapil Dev
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Mohammed A Alsahli
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
| | - Arshad Husain Rahmani
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
| | - Ahmad Almatroudi
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
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Washirasaksiri C, Srivanichakorn W, Godsland IF, Kositamongkol C, Chariyalertsak S, Kessomboon P, Assanangkornchai S, Taneepanichskul S, Neelapaichit N, Phisalprapa P, Johnston DG, Oliver NS, Aekplakorn W. Increasing glycaemia is associated with a significant decline in HDL cholesterol in women with prediabetes in two national populations. Sci Rep 2021; 11:12194. [PMID: 34108497 PMCID: PMC8190299 DOI: 10.1038/s41598-021-91075-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/20/2021] [Indexed: 12/17/2022] Open
Abstract
Internationally, studies have shown associations between lipids and glycemia; however, whether the link varies by gender and population has been rarely examined. We investigated relationships between glycemia and HDL- and Non-HDL-cholesterol and their modification by gender. We undertook a cross-sectional analysis from the National Health Examination Survey for Thailand (NHES-Thailand) and the Health Survey for England (HS-England) in adults aged 18-75 year. Glycaemia was assessed by FPG in Thailand and by HbA1c in the UK. In population- and gender-stratified analyses, the relationships between glycemia and lipids were explored. A total of 15,145 Thai and 3484 UK adults with blood measurement were included. The prevalences of prediabetes were: in NHES-Thailand, 16% (SE = 0.004), based on FPG (5.6 to < 7.0 mmol/L) and in HS-England, 19% (0.007) based on HbA1c (39 to < 48 mmol/mol). Increasingly abnormal glucose homeostasis was associated with increasing age, adiposity, SBP, proportion of antihypertensive and lipid-lowering agent use and with decreasing HDL-cholesterol. Independent of age, adiposity, smoking, alcohol, physical activity, and lipid and BP lowering drug use, increasing glycemia was associated with decreasing HDL-cholesterol specifically in women with prediabetes (NHES-Thailand, beta-coefficient - 0.07 (95% CI - 0.15, - 0.001) p = 0.04 and HS-England, - 0.03 (- 0.04, - 0.006) p = 0.01). In both populations, among those with prediabetes, increasing glycaemia is associated with an adverse, significant decline in HDL cholesterol, specifically in women. These adverse effects are apparent in widely-differing international populations.
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Affiliation(s)
- Chaiwat Washirasaksiri
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Weerachai Srivanichakorn
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand.
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College, London, SW7 2AZ, UK.
| | - Ian F Godsland
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College, London, SW7 2AZ, UK
| | - Chayanis Kositamongkol
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | | | | | | | | | - Nareemarn Neelapaichit
- Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pochamana Phisalprapa
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Desmond G Johnston
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College, London, SW7 2AZ, UK
| | - Nick S Oliver
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College, London, SW7 2AZ, UK
| | - Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Rd., Ratchathewi, Bangkok, Thailand
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Ranasinghe P, Jayawardena R, Gamage N, Sivanandam N, Misra A. Prevalence and trends of the diabetes epidemic in urban and rural India: A pooled systematic review and meta-analysis of 1.7 million adults. Ann Epidemiol 2021; 58:128-148. [PMID: 33727086 DOI: 10.1016/j.annepidem.2021.02.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE India has experienced a recent sharp increase in diabetes/pre-diabetes. We conducted a systematic-review and meta-analyses to describe the most recent prevalence and trends of pre-diabetes/diabetes in urban and rural India. METHODS MethodsA literature search was conducted in PubMed and Scopus databases for population-based studies describing prevalence of diabetes/pre-diabetes in urban/rural populations. Trends were analysed in rural and urban settings overall, genderwise and statewise. RESULTS The study reports data from 1,778,706 adults in India (69-studies), from surveys conducted from 1972-2017. Prevalence of diabetes increased in both rural and urban India from 2.4% and 3.3% in 1972 to 15.0% and 19.0% respectively in year 2015-2019. This was independently observed in both genders. Similar increasing prevalence was observed for pre-diabetes, overall and in both genders. In the latest decade (2010-2019) rural and urban prevalence was highest in states of Goa (17.4%) and Tamil Nadu (24.0%) respectively. Statewise analysis observed a wide disparity in prevalence between the North and the South of India. CONCLUSION Pooled estimates show a relatively high burden of diabetes and pre-diabetes in rural and urban India, with narrowed urban-rural gap. Hence, it is important to plan urgent primary and secondary prevention strategies to minimize further increase in areas with high prevalence.
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Affiliation(s)
- Priyanga Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colmbo, Sri Lanka; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Nishadi Gamage
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Nilani Sivanandam
- Department of Physiology, Faculty of Medicine, University of Colombo, Colmbo, Sri Lanka
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, New Delhi, India
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Khoo CM, Deerochanawong C, Chan SP, Matawaran B, Sheu WH, Chan J, Mithal A, Luk A, Suastika K, Yoon K, Ji L, Man NH, Pollock C. Use of sodium-glucose co-transporter-2 inhibitors in Asian patients with type 2 diabetes and kidney disease: An Asian perspective and expert recommendations. Diabetes Obes Metab 2021; 23:299-317. [PMID: 33155749 PMCID: PMC7839543 DOI: 10.1111/dom.14251] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/17/2020] [Accepted: 11/01/2020] [Indexed: 12/14/2022]
Abstract
Early onset of type 2 diabetes and a high prevalence of co-morbidities predispose the Asian population to a high risk for, and rapid progression of, diabetic kidney disease (DKD). Apart from renin-angiotensin system inhibitors, sodium-glucose co-transporter-2 (SGLT-2) inhibitors have been shown to delay renal disease progression in patients with DKD. In this review article, we consolidate the existing literature on SGLT-2 inhibitor use in Asian patients with DKD to establish contemporary guidance for clinicians. We extensively reviewed recommendations from international and regional guidelines, data from studies on Asian patients with DKD, global trials (DAPA-CKD, CREDENCE and DELIGHT) and cardiovascular outcomes trials. In patients with DKD, SGLT-2 inhibitor therapy significantly reduced albuminuria and the risk of hard renal outcomes (defined as the onset of end-stage kidney disease, substantial decline in renal function from baseline and renal death), cardiovascular outcomes and hospitalization for heart failure. In all the cardiovascular and renal outcomes trials, there was an initial decline in the estimated glomerular filtration rate (eGFR), which was followed by a slowing in the decline of renal function compared with that seen with placebo. Despite an attenuation in glucose-lowering efficacy in patients with low eGFR, there were sustained reductions in body weight and blood pressure, and an increase in haematocrit. Based on the available evidence, we conclude that SGLT-2 inhibitors represent an evidence-based therapeutic option for delaying the progression of renal disease in Asian patients with DKD and preserving renal function in patients at high risk of kidney disease.
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Affiliation(s)
| | | | - Siew Pheng Chan
- Department of MedicineUniversity of Malaya Medical CenterKuala LumpurMalaysia
| | - Bien Matawaran
- Department of Medicine, Section of Endocrinology, Diabetes and MetabolismUniversity of Santo Tomas HospitalManilaPhilippines
| | - Wayne Huey‐Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
| | - Juliana Chan
- Department of Medicine and TherapeuticsHong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong
| | | | - Andrea Luk
- Department of Medicine and TherapeuticsHong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong
| | - Ketut Suastika
- Faculty of MedicineUdayana University, Sanglah General HospitalBaliIndonesia
| | - Kun‐Ho Yoon
- Department of Endocrinology & Metabolism, Seoul St Maryʼs HospitalThe Catholic University of KoreaSeoulSouth Korea
| | - Linong Ji
- Peking University Peopleʼs HospitalPekingChina
| | | | - Carol Pollock
- The University of Sydney School of MedicineSydneyNew South WalesAustralia
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The EZ, Ng MY, Ng GJL, Er BGC, Quek AML, Paliwal P, Yeo LL, Chan BPL, Sharma VK, Teoh HL, Khoo EYH, Seet RCS. Long-term outcomes of ischaemic stroke patients with diabetes in a
multi-ethnic cohort in Singapore. ANNALS ACADEMY OF MEDICINE SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2020105] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
ABSTRACT
Introduction: Diabetes increases the risk of ischaemic stroke especially among Asians. This study aims
to investigate contemporaneous long-term cardiovascular outcomes of ischaemic stroke patients with
diabetes in a multi-ethnic Asian cohort.
