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Devaraji V, Sivaraman J, Prabhu S. Large-scale computational screening of Indian medicinal plants reveals Cassia angustifolia to be a potentially anti-diabetic. J Biomol Struct Dyn 2024; 42:194-210. [PMID: 36961200 DOI: 10.1080/07391102.2023.2192886] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
Researchers are investigating the medicinal properties of herbal plants throughout the world, which often leads to the discovery of novel plants and their chemicals for prophylactic needs of humans. Natural phytochemicals continue to be sought as alternative treatments for various diseases because of their non-toxic and therapeutic properties. In recent years, computational phytochemistry has enabled large-scale screening of phytochemicals, enabling researchers to pursue a wide range of therapeutic research alternatives to traditional ethnopharmacology. We propose to identify an anti-diabetic plant by computational screening on Indian herbal plants in conjunction with experimental characterization and biological validation. The methodology involves the creation of an in-house Indian herbal plant database. Molecular docking is used to screen against alpha amylase for anti-diabetic prophylaxis. Cassia angustifolia was chosen because its phytochemicals are able to bind to alpha amylase. Plants were experimentally extracted, botanically studied and their biological activity was evaluated. Further, the use of molecular dynamics was then applied to pinpoint the phytochemicals responsible for the affinity of alpha amylase. Results in the phytochemical analysis of the extracts revealed strong presence of alkaloids, flavonoids and cardiac glycosides. Moreover, alpha amylase biological activity with C. angustifolia extracts of chloroform, hexane and ethyl acetate demonstrated activity of 3.26, 8.01 and 30.33 µg/ml validating computational predictions. In conclusion, this study developed, validated computational predictions of identifying potential anti-diabetic plants 'Cassia angustifolia' from house herbal databases. Hope this study shall inspire explore plant therapeutic repurposing using computational methods of drug discovery.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Vinod Devaraji
- Computational Drug Design Lab, Department of Biotechnology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Jayanthi Sivaraman
- Computational Drug Design Lab, Department of Biotechnology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - S Prabhu
- Department of Botany, Annai Vailankanni Arts and Science College, Thanjavur, India
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2
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Swaray SM, Tetteh J, Djonor SK, Ekem-Ferguson G, Clottey RY, Yacoba A, Yawson AE. Changes in trends and patterns of glycaemic control at Ghana's National Diabetes Management and Research Centre during the era of the COVID-19 pandemic. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002024. [PMID: 37315063 DOI: 10.1371/journal.pgph.0002024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/12/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Maintaining optimal glycaemic control (GC) delays the onset and progression of diabetes-related complications, especially microvascular complications. We aimed to establish the trend and pattern of GC, and its associated factors in persons living with diabetes (PLWD), and to examine the influence of COVID-19 on GC. METHODS A retrospective study involving secondary data from 2,593 patients' physical records from the National Diabetes Management and Research Centre (NDMRC) in Accra, extracted from 2015-2021. Growth rate of GC was assessed, and ordinal logistic and Poisson models weighted with Mahalanobis distance matching within propensity caliper were adopted to assess the impact of COVID-19 pandemic on GC. Stata 16.1 was utilized and the significant value set as p≤0.05. RESULTS GC pattern indicated a steady deterioration ranging from 38.6% (95%CI = 34.5-42.9) in 2015 to 69.2% (95%CI = 63.5-74.4) in 2021. The overall growth from 2015-2021 was 8.7%. Being a woman and increasing diastolic pressure significantly increase the likelihood of poor glycaemic control (PGC) by 22% and 25%, respectively compared with their respective counterparts [aOR(95%CI = 1.01-1.46 and 1.25(1.10-1.41), respectively]; whilst lower age increased the risk of PGC throughout the years. We found that risk of PGC during the era of COVID-19 was approximately 1.57(95%CI = 1.08-2.30) times significant, whilst the adjusted prevalence ratio (aPR) of PGC during the era of COVID-19 was approximately 64% significantly higher than the era without COVID-19 (aPR = 1.64, 95%CI = 1.10-2.43). CONCLUSION GC worsened from 2015-2021, especially during the COVID era. Younger age, uncontrolled blood pressure and/or being a woman were associated with PGC. The NDMRC and other centres that provide specialist healthcare in resource-limited settings, must determine the factors that militate against optimal service delivery in the era of the COVID-19 pandemic, and implement measures that would improve resilience in provision of essential care in the face of shocks.
