DiabCare survey of diabetes management and complications in the Gulf countries

Diabetes-Related Microvascular Complications in Primary Health Care Settings in the West Bank, Palestine

BACKGROUND

Worldwide, retinopathy, nephropathy, and neuropathy are the major diabetes-related microvascular complications. In Palestine, a low-middle-income country, diabetes is the fourth reason for death. However, a few studies examined diabetes microvascular consequences and its management. Therefore, we carried out a national study that aims to investigate the factors associated with diabetes-related microvascular complications among individuals seeking care in primary healthcare settings of the West Bank of Palestine.

METHOD

Using a cluster systematic sampling technique, 882 participants with diabetes patients were chosen for a cross-sectional study from primary healthcare facilities operated by the Ministry of Health (PMoH), the United Nations Relief and Works Agency (UNRWA), and the Palestinian Medical Relief Society (PMRS). Data about patients related to diabetes-related complications, medication use, and other diseases were extracted from patients' medical records. In addition, an interview face-to-face questionnaire was used to collect information about patients' sociodemographic variables, medical history, smoking habits, duration of the disease, presence of concurrent conditions previous referrals, and hospital admissions, as well as their level of knowledge regarding diabetes, complications, and treatments.

RESULTS

Approximately 34.4% of persons with diabetes patients in Palestine encounter at least one microvascular complication associated with diabetes. The most prevalent diabetes-related microvascular complication was retinopathy (17.3%), 23.4% of participants had more than one microvascular complication, and 29% of male patients had erectile dysfunction. A higher probability of having any microvascular complications was associated with older age (over 60 years). Participants with diabetes patients with fundoscopy or ophthalmology reports, according to diabetes follow-up guidelines, were less likely to develop retinopathy. Also, those who performed regular kidney function testing were less likely to have nephropathy, and those who performed a regular foot exam were less likely to develop diabetic foot.

CONCLUSIONS

Diabetes-related microvascular complications were associated with patient age, low education level, residency location, and adherence to diabetes follow-up guidelines of diabetes management; i.e., having been tested for HbA1c, consulting with specialists, regular kidney function, and foot examination. These factors can be utilized in setting up proper management protocols to prevent or delay microvascular complications in many patients.

Prevalence of type 2 diabetes complications and its association with diet knowledge and skills and self-care barriers in Tabriz, Iran: A cross-sectional study

Background and Aims

Diabetes can lead to multiple complications that can reduce the quality of life, impose additional costs on the healthcare systems and ultimately lead to premature death. Proper self-care in diabetic patients can impede or delay the onset of diabetes complications. This study aimed to investigate diabetes complications and their association with diet knowledge, skills, and self-care barriers.

Methods

This was a cross-sectional study. A total of 1139 patients with Type 2 Diabetes Mellitus (T2DM) referring to health centers in Tabriz, Iran, were included from January to July 2019. Data were collected using two questionnaires: (1) a sociodemographic questionnaire and (2) a Personal Diabetes Questionnaire (PDQ). Data were analyzed using SPSS software version 22. χ ² test was used to examine the association between the socioeconomic and disease-related variables and the prevalence of diabetes complications. T-test was used to examine the association between diet knowledge and skills, self-care barriers, and the incidence of diabetes complications.

Results

In this study, 76.1% of patients had at least one complication, and 30.2% had a history of hospitalization due to diabetes complications during the past year. Approximately 49% and 43% were diagnosed with high blood pressure and hyperlipidemia, respectively. Cardiovascular disease was the most common diabetes complication (15.9%) and the cause of hospitalization (11.01%) in patients with diabetes. Barriers to diet adherence, blood glucose monitoring, and exercise were significantly associated with self-reported diabetes complications (p < 0.001). Our results showed no significant association between the number of complications and diet knowledge and skills (p = 0.44).

Conclusion

This study indicated that the prevalence of diabetes complications was higher among patients with more barriers to self-care. In light of these findings, taking appropriate measures to reduce barriers to self-care can prevent or delay the onset of diabetes complications.