Methods: Consecutive patients with ischaemic stroke were recruited from the National University
Hospital, Singapore. Data on age, gender, ethnicity, risk factors (including diabetes status and body mass
index [BMI]), stroke severity and mechanisms were collected. These patients were followed up until the
day of the first cardiovascular event or July 2016, whichever was earlier. The primary endpoint was the time
from enrolment to the first occurrence of a composite of cerebrovascular and coronary artery events.
Results: Between July 2011 and December 2013, 720 patients (mean age 60.6 years, 71% men, 43%
with diabetes, median National Institute Health Stroke Severity scale 2) were enrolled and followed up.
A total of 175 cardiovascular events occurred during a median follow-up of 3.25 years (6.90 events per
1,000 person-month), comprising 163 cerebrovascular and 42 coronary artery events. The adjusted
hazard ratio of diabetes was 1.50 (95% CI 1.08–2.10). In a multivariable Cox proportional hazards
model, Malay and Indian ethnicities, BMI <23kg/m2 and a prior diagnosis of diabetes were identified
as independent predictors of recurrent cardiovascular events.
Conclusion: Our study provides quantitative data on the event rates of ischaemic stroke patients with
diabetes. These findings provide insights on stroke predictors in a multi-ethnic Asian population, which
may have implications in the design of future interventional studies.
Keywords: Asian, body mass index, cardiovascular, stroke phenotype
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Affiliation(s)
| | - Mei Yen Ng
- National University of Singapore, Singapore
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Selim S, Nabi MU, Saifuddin M, Hannan MA, Bakar MA, Talukder SK, Hasan ABMK, Amin MN, Hoque MA, Rahman MS, Mir AS, Afsana F. Demographic, Clinical and Biochemical Characteristics of Drug Naive Type 2 Diabetes Patients of Bangladesh. OPEN JOURNAL OF ENDOCRINE AND METABOLIC DISEASES 2021. [DOI: 10.4236/ojemd.2021.118012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sorensen TB, Wilson R, Gregson J, Shankar B, Dangour AD, Kinra S. Is night-time light intensity associated with cardiovascular disease risk factors among adults in early-stage urbanisation in South India? A cross-sectional study of the Andhra Pradesh Children and Parents Study. BMJ Open 2020; 10:e036213. [PMID: 33444171 PMCID: PMC7678398 DOI: 10.1136/bmjopen-2019-036213] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 07/16/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To explore associations of night-time light intensity (NTLI), a novel proxy for continuous urbanisation levels, with mean systolic blood pressure (SBP), body mass index (BMI), fasting serum low-density lipoprotein (LDL) and fasting plasma glucose (FPG), among adults in early-stage urbanisation in Telangana, South India. DESIGN Cross-sectional analysis of the third wave of the Andhra Pradesh Children and Parents Study cohort. SETTING 28 villages representing a continuum of urbanisation levels, ranging from rural settlement to medium-sized town in Telangana, South India. PARTICIPANTS Data were available from 6944 participants, 6236 of whom were eligible after excluding pregnant women, participants younger than 18 years of age and participants missing data for age. Participants were excluded if they did not provide fasting blood samples, had implausible or missing outcome values, were medicated for hypertension or diabetes or had triglyceride levels invalidating derived LDL. The analysis included 5924 participants for BMI, 5752 participants for SBP, 5287 participants for LDL and 5328 participants for FPG. RESULTS Increasing NTLI was positively associated with mean BMI, SBP and LDL but not FPG. Adjusted mean differences across the range of village-level NTLI were 1.0 kg/m2 (95% CI 0.01 to 1.9) for BMI; 4.2 mm Hg (95% CI 1.0 to 7.4) for SBP; 0.3 mmol/L (95% CI -0.01 to 0.7) for LDL; and -0.01 mmol/L (95% CI -0.4 to 0.4) for FPG. Associations of NTLI with BMI and SBP were stronger in older age groups. CONCLUSION The association of NTLI with cardiovascular disease (CVD) risk factors identify NTLI as a potentially important tool for exploring urbanisation-related health. Consistent associations of moderate increases in urbanisation levels with important CVD risk factors warrant prevention strategies to curb expected large public health impacts from continued and rapid urbanisation in India.
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Affiliation(s)
- Tina Bonde Sorensen
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Robin Wilson
- Department of Geography & Environment, University of Southampton, Southampton, UK
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Bhavani Shankar
- Department of Geography, The University of Sheffield, Sheffield, UK
| | - Alan D Dangour
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Nair DR, Satheesh K, Raghavan A, Nanditha A, Vinitha R, Susairaj P, Snehalatha C, Ramachandran A. Trend in the clinical profile of type 2 diabetes in India - Study from a diabetes care centre in South India. Diabetes Metab Syndr 2020; 14:1851-1857. [PMID: 32977086 DOI: 10.1016/j.dsx.2020.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM Study the changing clinical and therapeutic profiles of type 2 diabetes (T2D) patients during a 10-year period in a diabetes care centre in Southern India. METHODS Retrospective, cross-sectional data of newly registered and review patients at four periods between 2009 and 2018 were analysed (n = 50,322). Clinical findings, anthropometry, blood pressure (BP), glycaemia, lipids, treatment, and co-morbid conditions were analysed. We studied the trends in age and gender distributions, body mass index (BMI), glycaemia, (Glycosylated haemoglobin A1c (HbA1c) levels), BP, cholesterol, triglycerides and therapeutic regimen during this period. Trend analyses were done. RESULTS Approximately 60% of patients were men. Percentages in 30-40 years increased, ∼60% were aged 50-69 years and proportion of older patients decreased (p < 0.0001). In 10 years, 85.9% was overweight, obesity increased from 22.1% to 25.0% (p < 0.0001) and <13% maintained normal BMI. HbA1c <7.0% remained approximately at 22%, percentage with moderate glycaemic control (HbA1c 7.0-7.9%) increased significantly, HbA1c of ≥9.0% decreased from 35.1% to 29.1% (p < 0.0001). Use of monotherapy decreased. Prevalence of hypertension increased from 16.2% to 21.6% (p < 0.0001); use of Angiotensin Receptor Blockers (ARB) and calcium channel blockers increased, Angiotensin Converting Enzyme Inhibitors and thiazides decreased (p < 0.0001). Increased use of statins paralleled with reduction in total cholesterol and LDLc. CONCLUSION Increasing percentages of younger patients and obesity, use of multiple drugs and reduction in HbA1c were the important observations. Rising prevalence of hypertension, increased use of ARB and statins with better control of dyslipidaemia was observed. Achievement of ideal HbA1c and BP were suboptimal.
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Affiliation(s)
- Dhruv Rajesh Nair
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Krishnamoorthy Satheesh
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Arun Raghavan
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Arun Nanditha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ramachandran Vinitha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Priscilla Susairaj
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Chamukuttan Snehalatha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
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Sajid MR, Muhammad N, Zakaria R, Bukhari SAC. Modifiable risk factors and overall cardiovascular mortality: Moderation of urbanization. J Public Health Res 2020; 9:1893. [PMID: 33244464 PMCID: PMC7686791 DOI: 10.4081/jphr.2020.1893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/16/2020] [Indexed: 01/14/2023] Open
Abstract
Background: Modifiable risk factors are associated with cardiovascular mortality (CVM) which is a leading form of global mortality. However, diverse nature of urbanization and its objective measurement can modify their relationship. This study aims to investigate the moderating role of urbanization in the relationship of combined exposure (CE) of modifiable risk factors and CVM. Design and Methods: This is the first comprehensive study which considers different forms of urbanization to gauge its manifold impact. Therefore, in addition to existing original quantitative form and traditional two categories of urbanization, a new form consisted of four levels of urbanization was duly introduced. This study used data of 129 countries mainly retrieved from a WHO report, Non-Communicable Diseases Country Profile 2014. Factor scores obtained through confirmatory factor analysis were used to compute the CE. Age-income adjusted regression model for CVM was tested as a baseline with three bootstrap regression models developed for the three forms of urbanization. Results: Results revealed that the CE and CVM baseline relationship was significantly moderated through the original quantitative form of urbanization. Contrarily, the two traditional categories of urbanization could not capture the moderating impact. However, the four levels of urbanization were objectively estimated the urbanization impact and subsequently indicated that the CE was more alarming in causing the CVM in levels 2 and 3 urbanized countries, mainly from low-middle-income countries. Conclusion: This study concluded that the urbanization is a strong moderator and it could be gauged effectively through four levels whereas sufficiency of two traditional categories of urbanization is questionable.
