Prevalence and incidence of diabetic retinopathy in patients with diabetes of Latin America and the Caribbean: A systematic review and meta-analysis

OBJECTIVES

This systematic review aimed to assess the prevalence and incidence of diabetic retinopathy in patients with diabetes of Latin America and the Caribbean.

METHODS

We searched Web of Science (WoS)/Core Collection, WoS/MEDLINE, WoS/Scielo, Scopus, PubMed/Medline and Embase databases until January 16, 2023. We meta-analyzed prevalences according to type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).

RESULTS

Forty-three prevalence studies (47 585 participants) and one incidence study (436 participants) were included. The overall prevalence of retinopathy in patients with T1DM was 40.6% (95% CI: 34.7 to 46.6; I2: 92.1%) and in T2DM was 37.3% (95% CI: 31.0 to 43.8; I2: 97.7), but the evidence is very uncertain (very low certainty of evidence). In meta-regression, we found that age (T1DM) and time in diabetes (T2DM) were factors associated with the prevalence. On the other hand, one study found a cumulative incidence of diabetic retinopathy of 39.6% at 9 years of follow-up.

CONCLUSIONS

Two out of five patients with T1DM or T2DM may present diabetic retinopathy in Latin America and the Caribbean, but the evidence is very uncertain. This is a major public health problem, and policies and strategies for early detection and opportunely treatment should be proposed.

Prevalence of diabetic foot at risk of ulcer development and its components stratification according to the international working group on the diabetic foot (IWGDF): A systematic review with metanalysis

AIMS

To determine the overall prevalence of diabetic foot at risk according to the International Working Group on the Diabetic Foot stratification.

MATERIALS AND METHODS

We searched PubMed/Medline, Scopus, Web of Science, and Embase. We included cross-sectional studies or cohorts from 1999 to March 2022. We performed a meta-analysis of proportions using a random-effects model. We assessed heterogeneity through subgroup analysis by continent and other characteristics.

RESULTS

We included 36 studies with a total population of 11,850 people from 23 countries. The estimated overall prevalence of diabetic foot at risk was 53.2% (95% CI: 45.1-61.3), I2 = 98.7%, p < 0.001. In the analysis by subgroups, South and Central America had the highest prevalence and Africa the lowest. The factors explaining the heterogeneity were the presence of chronic kidney disease, diagnostic method for peripheral arterial disease, and quality. The estimates presented very low certainty of evidence.

CONCLUSIONS

The overall prevalence of diabetic foot at risk is high. The high heterogeneity between continents can be explained by methodological aspects and the type of population. However, using the same classification is necessary for standardization of the way of measuring the components, as well as better designed general population-based studies.

Green space exposure and type 2 diabetes mellitus incidence: A systematic review

INTRODUCTION

Epidemiological studies have suggested that exposure to green spaces is associated with a lower prevalence of diabetes. The aim of this systematic review was to summarize the evidence on green spaces and diabetes mellitus II (T2DM) in longitudinal studies.

METHODS

We searched PubMed, SCOPUS, Web of Science (WoS)/Core Collection, WoS/MEDLINE, and EMBASE until February 2023. We included cohort studies that assessed the incidence of T2DM according to the level of exposure to green spaces. Two authors independently performed study selection, data extraction, and analysis of risk of bias. No meta-analysis was performed due to clinical heterogeneity between studies.

RESULTS

We included 13 cohort studies with a sample size ranging from 1700 to 1 922 545 participants. Studies presented different ways of defining (quartiles, percentages) and measuring (tools, buffers) green spaces. Similarly, the definition of T2DM was heterogeneous (self-reports, medical records, clinical criteria). Twelve studies showed that individuals with higher exposure to green spaces had a decreased incidence of T2DM. Out of these 12 studies, 10 revealed statistically significant differences. All studies were of high methodological quality, except for one.

CONCLUSION

Our findings suggest that exposure to green space could be a protective factor for the development of T2DM. Promoting policies to preserve and increase green space could help to reduce T2DM at the community level. More standardization of green space exposure definition is needed in studies on green space and T2DM.

