The Global Burden of Type 2 Diabetes Attributable to Dietary Risks: Insights from the Global Burden of Disease Study 2019

Hyperglycaemia and Its Risk Factors Among Adults Living With HIV on Follow-Up at the Hawassa City Administration, Southern Ethiopia: A Cross-Sectional Study

BACKGROUND

Ethiopia implemented the universal test and treat in 2017 and later adopted dolutegravir-based regimens for people living with HIV (PLWH). However, the impact of these changes on glucose metabolism in Ethiopia remains unclear, highlighting the need for further investigation.

METHODS

A cross-sectional study was conducted in southern Ethiopia from 5 January 2023 to 30 May 2024. We included 443 adult PLWH using systematic random sampling. American Diabetes Association criteria was used to define hyperglycaemia. To identify factors associated with hyperglycaemia, binary logistic regression was used with adjusted odds ratio (AOR) and 95% confidence interval (CI).

RESULTS

Overall prevalence of hyperglycaemia was 24.4% (16.7% prediabetes and 7.7% diabetes mellitus [DM]). Of the participants with DM, 82.3% were newly diagnosed. Significant predictors of hyperglycaemia were age > 50 years (AOR 2.1; 95% CI 1.1-3.9), alcohol intake (AOR 2.1; 95% CI 1.02-4.2), obesity (AOR 3.2; 95% CI 1.3-7.9), high waist-hip ratio (AOR 2.6; 95% CI 1.4-5.05) and LDL-cholesterol (AOR 2.2; 95% CI 1.02-4.6). While significant predictors of DM were alcohol intake (AOR 3.0; 95% CI 1.1-8.4), co-morbidity (AOR 2.6; 95% CI 1.1-6.05), high waist circumference (AOR 7.5; 95% CI 1.3-43.3), high waist-hip ratio (AOR 4.1; 95% CI 1.02-16.2) and high triglycerides (AOR 3.2; 95% CI 1.3-7.7). Dolutegravir-based regimen was not associated with hyperglycaemia.

CONCLUSION

Hyperglycaemia prevalence among adult PLWH on antiretroviral therapy in southern Ethiopia is rising, with most diabetes cases newly identified. This emphasises the critical need for routine screening to enable early detection, prevention and management.

Global regional, and national burden of type 2 diabetes attributable to dietary factors from 1990 to 2021

The study comprehensively assesses the global burden of type 2 diabetes (T2D) linked to dietary factors from 1990 to 2021. Data from the Global Burden of Disease Study 2021 (GBD 2021) was analyzed for T2D dietary risk factors across 204 countries, using age-standardized metrics and SDI quintiles, with joinpoint regression and other analytical methods. The results revealed a significant increase in the global burden of T2D, with a 1.92-fold rise in DALYs and a 1.28-fold rise in total mortality cases due to dietary risks. High intake of processed meat and sugar-sweetened beverages were identified as major contributors to the increasing burden, whereas the age-standardized mortality rates attributable to low vegetable intake declined over time. The study also emphasized the impact of age, period, and cohort effects on the incidence of T2D, along with the growing health disparity gaps between high and low SDI countries. The study emphasizes the importance of dietary interventions to reduce T2D burden, suggesting a decrease in processed meat and sugary drink consumption and an increase in vegetable intake. It calls for global strategies to address health disparities and improve equitable access to health resources.

Produce prescription to improve health among adults with type 2 diabetes in Australia: Protocol for a randomised controlled trial

BACKGROUND

'Food is medicine' programs such as Produce Prescription (PRx) aim to integrate food-based nutrition programs into healthcare, for the prevention, management and treatment of diet-related diseases, typically for those experiencing food insecurity. However, the impact of PRx on health indicators in Australia has never been tested in a randomised trial.

OBJECTIVES

To determine the effect of PRx on blood glucose control and other health indicators in adults with type 2 diabetes experiencing hyperglycaemia and food insecurity and/or financial hardship in Australia.

METHODS

Using a parallel design randomised controlled trial, n = 224 participants will be randomised (1:1) to PRx or usual care. Over 26 weeks, the intervention group will receive a weekly delivery of fruits, vegetables, wholegrains and nuts, and up to 3 sessions with an accredited dietitian. Controls will receive usual care. The primary outcome is change in mean HbA1c over 26 weeks, comparing the intervention and control group. Secondary outcomes include between-group differences at 26 weeks in change in blood pressure, body weight, blood lipids, food and nutrition insecurity, person-reported outcome measures, medication use, and diet quality. Implementation outcomes assessed will include feasibility, acceptability, scalability and cost effectiveness.

