Burden of Hypertension and Diabetes among Urban Population Aged ≥ 60 years in South Delhi: A Community Based Study

Factors influencing medication adherence in co-morbid hypertension and diabetes patients: A scoping review

Introduction

Interest in medication adherence has expanded significantly, especially in relation to the management of hypertension or diabetes in recent years. A scoping review that focuses on medication adherence in the co-morbidity of hypertension and diabetes provides crucial guidance for effective management of these interrelated diseases.

Aim

To conduct a scoping review of factors associated with medication adherence among individuals with co-morbid hypertension and diabetes.

Methods

The evaluation was conducted in accordance with the PRISMA-ScR guidelines to ensure the quality of the study. We searched three databases (Scopus, CINAHL, Medline) and one search engine (Google Scholar) from April 2023 to July 2023 on studies related to medication adherence in co-morbid hypertension and diabetes. Except for reviews there were no restrictions on design, location, and time of study.

Results

In total, 972 studies that were not duplicated were obtained. After eligibility and screening procedures were completed, 31 articles were ultimately included in the scoping review. Medication adherence was significantly affected by patient, condition, therapy, socio-economic and health related factors. Intervention trials revealed that education and counselling by pharmacists, nurses, physicians, diabetes educators, community health workers and the use of telephone to motivate patients significantly improved medication adherence.

Conclusion

This review shows the intricate factors influencing medication adherence in patients with co-morbid hypertension and diabetes, emphasizing the need for tailored interventions involving healthcare professionals, policymakers, and researchers.

Predictors of Control Status of Hypertension in India: A Systematic Review and Meta-analysis

Predictors of hypertension (HTN) control status have not been well understood in India. This information is crucial for policymakers and program managers to devise newer HTN control strategies and implement relevant policies and programs. Therefore, we undertook this meta-analysis to estimate the effect of various factors on the control status of HTN in India. We systematically searched PubMed and Embase for observational studies and community-based trials published between April 2013 and March 2021 conducted among people (≥ 15 years) with hypertension in India. Quality of studies was assessed using Newcastle Ottawa (NO) scale. Meta-analysis was performed using random effects model. We reported the effect of various factors on the prevalence of controlled HTN using pooled odds ratio (OR) with 95% confidence interval (CI). Of the 842 studies screened, we analyzed nine studies that included 2,441 individuals. Based on the NO scale, majority (90%) of studies had a low risk of bias. The odds of having controlled HTN were significantly higher among women (OR 1.78, 95% CI 1.62-1.95), those aged > 45 years (OR 1.69, 95% CI 1.44-1.97), and those residing in urban parts of India (OR 1.74; 95% CI 1.48-2.03). These measures varied considerably across different regions of the country. Very few studies reported data on the relationship between behavioural risk factors of non-communicable diseases (NCDs) and HTN control status. We did not find any statistically significant differences between behavioural risk factors of NCDs and HTN control status. To improve HTN control in India, the ongoing/newer HTN control programs need to target men, those aged 15-45, and rural residents. Future studies on HTN control determinants should report disaggregated data and use standardized definitions for behavioral risk factors to enhance reliability and comprehensiveness of findings on the determinants of HTN control in future reviews.

Prevalence and risk factor of diabetes among the elderly people in West Bengal: evidence-based LASI 1st wave

BACKGROUND

The complication of Diabetes is one of the important health issues among the older adult population in any region. The higher risks of diabetes prevalence among older adult people in the countries was due to social-cultural changes such as increasing urbanization, dietary changes, without physical activity, and unhealthy lifestyle behavior. The present study examines the prevalence and associated risk factors of diabetes among older adults in the state of West Bengal.

METHODS

The first wave of the Longitudinal Ageing Study in India 2017-18 was used to achieve the study objectives. Descriptive statistics with multinomial logistic regression models were used to carry out crude and adjusted odds ratios with 95% confidence intervals and examine the associated risk factors of diabetes prevalence among older adults.

RESULTS

The findings of the study indicate that the overall prevalence of diabetes among the study participants was found to be 12.4% which was significantly higher in urban areas (19%) compare to rural areas (6%). The socio-economic and bio-demographic factors like educational status, richest background family, marital status, obesity, and family history of diabetes were significantly associated with higher risks of diabetes prevalence among the older adult population in West Bengal. The risks of diabetes in the richest adult people were significantly higher than in the poorest adult people (OR = 2.78; 95% CI: 1.974-3.917). The higher risks of diabetes mellitus among the richest wealthy people are because of lifestyle behavior, smoking, and tobacco consumption respectively.