Levels and Correlates of Numeracy Skills in Lebanese Adults with Diabetes: A Cross-Sectional Study

Diabetes numeracy skills are required in the interpretation of food labels, insulin pump dosage, the interpretation of blood glucose meter data, and the determination of carbohydrate intake. This study assessed the levels and correlates of numeracy skills in Lebanese adults with diabetes to identify those most at risk of uncontrolled diabetes. In total, 299 adults with diabetes, mean age 47.4 ± 19.8 years, took the questionnaire. It consisted of self-developed items on sociodemographic and health-related factors, in addition to the Diabetes Numeracy Test-15 (DNT-15) and the Single Item Literacy Screener. Many participants (62%) scored < 10 on the DNT-15 indicating insufficient numeracy skills. DNT-15 scores were positively associated with literacy, exercise, healthy diet, perceived diabetes control, frequency of glycaemia measurement, ability to afford treatment, and ease of understanding information related to diabetes. Age, BMI, and complications were negatively correlated with DNT-15 score. Numeracy skills were higher in males, single individuals, and in people with type 1 diabetes, fewer complications, controlled HbA1c, higher income, higher education, a prior visit to a dietician, and ability to maintain personal care despite COVID-19. Interventions to strengthen numeracy skills would empower individuals with diabetes, lead to appropriate self-management behaviors, and prevent health complications in at-risk individuals.

Current gaps in management and timely referral of cardiorenal complications among people with type 2 diabetes mellitus in the Middle East and African countries: Expert recommendations

The upsurge of type 2 diabetes mellitus is a major public health concern in the Middle East and North Africa (MENA) and Africa (AFR) region, with cardiorenal complications (CRCs) being the predominant cause of premature morbidity and mortality. High prevalence of cardiometabolic risk factors, lack of awareness among patients and physicians, deficient infrastructure, and economic constraints lead to a cascade of CRCs at a significantly earlier age in MENA and AFR. In this review, we present consensus recommendations by experts in MENA and AFR, highlighting region-specific challenges and potential solutions for management of CRCs. Health professionals who understand sociocultural barriers can significantly increase patient awareness and encourage health-seeking behavior through simple educational tools. Increasing physician knowledge on early identification of CRCs and personalized treatment based on risk stratification, alongside optimum glycemic control, can mitigate therapeutic inertia. Early diagnosis of high-risk people with regular and systematic monitoring of cardiorenal parameters, development of region-specific care pathways for timely referral to specialists, followed by guideline-recommended care with novel antidiabetics are imperative. Adherence to guideline-recommended care can catalyze utilization of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists with demonstrated cardiorenal benefits-thus paving the way for overcoming care gaps in a cost-effective manner. Leveraging digital technology like electronic medical records can help generate real-world data and provide insights on voids in adoption of newer antidiabetic medications. A patient-centric approach, collaborative care among physicians from different specialties, alongside involvement of policy makers are key for improving patient outcomes and quality of care in MENA and AFR.

Expert-Group Practical Advice on Insulin Initiation and Titration for Patients with Type 2 Diabetes in the Gulf Region

The type 2 diabetes mellitus (T2DM) management represents a major challenge in the Gulf region. Hyperglycemia is a major risk factor for microvascular and macrovascular complications and increased mortality. Early dietary and lifestyle changes alongside a step-wise targeted pharmacological approach to achieve a glycated hemoglobin (HbA_1c) level of &#x3c;7% are recommended to limit these complications. However, achievement of this HbA_1c target remains a major challenge, especially in the Gulf region. Both physician and patient-led barriers limit timely initiation and titration of insulin. An expert-group advisory committee reviewed the current guideline recommendations, strategized best practice, and curated clinical practical advices to enable primary-care physicians to optimally initiate and titrate insulin in patients with T2DM.

Prevalence and risk factors of vascular complications in type 2 diabetes mellitus: Results from discover Middle East and Africa cohort

BACKGROUND

We evaluated the prevalence of vascular complications and associated risk factors in individuals with type 2 diabetes mellitus (T2DM) initiating second-line glucose-lowering therapy from the Middle East and Africa (MEA) cohort of the 3-year prospective DISCOVER study involving 15,992 patients in 38 countries.