DISCUSSION

This Australia-first PRx trial will provide novel and rigorous data for an intervention that may be feasible to improve health and health equity as part of the Australian healthcare system. We anticipate PRx will lead to a clinically meaningful reduction in HbA1c, contribute to improved health equity and long-term health benefits for adults with type 2 diabetes and food insecurity.

Comparative diabetes mellitus burden trends across global, Chinese, US, and Indian populations using GBD 2021 database

Diabetic mellitus (DM) poses a significant challenge and stress to global health, comparing the burden of disease in the world's three most populous countries while projecting changes in trends in age-standardized rate (ASR) -deaths and disability adjusted life years (DALYs) up to 2050. Using GBD2021 data, we examined DM trends in China, US, India and globally for 1990-2021, and projected deaths and DALYs for DM (types 1 and 2) for 2022-2050 using Bayesian age-period-cohort (BAPC) model. It was found that the ASR-DALYs and deaths for T1DM are trending downward globally, while those for T2DM are trending upward. In terms of gender differences, the burden of T1DM by gender was insignificant, whereas the burden of disease was significantly higher in men with T2DM than in women. The burden of disease for T1DM peaks around the ages of 40-44 years, while the burden of disease for T2DM peaks at 65-69 years. Population growth and ageing are major factors influencing the disease burden of diabetes. The projection of ASR-deaths and DALYs globally for 2022-2050 showed a decreasing trend in T1DM and an increasing trend in T2DM (especially in China and India). The increasing burden of T2DM disease globally and in three countries by 2050 should be taken seriously.

Short-term exposure to PM2.5 and its components and type 2 diabetes-related hospital admissions, length of stay, and hospital costs in Shanghai

The short-term influence of particles with an aerodynamic diameter ≤2.5 μm (PM2.5) and its individual elements on hospital costs, the length of hospital stay (LOS), and hospital admissions caused by type 2 diabetes remains unclear. A generalized additive model (GAM) with quasi-Poisson distribution was utilized to assess the association of individual pollutants and mixtures. For every 10 μg/m3 rise in PM2.5 and a per-SD increase in NH4+at lag0, hospital admissions increased by 0.93% (95% CI: 0.68, 1.19) and 2.81% (95% CI: 2.20, 3.42); hospital costs rose by 24.58 thousands of CNY (95% CI: 5.95, 43.22) and 77.06 thousands of CNY (95% CI: 33.07, 121.04); LOS increased by 9.53 days (95% CI: 0.44, 18.62) and 27.80 days (95% CI: 6.34, 49.27), respectively. Factor analysis showed that mixed-source particulate pollution was significantly associated with an increase in hospital admissions (0.27%, 95% CI: (0.20, 0.34)), LOS (2.87 days, 95% CI: (0.35, 5.40)), and hospital costs (71.68 thousands of CNY, 95% CI: (19.89,123.46)). These findings suggested that short-term exposure to elevated levels of PM2.5 as well as its components increased the risk of hospital costs, LOS, and hospital admissions due to type 2 diabetes.

Prevalence and associated factors of diabetes among adult populations of Hawassa town, southern Ethiopia: A community based cross-sectional study

INTRODUCTION

Knowing the magnitude and preventable risk factors of diabetes has a significant contribution in targeted prevention intervention which ultimately ensures the existence of healthier and productive individuals in a country. Diabetes has untoward impact on health, social and economic consequences. Exploring preventable risk factors are extremely important because of their potential association and interaction with diabetes. Therefore, the aim of this study was to investigate the magnitude and modifiable risk factors of diabetes among adult populations in Hawassa town, southern Ethiopia.

METHODS

A community based cross-sectional study was conducted from September, 2023 to November, 2023 among adult populations. A multi-stage sampling technique was employed to select 1,113 study participants between the ages of 20-69 years. An interviewer-administered questionnaire was used to collect data. Additionally, participants were also instructed to fast overnight, after which the standard fasting blood glucose test was conducted. A binary logistic regression model was fitted to identify independent predictors of diabetes.