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Affiliation(s)
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - George Ekem-Ferguson
- National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Psychiatry, Korle Bu Teaching Hospital, Accra, Ghana
| | - Ruth Yawa Clottey
- National Diabetes Management and Research Centre, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Atiase Yacoba
- National Diabetes Management and Research Centre, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Medicine & Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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Maxey J, Gupta A, Houchens N. Quality and safety in the literature: April 2023. BMJ Qual Saf 2023; 32:235-240. [PMID: 36931631 DOI: 10.1136/bmjqs-2023-015977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Jordan Maxey
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Akalu Y, Yeshaw Y, Tesema GA, Tiruneh SA, Teshale AB, Angaw DA, Gebrie M, Dagnew B. Suboptimal blood pressure control and its associated factors among people living with diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis. Syst Rev 2022; 11:220. [PMID: 36243876 PMCID: PMC9569048 DOI: 10.1186/s13643-022-02090-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Suboptimal blood pressure control among people living with diabetes mellitus (DM) is one of the primary causes of cardiovascular complications and death in sub-Saharan Africa (SSA). However, there is a paucity of evidence on the prevalence and associated factors of suboptimal blood pressure control in SSA. Therefore, this review aimed to estimate its pooled prevalence and associated factors among people living with DM in SSA. METHODS: We systematically searched PubMed, African Journals OnLine, HINARI, ScienceDirect, Google Scholar, and direct Google to access observational studies conducted in SSA. Microsoft Excel spreadsheet was used to extract the data, which was exported into STATA/MP version 16.0 for further analyses. Heterogeneity across studies was checked using Cochran's Q test statistics and I2 test, and small study effect was checked using Funnel plot symmetry and Egger's statistical test at a 5% significant level. A random-effects model was used to estimate the pooled prevalence and associated factors of suboptimal blood pressure control at a 95% confidence interval (CI) and significance level of p < 0.05. RESULTS Of the 7329 articles retrieved, 21 articles were eligible for the meta-analysis. After performing random-effects model, the pooled prevalence of suboptimal blood pressure control was 69.8% (95% CI: 63.43, 76.25%). Poor adherence to antihypertensive treatment (OR = 1.7; 95% CI: 1.03-2.80, I2 = 0.0%, p = 0.531) and overweight (OR = 2.4, 95% CI: 1.57-3.68, I2 = 0.00%, p = 0.47) were significantly associated with suboptimal blood pressure control. CONCLUSIONS The prevalence of suboptimal blood pressure control among diabetic patients in SSA was high, and poor adherence to antihypertensive treatment and overweight were significantly associated with suboptimal blood pressure control. Hence, there is an urgent need for initiatives to improve and control hypertension, and preventive measures should concentrate on modifiable risk factors. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020187901.
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Affiliation(s)
- Yonas Akalu
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia.
| | - Yigizie Yeshaw
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia.,Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Misganew Gebrie
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Baye Dagnew
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
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Saleh S, George J, Kott KA, Meikle PJ, Figtree GA. The Translation and Commercialisation of Biomarkers for Cardiovascular Disease—A Review. Front Cardiovasc Med 2022; 9:897106. [PMID: 35722087 PMCID: PMC9201254 DOI: 10.3389/fcvm.2022.897106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
As a leading cause of mortality and morbidity worldwide, cardiovascular disease and its diagnosis, quantification, and stratification remain significant health issues. Increasingly, patients present with cardiovascular disease in the absence of known risk factors, suggesting the presence of yet unrecognized pathological processes and disease predispositions. Fortunately, a host of emerging cardiovascular biomarkers characterizing and quantifying ischaemic heart disease have shown great promise in both laboratory settings and clinical trials. These have demonstrated improved predictive value additional to widely accepted biomarkers as well as providing insight into molecular phenotypes beneath the broad umbrella of cardiovascular disease that may allow for further personalized treatment regimens. However, the process of translation into clinical practice – particularly navigating the legal and commercial landscape – poses a number of challenges. Practical and legal barriers to the biomarker translational pipeline must be further considered to develop strategies to bring novel biomarkers into the clinical sphere and apply these advances at the patient bedside. Here we review the progress of emerging biomarkers in the cardiovascular space, with particular focus on those relevant to the unmet needs in ischaemic heart disease.