METHODS

Baseline cross-sectional data collected from healthcare settings were used to assess micro and macrovascular complications prevalence as crude and age- and sex-standardised. The multi-variable analysis assessed factors associated with these complications.

RESULTS

Of 3,525 enrolled patients (mean age: 54.3 ± 10.8 years), >40% had hypertension and hyperlipidaemia. Metformin monotherapy was the first-line therapy in 56.5%, followed by metformin+sulphonylurea (20.3%). Crude and standardised prevalence of microvascular complications were 17.7% and 16.9% (95% confidence interval [CI], 16.77-16.98) and macrovascular complications were 10.7% and 8.7% (95% CI, 8.59-8.76). Factors significantly (p<0.05) associated with micro and macrovascular complications (odds ratios [95% CI]) were age (1.24 [1.12-1.39] and 1.58 [1.35-1.84]), male sex (1.33 [1.04-1.70] and 1.71 [1.22-2.40]), hyperlipidaemia (1.33 [1.07-1.65] and 1.96 [1.46-2.63]) and hypertension (1.75 [1.40-2.19] and 2.84 [2.07-3.92]).

CONCLUSION

A substantial burden of vascular complications with prominent risk factors in the MEA cohort calls for early preventive interventions.

The Role of Nicorandil in the Management of Chronic Coronary Syndromes in the Gulf Region

Chronic coronary syndromes (CCS) and stable angina are a growing clinical burden worldwide. This is of particular concern in the Gulf region given its high prevalence of cardiovascular risk factors, especially diabetes mellitus and smoking. Despite recommendations on the use of first- and second-line anti-anginal medication, management challenges remain. Current guidelines for pharmacologic treatment are not determined by the range of pathophysiological mechanisms of ischaemia and consequent angina, which may occur either in isolation or co-exist. In this article, we highlight the need to improve knowledge of the epidemiology of chronic coronary syndromes in the Middle East and Gulf region, and the need for studies of stratified pharmacologic approaches to improve symptomatic angina and quality of life in the large and growing number of patients with coronary artery disease from this region. We discuss the role of nicorandil, currently recommended as a second-line anti-anginal drug in CCS patients, and suggest that this may be a particularly useful add-on therapy for patients in the Gulf region.

The Current and Forecasted Status of Type 2 Diabetes in the Arab Society of Israel

BACKGROUND

Diabetes mellitus (DM) is considered one of the main causes of mortality, morbidity, and health care expenditures. Effectively treating this disease is of crucial importance and imposes a global challenge. The incidence of Type 2 DM (T2DM) is rapidly rising in both developing and developed countries. The Arab community in Israel is a distinct ethnic group with unique characteristics. Recently, this community has undergone major changes in its lifestyle, adopting the Westernized one, which could have caused an increase in the T2DM incidence rate.

OBJECTIVE

This review aims to shed light on various studies undertaken to explore the prevalence of diabetes and determine its current status in the Arab society of Israel, resting on previous and current data. It is presented to highlight the status of diabetes globally and to focus on its current situation in the Arab society of Israel, attempting to forecast its direction in the upcoming decade.

METHODS

Data were obtained from our previous comprehensive socio-economic and health crosssectional surveys for successive periods from 2004 to 2017. These surveys were conducted on the Arab society of Israel by the Galilee Society.

RESULTS

Our results showed a progressive increase in the prevalence of T2DM from 3.4% to 7.6% in the Arab society of Israel. This trend is expected to continue rising in the coming decade, and based on our predictions, may exceed 12% in 2030.

CONCLUSION

Substantial and practical health-related actions must be initiated to prevent an increasing number of adults from developing diabetes and its complications.

Audit of diabetic care in family practice center in Abha City, Aseer region: CBAHI standards application

OBJECTIVE

The objectives of this study is to assess the quality of diabetic care at AlManhal PHCC based on CBAHI standards.

