International Journal of Diabetes in Developing Countries最新文献

Background

India is the second major epicenter of diabetes mellitus (DM) prevalence after China and predicted to overtake China by 2045. DM is associated with multimorbidity which has tremendous impact on mental health. However, little is known about patterns of morbidities and their associations with depression.

Objective

The purpose of this article is to ascertain multimorbidity in the DM population and to assess the relationship between multimorbidity and depressive symptoms.

Methods

A cross-sectional analysis was conducted using data from the “Longitudinal Ageing Study in India (LASI),” a national representative survey. Regression analysis was used to investigate the relationship between multimorbidity and depressive symptoms. The mean difference of depressive symptoms with multimorbidity was calculated using one-way ANOVA.

Results

The total population included in the study was 8855. Around 72.8% had multimorbidity, out of which 43%, 20.4%, and 9.4% fall under single, double, and triple or more than triple morbidity category, respectively. The odds of having depression in single morbidity (AOR, 1.24), double morbidity (AOR, 1.34), and triple or more morbidity (AOR, 1.51), poor self-rated health (AOR, 1.45), unenrolled in health insurance policy (AOR, 1.21), hospitalized in the past 12 months (AOR, 1.12), and taking insulin injections (AOR, 1.24) were significantly higher. There were significant mean differences in depression with different categories of multimorbidity conditions (F = 19.63, p = 0.000).

Conclusion

Higher rate of multimorbidity among DM patients was recorded. Multimorbidity substantially increases the risk of acquiring depression. Timely identification and appropriate management multimorbidity of diabetes are important for reducing to incidence of depression and better quality of life and functionality.

Objective

This study aimed to assess the presence and characteristics of cardiovascular autonomic neuropathy (CAN) in people with type 2 diabetes with and without Charcot neuroarthropathy (CN).

Background

Diabetes can affect nerves in many ways beyond sensitive neuropathy.

Methods

A cross-sectional study was carried out in people with diabetes and CN who were matched for sex and age with two groups of people with diabetes without CN. All subjects underwent CAN assessment with seven tests (four Ewing tests and three bands of spectral analysis), and a severity score was constructed using these seven tests (each altered test equivalent to 1 point).

Results

Of the 69 people evaluated, 49 (71%) had incipient or installed CAN. A total of 95.2% of people with Charcot neuroarthropathy had incipient or installed CAN. There was a higher prevalence of dyslipidemia among people with installed autonomic neuropathy than among those with incipient CAN or without CAN. Thirty-four (69%) people with CAN had increased urinary albumin excretion. The severity score, constructed from the seven tests used for the diagnosis of CAN, revealed a greater number of altered tests and higher scores among people with CN when compared to the other participants, indicating greater severity of the condition.

Conclusions

There is a high prevalence of CAN in people with type 2 diabetes followed in a tertiary health service and the use of severity score may enable to differentiate people with or without CN. We suggest that this score could be used as a new tool in caring for people with diabetes to identify the most severe CAN.

Objective

To determine the proportion of patients of type 2 Diabetes taking oral antidiabetics with self reported hypoglycemia and its causes.

Background

Hypoglycemia, an acute complication of diabetes mellitus is not only responsible for recurrent morbidity but also can lead to permanent brain damage or fatality if not recognized and treated in time. Also, hypoglycemia prevents achieving glycemic targets in diabetic patients.

Methods

Cross-sectional observation study of 70 patients of type 2 diabetes on oral anti-diabetics was conducted at Lok Nayak Hospital to determine the proportion of patients with self reported hypoglycemia and also to find out the various causes of hypoglycemia by subjecting them to a structured questionnaire. Hypoglycemia was considered when patient experienced at least one symptom, at least 2–3 times in last one month and symptom(s) were relieved by consuming sugar/meal.

Results

38.6% of the study subjects had hypoglycemia, out of which 92.59% patients had symptomatic hypoglycemia. Out of the patients experiencing hypoglycemia, 32% had severe episodes, 12% visited the hospital and 48% had more than 5 episodes per month. Dizziness was the commonest reported symptom (64%), followed by palpitations (52%). Attributed causes of hypoglycemia were missing meal (64%), drugs other than oral anti-diabetics (44%), sulfonylureas (44.2% in patients taking vs. 26.9% in patients not taking sulfonylurea), comorbidities (41% with vs. 22.4% without comorbidities) and lower socioeconomic status. One-third of patients experiencing were checking blood glucose levels during the symptoms. Highest prevalence of hypoglycemia was seen with HbA_1c < 6.5% (p-value 0.04 when compared with subjects with HbA_1c ≥ 6.5%), followed by ≥ 8% and least in 6.5–7.9%.