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Affiliation(s)
- Soloman Saleh
- Cardiothoracic and Vascular Health, Kolling Institute of Medical Research, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jacob George
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Katharine A. Kott
- Cardiothoracic and Vascular Health, Kolling Institute of Medical Research, Sydney, NSW, Australia
- Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Peter J. Meikle
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Gemma A. Figtree
- Cardiothoracic and Vascular Health, Kolling Institute of Medical Research, Sydney, NSW, Australia
- Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- *Correspondence: Gemma A. Figtree
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6
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Midthassel TC, Hansen AH. Are lifestyle changes from online information associated with discussing the information with a doctor? A cross -sectional study. PLoS One 2022; 16:e0261471. [PMID: 34972136 PMCID: PMC8719672 DOI: 10.1371/journal.pone.0261471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 12/02/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The prevalence of diabetes and the use of electronic health (eHealth) are increasing. Lifestyle changes in a positive direction may reduce morbidity and mortality in patients with diabetes. The main objective of this study was to test the association between lifestyle changes based on online information seeking and discussing the information with a doctor. METHODS In this cross-sectional study we used e-mail survey data from 1250 members of The Norwegian Diabetes Association, collected in 2018. Included in the analyses were 847 men and women aged 18 to 89 years diagnosed with diabetes and who reported use of eHealth within the previous year. We used descriptive statistics to estimate lifestyle changes based on information from the internet. Logistic regressions were used to estimate the associations between lifestyle changes after online information seeking and discussing the information with a doctor. Analyses were adjusted for gender, age, education, and self-rated health. RESULTS Lifestyle changes accomplished after online information seeking was reported by 46.9% (397/847) of the participants. The odds of changing lifestyle were more than doubled for those who had discussed information from the internet with a doctor (odds ratio 2.54, confidence interval 1.90-3.40). The odds of lifestyle changes were lower in the age groups 30-39 years and 60 years and over, compared to those aged 18-29 years (the reference group). Lifestyle changes were not associated with gender, education, or self-rated health. CONCLUSIONS Our findings indicate that health-care professionals can play an important role in lifestyle changes additional to health-advice found on the internet. This study underlines the importance of easily accessible high-quality online information, as well as the importance of making room for discussing lifestyle in the clinical encounter.
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Affiliation(s)
- Tiki Celine Midthassel
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Helen Hansen
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- University Hospital of North Norway, Tromsø, Norway
- * E-mail: ,
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7
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Spencer S, Chung JR, Belongia EA, Sundaram M, Meece J, Coleman LA, Zimmerman RK, Nowalk MP, Moehling Geffel K, Ross T, Carter CE, Shay D, Levine M, Liepkalns J, Kim JH, Sambhara S, Thompson MG, Flannery B. Impact of diabetes status on immunogenicity of trivalent inactivated influenza vaccine in older adults. Influenza Other Respir Viruses 2021; 16:562-567. [PMID: 34859584 PMCID: PMC8983908 DOI: 10.1111/irv.12933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022] Open
Abstract
Individuals with type 2 diabetes mellitus experience high rates of influenza virus infection and complications. We compared the magnitude and duration of serologic response to trivalent influenza vaccine in adults aged 50–80 with and without type 2 diabetes mellitus. Serologic response to influenza vaccination was similar in both groups: greater fold‐increases in antibody titer occurred among participants with lower pre‐vaccination antibody titers. Waning of antibody titers was not influenced by diabetes status.