RESULTS

The overall prevalence of diabetes was 14.4% (95% Confidence Interval (CI): 12.4%, 16.4%). Being male (Adjusted Odds Ratio (AOR):2.10; 95% CI: 1.34, 3.29), being unable to read and write (AOR: 3.38; 95% CI: 1.09, 10.47), read and write (AOR: 3.38; 95% CI: 1.09, 10.47) and medium cycle (AOR 2.79; 95% CI: 1.02, 7.63) compared to college and above, consume less than 5 servings of fruits on daily base (AOR: 2.80; 95% CI: 1.18, 6.62), having ever chewed khat (AOR 6.50; 95% CI: 4.07, 10.39) and being overweight and obese (AOR: 2.43; 95% CI: 1.54, 3.83) were independently associated with diabetes mellitus (DM).

CONCLUSION

This study identified a high prevalence of diabetes among adults in Hawassa, driven by various risk factors. This presents an opportunity to mitigate diabetes risk through public health measures, including avoiding khat chewing, promoting healthy diets, managing overweight and obesity, implementing community-based screening, enhancing health literacy, and integrating health information into daily life.

Trends and disability-attributable risk factors of type 2 diabetes mellitus in Southeast Asia (1990-2019): An in-depth 30-year analysis from the Global Burden of Disease study

BACKGROUND AND AIMS

To provide insight on targeted approach to mitigate diabetes burden, this research aims to analyze the trends of prevalence, mortality, and disability attributable to risk factors for type 2 diabetes mellitus (T2DM) from 1990 to 2019 in the Southeast Asia (SEA) region.

METHODS AND RESULTS

Age-standardized rates for prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (DALYs) from 1990 to 2019 from the Global Burden of Disease Study were assessed. DALYs-related risk factors were estimated using multivariate regression analysis and estimated annual percentage change (EAPC) was calculated to quantify the temporal trends. Over 30 years, the SEA region experienced a 59.5 % rise in T2DM ASPR, 17.33 % in ASMR, and 26.97 % in DALYs. The T2DM DALYs rate per 100,000 population was 1002.91 (885.23-1132.40) in 1990 and 1273.42 (1103.92-1452.41) in 2019, increasing by 27 %. Cambodia and Indonesia had the highest worsening in three parameters, while most significant improvement in all parameters was observed in Singapore. The curvilinear association was demonstrated between ASMR and DALYs to Gross Domestic Product (GDP) per capita. Prominent risk factors affecting DALYs increase were high fasting plasma glucose (FPG) (p < 0.001), high body mass index (BMI) (p < 0.001), tobacco use (p = 0.012), and household pollution (p = 0.03). Men were more affected than women.

CONCLUSION

The burden of T2DM in the SEA region has increased significantly during the 30-year period. Policymakers should address high BMI, high FPG, smoking, and air pollution to regulate T2DM burden in SEA.

The burden of type 2 diabetes attributable to dietary risks in China: Insights from the global burden of disease study 2021

OBJECTIVES

This study aims to comprehensively assess how dietary risk factors have influenced the prevalence of Type 2 Diabetes Mellitus (T2DM) in China from 1990 to 2021. The study seeks to provide robust data and scientific evidence essential for formulating effective preventive and control strategies to combat T2DM in China.

STUDY DESIGN

This cross-sectional study conducted secondary analyses using data from the Global Burden of Disease 2021 (GBD 2021) to assess the burden of T2DM in China attributable to dietary risks.

METHODS

The study analyzed age-adjusted metrics related to T2DM, including death counts, Disability-Adjusted Life Years (DALYs), and Age-Standardized Rates (ASRs), using GBD 2021 data, stratified by age and sex. Additionally, Estimated Annual Percentage Changes (EAPCs) were employed to track trends over time.

RESULTS

In 2021, the results show that 21.43 % of T2DM-related deaths and 23.51 % of DALYs were attributable to dietary risk factors, notably a diet low in whole grains and high in red and processed meats. Over the period from 1990 to 2021, there has been an increasing trend in the EAPCs of death rates and DALYs associated with dietary risks in China, suggesting a substantial impact of dietary factors on the burden of T2DM in the country.

CONCLUSION

This study highlights the urgent need for targeted public health interventions to promote dietary changes and reduce the burden of T2DM in China.

A Swedish dietary guideline index, gut microbial α-diversity and prevalence of metabolic syndrome - observations in the Swedish CArdioPulmonary bioImage Study (SCAPIS)

Background

Metabolic syndrome (MetS) is characterized by coexisting risk factors for type 2 diabetes and cardiovascular disease. Diet is of importance in their aetiology, and gut microbiota (GM) may constitute a link between diet and metabolic health. Understanding the interplay between diet and GM could contribute novel insights for future dietary guidelines, and aid in preventive actions to motivate adherence to dietary guidelines.