CONCLUSION

The study needs to policy and awareness program to reduce economic inequality and prevention of diabetes care and treatment-seeking behavior, especially for the older adult population in West Bengal.

Socioeconomic impact and burden of hypertension in the Philippines projected in 2050

Hypertension has remained the number one cause of cardiovascular death in the Philippines for over three (3) decades. Despite this finding, the burden accounted for by hypertension is investigated to a lesser extent. We performed this study to determine the socioeconomic impact of hypertension in the Philippines, and it was projected in the next 30 years. We gathered primary data through interviews, Labor Force Survey (N = 806), and secondary data from various government published reports. The cost of illness (COI) was calculated using the direct morbidity and mortality costs. The impact (% of respondents) of uncontrolled hypertension on productivity at work showed the following; four (4) days missing work (72%) and ten (10) days lost of productivity (63%). The impact (% of respondents) of uncontrolled hypertension on productivity at home showed the following: six (6) days of household suspended (66%), eleven (11) days reduced household work (78%), and five (5) days affected social activity (60%). The productivity loss of premature mortality accounts for 17% of the total economic burden in 2020 and will increase to 20% by 2050. In 2020, 70% of the total economic burden was accounted for direct & indirect care. At its present value, the economic cost of hypertension is expected to increase from US$1 billion in 2020 to US$1.9 billion by 2050. The socioeconomic impact of uncontrolled hypertension in the Philippines was enormous, challenging, and overwhelming for the next 30 years.

Prevalence, Awareness, Treatment and Control of Diabetes in India From the Countrywide National NCD Monitoring Survey

Background

To determine the prevalence, awareness, treatment and control of diabetes mellitus (DM) and associated factors amongst adults (18–69 years) in India from the National Noncommunicable Disease Monitoring Survey (NNMS).

Methods

NNMS was a comprehensive, cross-sectional survey conducted in 2017–18 on a national sample of 12,000 households in 600 primary sampling units. In every household, one eligible adult aged 18–69 years were selected. Information on NCD risk factors and their health-seeking behaviors were collected. Anthropometric measurements, blood pressure and fasting capillary blood glucose were measured. DM was defined as fasting blood glucose (FBG) ≥126 mg/dl including those on medication. Awareness, treatment, and control of DM were defined as adults previously diagnosed with DM by a doctor, on prescribed medication for DM, and FBG <126 mg/dl, respectively. The weighted data are presented as mean and proportions with 95% CI. We applied the Student t-test for continuous variables, Pearson's chi-square test for categorical variables and multivariate regression to determine the odds ratio. For statistical significance, a p-value < 0.05 was considered.

Results

Prevalence of DM and impaired fasting blood glucose (IFG) in India was 9.3% and 24.5% respectively. Among those with DM, 45.8% were aware, 36.1% were on treatment and 15.7% had it under control. More than three-fourths of adults approached the allopathic practitioners for consultation (84.0%) and treatment (78.8%) for diabetes. Older adults were associated with an increased risk for DM [OR 8.89 (95% CI 6.66–11.87) and were 16 times more aware of DM. Better awareness, treatment and control levels were seen among adults with raised blood pressure and raised cholesterol.

Conclusions

The prevalence of DM and IFG is high among adults, while the levels of awareness, treatment and control are still low in India, and this varied notably between the age groups. Multifaceted approaches that include improved awareness, adherence to treatment, better preventive and counseling services are crucial to halt diabetes in India. Also, expanding traditional systems of medicine (Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy [AYUSH]) into diabetes prevention and control practices open solutions to manage this crisis.

Prevalence of Diabetes and Its Relationship With Body Mass Index Among Elderly People in a Rural Area of Northeastern State of India

Background

Diabetes and its complications are a major public health concern in elderly populations. However, there is little population-based data on diabetes and its risk factors among the elderly population living in rural areas of India. The objective of this population-based study was to assess the prevalence of diabetes in the elderly population and its relationship with body mass index (BMI).