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Affiliation(s)
- Sarah Spencer
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessie R Chung
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Edward A Belongia
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Maria Sundaram
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Jennifer Meece
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Laura A Coleman
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland.,Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Richard K Zimmerman
- Schools of Medicine Department of Family Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Patricia Nowalk
- Schools of Medicine Department of Family Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Krissy Moehling Geffel
- Schools of Medicine Department of Family Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ted Ross
- Center for Vaccines and Immunology, Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA.,Schools of Medicine Department of Family Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chalise E Carter
- Center for Vaccines and Immunology, Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA.,Schools of Medicine Department of Family Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Shay
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min Levine
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Justine Liepkalns
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Department of Biology, University of Washington, Seattle, Washington, USA
| | - Jin Hyang Kim
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Translational Medicine, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Suryaprakash Sambhara
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark G Thompson
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan Flannery
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Augusto GA, Cassola N, Dualib PM, Saconato H, Melnik T. Sodium-glucose cotransporter-2 inhibitors for type 2 diabetes mellitus in adults: An overview of 46 systematic reviews. Diabetes Obes Metab 2021; 23:2289-2302. [PMID: 34142426 DOI: 10.1111/dom.14470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 12/11/2022]
Abstract
AIMS To summarize the evidence from systematic reviews (SRs) of randomized controlled trials (RCTs) evaluating the efficacy and safety of sodium-glucose cotransporter-2 (SGLT2) inhibitors versus placebo or active comparators for type 2 diabetes mellitus. MATERIALS AND METHODS We searched six databases between 2014 and 2021. We assessed the quality of evidence using Assessment of Multiple Systematic Reviews (AMSTAR 2) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) and summarized the main outcome results according to their evidence of benefit (PROSPERO ID: CRD42019132431). RESULTS We included 46 SRs, comprising 175 RCTs and 136 096 participants. The results showed "clear evidence of benefit" in relation to: myocardial infarction (odds ratio [OR]/hazard ratio [HR] 0.85 to 0.91); cardiovascular mortality (OR/HR 0.67 to 0.86); heart failure (OR/HR 0.64 to 0.69); albuminuria progression and composite renal outcome (relative risk [RR]/HR 0.55 to 0.63); glycated haemoglobin (HbA1c) versus placebo (mean difference [MD] -0.49% to -0.77% [5.4 to 8.4 mmol/mol]); and weight versus placebo (MD -1.09 kg to -2.99 kg). "Possible benefit" was observed in relation to major adverse cardiovascular events (OR/HR 0.80 to 0.89), all-cause mortality and nonalcoholic fatty liver disease. SGLT2 inhibitors showed "clear evidence of no effect or equivalence" in relation to stroke and fractures. "Clear evidence of harm" was observed in relation to genital infections (RR/OR 2.06 to 5.25) and ketoacidosis (HR/OR 1.36 to 2.20). Regarding amputation risk and urinary tract infections, we found "no conclusions possible due to lack of evidence". CONCLUSIONS Our results showed that SGLT2 inhibitors have beneficial effects in relation to renal and cardiovascular outcomes (except for stroke), HbA1c and weight. Further studies are needed to assess urinary infections and amputation risk.
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Affiliation(s)
- Gustavo A Augusto
- Brazilian Cochrane Centre, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Nicolle Cassola
- Brazilian Cochrane Centre, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Patrícia M Dualib
- Diabetes Centre of the Endocrinology Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Humberto Saconato
- Brazilian Cochrane Centre, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Tamara Melnik
- Brazilian Cochrane Centre, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil
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9
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Ngassa Piotie P, Webb EM, Rheeder P. Suboptimal control for patients with type 2 diabetes in the Central Chronic Medicine Dispensing programme in South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e7. [PMID: 33764132 PMCID: PMC8063568 DOI: 10.4102/phcfm.v13i1.2648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In South Africa, the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme allows stable patients with non-communicable diseases, including type 2 diabetes mellitus (T2DM), to collect their medication from a pick-up location near their home, thus avoiding long waiting times and travel expenses. The CCMDD programme aims at improving patient retention and adherence through better access to medicines, resulting in better health outcomes. AIM We assessed whether patients with T2DM enrolled in CCMDD achieved the recommended targets for glycaemic, blood pressure (BP) and lipid control. SETTING City of Tshwane, South Africa. METHODS We reviewed the records of 198 T2DM patients enrolled in CCMDD and assessed their control of haemoglobin A1c (HbA1c), BP and lipids. RESULTS Most of the records reviewed belonged to women (64.7%), African (89.9%), hypertensive (82.7%) and to patients exclusively on oral antidiabetic agents (98.5%). Patients were, on average, 57.7 (s.d. = 12.1) years old and had participated in the CCMDD programme for, on average, 2 years. The mean HbA1c was 8% (s.d. = 2). Glycaemic control was achieved by only 29.2% of patients, and 49% of patients had HbA1c between 7% and 9%. Ninety-three patients (66%) had achieved the total cholesterol target, 57.4% achieved BP targets and 6.9% had achieved the low-density lipoprotein cholesterol target. CONCLUSION A small group of patients achieved the targets for glycaemic, BP and lipid control. Despite improved accessibility to medication, the CCMDD is not synonymous of improved clinical outcomes. Future research should ascertain the factors associated with suboptimal control for these patients.
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Affiliation(s)
- Patrick Ngassa Piotie
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria.
