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Kengne AP, Ramachandran A. Feasibility of prevention of type 2 diabetes in low- and middle-income countries. Diabetologia 2024; 67:763-772. [PMID: 38355989 PMCID: PMC10954968 DOI: 10.1007/s00125-023-06085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/17/2023] [Indexed: 02/16/2024]
Abstract
Type 2 diabetes is a leading cause of global mortality and morbidity. Nearly 80% of individuals with diabetes live in low- and middle-income countries (LMICs), where nearly half of those with the condition remain undiagnosed. The majority of known cases have sub-optimal clinical outcomes. Moreover, large populations with impaired glucose tolerance and/or impaired fasting glucose contribute to the rapid increase in type 2 diabetes. Globally, priority should be given to limit the population with diabetes, especially in LMICs, alongside actions to optimise the care of people diagnosed with diabetes. Primary prevention studies in LMICs have generated evidence to show the efficacy and scalability of strategies to fully prevent or delay the development of diabetes in high-risk groups. However, these are mainly limited to certain countries in Asia, particularly China and India. The studies have indicated that prevention policies are effective in populations with a high risk of type 2 diabetes, and they also have long-term benefits, not only for the risk of type 2 diabetes but also for the risk of associated metabolic disorders, such as CVDs. For the effective conduct of national programmes, innovative mechanisms must be implemented, such as the use of information technology, joint efforts of multiple teams implementing similar programmes, and involvement of governmental and non-governmental partnerships. Continuous monitoring and long-term studies are required to assess the utility of these programmes. The effectiveness of such programmes in LMICs has not been proven over the longer term, except in China. Despite the available evidence, the feasibility of prevention strategies for type 2 diabetes in LMICs at population level remains an enigma. There remain challenges in the form of cultural, societal and economic constraints; insufficient infrastructure and healthcare capacity; and the non-fully elucidated natural history and determinants of type 2 diabetes in LMICs.
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Affiliation(s)
- Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University, Mthatha, South Africa.
| | - Ambady Ramachandran
- Indian Diabetes Research Foundation, Chennai, India
- Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
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Mukherjee S, Yadav P, Ray SK, Jadhav AA, Wakode SL. Clinical Risk Assessment and Comparison of Bias between Laboratory Methods for Estimation of HbA1c for Glycated Hemoglobin in Hyperglycemic Patients. Curr Diabetes Rev 2024; 20:e261023222764. [PMID: 37921160 DOI: 10.2174/0115733998257140231011102518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/28/2023] [Accepted: 08/25/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Hemoglobin A1c (HbA1c), also known as glycated hemoglobin, is a blood test used to evaluate and track a patient's blood sugar levels over the previous 2-3 months. We have compared the analytical performance of the D10 hemoglobin (HPLC) testing system to that of the immunoturbidimetric technique, which is a light-scattering immunoassay. OBJECTIVES To assess the clinical risk assessment between two methods (Compare the two Immunoturbidometric methods (AU680) vs. HPLC method (D10)) in hyperglycemic patients and assess the acceptability of the respective methods in the Clinical biochemistry laboratory. METHODS The charge of the globins in Hb was used as the basis for the HPLC method used to measure HbA1c. HPLC detects and quantifies even the tiniest Hb fractions and the full spectrum of Hb variants. HbA1c was measured using the immunoturbidimetric (AU 680 Beckmann coulter analyzer) and high-performance liquid chromatography (HPLC) techniques. Experiments also made use of immunoturbidimetric techniques (using an AU 680 Beckmann coulter analyzer equipment). RESULTS There is no statistically significant difference in HbA1c readings between male and female patients, as measured by either the Immunoturbidimetric or HPLC techniques. CONCLUSION The immunoturbidimetric and high-performance liquid chromatography techniques for estimating HbA1c yielded identical results. From the results of this study, we may deduce that both techniques are valid for estimating HbA1c. As a result, it may be suggested that both approaches can be used to estimate HbA1c in diabetic individuals.