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Affiliation(s)
- Mirza Rizwan Sajid
- Centre for Mathematical Sciences, College of Computing and Applied Sciences, Universiti Malaysia Pahang, Gambang, Malaysia
| | - Noryanti Muhammad
- Centre for Mathematical Sciences, College of Computing and Applied Sciences, Universiti Malaysia Pahang, Gambang, Malaysia
| | - Roslinazairimah Zakaria
- Centre for Mathematical Sciences, College of Computing and Applied Sciences, Universiti Malaysia Pahang, Gambang, Malaysia
| | - Syed Ahmad Chan Bukhari
- Division of Computer Science, Mathematics and Science, Collins College of Professional Studies, St. Johns University, New York, NY, USA
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Chandrupatla SG, Khalid I, Muthuluri T, Dantala S, Tavares M. Diabetes and prediabetes prevalence among young and middle-aged adults in India, with an analysis of geographic differences: findings from the National Family Health Survey. Epidemiol Health 2020; 42:e2020065. [PMID: 32972049 PMCID: PMC7871157 DOI: 10.4178/epih.e2020065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/13/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study aimed to approximate the prevalence of hyperglycemia in India. METHODS The study was conducted using the Demographic and Health Survey 2015-16 (also known as the National Family Health Survey-4), which surveyed 811,808 individuals using a stratified, multistage, cluster sampling design. This cross-sectional survey recorded socio-demographic and anthropometric data, including blood glucose levels, of adults aged 18 years to 54 years. RESULTS The final analysis included 718,597 individuals, of whom 49.90% (weighted) were males. The overall prevalence of diabetes was 6.65% and that of prediabetes was 5.57%. A positive association was seen with urban residence, geographic region, sex, age, body mass index, socioeconomic status, and hypertension. Approximately two-thirds of individuals with diabetes lived in urban areas, and about half of the urban population was considered overweight/obese. South India showed a higher prevalence of diabetes (prevalence ratio, 2.01; p<0.001) than northern India. CONCLUSIONS Hyperglycemia (diabetes and prediabetes) has a high prevalence in India and is a major public health issue. Diabetes is unevenly distributed based on geographic location and urbanization. Prevention, early detection, and treatment strategies should consider this uneven distribution of diabetes.
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Affiliation(s)
- Siddardha G. Chandrupatla
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Isma Khalid
- Department of Pediatric Dentistry, Boston University, Boston, MA, USA
| | - Tejdeep Muthuluri
- Deptartment of Oral Surgery, SVS Dental College, Mehboobnagar, India
| | | | - Mary Tavares
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
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Atre S, Deshmukh S, Kulkarni M. Prevalence of type 2 diabetes mellitus (T2DM) in India: A systematic review (1994-2018). Diabetes Metab Syndr 2020; 14:897-906. [PMID: 32570014 DOI: 10.1016/j.dsx.2020.05.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 02/01/2023]
Abstract
AIM To conduct a systematic and critical review of published studies on prevalence of Type 2 diabetes mellitus (T2DM) in urban and rural areas of India. METHODS We conducted a literature search in PubMed, EMBASE and Web of Science using the terms 'prevalence', 'Type 2 diabetes, 'India', 'urban' and 'rural' for English language articles published during January 1994-December 2018. We selected articles that reported the results of original studies that randomly sampled adults aged 15-80 years, and which reported T2DM prevalence based on the actual examination of blood samples. RESULTS Of 1751 articles screened by titles and abstracts, 37 fulfilled our inclusion criteria. Majority (28 of 37; 76%) of studies were from South India, especially from the states of Tamil Nadu, Andhra Pradesh, Kerala and Karnataka. The prevalence of T2DM showed a wide range from 1.9% to 25.2%. Only 11 studies covering 24 regions separately reported the data by urban or rural location. Albeit inconsistent, 17 studies reported prevalence of T2DM by age group. CONCLUSION In this systematic review, we show that there remains an ambiguity about the actual prevalence of T2DM from India due to several factors. The findings underscore a strong need for having periodic regional surveillance involving appropriate epidemiological methods.
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Affiliation(s)
- Sachin Atre
- Dr. D.Y. Patil Medical College Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth Pimpri, Pune 411018, India.
| | - Sona Deshmukh
- Byramjee-Jeejeebhoy Medical College, Clinical Research Site, Pune 411001, India
| | - Manjusha Kulkarni
- Environmental Health and Safety, Kent State University, Kent, OH, 44242, USA
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Opare-Addo MNA, Osei FA, Buabeng KO, Marfo AF, Nyanor I, Amuzu EX, Ansong D, Owusu-Dabo E. Healthcare services utilisation among patients with hypertension and diabetes in rural Ghana. Afr J Prim Health Care Fam Med 2020; 12:e1-e8. [PMID: 32787405 PMCID: PMC7433304 DOI: 10.4102/phcfm.v12i1.2114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 02/04/2020] [Accepted: 02/08/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) remain a global burden and is projected to increase due to aging, rapid urbanization and unhealthy lifestyles. The study was conducted to determine the prevalence of hypertension and diabetes in rural districts in the Ashanti region of Ghana and to determine factors that influence utilization of health care services. SETTING Offinso North, Amansie West, Ahafo Ano South, and Asante Akim South. METHODS A population based prospective cross-sectional study comprising of adults aged 18 years and above was carried out from January 2016 to March 2016. A multistage sampling method was employed to select four rural districts in the Ashanti region of Ghana. A structured questionnaire was used to collect primary data from respondents. RESULTS A total of 684 participants were recruited in the study. The prevalence of hypertension and diabetes was found to be 16.23% and 5.41% respectively. The prevalence of diabetes and hypertension comorbidity was 1.61%. The public hospital was the most preferred choice of facility (52.56%) for patients with NCDs.Educational level significantly decreased the likelihood of seeking healthcare in OTCMS and Health Centre to Hospitals (RRR = 0.1, 95% CI = 0.011-0.917, p = 0.042) and (RRR = 0.4, 95% CI = 0.198-0.679, p = 0.001) respectively. CONCLUSION The prevalence of self -reported hypertension and diabetes observed in this study was relatively lower for hypertension and higher for diabetes as compared to other studies in Ghana. The public hospital is the most preferred choice of health facilities for patients with hypertension and diabetes in the rural districts.
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Affiliation(s)
- Mercy N A Opare-Addo
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi.
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Aguayo GA, Schritz A, Ruiz-Castell M, Villarroel L, Valdivia G, Fagherazzi G, Witte DR, Lawson A. Identifying hotspots of cardiometabolic outcomes based on a Bayesian approach: The example of Chile. PLoS One 2020; 15:e0235009. [PMID: 32569307 PMCID: PMC7307745 DOI: 10.1371/journal.pone.0235009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is a need to identify priority zones for cardiometabolic prevention. Disease mapping in countries with high heterogeneity in the geographic distribution of the population is challenging. Our goal was to map the cardiometabolic health and identify hotspots of disease using data from a national health survey. METHODS Using Chile as a case study, we applied a Bayesian hierarchical modelling. We performed a cross-sectional analysis of the 2009-2010 Chilean Health Survey. Outcomes were diabetes (all types), obesity, hypertension, and high LDL cholesterol. To estimate prevalence, we used individual and aggregated data by province. We identified hotspots defined as prevalence in provinces significantly greater than the national prevalence. Models were adjusted for age, sex, their interaction, and sampling weight. We imputed missing data. We applied a joint outcome modelling approach to capture the association between the four outcomes. RESULTS We analysed data from 4,780 participants (mean age (SD) 46 (19) years; 60% women). The national prevalence (percentage (95% credible intervals) for diabetes, obesity, hypertension and high LDL cholesterol were 10.9 (4.5, 19.2), 30.0 (17.7, 45.3), 36.4 (16.4, 57.6), and 13.7 (3.4, 32.2) respectively. Prevalence of diabetes was lower in the far south. Prevalence of obesity and hypertension increased from north to far south. Prevalence of high LDL cholesterol was higher in the north and south. A hotspot for diabetes was located in the centre. Hotspots for obesity were mainly situated in the south and far south, for hypertension in the centre, south and far south and for high LDL cholesterol in the far south. CONCLUSIONS The distribution of cardiometabolic risk factors in Chile has a characteristic pattern with a general trend to a north-south gradient. Our approach is reproducible and demonstrates that the Bayesian approach enables the accurate identification of hotspots and mapping of disease, allowing the identification of areas for cardiometabolic prevention.