Prevalence of Foot At-Risk and its Associated Characteristics among Outpatients with Diabetes Mellitus in a Peruvian Public Hospital

OBJECTIVE

To assess the prevalence of patients at risk of developing diabetic foot complications (i.e. foot at-risk) and its clinical components according to the updated International Working Group on Diabetic Foot (IWGDF) criteria and to describe demographic and diabetes-related characteristics.

METHODS

We conducted a cross-sectional study at María Auxiliadora Hospital between 2017 and 2018. The criteria for foot at-risk in the IWGDF 2019 risk stratification system are classified into four risk categories, R0-R3, ranging from no peripheral arterial disease (PAD) and no peripheral neuropathy (PN) to the presence of PAD or PN in combination with previous foot ulcer, amputation, or end- stage renal disease (R3). According to this system, we obtained prevalence ratios (PR) of foot at-risk categories dependent on sex, age, diabetes duration, and Total Symptom Score. A sample size of 402 subjects was included in the study.

RESULTS

Subjects included had a mean age of 61 years, and 66% were female. There were no patients with type 1 diabetes, and 59% percent had adiabetes duration of less than ten years. The prevalence of foot at-risk was 54.3% defined by the IWGDF 2019 criteria, which gave prevalence17% higher than that defined with the previous 1999 criteria. PN and PAD frequency was 37.3% and 30.1%, respectively. Foot at-risk prevalence was 40% higher in those with severe Total Symptom Score (PR 1.40, 95% CI 1.09-1.80) and also 39% higher in men than in women (PR 1.39, 95% CI 1.17-1.64). Likewise, diabetes duration of more than ten years had a 25% higher prevalence of foot at-risk (PR 1.25, 95% CI 1.05-1.49), and those older than 60 years had a 20% higher presence of this condition (PR 1.20, 95% CI 1.0011.43).

CONCLUSIONS

Our hospital faces a substantial burden of diabetic foot risk in men, patients with long diabetes duration, and those with painful neuropathy. More initiatives are required at primary or hospital level to detect this critical condition. Likewise, reference centers with multidisciplinary teams to apply prevention and therapeutic interventions are urgently needed.

Association Between the Diabetes mellitus Duration and the Severity of Diabetic Foot Disease in Hospitalized Patients in Latin America

The objective was to determine the association between a diabetes mellitus duration greater than 10 years and the severity of diabetic foot in hospitalized patients in Latin America.Analytical, observational, and retrospective study based in secondary databases. Patients older than 18 years with diagnosis of diabetes mellitus (DM) and hospitalized for any causes were included. The independent and dependent variables were having more than 10 years of diagnosis of DM and the severity of the diabetic foot disease (Wagner> = 2), respectively. A crude Poisson regression analysis was performed to obtain prevalence rates adjusted to confounders.Male gender was 54.8% and the median age was 62 years. In the group with more than10 years of disease (n = 903) 18% (n = 162) had severe injuries. We performed two Poisson regression analyzes, one of which included the entire sample; and in the other, only patients with some degree of ulcer were included at the time of evaluation (Wagner > = 1). In the first analysis the PR was 1.95 (p < 0.01) adjusted for the significant variables in the bivariate analysis and in the second analysis the PR was 1.18 (p < 0.01) adding to the adjustment the days of injury prior to hospitalization and the location of the ulcer.We conclude that in patients with more than 10 years of diabetes mellitus, diabetic foot injuries are more severe, regardless type of diabetes, gender, age, history of amputation and days of injury prior to hospitalization for inpatients in Latin America.

Nationwide prevalence and clinical characteristics of inpatient diabetic foot complications: A Peruvian multicenter study

OBJECTIVE

To evaluate the burden of diabetic foot complications amongst inpatients in Peru.

MATERIALS AND METHODS

Cross-sectional multicenter study, performed in public hospitals, in one-day enrollment between October and December 2018.

