International Journal of Diabetes in Developing Countries最新文献

Background

Diabetic Kidney Disease (DKD) is a serious complication of diabetes. Identifying high-risk DKD patients can lead to better clinical outcomes.

Objective

This study aimed to investigate the relevance of three potential predictive markers for DKD: Kidney Injury Molecule-1 (KIM-1), Tumor Necrosis Factor Receptor 1 (TNFR1), and urinary albumin-to-creatinine ratio (ACR).

Methods

We recruited 120 participants, including 30 individuals with type 2 diabetes (T2D) but no renal complications, 30 with DKD, and 60 healthy controls. Blood and urine analyses were performed to assess lipid and liver parameters, ACR, and estimated glomerular filtration rate (eGFR). Plasma levels of KIM-1 and TNFR1 were measured using the sandwich ELISA method.

Results

The results demonstrated that KIM-1 (p = 0.008) and TNFR1 (p = 0.006) levels were significantly higher in individuals with T2D compared to the controls and even more elevated in those with DKD (p = 0.003 and p = 0.000, respectively). KIM-1 (p = 0.000) and TNFR1 (p = 0.001) levels were significantly elevated in individuals with T2D without elevated albuminuria compared to control. KIM-1 and TNFR1 exhibited correlations with ACR (r = 0.400; p = 0.002 and r = 0.607; p = 0.000, respectively) and eGFR (r = -0.425; p = 0.001 and r = -0.661; p = 0.000, respectively). The ROC curve analysis revealed an area under the curve (AUC) of 0.91 for TNFR1, 0.76 for KIM-1, and 0.95 for ACR. However, the ACR, KIM-1, and TNFR1 combination showed the best predictive performance with an AUC of 0.98.

Conclusion

Plasma levels of KIM-1 and TNFR1 are promising biomarkers for predicting kidney disease in individuals with diabetes, and their combination with ACR improves the overall diagnostic accuracy.

Objective

Diabetes mellitus and hypertension have a high prevalence of non-communicable diseases threatening the world. In such a case, the quality of life of these patients is of utmost importance. Quality of life was assessed from both diabetes mellitus and hypertensive patients located in the urban population of India with MINICHAL and WHOQOL-BREF Instruments.

Methods

The study was conducted about the quality of life for 20 months in a Private Hospital, Tiruvannamalai, with 445 outpatients suffering from both diabetes mellitus and hypertension. All patients were interviewed using a self-designed questionnaire to assess their quality of life using a MINICHAL scale and a WHOQOL-BREF scale.

Results

In our study, the WHOQOL-BREF scale shows an average quality of life, whereas the MINICHAL scale shows a good quality of life. The correlation between both scales shows a significant positive correlation in all the domains. Diabetes mellitus and hypertension deteriorate the quality of life.

Conclusion

The motivation by the healthcare professional will provide a better quality of life and make them adhere to their medication and lifestyle modifications of the patients. Therefore, self-care is needed to manage and prevent diabetes mellitus and hypertension complications.

Objective

Parenting a child with diabetes can be extremely challenging, impacting the parent’s mental health and life trajectory, which can impact the child’s health outcomes as well. Sociocultural background can further impact this experience, yet research in the Asian context is scarce. We aimed to synthesize the qualitative evidence exploring the experience of parents with children with type 1 diabetes mellitus (T1DM) in Asian countries.

Methods

A systematic review was conducted using PubMed and Scopus databases. Studies were included which followed a qualitative paradigm, were conducted in Asian countries on parents of children with type 1 diabetes mellitus (T1DM) below the age of 18 years.

Results

The sample (n = 124 parents, age range = 21–54 years) was predominantly mothers, i.e., 93%. The common themes were navigating the diagnosis, psychological distress, financial strain, systemic healthcare challenges, the role of gender, stigma, and the coping strategies employed by the parents. Mothers predominantly assumed primary caregiving roles, often facing significant emotional and practical burdens in the short and long run.

Conclusion

Despite the scant research, the synthesis clearly outlines the profound challenges parents face and calls for culturally sensitive support systems to alleviate caregiver burden and improve outcomes for children with T1DM. Further research is needed with stronger theoretical frameworks and the South Asian population and countries require attention.

Background

An essential component of effective self-management of diabetes is an active patient. Various interventions to increase patient activation are available in the literature. Benefiting from the experiences of patients with different activation levels in increasing activation will help in planning patient-specific interventions.

Objective

This qualitative study was conducted to investigate the experiences of individuals with diabetes regarding activation in diabetes self-management.

Methods

This study was conducted in a descriptive phenomenological type. Individuals with diabetes with low activation level and high activation level were included in the study. A semi-structured standardized questionnaire prepared by the researcher using the literature was used to collect data.

