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Ekpor E, Addo-Mensah D, Akyirem S. Prevalence of dyslipidemia among persons with type 2 diabetes in Africa: a systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:3468-3477. [PMID: 38846843 PMCID: PMC11152840 DOI: 10.1097/ms9.0000000000002122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/20/2024] [Indexed: 06/09/2024] Open
Abstract
Background Dyslipidemia is an established cardiovascular risk factor in persons with type 2 diabetes (T2D), yet the extent to which these conditions co-occur in Africa is unknown. This systematic review and meta-analysis aimed to determine the prevalence of dyslipidemia among persons with T2D in Africa. Methods Medline, Embase, Global Health, Scopus, and Web of Science were searched on 5 December 2023. This review adhered to the PRISMA guidelines and was prospectively registered on PROSPERO. The prevalence data for dyslipidemia was pooled through a random-effects meta-analysis. The authors assessed heterogeneity and publication bias using I 2 statistics and Egger's test, respectively. Results Our search identified 8035 records, of which 60 articles involving 20 034 individuals with T2D were included in this review. The pooled prevalence of dyslipidemia recorded 38.6% (95% CI: 34.1-43.4) for high TC (≥ 5.2 mmol/l), 52.7% (95% CI: 44.2-61.1) for high low-density lipoprotein cholesterol (LDL-C) (≥ 2.6 mmol/l), 43.5% (95% CI: 37.1-50.0) for low high-density lipoprotein cholesterol (HDL-C) (< 1.0 mmol/l in men and less than 1.3 mmol/l in women), and 37.4% (95% CI: 32.2-42.9) for high triglycerides (TG) (≥ 1.7 mmol/l). Subgroup analysis based on gender indicated a notably higher prevalence of dyslipidemia among females compared to males. Conclusion Dyslipidemia is prevalent among persons with T2D in Africa. This highlights the need for early screening, diagnosis, and management of dyslipidemia to mitigate the risk of cardiovascular complications in this population.
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Affiliation(s)
- Emmanuel Ekpor
- School of Nursing and Midwifery, University of Ghana, Legon
- Christian Health Association of Ghana, Accra, Ghana
| | - Dorothy Addo-Mensah
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Annose RT, Asefa H, Gezahagn Y, Abebe G, Hailu Zewde T. Determinants of cardiovascular disease among type 2 diabetic patients attending diabetic follow-up clinic in Arba Minch general hospital, southern Ethiopia: an unmatched case-control study. Ann Med Surg (Lond) 2024; 86:2467-2473. [PMID: 38694275 PMCID: PMC11060215 DOI: 10.1097/ms9.0000000000001951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/04/2024] [Indexed: 05/04/2024] Open
Abstract
Background Cardiovascular disease (CVD) is a major cause of death and disability among patients with type 2 diabetes, especially in low-income and middle-income countries. Type 2 diabetes mellitus (T2DM) patients have a 2-4-fold increased risk of CVD. There is limited data about cardiovascular disease risks and its determinants among T2DM patients in Ethiopia. This study aimed to identify possible predictors of cardiovascular diseases among adults with T2DM in southern Ethiopia. Methods A hospital-based unmatched case-control study was conducted at southern Ethiopia Arbaminch Hospital on 196 randomly selected patients with type 2 diabetes on follow-up (98 cases and 98 controls). The authors collected data using a structured interviewer-administered questionnaire, laboratory checklist, and additional document review of T2DM patients. A multivariable binary logistic regression was fitted to identify cardiovascular disease determinants, and the findings were presented using an adjusted odds ratio (AOR) with a 95% CI. Result The mean reported age (±SD) of the cases and the controls was 56.3.3 (±8.9) and 52.3 (±9.3) years, respectively. The two identified independent determinants of cardiovascular disease with AOR [95% CI] were hypertension [AOR=4.953, 95% CI (2.47, 9.93) and persistent urine albuminuria [AOR=12.9, 95% CI (3.98, 41.7)]. Conclusion This study showed that having high blood pressure and persistent urine albuminuria are independent predictors of cardiovascular disease in T2DM patients. The current study setting needs an intervention for mitigating these cardiovascular disease determinants.