RESULTS

We included 8346 patients from 39 national hospitals. Diabetic foot (DF) inpatient point prevalence was 2.8% (CI 95% 2.4-3.1), and DF point prevalence among Diabetes Mellitus (DM) inpatients was 18.9% (CI 95% 16.7-21.1). DF prevalence was higher in jungle and coastal hospitals than highlands ones, and there was no difference according to its care complexity level. Of the 234 patients with DF, 73% were males, age average was 62 ± 12 years, with DM mean time duration of 15 ± 9.9 years. Regarding to DF etiology, 91% and 68% had some degree of peripheral neuropathy and peripheral artery disease, respectively. According to the Infectious Diseases Society of America criteria, 61% presented moderate to severe infections, and 40% had bone involvement. Debridement within 48 h was performed in 36% of sepsis cases.

CONCLUSION

Peru has a substantial burden of DF disease, with a greater share of that burden falling on less equipped hospitals in the country's jungle and coastal regions. Interdisciplinary teams and pathways may improve the time of surgical debridement in the highest risk patients.

[Association between knowledge and practices on HIV infection in Peruvian women: secondary analysis of national survey]

BACKGROUND

Reproductive-age women are a vulnerable population for HIV infection. The relationship between knowledge and practices is not well described in a context where levels of knowledge, attitudes, and practices about HIV infection are inadequate.

AIM

To determine the association between knowledge and practices about HIV infection in Peruvian reproductive-age women.

METHODS

Analysis of secondary data from the 2019 Demographic and Family Health Survey. It got a probabilistic, stratified, and two-stage sample. We included reproductive-age and actively sexual women. Scores above the upper tertile of the observations were defined as "adequate knowledge" by answering 18 questions. Then, we determined the association between adequate knowledge with each of the five practices. Descriptive and inferential statistics -bivariate and multivariate- were used with the Poisson regression for survey analysis.

RESULTS

The mean of correct answers was 12.6 (95% CI: 12.5 - 12.7). 19.2% of Peruvian women had used a condom in the last sexual relationship. An adequate level of knowledge was associated with the use of condoms in the last sexual intercourse (PRa: 1.20; 95% CI:1.06 - 1.36), with having a sexually transmitted infection in the last year, and with having a diagnostic test for HIV infection.

CONCLUSIONS

Considering a low prevalence of condom use in the last sexual intercourse of Peruvian women of reproductive age, adequate general knowledge about HIV infection has associated with the accomplishment of this practice.

Prevalence and incidence of diabetic peripheral neuropathy in Latin America and the Caribbean: A systematic review and meta-analysis

AIMS

The objective of this systematic review and meta-analysis is to estimate the prevalence and incidence of diabetic peripheral neuropathy (DPN) in Latin America and the Caribbean (LAC).

MATERIALS AND METHODS

We searched MEDLINE, SCOPUS, Web of Science, EMBASE and LILACS databases of published observational studies in LAC up to December 2020. Meta-analyses of proportions were performed using random-effects models using Stata Program 15.1. Heterogeneity was evaluated through sensitivity, subgroup, and meta-regression analyses. Evidence certainty was performed with the GRADE approach.

RESULTS

Twenty-nine studies from eight countries were included. The estimated prevalence of DPN was 46.5% (95%CI: 38.0-55.0) with a significant heterogeneity (I2 = 98.2%; p<0.01). Only two studies reported incidence, and the pooled effect size was 13.7% (95%CI: 10.6-17.2). We found an increasing trend of cumulative DPN prevalence over time. The main sources of heterogeneity associated with higher prevalence were diagnosis criteria, higher A1c (%), and inadequate sample size. We judge the included evidence as very low certainty.

CONCLUSION

The overall prevalence of DPN is high in LAC with significant heterogeneity between and within countries that could be explained by population type and methodological aspects. Significant gaps (e.g., under-representation of most countries, lack of incidence studies, and heterogenous case definition) were identified. Standardized and population-based studies of DPN in LAC are needed.