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10
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Baranwal JK, Maskey R, Chaudhari RK, Sherchand O. Assessment of Achievement of American Diabetes Association (ADA) Targets in Patients with Type 2 Diabetes Mellitus at a Tertiary Care Centre in Eastern Nepal. Diabetes Metab Syndr Obes 2020; 13:2959-2964. [PMID: 32943892 PMCID: PMC7468501 DOI: 10.2147/dmso.s262643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/07/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Management of type 2 diabetes is not limited to blood glucose control, it also addresses blood pressure and lipid levels in order to prevent associated vascular complications and improve the chances of survival and quality-of-life. Although the American Diabetes Association (ADA) has lain specific target levels for glycated hemoglobin, blood pressure and serum low density cholesterol to be achieved by non-pregnant patients with type 2 diabetes mellitus, these are not being achieved in practice. We took on this study to describe the extent of ADA target achievement at our center. METHODS We analyzed data of type 2 diabetes patients who attended the endocrinology clinic at our hospital within the past 1 year from the start of the study. Data of the pregnant women and patients with mentions of conditions that might interfere with measurement of HbA1c were excluded. RESULTS We analyzed 336 records, 45.8% (n=154) males and 54.16% (n=182) females. The mean age of patients was 52.28±11.9 years. The percentages of patients who had HbA1c <7%, blood pressure <140/90 mm of Hg, and LDL-c <100 mg/dL were 56.5%, 72%, and 56.3%, respectively. Only 37.8% of patients were found to have achieved all three ADA targets. Our findings show that a higher percentage of patients who were ≥50 years of age met LDL-c goals as compared to those <50 years of age, 61.9% vs 49% (P<0.05) and that blood pressure control was better among younger age group, 78.9% vs 66.7% (P<0.05). CONCLUSION Our study highlights that a significant proportion of patients missed on achieving the ADA targets. This is worrisome and further studies should be done to find out possible reasons behind this.
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Affiliation(s)
- Jouslin K Baranwal
- Department of Biochemistry, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Robin Maskey
- Department of Internal Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rajendra K Chaudhari
- Department of Biochemistry, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Ojaswee Sherchand
- Department of Biochemistry, B.P Koirala Institute of Health Sciences, Dharan, Nepal
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11
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Godman B, Basu D, Pillay Y, Mwita JC, Rwegerera GM, Anand Paramadhas BD, Tiroyakgosi C, Okwen PM, Niba LL, Nonvignon J, Sefah I, Oluka M, Guantai AN, Kibuule D, Kalemeera F, Mubita M, Fadare J, Ogunleye OO, Distiller LA, Rampamba EM, Wing J, Mueller D, Alfadl A, Amu AA, Matsebula Z, Kalungia A, Zaranyika T, Masuka N, Wale J, Hill R, Kurdi A, Timoney A, Campbell S, Meyer JC. Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future. Front Pharmacol 2020; 11:108. [PMID: 32265688 PMCID: PMC7098994 DOI: 10.3389/fphar.2020.00108] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention. Objective Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases. Our Approach Contextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance. Ongoing Activities A number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities. Conclusion There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Yogan Pillay
- HIV & AIDS, TB and Maternal, Child and Women's Health, National Department of Health, Pretoria, South Africa
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | | | - Celda Tiroyakgosi
- Botswana Essential Drugs Action Program, Ministry of Health and Wellness, Gaborone, Botswana
| | - Patrick Mbah Okwen
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Department of Public Health, University of Bamenda, Bambili, Cameroon
| | | | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Anastasia N Guantai
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Larry A Distiller
- Centre for Diabetes & Endocrinology (Pty) Ltd, Johannesburg, South Africa
| | - Enos M Rampamba
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Pharmacy, Tshilidzini Regional Hospital, Limpopo Department Of Health, Shayandima, South Africa
| | - Jeffrey Wing
- School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Debjani Mueller
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.,Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health, Khartoum, Sudan.,Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | | | | | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Nyasha Masuka
- Independent Health Systems Consultant, Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, United Kingdom
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Angela Timoney
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,NHS Lothian Director of Pharmacy, NHS Lothian, Edinburgh, United Kingdom
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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12
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Van den Bulck SA, Vankrunkelsven P, Goderis G, Broekx L, Dreesen K, Ruijten L, Mpoukouvalas D, Hermens R. Development of quality indicators for type 2 diabetes, extractable from the electronic health record of the general physician. A rand-modified Delphi method. Prim Care Diabetes 2020; 14:75-84. [PMID: 31204263 DOI: 10.1016/j.pcd.2019.05.002] [Citation(s) in RCA: 4] [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: 03/14/2019] [Revised: 05/01/2019] [Accepted: 05/12/2019] [Indexed: 11/17/2022]
Abstract
AIMS Type 2 diabetes mellitus is a worldwide cause of significant morbidity and mortality. The general physician (GP) plays an important role in managing this disease and the use of the electronic health record (EHR) can improve quality for type 2 diabetes care. We aimed to develop a set of evidence-based and EHR extractable quality indicators for type 2 diabetes, enabling an automated quality assessment. METHODS We used a Rand-modified Delphi method. Recommendations were selected from (inter)national guidelines using the 'SMART' principle and scored by a multidisciplinary expert panel. After analysis of the median score, prioritization and consensus, recommendations were discussed during a consensus meeting. A final validation round resulted in a core set of recommendations, which were transformed into quality indicators. RESULTS A total of 101 recommendations originating from 10 (inter)national guidelines were presented to the expert panel, which resulted in a core set of 50 recommendations that were merged and modified into 36 recommendations after the consensus meeting. The panel added 3 recommendations. This resulted in a final set of 39 quality indicators. CONCLUSIONS Our study presents a set of 39 quality indicators for type 2 diabetes in primary care that are EHR extractable, enabling automated quality assessment.