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Affiliation(s)
| | | | - Yenealem Gezahagn
- Faculty of Public Health, College of Medicine and Health Science, Jima University, Jima, Ethiopia
| | - Getachew Abebe
- Department of Anatomy, College of Medicine and Health Science, Arba Minch University, Arba Minch
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Ha KS. Transglutaminase 2 in diabetes mellitus: Unraveling its multifaceted role and therapeutic implications for vascular complications. Theranostics 2024; 14:2329-2344. [PMID: 38646650 PMCID: PMC11024853 DOI: 10.7150/thno.95742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/17/2024] [Indexed: 04/23/2024] Open
Abstract
Diabetes, a severe metabolic disease characterized by chronic hypoglycemia, poses debilitating and life-threatening risks of microvascular and macrovascular complications, including blindness, kidney failure, heart attacks, and limb amputation. Addressing these complications is paramount, urging the development of interventions targeting diabetes-associated vascular dysfunctions. To effectively combat diabetes, a comprehensive understanding of the pathological mechanisms underlying complications and identification of precise therapeutic targets are imperative. Transglutaminase 2 (TGase2) is a multifunctional enzyme implicated in the pathogenesis of diverse diseases such as neurodegenerative disorders, fibrosis, and inflammatory conditions. TGase2 has recently emerged as a key player in both the pathogenesis and therapeutic intervention of diabetic complications. This review highlights TGase2 as a therapeutic target for diabetic complications and explores TGase2 inhibition as a promising therapeutic approach in their treatment.
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Affiliation(s)
- Kwon-Soo Ha
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, Kangwon-do 24341, Korea
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Kim J, Anthopolos R, Zhong J. Bias correction models for electronic health records data in the presence of non-random sampling. Biometrics 2024; 80:ujae014. [PMID: 38488466 PMCID: PMC10941326 DOI: 10.1093/biomtc/ujae014] [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: 04/14/2023] [Revised: 01/12/2024] [Accepted: 02/20/2024] [Indexed: 03/18/2024]
Abstract
Electronic health records (EHRs) contain rich clinical information for millions of patients and are increasingly used for public health research. However, non-random inclusion of subjects in EHRs can result in selection bias, with factors such as demographics, socioeconomic status, healthcare referral patterns, and underlying health status playing a role. While this issue has been well documented, little work has been done to develop or apply bias-correction methods, often due to the fact that most of these factors are unavailable in EHRs. To address this gap, we propose a series of Heckman type bias correction methods by incorporating social determinants of health selection covariates to model the EHR non-random sampling probability. Through simulations under various settings, we demonstrate the effectiveness of our proposed method in correcting biases in both the association coefficient and the outcome mean. Our method augments the utility of EHRs for public health inferences, as we show by estimating the prevalence of cardiovascular disease and its correlation with risk factors in the New York City network of EHRs.