Methodology

A population-based, cross-sectional study was conducted among elderly individuals (≥60 years) during the period 2013-2016 in rural areas of Dibrugarh district of Assam. Multi-stage sampling design was adopted to select the study participants. Data on socio-demographic profile and diagnosis/treatment history of diabetes were collected using pre-designed and pre-tested questionnaire. Fasting blood sugar was tested. Weight and height were measured to calculate BMI. Multivariate logistic regression analysis was performed to assess the relationship between diabetes and BMI.

Results

Data were collected from 430 (male: 210, female: 220) individuals. The overall prevalence of diabetes was 7.9% (male: 7.1%, female: 8.6%). Higher level of education was associated with increased prevalence of diabetes. Prevalence of diabetes increased as the BMI of participants increased. Prevalence of diabetes among obese individuals (BMI ≥25 kg/m²) was 30.4% compared to only 5% among normal weight individuals. Obesity was associated with eight-fold higher risk of diabetes compared with the individuals of normal weight in multivariate analysis.

Conclusions

The study reveals nearly 8% population-based prevalence of diabetes in rural elderly people in the study district. Our study provides epidemiological evidence that obesity is a major driver of diabetes among rural elderly people.

Prevalence of diabetes and prediabetes in tribal population of Kashmir: Lessons for the future

AIMS

Considering a surge in the incidence of Diabetes mellitus (DM) across all ethnic groups and lack of any representative data from the tribal communities of Jammu and Kashmir, the present study aimed to assess the prevalence of DM and prediabetes in them.

METHODS

Subjects were recruited from five districts of Kashmir valley using multistage cluster sampling by probability proportional to size (PPS) technique. Data collection included recording of socio-demographic, medical facts, assessment of anthropometric parameters and biochemical evaluation HbA1c and random blood glucose measurements as per the American Diabetes Association (ADA) criteria were used for diagnosis of DM.

RESULTS

A total of 6808 subjects were recruited in this study including 2872 (42%) men and 3936 (58%) women with mean age of 39.60 ± 20.19 years and 35.17 ± 16.70 years, respectively. Around 8.60% subjects were obese, 38.9% were found to be hypertensive, 73% had dyslipidemia and 3.75% had metabolic syndrome. About 1.26% (0.5% males and 0.9% females) had DM and 11.64% had prediabetes based on HbA1c cut offs. Increasing age, body mass index and family history portend significant risk factors while smoking and sedentary lifestyle increased the risk marginally.

CONCLUSIONS

Although the prevalence of DM among tribals of Kashmir valley is lower than general population, the higher prediabetes to DM ratio may indicate a future trend of increasing DM prevalence in this disadvantageous subpopulation.

Prevalence, awareness, treatment, and control of diabetes and hypertension among elderly persons in a rural area of Ballabgarh, Haryana

BACKGROUND

In India, from 1971 to 2011, the proportion of elderly population has increased from 5.3% to 8.6%. According to the National Sample Survey, 60^th round (2004), out of every 1000 elderly persons living in rural India, 40 were estimated to be diabetic, and 36 were estimated to be hypertensive. The objective of the study was to find the prevalence of diabetes and hypertension in elderly persons in a rural area of Ballabgarh, Haryana, and to assess the awareness, treatment, and control among them.

METHOD

A total of 420 persons aged 60 years and above were selected by simple random sampling. House-to-house visit was done. A pretested interview schedule was administered. Blood pressure was measured using digital blood pressure machine. Two milliliters of venous blood was collected in vials for HbA1c estimation.

RESULTS

Of the 420 participants, 386 were available for blood pressure measurement, and 374 were available for HbA1c estimation. The prevalence of diabetes was 21.7%, and that of hypertension was 50.3%. Among diabetics, 45.7% were aware, of which, 94.6% were treated, and among them, 34.3% had their blood sugar under control. Among hypertensives, 58.8% were aware, of which, 96.5% were treated, and of the treated participants, 24.5% had controlled blood pressure.

CONCLUSION

The high prevalence, low awareness, and low proportion of controlled diseased population highlights the importance of strengthening primary care and improving awareness about diabetes and hypertension among elderly persons in rural areas.