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Affiliation(s)
- Steve A Van den Bulck
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Patrik Vankrunkelsven
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Geert Goderis
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Lien Broekx
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Kathleen Dreesen
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Laura Ruijten
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Dimitri Mpoukouvalas
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Rosella Hermens
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Scientific Institute for Quality in Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
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13
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Yang L, Chen J, Lu H, Lai J, He Y, Liu S, Guo X. Pueraria lobatafor Diabetes Mellitus: Past, Present and Future. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2019; 47:1419-1444. [PMID: 31659910 DOI: 10.1142/s0192415x19500733] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Gegen (Radix Puerariae Lobatae), the root of Pueraria lobata, is an edible and medicinal herb which has been used in treating diabetic symptoms in the orient for thousands of years. We present an evidence map of the efficacy and safety of Gegen and Gegen formulas (GGFs) that use Gegen as an essential herb for diabetes, and also its mechanism of actions. We comprehensively searched the ancient medical records to identify empirical evidence; conducted a systematic review (SR) based on moderate- to high-quality randomized controlled trials (RCTs) to synthesize the clinical evidence; and reviewed the possible mechanisms of its antidiabetic effects. Empirical application of Gegen in treating diabetic symptoms dated back to more than 2000 years ago. Common herbs used in RCTs that accompany with Gegen included Radix et Rhizoma Glycyrrhizae, Radix et Rhizoma Ginseng, Rhizoma Dioscoreae, Poria, and Radix Ophiopogonis. The combinations used today are consistent with their usage in ancient times. Results of the SR showed that GGFs could benefit patients with type 2 diabetes for blood glucose control. When in combination with hypoglycemic agents or insulin, GGFs enhanced the glucose-lowering effect as well as the lipid-lowering effects. Also, the incidence and the risk of adverse events (AE), especially the hypoglycemic episodes, were lower in the combination group. No serious or life-threatening AE was reported. The experimental evidence presented that Gegen and GGFs might exert and enhance the anti-diabetic effects through activation of multiple mechanisms, such as reducing insulin resistance, increasing insulin release, inhibiting glucose absorption and reabsorption, and improving insulin sensitivity, glucose uptake, and metabolism.