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Affiliation(s)
- Jiyu Kim
- Department of Population Health, NYU Grossman School of Medicine, New York University, 180 Madison Ave, New York, NY 10016, United States
| | - Rebecca Anthopolos
- Department of Population Health, NYU Grossman School of Medicine, New York University, 180 Madison Ave, New York, NY 10016, United States
| | - Judy Zhong
- Department of Population Health, NYU Grossman School of Medicine, New York University, 180 Madison Ave, New York, NY 10016, United States
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Hinneh T, Akyirem S, Bossman IF, Lambongang V, Ofori-Aning P, Ogungbe O, Commodore Mensah Y. Regional prevalence of hypertension among people diagnosed with diabetes in Africa, a systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001931. [PMID: 38051707 PMCID: PMC10697518 DOI: 10.1371/journal.pgph.0001931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/03/2023] [Indexed: 12/07/2023]
Abstract
Hypertension and diabetes comorbidity can increase healthcare expenditure and the risk of coronary heart disease. We conducted a systematic review and meta-analysis to estimate the prevalence of hypertension among people with diabetes in African countries. We searched EMBASE, PubMed and HINARI databases from inception to March 2023. Cross-sectional studies reporting the prevalence of hypertension among people with diabetes and published in English in Africa were eligible for inclusion. The cross-sectional study design component of the mixed method appraisal tool was used to assess the quality of the included studies. We quantified the overall and regional prevalence of hypertension among people with diabetes using random-effects meta-analysis. We assessed heterogeneity and publication bias using I2 statistics and funnel plots. Out of 3815 articles retrieved from the various databases, 41 met the inclusion criteria with sample sizes ranging from 80 to 116726. The mean age was 58 years (± 11) and 56% were women. The pooled prevalence of hypertension in people diagnosed with diabetes was 58.1% [95% CI: 52.0% - 63.2%]. By region, Central Africa had the highest hypertension prevalence; 77.6% [95% CI: 53.0% - 91.4%], Southern Africa 69.1% [95% CI: 59.8% - 77.1%;], North Africa 63.4% [95% CI: 37.1% - 69.1%;], West Africa 51.5% [95% CI: 41.8% - 61.1%] and East Africa 53.0% [95% CI: 45.8% - 59.1%]. Increasing age, being overweight/obese, being employed, longer duration of diabetes, urban residence, and male sex were reported to be associated with a higher likelihood of developing hypertension. The high prevalence of hypertension among people with diabetes in Africa highlights the critical need for an integrated differentiated service delivery to improve and strengthen primary care and prevent cardiovascular disease. Findings from this meta-analysis may inform the delivery of interventions to prevent premature cardiovascular disease deaths among persons in the region.
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Affiliation(s)
- Thomas Hinneh
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - Samuel Akyirem
- Yale School of Nursing, Yale University, New Haven, Connecticut, United States of America
| | | | - Victor Lambongang
- School of Health Sciences, Liberty University, Lynchburg, Virginia, United States of America
| | - Patriot Ofori-Aning
- Department of Medicine for Older People, Stockport NHS Foundation Trust, Manchester, United Kingdom
| | - Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Yvonne Commodore Mensah
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Verma S, Sabbour H, Alamuddin N, Alawadi F, Alkandari H, Almahmeed W, Assaad-Khalil SH, Haddad J, Lombard L, Malik RA, Mashaki Ceyhan E, Prasad P, Tombak G, Salek S. A cross-sectional study of the prevalence and clinical management of atherosclerotic cardiovascular diseases in patients with type 2 diabetes across the Middle East and Africa (PACT-MEA): Study design and rationale. Diabetes Obes Metab 2023; 25:1444-1452. [PMID: 36775980 DOI: 10.1111/dom.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 02/14/2023]
Abstract
AIM To investigate the epidemiology and clinical management of patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (eASCVD) or high/very high ASCVD risk, defined by the 2021 European Society of Cardiology Guidelines, in seven countries in the Middle East and Africa (PACT-MEA; NCT05317845), and to assess physicians' attitudes and the basis for their decision-making in the management of these patients. MATERIALS AND METHODS PACT-MEA is a cross-sectional, observational study undertaken in Bahrain, Egypt, Jordan, Kuwait, Qatar, South Africa and the United Arab Emirates based on a medical chart review of approximately 3700 patients with T2D in primary and secondary care settings, and a survey of approximately 400 physicians treating patients with T2D. RESULTS The primary and secondary objectives are to determine the prevalence of eASCVD and high/very high ASCVD risk in patients with T2D. Current treatment with cardioprotective antidiabetic medication, the proportion of patients meeting the treatment criteria for reimbursement in the study countries where there is an applicable reimbursement guideline, and physician-reported factors in clinical decision-making in T2D management, will also be assessed. CONCLUSIONS This large cross-sectional study will establish the estimated prevalence and management of eASCVD and high/very high ASCVD risk in patients with type 2 diabetes across the Middle East and Africa.
