Diabetes epidemiology and management最新文献

Background

Vitamin D is an essential component of healthy bones and its deficiency is widespread in obese patients. Through our study, we aimed to look into vitamin D status in obese and non-obese patients and determine its association with hypertension, glucose levels, and lipid profiles.

Patients and methods

A case-control study was laid out to compare serum Vitamin D levels between obese patients and controls. Obese patients (n= 67) over 18 years old were recruited from our Endocrinology-Diabetology and Nutrition department between March 2018 and September 2023. Controls (n = 60) were randomly assigned and were matched for age, sex, glycated hemoglobin, ethnicity, and geographic area. The levels of Vitamin D in the serum were determined in obese patients and non-obese controls.

Results

Average serum Vitamin D concentration was established in both groups, reaching 10,41±4,2 ng/ml in obese patients and 15,14±6,1 ng/ml in the control group. The mean serum Vitamin D was significantly lower in the obese group (p = 0,000). A positive correlation was noticed between body fat and serum Vitamin D (p < 0,05). A significant correlation between vitamin D status and glycated hemoglobin in the obese group (p = 0,047) was found, whereas it was insignificant in the control group (p = 0,966). In addition, the correlation between vitamin D, blood pressure, and body mass index was significant (p = 0.004) as well as between vitamin D and triglycerides (p = 0.015) and cholesterol (p = 0.014).

Conclusion

Vitamin D deficiency is common in obese patients, as highlighted by our study, which is in line with other findings. This may be explained by the fact that vitamin D must be supplied at a greater volume in obese patients. A significant correlation between BMI, vitamin D, glycated hemoglobin, blood pressure, triglycerides, and total cholesterol was found. The pathophysiology behind this association is complex. Further research is needed to clarify the relationship between vitamin D, adipose tissue, and the other components of metabolic syndrome.

Gestational diabetes is a prevalent condition that affects up to 24.2 % of women in South-East Asia. A study conducted in Iran highlighted the correlation between gestational diabetes and anxiety/depression. Improvements can be made by conducting a cohort study to better establish the causality between the compounding factors of mental health and gestational diabetes. Additionally, conducting a follow-up study in a region with a higher incidence of gestational diabetes, such as South-East Asia, can broaden the geographic distribution of the available data. We must promote awareness campaigns highlighting this correlation to improve holistic healthcare strategies.

Background

French health authorities recommend the testing of HbA1c every 3 to 6 months in patients with diabetes. The successive containments linked to the SARSCoV-2 pandemic may have had a profound impact on the follow-up of diabetic patients in primary care. The objective of this study was to investigate the effect of containments on the volume of HbA1c assays and on HbA1c values of type 2 diabetic patients monitored in primary care in Northern France compared to usual seasonal variations.

Methods

Epidemiological study of a multicentre retrospective cohort, collecting the number and the value of HbA1c assays from type 2 diabetic patients, carried out in 73 private medical analysis laboratories in Northern France region between October 1, 2018 and October 31, 2022.

Results

A total of 196,744 patients and 828,037 tests were included. The first and third containments were associated with a significant decrease in the mean number of performed HbA1c tests, the decrease in the 2nd containment did not reach significance. We observed a significant decrease in HbA1c testing during the winter holiday season and the summer months. The variations in HbA1c values were not substantial compared to seasonal variations.

Background

In Denmark, the primary responsibility for treatment of patients with diabetes has shifted from hospitals to primary care. Thus, general practice has assumed responsibility for a complex and multifaceted disease. To address this situation a stratification tool to assist the nurses in primary care in their work with diabetes patients was developed.

Aim

In the present study we evaluated this stratification tool.

Method

The evaluation was based on 18 semi-structured interviews conducted with nurses employed in primary care across Denmark, and who had experience with the stratification tool. The data was subsequently analyzed by content and thematic analyses.

Results

The interviewees were generally positive towards the stratification tool. The analyses established three themes 1. Treatment, 2. Resources, and 3. Points of critique.

Conclusions

Our study indicates that a combined tool for risk stratification of patients with T2D and for subsequent risk communication is perceived as positive and supportive for quality in care. It is seen to potentially reduce the resources presently allocated to well-regulated and stable T2D patients. These resources will eventually be available for other patients. The positive reception by nurses supports that tools like the Diabetes Control Support Tool could be developed and implemented in general practice.

Aims

The DAR 2020 survey summarised fasting practices and complications in people with type 2 diabetes (T2D) who fasted during Ramadan, and impact of pre-Ramadan diabetes education towards controlling the complications.

Methods

Eight week post-Ramadan, Muslim people with T2D from 13 countries of five regions (South Asia, Southeast Asia, Gulf Nations, Middle East and North Africa) consented to answer questionnaire on breaking fast, hypoglycaemia, hyperglycaemia, Ramadan-focused diabetes education and self-monitoring of blood glucose (SMBG).

Results

Among 4889 participants who observed Ramadan fast (>25 days), 51.1 % were females. Hypoglycaemia and hyperglycaemia was recorded mostly in North Africa (25.2 %) and Gulf Nations (30.2 %), respectively. In Middle East, 2.5 % and 3.1 % people required hospitalisation following hypoglycaemia and hyperglycaemia respectively. In South Asia, lowest incidents of hypoglycaemia (8.4 %) and hyperglycaemia (7.0 %) were noted. Pre-Ramadan diabetic education was received by total 45.9 % participants. SMBG was performed more frequently in North Africa (19.5 %). Metformin, Sulfonylureas and basal insulin were used most commonly in all regions.