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Affiliation(s)
- Gloria A. Aguayo
- Population Health Department, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Anna Schritz
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Maria Ruiz-Castell
- Population Health Department, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Luis Villarroel
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gonzalo Valdivia
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Guy Fagherazzi
- Population Health Department, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Daniel R. Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - Andrew Lawson
- Department of Public Health Sciences, Medical University of South Carolina, South Carolina, Charleston, United States of America
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Das AK, Mithal A, Kumar KMP, Unnikrishnan AG, Kalra S, Thacker H, Sethi B, Ghosh R, Mathew A, Chodankar D, Mohanasundaram S, Menon SK, Trivedi C, Naqvi M, Kanade V, Salvi V, Chatterjee G, Rais N, Wangnoo SK, Chowdhury S, Zargar AH, Joshi S. Rationale, study design and methodology of the LANDMARC trial: a 3-year, pan-India, prospective, longitudinal study to assess management and real-world outcomes of diabetes mellitus. Diabet Med 2020; 37:885-892. [PMID: 31691356 PMCID: PMC7216981 DOI: 10.1111/dme.14171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 11/30/2022]
Abstract
AIM India contributes towards a large part of the worldwide epidemic of diabetes and its associated complications. However, there are limited longitudinal studies available in India to understand the occurrence of diabetes complications over time. This pan-India longitudinal study was initiated to assess the real-world outcomes of diabetes across the country. METHODS The LANDMARC study is the first prospective, multicentre, longitudinal, observational study investigating a large cohort of people with type 2 diabetes mellitus across India over a period of 3 years. The primary objective of this ongoing study is to determine the proportion of people developing macrovascular diabetes complications over the duration of the study (36 months ± 45 days) distributed over seven visits; the secondary objective is to evaluate microvascular diabetes complications, glycaemic control and time-to-treatment adaptation or intensification. Overall, 6300 participants (aged 25-60 years) diagnosed with type 2 diabetes for at least 2 years will be included from 450 centres across India. Data will be recorded for baseline demographics, comorbidities, glycaemic measurements, use of anti-hyperglycaemic medications and any cardiovascular or other diabetes-related events occurring during the observational study period. CONCLUSIONS The LANDMARC study is expected to reveal the trends in complications associated with diabetes, treatment strategies used by physicians, and correlation among treatment, control and complications of diabetes within the Indian context. The findings of this study will help to identify the disease burden, emergence of early-onset complications and dose titration patterns, and eventually develop person-centred care and facilitate public health agencies to invest appropriate resources in the management of diabetes. (Trial Registration No: CTRI/2017/05/008452).
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Affiliation(s)
- A. K. Das
- Pondicherry Institute of Medical Sciences (PIMS)PuducherryIndia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - N. Rais
- Chowpatti Medical CentreMumbaiIndia
| | - S. K. Wangnoo
- Apollo Hospital Education and Research FoundationNew DelhiIndia
| | | | - A. H. Zargar
- Center for Diabetes & Endocrine CareSrinagarIndia
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Sathiakumar N, Mishra S, McClure L, Golla V, Guddattu V, Lungu C. Relationship between diabetes mellitus and indoor air pollution: An exploratory analysis. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2020. [DOI: 10.4103/jncd.jncd_38_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dietary habits contribute to define the risk of type 2 diabetes in humans. Clin Nutr ESPEN 2019; 34:8-17. [DOI: 10.1016/j.clnesp.2019.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 12/25/2022]
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Deerochanawong C, Chan SP, Matawaran BJ, Sheu WH, Chan J, Man NH, Suastika K, Khoo CM, Yoon K, Luk A, Mithal A, Linong J. Use of sodium-glucose co-transporter-2 inhibitors in patients with type 2 diabetes mellitus and multiple cardiovascular risk factors: An Asian perspective and expert recommendations. Diabetes Obes Metab 2019; 21:2354-2367. [PMID: 31264765 PMCID: PMC6852284 DOI: 10.1111/dom.13819] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/16/2019] [Accepted: 06/26/2019] [Indexed: 12/21/2022]
Abstract
Diabetes mellitus in Asia accounts for more than half of the global prevalence. There is a high prevalence of cardiovascular disease (CVD) in the region among people with type 2 diabetes mellitus (T2DM) and it is often associated with multiple risk factors including hypertension, renal disease and obesity. The early onset of T2DM and the eventual long disease duration portends an increasing proportion of the population to premature CVD. In addition to lowering blood glucose, sodium-glucose co-transporter-2 (SGLT-2) inhibitors exert favourable effects on multiple risk factors (including blood pressure, body weight and renal function) and provide an opportunity to reduce the risk of CVD in patients with T2DM. In this article, we consolidated the existing literature on SGLT-2 inhibitor use in Asian patients with T2DM and established contemporary guidance for clinicians. We extensively reviewed recommendations from international and regional guidelines, published data from clinical trials in the Asian population (dapagliflozin, canagliflozin, empagliflozin, ipragliflozin, luseogliflozin and tofogliflozin), CVD outcomes trials (EMPAREG-OUTCOME, CANVAS and DECLARE-TIMI 58) and real-world evidence studies (CVD-REAL, EASEL, CVD-REAL 2 and OBSERVE-4D). A series of clinical recommendations on the use of SGLT-2 inhibitors in Asian patients with T2DM was deliberated among experts with multiple rounds of review and voting. Based on the available evidence, we conclude that SGLT-2 inhibitors represent an evidence-based therapeutic option for the primary prevention of heart failure hospitalization and secondary prevention of CVD in patients with T2DM, and should be considered early on in the treatment algorithm for patients with multiple risk factors, or those with established CVD.
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Affiliation(s)
- Chaicharn Deerochanawong
- Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit UniversityBangkokThailand
| | - Siew P. Chan
- Department of Medicine, University of Malaya Medical CenterKuala LumperMalaysia
| | - Bien J. Matawaran
- Department of Medicine, Section of Endocrinology, Diabetes and MetabolismUniversity of Santo Tomas HospitalManilaPhilippines
| | - Wayne H.‐H. Sheu
- Division of Endocrinology and Metabolism, Department of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
| | - Juliana Chan
- Faculty of Medicine, The Chinese University of Hong KongHong Kong
| | - Nguyen H. Man
- Faculty of Medicine, FV HospitalHo Chi Minh CityVietnam
| | - Ketut Suastika
- Faculty of MedicineUdayana University, Sanglah General HospitalBaliIndonesia
| | - Chin M. Khoo
- Faculty of Medicine, National University of SingaporeSingapore
| | - Kun‐Ho Yoon
- Department of Medicine, Seoul St. Mary's Hospital, The Catholic University of KoreaSeoulSouth Korea
| | - Andrea Luk
- Faculty of Medicine, The Chinese University of Hong KongHong Kong
| | - Ambrish Mithal
- Division of Endocrinology and Diabetes, The MedicityGurgaonIndia
| | - Ji Linong
- Department of Endocrinology and Metabolism, Peking University People's HospitalPekingChina
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Ramachandran A, Snehalatha C, Shaw JE, Susairaj P, Simon M, Vijaya L, Satheesh K, Vinitha R, Raghavan A, Nanditha A. Response to Comment on Nanditha et al. Secular TRends in DiabEtes in India (STRiDE-I): Change in Prevalence in 10 Years Among Urban and Rural Populations in Tamil Nadu. Diabetes Care 2019;42:476-485. Diabetes Care 2019; 42:e139-e140. [PMID: 31332034 DOI: 10.2337/dci19-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Ambady Ramachandran
- India Diabetes Research Foundation, Chennai, India .,Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Chamukuttan Snehalatha
- India Diabetes Research Foundation, Chennai, India.,Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | | | - Priscilla Susairaj
- India Diabetes Research Foundation, Chennai, India.,Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Mary Simon
- India Diabetes Research Foundation, Chennai, India.,Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Lakshminarayanan Vijaya
- India Diabetes Research Foundation, Chennai, India.,Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Krishnamoorthy Satheesh
- India Diabetes Research Foundation, Chennai, India.,Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ramachandran Vinitha
- India Diabetes Research Foundation, Chennai, India.,Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Arun Raghavan
- India Diabetes Research Foundation, Chennai, India.,Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Arun Nanditha
- India Diabetes Research Foundation, Chennai, India.,Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
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Mohan V, Unnikrishnan R, Shobana S, Malavika M, Anjana RM, Sudha V. Are excess carbohydrates the main link to diabetes & its complications in Asians? Indian J Med Res 2019; 148:531-538. [PMID: 30666980 PMCID: PMC6366262 DOI: 10.4103/ijmr.ijmr_1698_18] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Dietary carbohydrates form the major source of energy in Asian diets. The carbohydrate quantity and quality play a vital function in the prevention and management of diabetes. High glycaemic index foods elicit higher glycaemic and insulinaemic responses and promote insulin resistance and type 2 diabetes (T2D) through beta-cell exhaustion. This article reviews the evidence associating dietary carbohydrates to the prevalence and incidence of T2D and metabolic syndrome (MS) in control of diabetes and their role in the complications of diabetes. Cross-sectional and longitudinal studies show that higher carbohydrate diets are linked to higher prevalence and incidence of T2D. However, the association seems to be stronger in Asian-Indians consuming diets high in carbohydrates and more marked on a background of obesity. There is also evidence for high carbohydrate diets and risk for MS and cardiovascular disease (CVD). However, the quality of carbohydrates is also equally important. Complex carbohydrates such as brown rice, whole wheat bread, legumes, pulses and green leafy vegetables are good carbs. Conversely, highly polished rice or refined wheat, sugar, glucose, highly processed foods such as cookies and pastries, fruit juice and sweetened beverages and fried potatoes or French fries are obviously ‘bad’ carbs. Ultimately, it is all a matter of balance and moderation in diet. For Indians who currently consume about 65-75 per cent of calories from carbohydrates, reducing this to 50-55 per cent and adding enough protein (20-25%) especially from vegetable sources and the rest from fat (20-30%) by including monounsaturated fats (e.g. groundnut or mustard oil, nuts and seeds) along with a plenty of green leafy vegetables, would be the best diet prescription for the prevention and management of non-communicable diseases such as T2D and CVD.