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Affiliation(s)
- Sukhes Mukherjee
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
| | - Prasant Yadav
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
| | - Suman Kumar Ray
- Independent Researcher, Bhopal, Madhya Pradesh, 462020, India
| | - Ashish A Jadhav
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
| | - Santosh L Wakode
- Department of Physiology. All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
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Aydınkoç-Tuzcu K, Şat S, Berger F, Barakat A, Danquah I, Schindler K, Fasching P. [Diabetes and migration (update 2023)]. Wien Klin Wochenschr 2023; 135:286-306. [PMID: 37101050 DOI: 10.1007/s00508-023-02175-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
The practice recommendation is intended to supplement the existing guidelines on diabetes mellitus and provides practical recommendations for the diagnosis, therapy and care of people with diabetes mellitus who come from different linguistic and cultural back-grounds. The article deals with the demographic datas of migration in Austria and Germany; with therapeutic advice concerning drug therapy and diabetes education for patients with migration background. In this context socio-cultural spezifics are discussed. These suggestions are seen complementary to the general treatment guidelines of the Austrian Diabetes Society and German Diabetes Society. Especially for the fast months Ramadan thera are a lot of informations. The most important point is that the patient care must highly individualized and the management plan may differ for each patient.
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Affiliation(s)
- Kadriye Aydınkoç-Tuzcu
- AG Diabetes und Migranten der DDG, Berlin, Deutschland.
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich.
- AG Migration und Diabetes der ÖDG, Wien, Deutschland.
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Montlearstraße 37, 1160, Wien, Österreich.
| | - Sebahat Şat
- MVZ DaVita Rhein-Ruhr, Düsseldorf, Deutschland
- AG Diabetes und Migranten der DDG, Berlin, Deutschland
- MVZ DaVita Nieren- und Dialysezentrum, Bismarckstraße, Düsseldorf, Deutschland
| | - Faize Berger
- AG Diabetes und Migranten der DDG, Berlin, Deutschland.
- AG Diabetes und Migranten der DDG, Deutsche Diabetes Gesellschaft (DDG), Albrechtstr. 9, 10117, Berlin, Deutschland.
| | - Alain Barakat
- AG Diabetes und Migranten der DDG, Berlin, Deutschland
- Diabetes Zentrum Duisburg-Mitte DZDM, Duisburg, Deutschland
| | - Ina Danquah
- AG Diabetes und Migranten der DDG, Berlin, Deutschland
- Heidelberger Institut für Global Health (HIGH), Medizinische Fakultät und Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - Karin Schindler
- Universitätsklinik für Innere Medizin III, Klinische Abteilung für Endokrinologie und Stoffwechsel, Medizinische Universität Wien, Wien, Österreich
- AG Migration und Diabetes der ÖDG, Wien, Deutschland
| | - Peter Fasching
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
- AG Migration und Diabetes der ÖDG, Wien, Deutschland
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Diabetes und Migration. DIABETOLOGE 2022. [DOI: 10.1007/s11428-022-00865-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Soliman AT, De Sanctis V, Yassin M, Alshurafa A, Ata F, Nashwan A. Blood transfusion and iron overload in patients with Sickle Cell Disease (SCD): Personal experience and a short update of diabetes mellitus occurrence. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022291. [PMID: 36043959 PMCID: PMC9534241 DOI: 10.23750/abm.v93i4.13330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 01/26/2023]
Abstract
The conventional treatment of β-thalassemia (β-TM) patients is based on the correction of anemia through regular blood transfusions and iron chelation therapy. However, allogeneic hematopoietic stem cell transplantation (HSCT) remains the only currently available technique that has curative potential. Variable frequency and severity of long-term growth and endocrine changes after conventional treatment as well as after HSCT have been reported by different centers. The goal of this mini-review is to summarize and update knowledge about long-term growth and endocrine changes after HSCT in patients with β-TM in comparison to those occurring in β-TM patients on conventional treatment. Regular surveillance, early diagnosis, treatment, and follow-up in a multi-disciplinary specialized setting are suggested to optimize the patient's quality of life (www.actabiomedica.it).