METHODS

This audit was conducted during 2018 at Al_Manhal PHCC through assessment all aspects of DM care ( structures, processes and outcomes) using CBAHI standards . Data entry and analysis were managed used SPSS.

RESULTS

Most of DM structures were available at the PHCC , however, health educational program , lab relevant facilities were partially met the standards. Records of 429 patients were assessed for process of care which were satisfactory except for laboratory investigations and eye examination which were partially met . Good DM metabolic control was (28%) , HTN control (71%) and lipid control( 54%), good compliance with appointment was 85% . The most common documented complications were retinopathy( 14%), nephropathy (4.5%) and CHD( 4%).

CONCLUSION AND RECOMMENDATIONS

This audit revealed that using of CBAHI standards for DM care at PHCC is simple and practical and could help to identify the weak areas that needs improvement. The present care of DM in our PHCC has acceptable infrastructures except for health education program , laboratory and referral system which should be scaled up to improve the processes and outcomes. DM control is still a big challenge and needs more collaborative effort between health care providers and patients.

Fuzzy Logic-Based Predictive Model for the Risk of Type 2 Diabetes Mellitus

This article presents a predictive model that can be used for the early detection of Type 2 Diabetes Mellitus using fuzzy logic. In order to formulate the model, risk factors associated with the risk of T2DM were elicited. The predictive model was formulated using fuzzy triangular membership functions following which the rules needed for the inference engine was elicited from experts. The model was simulated using the MATLAB Fuzzy logic Toolbox. The results of the study showed that the sensitivity of 11.67% and 100% precision for the low risk was recorded for both cases, specificity of 41.67% compared to 48.33% for the moderate risk, while there was 0% and 13.33% for the high risk. In conclusion, this model will help the doctor to know what course of preventive actions for a patient with high risk and what advice to give to those with low and moderate risk so that the occurrences of the diseases can be prevented altogether and thereby reducing the number of people dying from Type 2 Diabetes Mellitus diseases worldwide.

DiabCare Asia 2012: diabetes management, control, and complications in patients with type 2 diabetes in Indonesia

BACKGROUND Indonesia was a part of the most recent edition of DiabCare Asia held in 2008. DiabCare Asia 2012 is modeled after a similar project to provide the latest information to facilitate healthcare policymaking in this area.METHODS This was an observational, non-interventional, cross-sectional study of patients with type 2 diabetes mellitus from primary, secondary, and tertiary care centers in Indonesia. Patient data collected included demography, medical history complications, eye and foot examinations, diabetes management, and most recent laboratory investigations. Blood samples were collected from all patients for the analysis of glycated hemoglobin (HbA1c).RESULTS A total of 1,967 patients participated in the study, with a mean (SD) age of 58.4 (9.5) years and a median (range) duration of diabetes 6.0 (0.1−47.0) years. The percentage of patients with HbA1c <7.0% was 30.8% and the mean (SD) HbA1c level was 8.3 (2.2%). The proportion of patients using insulin was 34.7% with a mean (SD) total daily dose of 37.9 (24.1) IU. The most common diabetes-related complications were peripheral neuropathy (59.1%), erectile dysfunction (32.4%), and eye complications (29.1%).CONCLUSIONS Glycemic and metabolic control remain unsatisfactory in type 2 diabetes patients in Indonesia. Efforts are needed to optimize control and prevent complications in these patients.

Prevalence and correlates of diabetes and its comorbidities in four Gulf Cooperation Council countries: evidence from the World Health Survey Plus

BACKGROUND

The Gulf Cooperation Council countries are witnessing unprecedented changes due to fast economic development and population growth. The aims of this study were twofold: first, to estimate the prevalence of diabetes and its comorbidities; second, to examine the association of sociodemographic risk factors and healthcare service utilisation with diabetes.

METHODS

Data from the World Health Survey Plus (WHS+) from Kuwait, Oman, Saudi Arabia and the United Arab Emirates were used. The WHS+ is a nationally representative household survey of the adult population, conducted between 2008 and 2009. Both logistic regression and zero-inflated Poisson models were applied to examine the associations of risk factors, comorbidity and treatment with self-reported diabetes.