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Affiliation(s)
- Viswanathan Mohan
- Department of Diabetology, Dr Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Ranjit Unnikrishnan
- Department of Diabetology, Dr Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - S Shobana
- Department of Foods Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, India
| | - M Malavika
- Department of Foods Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, India
| | - R M Anjana
- Department of Diabetology, Dr Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - V Sudha
- Department of Foods Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, India
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Effect of diet composition on insulin sensitivity in humans. Clin Nutr ESPEN 2019; 33:29-38. [PMID: 31451269 DOI: 10.1016/j.clnesp.2019.05.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/21/2019] [Indexed: 12/27/2022]
Abstract
Diet composition has a marked impact on the risk of developing type 2 diabetes and cardiovascular disease. Prospective studies show that dietary patterns with elevated amount of animal products and low quantity of vegetable food items raise the risk of these diseases. In healthy subjects, animal protein intake intensifies insulin resistance whereas plant-based foods enhance insulin sensitivity. Similar effects have been documented in patients with diabetes. Accordingly, pre-pregnancy intake of meat (processed and unprocessed) has been strongly associated with a higher risk of gestational diabetes whereas greater pre-pregnancy vegetable protein consumption is associated with a lower risk of gestational diabetes. Population groups that modify their traditional dietary habit increasing the amount of animal products while reducing plant-based foods experience a remarkable rise in the frequency of type 2 diabetes. The association of animal protein intake with insulin resistance is independent of body mass index. In obese individuals that consume high animal protein diets, insulin sensitivity does not improve following weight loss. Diets aimed to lose weight that encourage restriction of carbohydrates and elevated consumption of animal protein intensify insulin resistance increasing the risk of developing type 2 diabetes and cardiovascular disease. The effect of dietary components on insulin sensitivity may contribute to explain the striking impact of eating habits on the risk of type 2 diabetes and cardiovascular disease. Insulin resistance predisposes to type 2 diabetes in healthy subjects and deteriorates metabolic control in patients with diabetes. In nondiabetic and diabetic individuals, insulin resistance is a major cardiovascular risk factor.
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Exploring Differences in the Rate of Type 2 Diabetes Among American Cities: How Urbanization Continues to Challenge the Traditional Epidemiological View. URBAN SCIENCE 2019. [DOI: 10.3390/urbansci3020053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
As the world’s largest urban regions continue to expand, a concomitant rise in non-communicable diseases, particularly type 2 diabetes, poses an increasingly ominous challenge to experts in the field of public health. Given that the majority of the world’s population (54%) resides in urban areas, a figure likely to reach two-thirds by 2050, this issue presents serious implications for medical practitioners as well as policymakers seeking to manage long-term healthcare costs while sustaining historic increases in life expectancy. To explore how these trends are continuing to affect the United States, a multiple regression analysis was conducted using data provided by the Centers for Disease Control and Prevention (CDC) through their initiative, 500 Cities: Local Data for Better Health. The regression models revealed that larger cities reported significantly higher rates of type 2 diabetes even after controlling for variables that have been perennially linked to disease onset (e.g., levels of obesity, sedentary behavior). Implications are discussed, most notably the argument for moving beyond the ‘food desert’ paradigm when identifying and explaining which characteristics of larger cities place their residents at increased risk. This approach could help reveal opportunities for intervention that may not have garnered sufficient attention in the extant literature.
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Maharani A, Sujarwoto, Praveen D, Oceandy D, Tampubolon G, Patel A. Cardiovascular disease risk factor prevalence and estimated 10-year cardiovascular risk scores in Indonesia: The SMARThealth Extend study. PLoS One 2019; 14:e0215219. [PMID: 31039155 PMCID: PMC6490907 DOI: 10.1371/journal.pone.0215219] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/28/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The brunt of cardiovascular disease (CVD) burden globally now resides within low- and middle-income countries, including Indonesia. However, little is known regarding cardiovascular health in Indonesia. This study aimed to estimate the prevalence of elevated CVD risk in a specific region of Indonesia. METHODS We conducted full household screening for cardiovascular risk factors among adults aged 40 years and older in 8 villages in Malang District, East Java Province, Indonesia, in 2016-2017. 10-year cardiovascular risk scores were calculated based on the World Health Organization/International Society of Hypertension's region-specific charts that use age, sex, blood pressure, diabetes status and smoking behaviour. RESULTS Among 22,093 participants, 6,455 (29.2%) had high cardiovascular risk, defined as the presence of coronary heart disease, stroke or other atherosclerotic disease; estimated 10-year CVD risk of ≥ 30%; or estimated 10-year CVD risk between 10% to 29% combined with a systolic blood pressure of > 140 mmHg. The prevalence of high CVD risk was greater in urban (31.6%, CI 30.7-32.5%) than in semi-urban (28.7%, CI 27.3-30.1%) and rural areas (26.2%, CI 25.2-27.2%). Only 11% and 1% of all the respondents with high CVD risk were on blood pressure lowering and statins treatment, respectively. CONCLUSIONS High cardiovascular risk is common among Indonesian adults aged ≥40 years, and rates of preventive treatment are low. Population-based and clinical approaches to preventing CVD should be a priority in both urban and rural areas.
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Affiliation(s)
- Asri Maharani
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Sujarwoto
- University of Brawijaya, Malang, Indonesia
| | - Devarsetty Praveen
- The George Institute for Global Health, University of New South Wales, Hyderabad, India
| | - Delvac Oceandy
- Division of Cardiovascular Science, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Department of Biomedicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Gindo Tampubolon
- Manchester Institute for Collaborative Research on Aging, University of Manchester, Manchester, United Kingdom
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Kurup R, Ansari AA, Singh J. A review on diabetic foot challenges in Guyanese perspective. Diabetes Metab Syndr 2019; 13:905-912. [PMID: 31336544 DOI: 10.1016/j.dsx.2018.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/19/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Diabetes mellitus signifies a major public health threat worldwide. Type 2 diabetes has been reported as the fourth leading cause of death and has affected 15.5% of the adult population in Guyana, South America. Diabetes has also led to major lower extremity amputation at the only referral public hospital in Guyana. Diabetic foot and related complications are known to be multifactorial. CONCLUSION In this review, we highlight the information on the diabetic foot and related complications with an emphasis on Guyanese background.
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Affiliation(s)
- Rajini Kurup
- Faculty of Health Sciences, University of Guyana, Georgetown, South America, Guyana.
| | - Abdullah Adil Ansari
- Faculty of Health Sciences, University of Guyana, Georgetown, South America, Guyana.
| | - Jaipaul Singh
- School of Pharmacy and Forensic and Investigative Sciences, University of South Lancashire, Preston, Lancashire, United Kingdom.