Results

In the study, the experiences of individuals with diabetes regarding activation were determined as five main themes: the meaning of being active in diabetes management, perceptions of obstacles to being active in diabetes management, facilitators of being active in diabetes management, expectations about being active in diabetes management, and suggestions for being active in diabetes management.

Conclusion

As a result of our study, experiences were obtained that will guide diabetic individuals and healthcare professionals in increasing the activation of individuals with diabetes.

Background

Stroke is a global health challenge. The increasing prevalence of diabetes and the ageing population further add to the complexities of stroke care.

Objective

This study aims to (1) describe the prevalence of diabetes in older patients with stroke and (2) compare the burden of comorbidities among patients with diabetes and frailty compared to those without these conditions.

Methods

This was a cross-sectional study in older patients aged ≥ 65 years with stroke. Comorbidities were assessed using the Charlson Comorbidity Index (CCI). Frailty assessments were done using the Clinical Frailty Scale. Participants were classified into four groups: Group 1, frail and diabetic; Group 2, non-frail and diabetic; Group 3, frail and non-diabetic; and Group 4, non-frail and non-diabetic.

Results

There were 384 participants (mean age 81.11 ± 6.37). Diabetes was present in 45.1%. The mean CCI was highest for the frail and diabetic group (6.97 ± 1.97), followed by non-frail and diabetic (6.00 ± 2.02), frail and non-diabetic (5.49 ± 1.79) and non-frail and non-diabetic (4.74 ± 1.68), p < 0.001. The non-frail and diabetic group had a significantly higher prevalence of hypertension (96.9%) and ischaemic heart disease (34.4%) compared to the other three groups.

Conclusions

There was a high prevalence of diabetes among older patients with stroke. While the frail and diabetic group had the highest overall burden of comorbidities, the non-frail and diabetic group had the most significant cardiovascular disease burden. These findings highlight the urgent need for integrated and personalized management approaches to enhance the overall well-being and quality of life for older stroke survivors with diabetes.

Objective 

Low-literacy parents of children with type 1 diabetes (T1D) often fail to estimate insulin correction dose (ICD) for hyperglycemia, causing poor diabetes control. A tool to estimate ICD for hyperglycemia, which requires singling out glucometer readings digit-wise, was developed and evaluated.

Methods

In this prospective trial, illiterate parent dyads of children with T1D were identified among all children admitted during January-March, 2022. They were sufficiently trained to use a “finger chart” for ICD determination for hyperglycemia. The “finger chart” requires singling out the glucometer readings digit-wise and then moving across the rows and columns to reach the needed ICD. Glycemic control was compared among participants using finger chart and the rest of the families at 3 and 6 months from baseline.

Results

Twelve parent-dyads (28%) used finger chart (IG), and the rest 31 (72%) determined the ICD themselves (CG). More families in the IG lived in rural habitats (83.3% vs 58.1%) and had lower socio-economic status and maternal education (p 0.003, p < 0.001, respectively). The body mass index, HbA1C, and frequency of low and high BGs were similar between the two groups at 3 months (p 0.71, 0.41, 0.78, 0.55, respectively) and 6 months (p 0.17, 0.69, 0.89, 0.30, respectively). Total daily insulin dose was higher in the IG at 3 months (p 0.003) but was comparable at 6 months (p 0.23).

Conclusion

This low-literacy tool can effectively help parents with low literacy in determining the ICD among children with T1D. This tool can be used in other low-literacy settings for ICD determination by suitable translation in local languages.

Trial registration

Prior ethical approval was obtained from the Institute Ethics Committee, Post Graduate Institute of Medical Education and Research (PGIMER) (INT/IEC/2021/SPL-252 dated 13 February, 2021). The trial was registered with the Clinical Trials Registry of India. Registration number: CTRI/2021/04/032739, Registered on 12 April, 2021, http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=52647&EncHid=&userName=Type%201%20diabetes.

Background

Sarcopenia is common in older adults, and type 2 diabetes mellitus (DM), highly prevalent in older adults, is a risk factor for sarcopenia. Early detection of sarcopenia is vital for the implementation of preventive and therapeutic measures.

Objective

We aimed to compare the SARC-F questionnaire and Ishii score screening methods for sarcopenia in patients with type 2 DM.

Methods

This cross-sectional study was conducted on 462 older adults with diabetes aged ≥ 60. Muscle mass and strength were assessed using the BIA device and handgrip dynamometer. Sarcopenia was defined in line with the European Sarcopenia Working Group 2 (EWGSOP2). The SARC-F questionnaire and Ishii score in screening for sarcopenia were compared.