Incidence of COVID-19 infection and prevalence of diabetes, obesity and hypertension according to altitude in Peruvian population

To investigate the cumulative incidence and mortality of COVID-19 and the prevalence of comorbidities such as diabetes, obesity and hypertension in regions with different altitude levels ranging from sea level to high altitude. METHODOLOGY: Analytical study in which we correlated secondary data obtained from reports of the Ministry of Health and National Institute for Statistics and Informatic. The cumulative incidence and mortality of COVID-19 in 25 peruvian regions is reported, together with its relationnship with altitude levels during March-July 2020 using Pearsońs correlation. We also aiming to assess the prevalence of diabetes, obesity and hypertension with altitude according to the ENDES 2018 data using Gamma statistics. RESULTS: COVID-19 maintained an inverse correlation with higher rates in the coastal regions and lower rates with increasing altitude in the cumulative incidence (Pearson = -0.8, p < 0.000) and mortality (Pearson = -0.77, p < 0.000), adjusted gender and age. The prevalence of diabetes and obesity showed the same inverse correlation trend with altitude (Gamma p < 0.000) but not hypertension (Gamma p = 0.13) CONCLUSIONS: The data in Peru it is suggested that physiological adaptation in a hypoxic environment at high altitude may protect persons from the severe impact of acute infection caused by SARS-CoV-2. The reduction in cumulative incidence and mortality rates with increasing altitude is the main finding. Possible mechanisms such as a decreased expression of angiotensin-converting enzyme 2 (ACE2) and a lower virulence because of a high altitude environment, may explain this epidemiological features. In addition, the lower prevalence of diabetes, obesity and hypertension may establish a protective epidemiology against these disease.

Prevalence of Diabetes Mellitus and Its Associated Unfavorable Outcomes in Patients With Acute Respiratory Syndromes Due to Coronaviruses Infection: A Systematic Review and Meta-Analysis

Introduction

Only 3 types of coronavirus cause aggressive respiratory disease in humans (MERS-Cov, SARS-Cov-1, and SARS-Cov-2). It has been reported higher infection rates and severe manifestations (ICU admission, need for mechanical ventilation, and death) in patients with comorbidities such as diabetes mellitus (DM). For this reason, this study aimed to determine the prevalence of diabetes comorbidity and its associated unfavorable health outcomes in patients with acute respiratory syndromes for coronavirus disease according to virus types.

Methods

Systematic review of literature in Pubmed/Medline, Scopus, Web of Science, Cochrane, and Scielo until April of 2020. We included cohort and cross-sectional studies with no restriction by language or geographical zone. The selection and extraction were undertaken by 2 reviewers, independently. The study quality was evaluated with Loney's instrument and data were synthesized by random effects model meta-analysis. The heterogeneity was quantified using an I ² statistic. Funnel plot, Egger, and Begg tests were used to evaluate publication biases, and subgroups and sensitivity analyses were performed. Finally, we used the GRADE approach to assess the evidence certainty (PROSPERO: CRD42020178049).

Results

We conducted the pooled analysis of 28 studies (n = 5960). The prevalence analysis according to virus type were 451.9 diabetes cases per 1000 infected patients (95% CI: 356.74-548.78; I ² = 89.71%) in MERS-Cov; 90.38 per 1000 (95% CI: 67.17-118.38) in SARS-Cov-1; and 100.42 per 1000 (95% CI: 77.85, 125.26 I ² = 67.94%) in SARS-Cov-2. The mortality rate were 36%, 6%, 10% and for MERS-Cov, SARS-Cov-1, and SARS-Cov-2, respectively. Due to the high risk of bias (75% of studies had very low quality), high heterogeneity (I ² higher than 60%), and publication bias (for MERS-Cov studies), we down rate the certainty to very low.

Conclusion

The prevalence of DM in patients with acute respiratory syndrome due to coronaviruses is high, predominantly with MERS-Cov infection. The unfavorable health outcomes are frequent in this subset of patients. Well-powered and population-based studies are needed, including detailed DM clinical profile (such as glycemic control, DM complications, and treatment regimens), comorbidities, and SARS-Cov-2 evolution to reevaluate the worldwide prevalence of this comorbidity and to typify clinical phenotypes with differential risk within the subpopulation of DM patients.