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Chinnici D, Middlehurst A, Tandon N, Arora M, Belton A, Reis Franco D, Margonari Bechara G, Castelo Branco F, Rawal T, Shrivastav R, Sung E, Germe M, Chaney D, Cavan D. Improving the school experience of children with diabetes: Evaluation of the KiDS project. J Clin Transl Endocrinol 2019; 15:70-75. [PMID: 30792956 PMCID: PMC6370558 DOI: 10.1016/j.jcte.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/10/2018] [Accepted: 12/03/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The International Diabetes Federation (IDF) launched the Kids and Diabetes in School (KiDS) project in collaboration with the International Society for Paediatric and Adolescent Diabetes (ISPAD) and Sanofi Diabetes to inform and teach school staff, children and parents on the management of diabetes in school. Brazil and India were chosen as pilot countries. METHODS The evaluation was conducted using a qualitative methodology using semi-structured face to face in-depth interviews. Five out of fifteen schools were selected, where teachers and parents of children with and without diabetes were interviewed. Interviews took place one and three months after the implementation of KiDS. FINDINGS Diabetes knowledge among the school staff and parents of children without diabetes was very limited prior to the KiDS Project in both countries. After introducing the KiDS information pack both groups mentioned increased knowledge on the management of diabetes. This was reflected through healthier food choices at school and the encouragement of physical activities. Increased awareness and understanding in the school staff were observed by parents of children with diabetes. INTERPRETATION The KiDS project received positive feedback on the educational materials. The pack was deemed informative, interesting and engaging, creating increased awareness and understanding among school staff, parents and children. The project has created a demand for diabetes intervention in schools. The pack has been translated into fourteen languages and was downloaded over 17,000 times by November 2018.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tina Rawal
- Public Health Foundation of India, India
| | | | - Els Sung
- International Diabetes Federation, Belgium
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Nanditha A, Snehalatha C, Satheesh K, Susairaj P, Simon M, Vijaya L, Raghavan A, Vinitha R, Ramachandran A. Secular TRends in DiabEtes in India (STRiDE-I): Change in Prevalence in 10 Years Among Urban and Rural Populations in Tamil Nadu. Diabetes Care 2019; 42:476-485. [PMID: 30659076 DOI: 10.2337/dc18-1559] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/19/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of the current study was to assess the secular trends in the prevalence of diabetes, prediabetes, and risk factors from two epidemiological surveys done 10 years apart in three adult populations of different geographic and socioeconomic backgrounds in Tamil Nadu, India. RESEARCH DESIGN AND METHODS This survey was conducted in 2016 using methodology similar to that used in 2006. Persons aged ≥20 years (n = 9,848) were screened for diabetes, prediabetes, and the risk variables. Fasting and 2-h plasma glucose, lipid profile, blood pressure, anthropometry, and socioeconomic and behavioral details were recorded. Comparative analyses of age-standardized prevalence were done. Prevalence ratios (PRs) between 2016 and 2006 of diabetes and also prediabetes were assessed using Poisson regression analyses. RESULTS Prevalence of diabetes increased from 18.6% (95% CI 16.6-20.5) to 21.9 (20.5-23.3) in the city, 16.4 (14.1-18.6) to 20.3 (18.9-21.6) in the town, and 9.2 (8.0-10.5) to 13.4 (11.9-14.8) in the periurban villages (PUVs) (P < 0.0001 in all). The PR showed a nonsignificant 8% rise in diabetes in the city, while significant increases had occurred in the town (39%) and PUVs (34%). Prevalence of prediabetes also increased. Age, family history of diabetes, and waist circumference were common risk determinants among the populations. Though general obesity and abdominal obesity increased, the latter was associated with the increased prevalence. CONCLUSIONS Prevalence of diabetes and prediabetes increased in all locations; the rise was significant only in the town and PUVs. Abdominal obesity is significantly associated with increased trend even among the villagers. Rural populations may be targeted for future public health measures to combat diabetes.
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Affiliation(s)
- Arun Nanditha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Chamukuttan Snehalatha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Krishnamoorthy Satheesh
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Priscilla Susairaj
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Mary Simon
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Lakshminarayanan Vijaya
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Arun Raghavan
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ramachandran Vinitha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
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Thanikachalam M, Fuller CH, Lane KJ, Sunderarajan J, Harivanzan V, Brugge D, Thanikachalam S. Urban environment as an independent predictor of insulin resistance in a South Asian population. Int J Health Geogr 2019; 18:5. [PMID: 30755210 PMCID: PMC6373002 DOI: 10.1186/s12942-019-0169-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/01/2019] [Indexed: 11/17/2022] Open
Abstract
Background Developing countries, such as India, are experiencing rapid urbanization, which may have a major impact on the environment: including worsening air and water quality, noise and the problems of waste disposal. We used health data from an ongoing cohort study based in southern India to examine the relationship between the urban environment and homeostasis model assessment of insulin resistance (HOMA-IR). Methods We utilized three metrics of urbanization: distance from urban center; population density in the India Census; and satellite-based land cover. Restricted to participants without diabetes (N = 6350); we built logistic regression models adjusted for traditional risk factors to test the association between urban environment and HOMA-IR. Results In adjusted models, residing within 0–20 km of the urban center was associated with an odds ratio for HOMA-IR of 1.79 (95% CI 1.39, 2.29) for females and 2.30 (95% CI 1.64, 3.22) for males compared to residing in the furthest 61–80 km distance group. Similar statistically significant results were identified using the other metrics. Conclusions We identified associations between urban environment and HOMA-IR in a cohort of adults. These associations were robust using various metrics of urbanization and adjustment for individual predictors. Our results are of public health concern due to the global movement of large numbers of people from rural to urban areas and the already large burden of diabetes. Electronic supplementary material The online version of this article (10.1186/s12942-019-0169-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohan Thanikachalam
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
| | - Christina H Fuller
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA
| | - Kevin J Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | | | | | - Doug Brugge
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.,Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, USA.,Jonathan M. Tisch College of Civic Life, Tufts University, Medford, MA, USA
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Selvaraj P, Muthunarayanan L. Prevalence of Metabolic Syndrome and Associated Risk Factors among Men in a Rural Health Centre Area in Tamil Nadu. J Lifestyle Med 2019; 9:44-51. [PMID: 30918833 PMCID: PMC6425909 DOI: 10.15280/jlm.2019.9.1.44] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 12/13/2018] [Indexed: 11/22/2022] Open
Abstract
Background MetS is one of the emerging health problems of the world with prevalence higher among Asians, including Indians, and is rising especially in the rural area. Hence, the objectives were to estimate the prevalence of MetS and its association with life style risk factors among adult men. Methods Cross-Sectional based study conducted in the rural area of Kancheepuram District recruiting 360 participants at the age group of 20–40 years by PPS from 9 villages and from each village participants were selected by simple random sampling. Using modified NCEP-ATP III guidelines, criteria for MetS were defined and the prevalence and its associated lifestyle risk factors were evaluated. Results The prevalence of MetS was found to be 16.7%. Higher prevalence was observed among the older age group 31–40 years with 32.4%. Among the five components of MetS, most observed component was Hypertriglyceridemia followed by high WC, abnormal DBP with 31%, 14% and 7% respectively. In Logistic Regression analysis, variables like Increased age, alcohol intake, high WC, raised TG level, raised FBS level and high average DBP were strongly associated with MetS as it was statistically significant. Conclusion The present study showed a high prevalence of MetS amongst men 31–40 years and strong association between MetS and lifestyle risk factors could be a major health problem in rural area, indicating that it was not necessarily a result of modernization. These findings make it critical to plan further healthcare interventions to prevent the adverse consequences of the disease.
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Affiliation(s)
- Pradeep Selvaraj
- Department of Community Medicine, SRM Medical College Hospital and Research Centre, Kattankulathur, Kanchipuram District, Tamil Nadu, India
| | - Logaraj Muthunarayanan
- Department of Community Medicine, SRM Medical College Hospital and Research Centre, Kattankulathur, Kanchipuram District, Tamil Nadu, India
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Vijayakumar G, Manghat S, Vijayakumar R, Simon L, Scaria LM, Vijayakumar A, Sreehari GK, Kutty VR, Rachana A, Jaleel A. Incidence of type 2 diabetes mellitus and prediabetes in Kerala, India: results from a 10-year prospective cohort. BMC Public Health 2019; 19:140. [PMID: 30704495 PMCID: PMC6357479 DOI: 10.1186/s12889-019-6445-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 01/16/2019] [Indexed: 12/02/2022] Open
Abstract
Background Kerala, the southern state of India, has experienced sudden rise in the prevalence estimates of diabetes. A cohort study on the incidence of type 2 diabetes mellitus (T2DM) in Kerala state thus aptly bridges the lacuna of incidence estimate of T2DM from a population at risk. Methods A 10-year prospective cohort study was carried out in two urban wards of central Kerala. The individuals who participated in the baseline survey in 2007 were again invited for a follow-up study in 2017. The data was analyzed using IBM SPSS Statistics for windows (version 21.0). Logistic regression analysis was used to estimate odds ratios and 95% confidence intervals. Findings are based on the 10-year follow-up data from 869 participants from the cohort. Results The overall follow-up and response rate of the study was 68.9 and 86.9% respectively. During the follow-up period, 190 people (21.9%) developed T2DM. The incidence rate of T2DM and impaired fasting glucose (IFG) were 24.5 per 1000 person years and 45.01 per 1000 person years respectively. Nearly 60% of participants with baseline IFG were converted to T2DM group in the follow-up period. Age > 45 years, family history of T2DM, BMI ≥ 25 kg/m2 and presence of central obesity emerged as important risk factors for incident T2DM. Conclusion High incidence of prediabetes over diabetes observed in this study shows an epidemic trend of T2DM in Kerala, India. It requires an immediate public health action.