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Affiliation(s)
- Lihong Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, P. R. China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, P. R. China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, P. R. China
| | - Jing Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, P. R. China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, P. R. China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, P. R. China
| | - Huanyu Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, P. R. China
| | - Jiaqi Lai
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, P. R. China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, P. R. China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, P. R. China
| | - Yihan He
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, P. R. China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, P. R. China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, P. R. China
| | - Shaonan Liu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, P. R. China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, P. R. China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, P. R. China
| | - Xinfeng Guo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, P. R. China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, P. R. China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, P. R. China
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14
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Mwita JC, Francis JM, Omech B, Botsile E, Oyewo A, Mokgwathi M, Molefe-Baikai OJ, Godman B, Tshikuka JG. Glycaemic, blood pressure and low-density lipoprotein-cholesterol control among patients with diabetes mellitus in a specialised clinic in Botswana: a cross-sectional study. BMJ Open 2019; 9:e026807. [PMID: 31340960 PMCID: PMC6661581 DOI: 10.1136/bmjopen-2018-026807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Control of glycaemic, hypertension and low-density lipoprotein-cholesterol (LDL-C) among patients with type 2 diabetes mellitus (T2DM) is vital for the prevention of cardiovascular diseases. The current study was an audit of glycaemic, hypertension and LDL-C control among ambulant patients with T2DM in Botswana. Also, the study aimed at assessing factors associated with attaining optimal glycaemic, hypertension and LDL-C therapeutic goals. DESIGN A cross-sectional study. SETTING A specialised public diabetes clinic in Gaborone, Botswana. PARTICIPANTS Patients with T2DM who had attended the clinic for ≥3 months between August 2017 and February 2018. PRIMARY OUTCOME MEASURE The proportion of patients with optimal glycaemic (HbA1c<7%), hypertension (blood pressure <140/90 mm Hg) and LDL-C (<1.8 mmol/L) control. RESULTS The proportions of patients meeting optimal targets were 32.3% for glycaemic, 54.2% for hypertension and 20.4% for LDL-C. Age≥ 50 years was positively associated with optimal glycaemic control (adjusted OR [AOR] 5.79; 95% CI 1.08 to 31.14). On the other hand, an increase in diabetes duration was inversely associated with optimal glycemic control (AOR 0.91; 95% CI 0.85 to 0.98). Being on an ACE inhibitor was inversely associated with optimal hypertension control (AOR 0.35; 95% CI 0.14 to 0.85). Being female was inversely associated with optimal LDL-C control (AOR 0.24; 95% CI (0.09 - 0.59). CONCLUSION Patients with T2DM in Gaborone, Botswana, presented with suboptimal control of recommended glycaemic, hypertension and LDL-C targets. These findings call for urgent individual and health systems interventions to address key determinants of the recommended therapeutic targets among patients with diabetes in this setting.
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Affiliation(s)
- Julius Chacha Mwita
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Joel M Francis
- Wits Reproductive Health and HIV Institute, Wits Health Consortium Pty Ltd, Johannesburg, South Africa
- Global Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Bernard Omech
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Elizabeth Botsile
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Aderonke Oyewo
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Matshidiso Mokgwathi
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Onkabetse Julia Molefe-Baikai
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Brian Godman
- Health Economics, University of Liverpool, Liverpool, UK
- Laboratory of Medicine, Division of Clinical Pharmacology, Karolinska Universitetssjukhuset, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Jose-Gaby Tshikuka
- Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Faculty of Health Sciences, National Pedagogical University, Kinshasa, Congo (the Democratic Republic of the)
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15
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Awadalla H, Noor SK, Elmadhoun WM, Almobarak AO, Elmak NE, Abdelaziz SI, Sulaiman AA, Ahmed MH. Diabetes complications in Sudanese individuals with type 2 diabetes: Overlooked problems in sub-Saharan Africa? Diabetes Metab Syndr 2017; 11 Suppl 2:S1047-S1051. [PMID: 28789834 DOI: 10.1016/j.dsx.2017.07.039] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is a major health problem in Sudan and is a leading cause of morbidity and mortality. The objective of this study is to determine the prevalence of complications of type 2 diabetes across different cities in the country. METHODS Individuals with type 2 diabetes, who have been on treatment for DM for at least one year and volunteered to participate, were selected from two diabetes centers in Sudan (Khartoum and Atbara). Participants were interviewed using standardized pretested questionnaire to record medical history, socio-demographic, life style characteristics and presence of complications of diabetes. RESULTS Four hundred and twenty four individuals with T2DM were included in this study (50.7% males and 49.3% females). Good glycemic control (HbA1c <7) was found in 15.7%. Hypertension was reported in 39.9% and myocardial infarction in 5.9%, while high cholesterol and triglyceride noted in 59.9%, 32.5% respectively. Low HDL was noted in 52.6%. Other complications like peripheral neuropathy, retinopathy and diabetic foot were observed in 68.2%, 72.6% and 12.7% respectively. Factors significantly associated with these complications were longer duration of diabetes (P<0.001), and living in urban areas (P<0.004). CONCLUSION High prevalence of complications of type 2 diabetes were observed especially in those with longer duration of diabetes and poor control.
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Affiliation(s)
- Heitham Awadalla
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
| | - Sufian K Noor
- Department of Medicine, Nile Valley University, Atbara, Sudan
| | | | - Ahmed O Almobarak
- Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Nehad E Elmak
- Public and Tropical Health Program, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Sulaf I Abdelaziz
- Department of Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Amel A Sulaiman
- Research & Information, Public Health Administration Unit- MOH, Qassim Region, Saudi Arabia
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK.