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Affiliation(s)
- Subodh Verma
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hani Sabbour
- Heart, Vascular & Thoracic Institute at Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Naji Alamuddin
- Royal College of Surgeons in Ireland-Bahrain, King Hamad University Hospital, Adliya, Bahrain
| | - Fatheya Alawadi
- Department of Endocrinology, Dubai Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - Hessa Alkandari
- Department of Pediatrics, Farwaniya Hospital, Kuwait City, Kuwait
- Department of Population Health, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Wael Almahmeed
- Heart, Vascular & Thoracic Institute at Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Samir H Assaad-Khalil
- Unit of Diabetes, Lipidology and Metabolism, Alexandria University, Alexandria, Egypt
- Department of Internal Medicine/Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jihad Haddad
- Endocrinology Section, Bader Medical Complex, Amman, Jordan
| | | | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | | | | | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Institute for Medicines Development, Cardiff, UK
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Jatoi NA, Elamin YA, Said AH, Al-Namer B, Al-Muallim FA, Al-Nemer FF, Al-Halal FM. Prevalence of Cardiovascular Risk Factors Among Patients With Diabetes Mellitus Type 2 at King Fahad University Hospital, Saudi Arabia. Cureus 2022; 14:e29489. [PMID: 36299951 PMCID: PMC9588283 DOI: 10.7759/cureus.29489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
Background Diabetes mellitus is considered a major risk factor for cardiovascular diseases. Patients with diabetes mellitus type 2 (DM-II) are at twice as high risk for the development of cardiovascular diseases than the general population. Thus, we aimed to assess the most prevalent cardiovascular risk (CVR) factors among DM-II patients in the Eastern province of Saudi Arabia. Method This is a cross-sectional, retrospective, and observational study conducted on DM-II patients at King Fahad University Hospital (KFUH) Al Khobar, Saudi Arabia, from January 2016 to December 2021. The total number of participants was 373 who were patients with DM-II. The patients' demographic information (age, sex, marital status, height, weight, body mass index (BMI), waist, hip circumference, and waist-hip ratio were calculated or obtained from hospital electronic records as were the CVR factors, age, gender, smoking habits, physical activity, BMI, haemodynamic measurements, glycosylated haemoglobin (HbA1C) levels and lipid profile. The collected data were analyzed by using SPSS Statistics v.28 (IBM Corp., Armonk, NY). The descriptive statistics were reported using mean±SD for numerical data and relative frequencies (%) for categorical data. P < 0.05 were counted significant. Quantitative data were analyzed using the ANOVA test to compare the means of the three groups. Qualitative data were analyzed and compared using the chi-square test. Fisher’s exact test was also used to study the statistical significance of variables. Spearman rank correlation was used to study the relationship between HbA1C and other CV risk factors. Results The mean age was 58 (± 13) years; females were 57% of the sample. Around 92% were smokers, 84% had a sedentary lifestyle, 72% had dyslipidemia, 58% were obese, 30% were overweight, 58% reported poorly control of their diabetes, 50% had hypertension and 32% had pre-hypertension. Furthermore, 89% of participants had two or more CVR factors other than DM-II. We found a significant association between high body mass index, dyslipidemia, high systolic blood pressure and pulse pressure (p<0.05) with HbA1C. Conclusion The majority of participants had two or more cardiovascular risk factors in addition to DM-II. Poor control of DM-II and cardiovascular risk factors cannot be ignored and primary to tertiary prevention must be the top priority when managing the diabetic population in order to prevent devastating outcomes and progression of reversible morbidity.