RESULTS

The highest level of diabetes was observed in Kuwait, with 40.8% among the oldest age group. High body mass index, older age and low education were all associated with diabetes in all settings. High levels of comorbidity existed within the diabetic population. Over 50% of diabetics in all countries reported having at least one chronic condition. In Kuwait and Saudi Arabia, one in five diabetics reported having two or more comorbidities. Treatment prevalence was above 80% across all sociodemographic categories.

CONCLUSION

The burden of diabetes, although high, is not uniform across populations in the four Gulf countries. Differential exposure to risk, such as unhealthy lifestyles, may be creating a disadvantage for certain populations and influencing the co-occurrence of chronic conditions. In response, a multifaceted and patient-centred approach is needed at all levels of healthcare to control and prevent non-communicable diseases.

Disease characteristics and treatment of patients with diabetes mellitus attending government health services in Indonesia, Peru, Romania and South Africa

OBJECTIVE

To describe the characteristics and management of Diabetes mellitus (DM) patients from low- and middle-income countries (LMIC).

METHODS

We systematically characterised consecutive DM patients attending public health services in urban settings in Indonesia, Peru, Romania and South Africa, collecting data on DM treatment history, complications, drug treatment, obesity, HbA1c and cardiovascular risk profile; and assessing treatment gaps against relevant national guidelines.

RESULTS

Patients (median 59 years, 62.9% female) mostly had type 2 diabetes (96%), half for >5 years (48.6%). Obesity (45.5%) and central obesity (females 84.8%; males 62.7%) were common. The median HbA1c was 8.7% (72 mmol/mol), ranging from 7.7% (61 mmol/mol; Peru) to 10.4% (90 mmol/mol; South Africa). Antidiabetes treatment included metformin (62.6%), insulin (37.8%), and other oral glucose-lowering drugs (34.8%). Disease complications included eyesight problems (50.4%), EGFR <60 ml/min (18.9%), heart disease (16.5%) and proteinuria (14.7%). Many had an elevated cardiovascular risk with elevated blood pressure (36%), LDL (71.0%) and smoking (13%), but few were taking antihypertensive drugs (47.1%), statins (28.5%) and aspirin (30.0%) when indicated. Few patients on insulin (8.0%), statins (8.4%) and antihypertensives (39.5%) reached treatment targets according to national guidelines. There were large differences between countries in terms of disease profile and medication use.

CONCLUSION

DM patients in government clinics in four LMIC with considerable growth of DM have insufficient glycaemic control, frequent macrovascular and other complications, and insufficient preventive measures for cardiovascular disease. These findings underline the need to identify treatment barriers and secure optimal DM care in such settings.

Self-management of type 2 diabetes in gulf cooperation council countries: A systematic review

Aims

This study aimed to systematically review intervention studies on self-management of type 2 diabetes in Gulf Cooperation Council (GCC) countries to determine the most effective self-management strategies for individuals with type 2 diabetes in this region.

Methods

A search strategy was developed using multiple databases: Medline and Embase (via Ovid), CINAHL (via EBSCO), and PubMed. Study and intervention characteristics, intervention structure, content, cultural adaptation, and outcomes were extracted from the included studies. To be included in the review the studies should have met the following criteria: have examined the effectiveness of at least one intervention involving a type 2 DSME programme, have involved participants over 18 years old diagnosed with type 2 diabetes, have taken place to in a GCC country, have a study design that was observational, quasi-experimental or controlled, have reported at least one individual and have a quantitative outcome. A narrative data synthesis was used to describe the studies and comment on their methodological quality.

Results

Of the 737 retrieved papers, only eight met the inclusion criteria. Only one study was a randomised controlled trial. A statistically significant improvement in HbA1c was reported in five of the eight studies. There was a significant improvement in physical activity levels as reported in four of the eight studies. Only three studies referred to aspects of cultural design or adaptation of the intervention implemented.