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16
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Kibirige D, Akabwai GP, Kampiire L, Kiggundu DS, Lumu W. Frequency and predictors of suboptimal glycemic control in an African diabetic population. Int J Gen Med 2017; 10:33-38. [PMID: 28260942 PMCID: PMC5325113 DOI: 10.2147/ijgm.s124548] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Persistent suboptimal glycemic control is invariably associated with onset and progression of acute and chronic diabetic complications in diabetic patients. In Uganda, studies documenting the magnitude and predictors of suboptimal glycemic control in adult ambulatory diabetic patients are limited. This study aimed at determining the frequency and predictors of suboptimal glycemic control in adult diabetic patients attending three urban outpatient diabetic clinics in Uganda. Methods In this hospital-based cross-sectional study, eligible ambulatory adult diabetic patients attending outpatient diabetic clinics of three urban hospitals were consecutively enrolled over 11 months. Suboptimal glycemic control was defined as glycated hemoglobin (HbA1c) level ≥7%. Multivariable analysis was applied to determine the predictors. Results The mean age of the study participants was 52.2±14.4 years, and the majority of them were females (283, 66.9%). The median (interquartile range) HbA1c level was 9% (6.8%–12.4%). Suboptimal glycemic control was noted in 311 study participants, accounting for 73.52% of the participants. HbA1c levels of 7%–8%, 8.1%–9.9%, and ≥10% were noted in 56 (13.24%), 76 (17.97%), and 179 (42.32%) study participants, respectively. The documented predictors of suboptimal glycemic control were metformin monotherapy (odds ratio: 0.36, 95% confidence interval: 0.21–0.63, p<0.005) and insulin therapy (odds ratio: 2.41, 95% confidence interval: 1.41–4.12, p=0.001). Conclusion Suboptimal glycemic control was highly prevalent in this study population with an association to metformin monotherapy and insulin therapy. Strategies aimed at improving glycemic control in diabetes care in Uganda should be enhanced.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine/Diabetic and Hypertension Clinics, Our Lady of Consolota Hospital, Kisubi
| | | | | | | | - William Lumu
- Department of Medicine and Diabetes/Endocrine Unit, Mengo Hospital, Mengo, Uganda
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17
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Huayanay-Espinoza IE, Guerra-Castañon F, Lazo-Porras M, Castaneda-Guarderas A, Thomas NJ, Garcia-Guarniz AL, Valdivia-Bustamante AA, Málaga G. Metabolic control in patients with type 2 diabetes mellitus in a public hospital in Peru: a cross-sectional study in a low-middle income country. PeerJ 2016; 4:e2577. [PMID: 27761351 PMCID: PMC5068371 DOI: 10.7717/peerj.2577] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/16/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess patients' achievement of ADA (American Diabetes Association) guideline recommendations for glycosylated hemoglobin, lipid profile, and blood pressure in a type 2 diabetes mellitus (T2DM) outpatient clinic in a low-middle income country (LMIC) setting. METHODS This is a descriptive cross-sectional study with 123 ambulatory T2DM patients who are being treated at a public hospital in Lima, Peru. Data was gathered via standardized interviews, clinical surveys, and anthropomorphic measurements for each patient. Blood samples were drawn in fasting state for measures of glucose, glycosylated hemoglobin (HbA1c), and lipid profile. Laboratory parameters and blood pressure were evaluated according to ADA recommendations. RESULTS Of the 123 patients, 81 were women and the mean age was 61.8 years. Glycemic control was abnormal in 82 (68.33%) participants, and 45 (37.50%) were unable to control their blood pressure. Lipid profile was abnormal in 73 (60.83%) participants. Only nine (7.50%) participants fulfilled ADA recommendations for glycemic, blood pressure, and lipid control. CONCLUSIONS Amongst individuals with type 2 diabetes, there was poor attainment of the ADA recommendations (HbA1c, blood pressure and LDL-cholesterol) for ambulatory T2DM patients. Interventions are urgently needed in order to prevent long-term diabetic complications.
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Affiliation(s)
| | - Felix Guerra-Castañon
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Lazo-Porras
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ana Castaneda-Guarderas
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, United States
- Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | | | | | | | - Germán Málaga
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Medicine “Alberto Hurtado,” Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Internal Medicine, Hospital Cayetano Heredia, Lima, Peru
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