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Affiliation(s)
- Gadadharan Vijayakumar
- Medical Trust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta (district), Kerala, 689503, India
| | - Sreeja Manghat
- Medical Trust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta (district), Kerala, 689503, India
| | - Revathi Vijayakumar
- Medical Trust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta (district), Kerala, 689503, India
| | - Leena Simon
- Medical Trust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta (district), Kerala, 689503, India
| | - Liss Maria Scaria
- Medical Trust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta (district), Kerala, 689503, India
| | - Aswathi Vijayakumar
- Medical Trust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta (district), Kerala, 689503, India
| | - Ganapathy K Sreehari
- Medical Trust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta (district), Kerala, 689503, India
| | - V Raman Kutty
- Achutha Menon Centre, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Arun Rachana
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Abdul Jaleel
- Rajiv Gandhi Centre for Biotechnology, Thycaud post, Poojappura, Thiruvananthapuram, Kerala, 695014, India.
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Chandrupatla SG, Ramachandra R, Dantala S, Pushpanjali K, Tavares M. Importance and Potential of Dentists in Identifying Patients at High Risk of Diabetes. Curr Diabetes Rev 2019; 15:67-73. [PMID: 29852874 DOI: 10.2174/1573399814666180531121921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 04/09/2018] [Accepted: 05/25/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The study was conducted to assess the utilization of medical and dental services by dental patients at two dental school hospitals and to approximate the number of patients having no known previous diagnosis of type 2 diabetes but are at high risk of acquiring it. METHODS A cross-sectional study was conducted at two dental school hospitals in India. A 20-item questionnaire was administered as interviews among the dental patients aged 35 to 55 years. Data was collected on past dental and medical visits, medical history, family history relevant to diabetes, cardiovascular health, BMI and waist circumference (measured). RESULTS A total of 413 adult patients (males 61.26%, females 38.74%) participated in the surveys. The mean age was 43.06 years. Results revealed that nearly 50% did not have a medical or a dental visit in the last 1 year, 33% had Cardiovascular Diseases (CVD). Among those who did not have medical visit in last one year 45% had BMI >25 kg, 55% had waist circumference above the normal range and 38% were at high risk of diabetes. CONCLUSION The high number of patients without a medical visit in the past year or more, as well as the high levels of diabetes risk indicators, affirms the need for dentists to perform chair-side screenings for diabetes. These results suggest the need for additional training among dental students to improve early detection and identification of high-risk patients to minimize potential morbidity due to diabetes.
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Affiliation(s)
- Siddardha G Chandrupatla
- Department of Oral Epidemiology and Health Policy, Harvard School of Dental Medicine, Boston, MA, United States
| | - Ranadheer Ramachandra
- Department of Public Health Dentistry, M.S. Ramaiah Dental College and Hospital, Bangalore, India
| | - Satyanarayana Dantala
- Department of Public Health Dentistry, Panineeya Dental College and Hospital, Hyderabad, India
| | - Krishnappa Pushpanjali
- Department of Public Health Dentistry, M.S. Ramaiah Dental College and Hospital, Bangalore, India
| | - Mary Tavares
- Department of Oral Epidemiology and Health Policy, Harvard School of Dental Medicine, Boston, MA, United States
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Banerjee J, Mishra N, Damle G, Dhas Y. Beyond LDL-c: The importance of serum oxidized LDL in predicting risk for type 2 diabetes in the middle-aged Asian Indians. Diabetes Metab Syndr 2019; 13:206-213. [PMID: 30641698 DOI: 10.1016/j.dsx.2018.08.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/31/2018] [Indexed: 11/25/2022]
Abstract
AIMS Oxidized low-density lipoprotein (OxLDL) as the residual lipid plays a crucial role in cardiovascular complications and type 2 diabetes. This study aimed to evaluate the relationship of OxLDL with the conventional risk markers and to find the association of OxLDL with the risk of development of type 2 diabetes in middle-aged (30-50 years) Asian Indians. MATERIALS AND METHODS A total of 78 type 2 diabetes patients and 78 age-matched controls were recruited. The serum OxLDL concentration was assessed by enzyme-linked immunosorbent assay (ELISA). Other anthropometric and biochemical measures were also carried out. Multiple logistic regression was used to determine the association of OxLDL and OxLDL to non-oxidized lipoproteins with the occurrence of type 2 diabetes. RESULTS OxLDL was significantly higher in type 2 diabetes cases than controls (p < 0.001) even though there was no significant difference in LDL cholesterol (LDL-c) between type 2 diabetes patients and controls. OxLDL correlated significantly with fasting plasma glucose (FPG) and insulin resistance (HOMA-IR). OxLDL did not show any significant correlation with LDL-c. Multiple logistic regression showed a significant association of OxLDL, OxLDL/LDL-c and OxLDL/HDL-c with type 2 diabetes (p < 0.001). LDL-c showed no association with type 2 diabetes. ROC-AUC curve analyses showed OxLDL/HDL-c to have highest discriminatory power for type 2 diabetes (AUC: 0.710 with 95% CI: 0.629-0.791, p < 0.001). CONCLUSION Our findings highlight the possibly more attention has to be given to OxLDL for managing lipids and diabetes progression as well as reducing cardiac risk in middle-aged type 2 diabetes patients.
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Affiliation(s)
- Joyita Banerjee
- Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Pune, India
| | - Neetu Mishra
- Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Pune, India.
| | - Gauri Damle
- Madhunayani Diabetes Care & Eye Laser Centre, Pune, India
| | - Yogita Dhas
- Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Pune, India
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Zhao C, Yang C, Wai STC, Zhang Y, P. Portillo M, Paoli P, Wu Y, San Cheang W, Liu B, Carpéné C, Xiao J, Cao H. Regulation of glucose metabolism by bioactive phytochemicals for the management of type 2 diabetes mellitus. Crit Rev Food Sci Nutr 2018; 59:830-847. [PMID: 30501400 DOI: 10.1080/10408398.2018.1501658] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Chao Zhao
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou, China
- Department of Chemistry, University of California, Davis, CA, USA
| | - Chengfeng Yang
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou, China
- Institute of Oceanography, Minjiang University, Fuzhou, China
| | - Sydney Tang Chi Wai
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Yanbo Zhang
- School Chinese Medicine, University of Hong Kong, Hong Kong, China
| | - Maria P. Portillo
- Department of Nutrition and Food Science, Faculty of Pharmacy, University of Basque Country (UPV/EHU) and Lucio Lascaray Research Center, Vitoria, Spain
- CIBEROBN Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), Spain
| | - Paolo Paoli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Yijing Wu
- Institute of Oceanography, Minjiang University, Fuzhou, China
- College of Food Science and Nutritional Engineering, China Agricultural University, China
| | - Wai San Cheang
- Institute of Chinese Medical Sciences, State Key Laboratory of Quality Control in Chinese Medicine, University of Macau, Macau SAR, China
| | - Bin Liu
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Christian Carpéné
- Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Institut National de la Santé et de la Recherche Médicale (INSERM U1048)/Université Paul Sabatier, Bât. L4, CHU Rangueil, Toulouse cedex 4, France
| | - Jianbo Xiao
- Institute of Chinese Medical Sciences, State Key Laboratory of Quality Control in Chinese Medicine, University of Macau, Macau SAR, China
| | - Hui Cao
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou, China
- Institute of Chinese Medical Sciences, State Key Laboratory of Quality Control in Chinese Medicine, University of Macau, Macau SAR, China
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Saif-Ur-Rahman KM, Anwar I, Hasan M, Hossain S, Shafique S, Haseen F, Khalequzzaman M, Rahman A, Islam S. Use of indices to measure socio-economic status (SES) in South-Asian urban health studies: a scoping review. Syst Rev 2018; 7:196. [PMID: 30447696 PMCID: PMC6240202 DOI: 10.1186/s13643-018-0867-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 11/01/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Universal health coverage (UHC) is a key area in post-2015 global agenda which has been incorporated as target for achieving health-related Sustainable Development Goals (SDGs). A global framework has been developed to monitor SDG indicators disaggregated by socioeconomic and demographic markers. This review identifies the indices used to measure socio-economic status (SES) in South Asian urban health studies. METHODS Two reviewers searched six databases including Cochran Library, Medline, LILACS, Web of Science, Science Direct, and Lancet journals independently. All South Asian health studies covering urban population, with any research-designs, written in English language, and published between January 2000 and June 2016 were included. Two reviewers independently screened and assessed for selection of eligible articles for inclusion. Any conflict between the reviewers was resolved by a third reviewer. RESULTS We retrieved 3529 studies through initial search. Through screening and applying inclusion and exclusion criteria, this review finally included 256 articles for full-text review. A total of 25 different SES indices were identified. SES indices were further categorized into 5 major groups, e.g., (1) asset-based wealth index, (2) wealth index combining education, (3) indices based on income and expenditure, (4) indices based on education and occupation, and (5) "indices without description." The largest proportion of studies, irrespective of country of origin, thematic area, and study design, used asset-based wealth index (n = 142, 54%) as inequality markers followed by the index based on income and expenditure (n = 80, 30%). Sri Lankan studies used income- and expenditure-based indices more than asset-based wealth index. Majority of the reviewed studies were on "maternal, neonatal, and child health" (n = 98, 38%) or on "non-communicable diseases" (n = 84, 33%). Reviewed studies were mostly from India (n = 145, 57%), Bangladesh (n = 42, 16%), and Pakistan (n = 27, 11%). Among the reviewed articles, 55% (n = 140) used primary data while the rest 45% studies used secondary data. CONCLUSION This scoping review identifies asset-based wealth index as the most frequently used indices for measuring socioeconomic status in South Asian urban health studies. This review also provides a clear idea about the use of other indices for the measurement SES in the region.