Prevalence of hypertension, diabetes, and associated risk factors among geriatric population living in a high-altitude region of rural Uttarakhand, India

Background:

Hypertension (HTN) and diabetes mellitus (DM) both are rapidly emerging as public health problems among geriatric population in developing countries. HTN can lead to stroke, myocardial infarction, congestive heart failure, and chronic kidney diseases among geriatric population. DM increases the risk of coronary heart disease, cerebrovascular disease, peripheral vascular disease, retinopathy, nephropathy, and neuropathy among geriatric population.

Methodology:

A community-based, cross-sectional study was conducted during 2015–2016 in District Nainital, Uttarakhand. A list of all villages with their population in the district was developed. From this list, 30 villages were identified using population proportionate to size sampling method. From each village, 30 geriatric subjects were selected. A total of 1003 geriatric subjects age 60 years and above were included in the study. Data were collected on sociodemographic profile, blood pressure, fasting blood glucose, anthropometry, and lipid profile from all the enrolled subjects. The prevalence of HTN and DM was assessed. Univariate and multivariate analyses were done to identify risk factors associated with HTN and DM.

Results:

The prevalence of HTN and DM was found to be 54.5% and 14.6%, respectively. For HTN, advancing age, high educational level and body mass index (BMI) (≥25 kg/m²) and for DM higher education level and BMI (≥25 kg/m²) were found to be significant risk factors.

Conclusion:

A high prevalence of HTN and DM was found in geriatric population residing in rural area of Uttarakhand.

Alarmingly high prevalence of hypertension and pre-hypertension in North India-results from a large cross-sectional STEPS survey

OBJECTIVES

The study was primarily aimed at estimating the prevalence of hypertension and pre-hypertension and the risk factors of hypertension in the North Indian state of Punjab. It also aimed at assessing the magnitude of undiagnosed cases of hypertension in the community and ascertaining the blood pressure control status of those on treatment.

METHODS

A non-communicable disease risk factor survey (based on WHO-STEPS approach) was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals. The study subjects were administered the WHO STEPS-questionnaire and also underwent anthropometric and blood pressure measurements.

RESULTS

Overall prevalence of HTN among the study participants was found out to be 40.1% (95% CI: 38.8-41.5%) whereas prevalence of pre-hypertension, isolated diastolic and isolated systolic hypertension were 40.8% (39.5-42.2%), 9.2% (8.4-10.0%) and 6.5% (5.9-7.2%) respectively. Age group (45-69 years), male gender, social group, marital status, alcohol use, obesity and salt intake (> = 5 gms/day) were the risk factors significantly associated with HTN. Among all persons with HTN, only 30.1% were known case of HTN or on treatment, among whom nearly 61% had controlled blood pressure. Patients with uncontrolled BP were more frequently male, obese patients, with sedentary lifestyle and patients with diabetes.

CONCLUSIONS

The study reported alarmingly high prevalence of hypertension, especially of undiagnosed or untreated cases amongst the adult population, a significant proportion of whom have uncontrolled blood pressure levels. This indicates the need for systematic screening and awareness program to identify the undiagnosed cases in the community and offer early treatment and regular follow up.

Prevalence and risk factors of diabetes in a large community-based study in North India: results from a STEPS survey in Punjab, India

AIMS

India is the diabetes capital with home to 69.1 million people with DM, the second highest number of cases after China. Recent epidemiological evidence indicates a rising DM epidemic across all classes, both affluent and the poor in India. This article reports on the prevalence of diabetes and pre-diabetes in the North Indian state of Punjab as part of a large household NCD Risk Factor Survey.

METHODS

A household NCD STEPS survey was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals. All the subjects were administered the WHO STEPS questionnaire, anthropometric and blood pressure measurements. Every alternate respondent in the sample (n = 2499) was assayed for blood parameters.

RESULTS

Overall prevalence of DM among the study participants was found out to be 8.3% (95% CI 7.3-9.4%) whereas prevalence of prediabetes was 6.3% (5.4-7.3%). Age group (45-69 years), marital status, hypertension, obesity and family history of DM were found to be the risk factors significantly associated with DM. Out of all persons with DM, only 18% were known case of DM or on treatment, among whom only about one-third had controlled blood glucose status.

CONCLUSIONS

The study reported high prevalence of diabetes, especially of undiagnosed cases amongst the adult population, most of whom have uncontrolled blood sugar levels. This indicates the need for systematic screening and awareness program to identify the undiagnosed cases in the community and offer early treatment and regular follow up.