Conclusions

Self-management interventions may have a positive impact on HbA1 levels in patients with type 2 diabetes in the GCC area. A greater emphasis placed on culturally appropriate self-management programmes may improve the effectiveness of self-management interventions for adults with type 2 diabetes in the GCC.

Prevalence of type 2 diabetes mellitus complications among palestinians with T2DM

AIMS

To assess the prevalence of microvascular and macrovascular complications of type 2 diabetes (T2DM) among Palestinians.

METHODS

1308 diagnosed T2DM attending four main Primary Health Care Clinics on the Southern West Bank of Palestine examined by a Mobile Diabetes Clinic team. All diabetes patients visiting the clinics during a one-month period for each clinic were included. Interviews, anthropometric measurements, physical examination, and laboratory tests: HbA1c, lipid profile, and kidney function tests analyzed in a central laboratory were obtained RESULTS: 1308 diabetes patients, including 839 females (64%), with a mean age of 57 years (SD=8.7), and mean diabetes duration 7.1 years(SD=6.25), participated. 95.3% presented as overweight (BMI >25kg/m²) or obese (BMI>30kg/m²) with mean BMI of 33.46 (SD=5.95). The mean HbA1c (tested in 1221 patients) was 9.21(SD=2). Only 16.1% had HbA1c <7.0%. Hypertension (blood pressure>140/90mmHg) were found in 23%, and dyslipidemia (total cholesterol>200mg/dl) was present in 37.3% of patients. 213(16.3%) had a history of the macrovascular disease (previous myocardial infarction or stroke), and 290 (25.9%) had microvascular complications. Moreover, 40 (4.9%) had advanced kidney disease with serum creatinine>1.4mg/dl.

CONCLUSIONS

The present cross-sectional study shows poor glycemic control in Palestine, while blood pressure and lipids are less poorly controlled. The study emphasizes the need to optimize the glucose-lowering treatment and to implement diabetes care program that could face the challenge of high uncontrolled diabetes as well as complications of diabetes.

An Audit of Insulin Usage and Insulin Injection Practices in a Large Indian Cohort

INTRODUCTION

Insulin remains the cornerstone of therapy in a substantial number of patients with type 2 diabetes mellitus (T2DM). Inadequate knowledge regarding insulin usage is likely to influence its acceptance and adherence, and outcome of therapy, underscoring great need to investigate knowledge, attitude, and practice of insulin usage in patients with T2DM.

METHODOLOGY

A cross-sectional registry-based retrospective study analyzed data collected from 748 respondents (male: 466, female: 282), mostly from high or middle economic status, who were enrolled as outpatient in a referral clinic during last 10 years (2006-2016), to assess the general characteristics of patients with type 2 diabetes and their baseline knowledge, attitude, and practice of insulin usage and injection practices.

RESULTS

Mean ± standard deviation (SD) of duration of diabetes was 12.24 ± 7.60 years and mean ± SD duration of insulin therapy was 3.42 ± 4.18 years, which was initiated after a mean ± SD diabetes duration of 8.80 ± 6.42 years. Mean insulin dose per kilogram of body weight/day was 0.51 ± 0.27 units. Total daily dose of insulin was 33.36 ± 18.44 units and number of injections/day (mean ± SD) was 2.06 ± 0.73. Among the respondents, 58.96% were on human insulin and 35.70% were on analog insulin. Pen devices were used by 66.08% of the population whereas 31.76% used insulin syringes. The prevalence of lipohypertrophy (LH) was 12.57%, which was significantly (P < 0.001) associated with wrong technique with regard to injection angle (10.45% vs. 23.02%), site of injection (7.00% vs. 30.51%), rotation of site of injection (0.88% vs. 17.66%), and reuse of needle (5.77% vs. 15.19%). LH was also significantly (P < 0.05) associated with the use of human (14.74%) compared to analog insulin (8.24%).

CONCLUSION

The current study highlights the unique patterns of insulin usage and associated high prevalence of LH among insulin users in India.