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Affiliation(s)
- K. M. Saif-Ur-Rahman
- Health Systems and Population Studies Division, icddr,b , Dhaka, Bangladesh
- Systematic Review Centre (SRC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Iqbal Anwar
- Health Systems and Population Studies Division, icddr,b , Dhaka, Bangladesh
| | - Md. Hasan
- Health Systems and Population Studies Division, icddr,b , Dhaka, Bangladesh
- Systematic Review Centre (SRC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Shahed Hossain
- Health Systems and Population Studies Division, icddr,b , Dhaka, Bangladesh
| | - Sohana Shafique
- Health Systems and Population Studies Division, icddr,b , Dhaka, Bangladesh
| | - Fariha Haseen
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
- Systematic Review Centre (SRC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Md. Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
- Systematic Review Centre (SRC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Aminur Rahman
- Health Systems and Population Studies Division, icddr,b , Dhaka, Bangladesh
| | - Shariful Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
- Systematic Review Centre (SRC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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Wangdi K, Jamtsho T. Risk factors for self-reported diabetes among Bhutanese adults: A nationally representative survey data analysis. PLoS One 2018; 13:e0206034. [PMID: 30439962 PMCID: PMC6237308 DOI: 10.1371/journal.pone.0206034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/07/2018] [Indexed: 11/18/2022] Open
Abstract
Background Bhutan, a small land-locked country in the eastern Himalayas has been undergoing an epidemiological and nutritional transition in the last two decades. The objective of this paper was to determine the prevalence and explore the risk factors of self-reported diabetes among Bhutanese adults. Methods We conducted a secondary data analysis among adults 18 years and older Bhutanese using the data from the National Health Survey 2012 (NHS, 2012) of Bhutan. The self-reported information on risk factors was obtained using standard protocols of the WHO STEPwise approach to Surveillance. The outcome of interest was self-reported diabetes on medication. Adjusted and unadjusted logistic regression analyses were performed to identify the risk factor of diabetes. Results A total of 31,066 participants aged 18 years and older were included for the analysis. The prevalence of self-reported hypertension was 1.8% (491). Risk factors for diabetes were: age groups: 35–44 years adjusted odds ratio (AOR) = 2.82 (95% CI, 1.07, 7.41), 45–54 years AOR = 6.02 (95% CI, 2.29, 15.83), 55–64 year AOR = 15.7 (95% CI 5.93, 41.55) and >65 years AOR = 19.60 (95% CI, 6.93, 55.71); high school and diploma/certificate education AOR = 2.57, (95% CI 1.62, 4.07) and AOR = 3.92 (95% CI 1.70, 9.07); and urban dwellers AOR = 2.37, (95% 1.58, 3.57); hypertension AOR = 3.3, (95% CI 2.47, 4.41); and fruit servings of 1–3 per week AOR = 1.63 (95% CI 1.15, 2.31). Conclusion The number of Bhutanese adults with diabetes and co-morbidities associated with it is likely to increase with the ageing of the population, nutrition transition, and high rural-urban migration in the near future. This calls for an urgent need to implement strategies to prevent diabetes in the Bhutanese population targeting risk factors including healthy lifestyle with increased physical activities and reduced smoking. At the same time treating other chronic morbidities including hypertension.
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Affiliation(s)
- Kinley Wangdi
- Phuentsholing General Hospital, Phuentsholing, Bhutan
- Department of Global Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
- * E-mail:
| | - Tshering Jamtsho
- School of Demography, ANU College of Arts & Social Sciences, The Australian National University, Canberra, Australia
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Gyawali B, Hansen MRH, Povlsen MB, Neupane D, Andersen PK, McLachlan CS, Sandbæk A, Vaidya A, Kallestrup P. Awareness, prevalence, treatment, and control of type 2 diabetes in a semi-urban area of Nepal: Findings from a cross-sectional study conducted as a part of COBIN-D trial. PLoS One 2018; 13:e0206491. [PMID: 30388140 PMCID: PMC6214524 DOI: 10.1371/journal.pone.0206491] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 10/15/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Type 2 diabetes is an escalating public health problem in Nepal. The current study aims to assess the prevalence, associated factors, awareness, treatment, and control of type 2 diabetes in a semi-urban area of Nepal. METHODS A population-based cross-sectional survey was conducted including 2,310 adults aged 25 years or above from a semi-urban area of Lekhnath Municipality of Nepal, during October 2016 to April 2017 using the World Health Organization (WHO) STEPS approach. Data on demographics, behavioral risk factors, blood pressure, anthropometric measurements (weight, height, waist and hip circumference), and fasting blood glucose were collected by face-to-face interviews during a door-to-door visit. Participants were considered to have type 2 diabetes if they had previously been diagnosed by a physician and/or were on antidiabetic medications and/or had fasting blood glucose ≥ 7.0 mmol/L. Participants were classified as being aware of their diabetes conditions if they had earlier been told that they had type 2 diabetes. Treatment of diabetes among those aware was if participants received any kind of medication treatment or counseling, and control of diabetes among those treated was defined as fasting blood glucose level was <7.0 mmol/L. Odds Ratio (OR) with 95% Confidence Interval (CI) was used to determine the strength of association. RESULTS The prevalence of type 2 diabetes was 11.7% (95% CI: 10.5-13.1). Among type 2 diabetes participants, 65% were aware of their disease, 94% of those who were aware received treatment, and 21% of the treated subjects had their diabetes under control. Factors significantly associated with type 2 diabetes were older age (OR = 3.2 for age group 45-54 years, OR = 3.8 for age group 55-64 years), Janajati ethnicity (OR = 1.4), abdominal obesity (OR = 2.3), being overweight or obese (OR = 1.4), and hypertension (OR = 2.0), while protective factors included being a female (OR = 0.4), medium physical activity (OR = 0.3), high physical activity (OR = 0.2), and not having family history of diabetes (OR = 0.3). CONCLUSIONS The study revealed a high prevalence of type 2 diabetes among adults. Older age, male gender, Janajati ethnicity, abdominal obesity, overweight or obesity, hypertension, low physical activity, and family history of diabetes were associated with type 2 diabetes. Immediate public health and individual measures are warranted to reduce further burden of type 2 diabetes.
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Affiliation(s)
- Bishal Gyawali
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Martin Rune Hassan Hansen
- Department of Public Health, Aarhus University, Aarhus C, Denmark
- National Research Center for the Working Environment, Copenhagen, Denmark
| | - Mia Buhl Povlsen
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Dinesh Neupane
- Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | | | | | - Annelli Sandbæk
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Abhinav Vaidya
- Department of Community Medicine, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Per Kallestrup
- Department of Public Health, Aarhus University, Aarhus C, Denmark
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Prediction of cardiovascular risk in a rural Indian population using WHO/ISH risk prediction charts: a community-based cross-sectional study. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0515-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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