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Aga F, Dunbar SB, Kebede T, Guteta S, Higgins MK, Gary RA. Foot self-care behaviour in type 2 diabetes adults with and without comorbid heart failure. Nurs Open 2022; 9:2473-2485. [PMID: 35678585 PMCID: PMC9374405 DOI: 10.1002/nop2.1265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/15/2022] [Indexed: 11/08/2022] Open
Abstract
AIMS To compare the correlates of foot self-care behaviours among type 2 diabetes mellitus (T2D) adults with and without comorbid heart failure (HF). DESIGN Cross-sectional, correlational, comparative design. METHODS A 210 T2D adults (105 with HF and 105 without HF) participated from August-December 2020. Foot self-care behaviour was measured using the foot care subscale of the Summary of Diabetes Self-Care Activities (SDSCA) instrument. A stepwise logistic regression analysis was used to explore variables predicting foot self-care behaviour. RESULTS The participants' mean age was 58.7 ± 10.9 years. Poor foot self-care behaviour was reported in T2D adults both with (53.3%) and without (54.3%) HF. Participants with HF-comorbidity were statistically significantly older and had higher total daily medication intake. Household income and the total number of daily medications statistically significantly predicted foot self-care behaviour in HF-comorbid T2D adults. Marital status, social support and body mass index predicted foot self-care behaviour in the non-HF group.
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Affiliation(s)
- Fekadu Aga
- School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Tedla Kebede
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Senbeta Guteta
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melinda Kay Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Rebecca A Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Polymer-Based Delivery of Peptide Drugs to Treat Diabetes: Normalizing Hyperglycemia and Preventing Diabetic Complications. BIOCHIP JOURNAL 2022. [DOI: 10.1007/s13206-022-00057-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Letta S, Aga F, Yadeta TA, Geda B, Dessie Y. Poor Self-Care Practices and Being Urban Resident Strongly Predict Chronic Complications Among Patients with Type 2 Diabetes in Eastern Ethiopia: A Hospital-Based Cross-Sectional Study. Diabetes Metab Syndr Obes 2022; 15:2095-2106. [PMID: 35898445 PMCID: PMC9309320 DOI: 10.2147/dmso.s368165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diabetes, together with its complications, has a considerable negative influence on people's quality of life and healthcare delivery and raises diabetic mortality. However, there is limited information about the diabetes-associated chronic complications in the study setting. Therefore, this study aimed to determine the burden and factors related to the chronic complications among patients with type 2 diabetes (T2D) in Eastern Ethiopia. METHODS A hospital-based cross-sectional study was conducted among 879 patients with T2D at two public hospitals in Harar. The data were collected through interviews using a structured questionnaire. Data related to the diagnosis of chronic complications and biochemical tests were extracted from medical records. The outcome variable was the number of chronic complications that happened to the patients. A generalized Poisson regression model with robust variance estimation was used to investigate the association of independent variables with chronic complications. An adjusted prevalence ratio with a 95% CI was reported to show an association using a p-value ≤0.05. RESULTS One or more chronic complications were presented in 43% of T2D (95% CI: 39.65, 46.19). Macrovascular and microvascular complications were found in 27.6% and 23.5% of patients, respectively. Urban residence (APR = 2.64; 95% CI: 1.54, 4.54), low wealth status (APR = 1.80; 95% CI: 1.17, 2.76), diabetes duration ≥5 years (APR = 1.46; 95% CI: 1.05, 2.01), hypertriglyceridemia (APR = 1.48; 95% CI: 1.07, 2.09) and poor self-care practices (APR = 1.62; 95% CI: 1.18, 2.23) were factors significantly associated with the chronic complications. CONCLUSION The burden of chronic complications was high, with nearly half of T2D patients experiencing one or more chronic complications. Almost one in ten patients suffered from multiple chronic complications. The complications were mainly influenced by being urban resident, low wealth status, and poor self-care practices. Therefore, health care providers need to educate patients and promote self-care practices and healthy lifestyles to achieve treatment goals and lower the risk of chronic complications.
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Affiliation(s)
- Shiferaw Letta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Correspondence: Shiferaw Letta, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Tel +251911771934, Email
| | - Fekadu Aga
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- Department of Nursing, College of Health Sciences, Madda Walabu University, Shashamene Campus, Shashamene, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Effect of constructing doctor-pharmacist joint pharmacy clinic for outpatients on the comprehensive management of type 2 diabetes mellitus: a pilot RCT. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00967-z] [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: 10/21/2022] Open
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