Conclusions

Lower prevalence of hypoglycemia in our study compared to other similar studies could be because of non-inclusion of patients on insulin in our study. High prevalence of multiple episodes justify the fact that hypoglycemia begets hypoglycemia. Hypoglycemia progressively increased as socioeconomic status changed from higher to lower, possibly due to non-availability of glucometer and lack of information. U-shaped correlation of hypoglycemic events was found with HbA_1c levels.

Objective

Plasma glucose and insulin concentrations are clinical markers used to diagnose metabolic diseases, particularly prediabetes and diabetes. In this paper, we conducted a cluster analysis using plasma glucose and insulin data collected during both fasting and 2-h postprandial periods.

Methods

Different clustering experiments were performed by changing the attributes, from one (fasting glucose) to four (fasting and postprandial glucose and insulin) attributes input to a k-means clustering algorithm. Based on the elbow and silhouette methods, three clusters were chosen to perform the clustering experiments. The Pearson correlation coefficient was utilized to evaluate the association between the levels of glucose and insulin within each created cluster.

Results

Results show that one cluster comprised individuals with prediabetes, another cluster consisted of individuals with diabetes, while subjects without prediabetes and diabetes were assigned to a separate cluster. Despite not being used as an attribute, we observed varying age ranges among subjects in the three clusters. Furthermore, significant correlations were found between fasting and postprandial insulin levels, as well as between fasting and postprandial glucose levels, suggesting a consistent relationship between these variables, and highlighting their interdependence in the context of glucose metabolism.

Conclusion

The clustering analysis successfully differentiated individuals into distinct clusters based on their metabolic conditions, confirming that the approach effectively captured the underlying patterns in the plasma glucose and insulin data. Furthermore, despite not being a considered attribute, the varying age ranges observed within the clusters indicate that age may play a role in the development and progression of diabetes. Additionally, the fasting and postprandial associations in insulin and glucose levels exhibited greater strength in the cluster encompassing individuals with diabetes, where insulin production or action is compromised.

Objective

Cardiovascular diseases (CVD) are the most common, deadly, noncommunicable disease group globally. This study aims to investigate the relationship between Systematic Coronary Risk Evaluation 2 (SCORE2) scores, which indicate the risk of future CVD in patients without known CVD and diabetes mellitus (DM) diagnoses, and HbA1c values.

Methods

In our retrospective cross-sectional study, patients under 40 years of age and over 69 years, those with a history of any CVD, those with a history of type 1 or type 2 DM, individuals with known anemia, patients using antihyperlipidemic or antidiabetic medications, and those with HbA1c levels of 6.5 and above were excluded. The relationship between the SCORE2 risk scores and related parameters was investigated among the included 249 patients.

Results

Among a total of 249 patients, with a mean age of 51.9 ± 7.5 years, 137 (55.0%) were male. Positive correlations were found between the SCORE2 (%) value of the patients and hemoglobin (rho = 0.222; p < 0.001), red blood cell (rho = 0.207; p = 0.001), hematocrit (rho = 0.267; p < 0.001), white blood cell (rho = 0.147; p = 0.021), triglyceride (rho = 0.247; p = 0.004), glucose (rho = 0.244; p < 0.001), HbA1c (rho = 0.208; p < 0.001), waist circumference (rho = 0.204; p = 0.001), and Visceral Adiposity Index (VAI) (rho = 0.145; p = 0.023) values.

Conclusion

A significant relationship was found between HbA1c and the current CVD risk score, SCORE2, in our patient group without DM. Our study is the first to examine this relationship in the literature. While no relationship was found between SCORE2 and body mass index (BMI), a significant relationship was found with the VAI. This indicates that CVD risk is more associated with visceral fat accumulation than total weight. Evaluating patients with normal BMI based on VAI will be beneficial in demonstrating CVD risk.

Abstract

Background

This commentary explores the landscape of non-nutritive sweeteners, further delves into the historical trajectory and the contemporary surge in the consumption of non-nutritive sweeteners (NNS), along with the accompanying controversies concerning their safety.

Objective

The aim is to provide a comprehensive understanding of the influences of NNS, drawn from global studies and diverse perspectives.