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Affiliation(s)
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Mohamed Yassin
- Department of Hematology, Hamad Medical Center, Doha, Qatar
| | - Awni Alshurafa
- Department of Hematology, Hamad Medical Center, Doha, Qatar
| | - Fateen Ata
- Department of Hematology, Hamad Medical Center, Doha, Qatar
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Şat S, Aydınkoç-Tuzcu K, Berger F, Barakat A, Schindler K, Fasching P. Diabetes und Migration. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1507-2545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sebahat Şat
- MVZ DaVita Rhein-Ruhr, Düsseldorf
- AG Diabetes und Migranten der DDG
| | - Kadriye Aydınkoç-Tuzcu
- AG Diabetes und Migranten der DDG
- Wilhelminenspital der Stadt Wien, 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wien
- AG Migration und Diabetes der ÖDG
| | | | - Alain Barakat
- AG Diabetes und Migranten der DDG
- Diabetes Zentrum Duisburg-Mitte DZDM
| | - Karin Schindler
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Endokrinologie und Stoffwechsel, Wien
- AG Migration und Diabetes der ÖDG
| | - Peter Fasching
- Wilhelminenspital der Stadt Wien, 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wien
- AG Migration und Diabetes der ÖDG
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Niwaha AJ, Rodgers LR, Greiner R, Balungi PA, Mwebaze R, McDonald TJ, Hattersley AT, Shields BM, Nyirenda MJ, Jones AG. HbA1c performs well in monitoring glucose control even in populations with high prevalence of medical conditions that may alter its reliability: the OPTIMAL observational multicenter study. BMJ Open Diabetes Res Care 2021; 9:9/1/e002350. [PMID: 34535465 PMCID: PMC8451306 DOI: 10.1136/bmjdrc-2021-002350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/22/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The utility of HbA1c (glycosylated hemoglobin) to estimate glycemic control in populations of African and other low-resource countries has been questioned because of high prevalence of other medical conditions that may affect its reliability. Using continuous glucose monitoring (CGM), we aimed to determine the comparative performance of HbA1c, fasting plasma glucose (FPG) (within 5 hours of a meal) and random non-fasting glucose (RPG) in assessing glycemic burden. RESEARCH DESIGN AND METHODS We assessed the performance of HbA1c, FPG and RPG in comparison to CGM mean glucose in 192 Ugandan participants with type 2 diabetes. Analysis was undertaken in all participants, and in subgroups with and without medical conditions reported to affect HbA1c reliability. We then assessed the performance of FPG and RPG, and optimal thresholds, in comparison to HbA1c in participants without medical conditions thought to alter HbA1c reliability. RESULTS 32.8% (63/192) of participants had medical conditions that may affect HbA1c reliability: anemia 9.4% (18/192), sickle cell trait and/or hemoglobin C (HbC) 22.4% (43/192), or renal impairment 6.3% (12/192). Despite high prevalence of medical conditions thought to affect HbA1c reliability, HbA1c had the strongest correlation with CGM measured glucose in day-to-day living (0.88, 95% CI 0.84 to 0.91), followed by FPG (0.82, 95% CI 0.76 to 0.86) and RPG (0.76, 95% CI 0.69 to 0.81). Among participants without conditions thought to affect HbA1c reliability, FPG and RPG had a similar diagnostic performance in identifying poor glycemic control defined by a range of HbA1c thresholds. FPG of ≥7.1 mmol/L and RPG of ≥10.5 mmol/L correctly identified 78.2% and 78.8%, respectively, of patients with an HbA1c of ≥7.0%. CONCLUSIONS HbA1c is the optimal test for monitoring glucose control even in low-income and middle-income countries where medical conditions that may alter its reliability are prevalent; FPG and RPG are valuable alternatives where HbA1c is not available.
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Affiliation(s)
- Anxious J Niwaha
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
- NCD Theme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Lauren R Rodgers
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Rosamund Greiner
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Priscilla A Balungi
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
- NCD Theme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Raymond Mwebaze
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
| | - Timothy J McDonald
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Beverley M Shields
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Moffat J Nyirenda
- NCD Theme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- NCD Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Angus G Jones
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
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