Results

The median age was 72 (67–76) for males and 68 (65–74) for females. The prevalence of sarcopenia based on the Ishii score, SARC-F, and EWGSOP2 was 28.4%, 40.9%, and 61.9%, respectively. The sensitivities of Ishii score and SARC-F in screening for sarcopenia were 84% and 47%, respectively. The Ishii score and SARCF specificities were 67% and 69%, respectively. PPV and NPV for the Ishii score were 79% and 45%, respectively. The PPV and NPV for the SARC-F were 71% and 55%, respectively. The AUC values of the Ishii score and SARC-F were 0.790 and 0.598, respectively.

Conclusion

The Ishii score can be used in daily practice to screen for sarcopenia in older adults with type 2 DM.

Background

Diabetic retinopathy (DR) is an autoimmune disorder that affects the human eyes, causing lesions on the retina as a consequence of diabetes mellitus. Early identification of DR is crucial for effective vision maintenance and preventing severe vision loss.

Objective

To develop and implement an automated and novel approach for the detection and classification of diabetic retinopathy, addressing the limitations of conventional DR detection systems which include complex disease detection, time-consuming processes, and low training efficiency.

Methods

The proposed work introduces an Improved Intelligent Water Drop (I²WD) optimization algorithm for selecting the most correlated features from the extracted feature set, thereby reducing the complexity of the classifier. For the prediction of DR, the Discriminated Multi-Instance Classification (DMIC) algorithm is employed, known for its higher accuracy and lower rate of incorrect predictions.

Results

The proposed Item Net–based I²WD-DMIC model is tested, validated, and compared using well-known benchmark datasets. The results demonstrate significant improvements in accuracy and efficiency over conventional DR detection methods.

Conclusion

The novel I²WD-DMIC approach offers a robust and efficient solution for diabetic retinopathy detection and classification, overcoming the typical limitations of traditional systems. This method shows promise in enhancing early diagnosis and improving patient outcomes in clinical settings.

Objective

To study growth trends and pubertal alterations in type 1 diabetes (T1D) children from northwest India.

Methods

A total of 208 children aged 8 to 18 years (boys, 109; girls, 99) diagnosed with T1D were enrolled from the Department’s Pediatric Endocrinology Clinic. Anthropometric and sexual maturation assessment was made in the Growth Laboratory using standardized instruments and scale. Demographic, socioeconomic, and clinical data (disease duration, glycemic control, and insulin details) were noted for each subject.

Results

Among T1D children, mean age at diagnosis was 8.04 ± 2.84 years and mean duration of therapy was 3.72 ± 3.27 years. All patients were on basal bolus regimen, and 77% had elevated insulin requirements. A good metabolic control was found in 24% of T1D children. Height and weight attainments of T1D children being higher at onset, i.e. 8 years, than their normal peers remained lower thereafter, indicating compromised auxological status. 8.2% and 12.4% of T1D children were underweight and short statured respectively. 33.3% of our T1D girls had attained menarche (mean age: 12.71 ± 1.89 years). The average age at which T1D girls entered puberty, i.e. stage B2, was 10.56 ± 1.29 years. Mean age of initiation of puberty in T1D boys (stage-G2) was 10.49 ± 1.65 years. The pubertal onset and progression among our patients was comparable to their normal peers. Notably, T1D children with poor control showed compromised physical growth.

Conclusions

Impaired growth is a notable concern among T1D children; crucial determinant being the duration of disease and level of metabolic control. However, pubertal development in our cohort proceeded without anomalies.

Objective

The data regarding the safety and efficacy of dapagliflozin during fasting is lacking especially in Pakistan. So, the current study aimed to explore the safety and efficacy of dapagliflozin in minimizing the episodes of hypoglycemia during fasting and reducing the HbA1c.

Methods

A single-center, prospective observational cohort study was conducted at the National Institute of Diabetes and Endocrinology Department (NIDE), Dow International Medical College (DIMC), from March to June 2022. Diabetic patients who were being treated with stable doses of metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors were included, and then, different doses of dapagliflozin (DAPA) were added in their standard regimen after dividing them into two groups (Group A and B receiving 5 mg and 10 mg of DAPA, respectively).

Results

Most of the study participants were females (63.9%) of which 37.7% had ages ranging from 41 to 50 years, were obese, and had diabetes ≤ 3 years with 24.6% participants having hypertension as comorbidity. Post-intervention analysis of the participants showed a significant decrease in HbA1c and blood pressure levels with the DAPA regimen (p-value = 0.000). Additionally, the efficacy of different doses was also significant (p-value = 0.008); however, the negative odds ratio of 0.929 indicated that increasing the dose would decrease the HbA1c.

Conclusions

It was found that DAPA was safe and effective for the patients as it improves the HbA1c levels, and there were no significant hypoglycemic events. Further, urinary tract infections and diabetic ketoacidosis were also not reported by the patients.