Objective

We intended to create a Swedish dietary guideline index (SweDGI) measuring adherence to 12 Swedish dietary guidelines and examine whether SweDGI and its components are associated with GM α-diversity (Shannon index) and prevalent MetS, and if the association between the Shannon index and MetS differs depending on SweDGI.

Design

SweDGI was based on food-frequency data assessed 2014-2018 in 10,396 diabetes-free participants from the Malmö and Uppsala-sites of the Swedish CArdioPulmonary bioImage Study (SCAPIS) (50-64 y, 53% women). We estimated the Shannon index from shotgun metagenomic sequencing-data to assess microbial richness and evenness. We used a general linear model to examine cross-sectional SweDGI-Shannon associations and logistic regression for associations with MetS.

Results

Most guidelines were followed by less than half of the participants. Men showed poorer adherence. Higher SweDGI was linked to higher Shannon index (P-trend across five SweDGI-groups = 1.7 × 10-12). Most guidelines contributed to this observation. Higher SweDGI and Shannon index were associated with lower MetS-prevalence, where the lowest prevalence was observed among those with both high SweDGI and high Shannon index (odds ratio:0.43; 95% confidence interval:0.35, 0.52). Both the Shannon index and SweDGI were associated with MetS, independently of the level of the other factor (P-interaction = 0.82).

Conclusions

We created a new index to comprehensively reflect adherence to the Swedish dietary guidelines in sub-cohorts within the large multicentre SCAPIS study. Better adherence was associated with a richer and more even GM and lower prevalence of MetS. The inverse association between the Shannon index and MetS was consistent at different levels of adherence to dietary guidelines.

Plant-based diets-impacts of consumption of little or no animal-source foods on human health

The world, in 2024, faces both climate and biodiversity crises, and the food system does contribute significantly to these crises. For some, the solution is simple - intakes of animal source foods (ASFs) should be considerably reduced, and consumption of plant-source foods (PSFs) should be greatly increased. Advocates for such a dietary transformation express confidence that plant-based diets will not only benefit planetary health, but will provide nutrient adequacy for all, and will also result in considerable protection from chronic non-communicable diseases (NCDs). However, as described in this perspective, the dramatic reductions in ASFs, entailed by many plant-based diets, will worsen already prevalent micronutrient and protein deficiencies. The protections provided by plant-based diets against NCDs appear to be more strongly associated with reduced intakes of calories and salt, and increased intakes of fruit, vegetables, nuts and whole grains, rather than with reduced intakes of ASFs. Any possible absolute adverse effects of red and processed meat consumption on NCDs are very small and uncertain. Other ASFs either appear to have no impact on NCDs (poultry meat and eggs), or are associated with protections against obesity, cardiovascular events, brain disorders and some cancers (seafood and dairy). Rigorous randomized controlled trials of all newly proposed environmentally-protective plant-based diets are required, so as to provide clear-cut evidence of micronutrient and protein adequacy, with or without, supplementation, fortification and/or biofortification. In the meantime, dietary guidelines should advise moderating excessive consumption, rather than substantially limiting or excluding ASFs from the human diet.

Exploring the Impact of Fasting and Fasting-Mimicking Diets on Type 2 Diabetes Management in Adults: A Systematic Review

Type 2 diabetes poses significant global health challenges, affecting both the quality of life and healthcare systems. This systematic review evaluates the efficacy of fasting and fasting-mimicking diets (FMD) in managing type 2 diabetes, with a focus on their effects on glycemic control, lipid profiles, and overall metabolic health in adult patients. A comprehensive search of PubMed and Cochrane Library databases identified several studies utilizing various fasting protocols, including intermittent fasting and FMD. Data synthesis and bias assessment were conducted using established methodologies, including the Cochrane Risk of Bias 2 (RoB 2) tool. The review found that fasting interventions significantly improve glycemic control and reduce body weight, with some protocols notably lowering HbA1c levels (p<0.05), highlighting the strong potential of fasting in diabetes management. However, the results varied, suggesting that individual differences in metabolic responses and adherence levels influence outcomes. In conclusion, while fasting and FMD show promise for improving metabolic health and managing diabetes, more standardized research is needed to understand the underlying mechanisms, optimize protocols, and confirm long-term benefits. Future research should prioritize larger sample sizes and extended follow-up periods to inform comprehensive clinical practice guidelines.