Methods

The commentary synthesizes findings from global studies, notably the NutriNet-Santé cohort, exploring associations between specific NNS and health consequences such as cerebrovascular events and malignancies. Additionally, it examines the research on consequences of NNS on gut microbiota and explores concerns linked to gestational diabetes, fetal exposure, and health of the offspring.

Results

While caution is advised during pregnancy and fetal development due to potential risks, NNS show promise in weight management and short-term dietary goals when used cautiously in lower amounts. The commentary underscores the necessity for inclusive, long-term studies to guide evidence-driven policies and guidelines.

Conclusion

While the article underscores the complexities and debates surrounding non-nutritive sweeteners (NNS), it also sheds light on the positive aspects. In the Indian context, where the intake of sweeteners is relatively low and mainly limited to beverages (tea or coffee), NNS appear to be safe, but prudent use is advocated. The article emphasizes the value of public education on NNS usage and concludes that, overall, NNS are reasonably safe when consumed in moderation. Continued research is needed to elucidate their intricate effects on health and impact on global health outcomes.

Implications

The article concludes with clear guidelines for using NNS in India, highlighting the need for informed decision-making and ongoing research to elucidate their broader health consequences.

Objective

Poor sugar regulation heightens the risk of complications linked to type 2 diabetes mellitus, while the adoption of effective diabetes self-management strategies has been shown to mitigate these risks. The objective of the study was to investigate the risk factors for diabetic foot by evaluating diabetes self-management using the Diabetes Self-Management Scale in patients with type 2 diabetes mellitus with and without diabetic foot.

Methods

The study is a single-centre, prospective, cross-sectional study conducted between August 29, 2022 and November 29, 2022. A total of 133 patients who presented to the diabetes and diabetic foot outpatient clinic were selected using a simple random sampling method. In order to make the evaluation, the sociodemographic form and Diabetes Self-Management Scale has been used. Potential risk factors associated with the presence of diabetic foot were examined using multivariate logistic regression analysis. A significance level of p < 0.05 was considered statistically significant.

Results

The mean age of the patients was 60.35 years and 45.1% (60) of them were female. According to the results of the multivariate logistic regression analysis, having more than 12 years of education, receiving diabetes education, and having higher Diabetes Self-Management Scale total scores negatively predicted the presence of diabetic foot. On the other hand, the duration of diabetes, systolic blood pressure, and HbA1c levels positively predicted the presence of diabetic foot.

Conclusion

Effective diabetes self-management plays a crucial role in improving diabetes complications. Care should be taken regarding diabetic foot in patients who have difficulties in effective diabetes self-management, as well as those with high systolic blood pressure, high HbA1c levels, shorter total education duration, and longer duration of diabetes.

Abstract

Background

Diabetes patients often suffer from diabetes keratopathy in the course of their illness. The examination of corneal endothelium in proliferative diabetic retinopathy (PDR) patients has important clinical significance. Here, we investigated the effect of PDR on corneal endothelial parameters.

Objective

To analyze the associations between corneal endothelial cell parameters and proliferative diabetic retinopathy (PDR).

Methods

We analyzed endothelial cell density (ECD), coefficient of variation in cell size (CV), hexagonality, and neutrophil/lymphocyte ratio (NLR) in patients with PDR and compared them with age-matched controls. The influences of duration of diabetes mellitus and level of glycosylated hemoglobin (HbA1c) were also analyzed.

Results

The study group included 106 eyes of 106 PDR patients and 85 eyes of 85 control subjects. Significant differences were found in ECD (2,436.11 ± 222.08 cells/mm² in PDR, 2527.16 ± 191.64 cells/mm² in controls; p < 0.05), CV (41.32 ± 7.40 in PDR, 37.71 ± 5.08 in controls; p < 0.05), Hex (50.07 ± 5.32 in PDR patients, 53.29 ± 5.73 in controls; p < 0.05), and NLR (2.94 ± 1.27 in PDR, 2.12 ± 0.56 in controls; p < 0.05). In the PDR group, ECD showed a decreasing trend as age increased (p trend < 0.05), and Spearman’s correlation indicated a significant positive correlation between NLR and macular thickness (p < 0.05).

Conclusions

PDR had deleterious effects on the corneal endothelium. PDR patients should undergo a rigorous corneal assessment to analyze the status of endothelial health, to identify the optimal treatment.