Conclusions

Fasting complications occurred in each region, but well-managed by the participants, physicians and family members amidst difficult time of COVID-19. The findings promote the necessity of patient education programmes for more people with diabetes to ensure safe fasting during Ramadan.

Background

Diabetic ketoacidosis is a severe metabolic emergency often associated with the onset of Type 1 Diabetes Mellitus, with significant morbidity and mortality. Its incidence as the initial presentation of Type 1 Diabetes Mellitus varies widely by country. In Morocco, there is a lack of comprehensive research on the prevalence and risk factors of diabetic ketoacidosis in children with newly diagnosed Type 1 Diabetes Mellitus, highlighting the need for this study.

Objectives

The aim of our study was to analyze the predictive factors of diabetic ketoacidosis at the onset of Type 1 Diabetes Mellitus in children and adolescents at a single medical center in Morocco to develop prevention and management strategies.

Methods

A retrospective, single-center study including 200 patients aged between 1 and 18 years at Type 1 Diabetes Mellitus onset, between September 2019 and September 2023. The population was divided into two groups according to the presence or absence of diabetic ketoacidosis. Medical records provided data for analysis with SPSS v21, employing Chi-square and Student's t-tests, followed by logistic regression to identify predictors of diabetic ketoacidosis.

Results

Multivariate regression identified several factors that were significantly associated with diabetic ketoacidosis at presentation, including age below 5 years (OR: 3.98; p = 0.021 compared to 6–10 years and OR: 5.07; P = 0.003 compared to 11–18 years), rural living (OR: 2.95; p = 0.032), low family income (OR: 9.22; p < 0.001), delayed diagnosis (OR: 21.27; p < 0.001), longer symptom duration before diagnosis (OR: 1.02; p = 0.010), preceding infections (OR: 2.72; p = 0.019), and lower vitamin D levels (OR: 0.90; p = 0.011).

Conclusion

Our findings underscore the critical need for increased awareness, education, use of point-of-care glucose testing, and targeted interventions in rural areas, in order to reduce the incidence of diabetic ketoacidosis. We also highlight the potential role of vitamin D in increasing the risk of diabetic ketoacidosis at the onset of Type 1 Diabetes Mellitus. This study provides important information on the present state of pediatric diabetes care in our country, and suggests target points for future interventions and research.

Introduction

Several previous studies have provided evidence that obesity is a significant risk factor for the increase in prediabetes, but there are discrepancies regarding whether all the classic ways of measuring obesity, the body mass index (BMI), the waist circumference (WC) or the Waist to height ratio (WHtR) present the same level of risk.

Objective

to carry out a systematic review (SR) with meta-analysis to determine the association between indicators of obesity and prediabetes.

Methods

A systematic review (SR) with a meta-analysis of observational studies was performed. The search was conducted in four databases: Pubmed/Medline, SCOPUS, Web of Science, and EMBASE. Association measures were presented as odds ratios (OR), relative risk (RR), or hazard ratio (HR), together with their 95% confidence intervals (95% CI).

Results

Of the total number of manuscripts chosen, 12 had an analytical cross-sectional design, and 4 were cohort studies. For the cross-sectional studies, together they presented a statistically significant association for BMI (OR: 1.99; 95% CI 1.65 – 1.34), WC (OR: 1.41; 95% CI 1.30 – 1.54), and WHtR (OR: 2.47 IC 95 % 1.50 – 4.06). In the meta-analysis of the cohort studies, an association was found with WC (RR: 4.95; 95% CI 3.42 – 7.17) but not with BMI (HR: 1.22; 95% CI 0.81 – 1.85). There were no studies with WHtR.

Conclusions

According to the results, considering cohort studies, WC could be the best risk indicator for prediabetes. There is a high degree of heterogeneity between the studies about the way obesity is measured, including the cut-off points used, so further longitudinal studies are needed to evaluate the association and confirm the results found.

Introduction

The prevalence of Type 2 Diabetes Mellitus (T2DM) is expected to rise, increasing the risk of cardiovascular disease. This study explores the relationship between high-density lipoprotein cholesterol (HDL) and glycemic control in T2DM patients, measured by hemoglobin A1c (HbA1c). While HDL is known to confer cardiovascular benefits, its impact on glycemic control remains unclear.

Methods

This cross-sectional study analyzed 30,195 Thai adults with T2DM data from the 2018 Thailand DM/HT database. Well-controlled HbA1c was defined as less than 53 mmol/mol (7 %). The study utilized multivariable linear, piecewise linear, and logistic regression analyses to investigate the relationship between HDL levels and glycemic control.

Results

The impact of HDL on HbA1c levels was nonlinear, showing a U-shaped relationship among the study participants with an HDL inflection point of 59 mg/dl. In females, a U-shaped relationship was also observed at the same inflection point, where increased HDL above this level was associated with a rise in HbA1c (Adjusted β = 0.205, P < 0.001). In contrast, a linear model better explained the consistent negative relationship between HDL and HbA1c in males (Adjusted β = –0.076, P < 0.001). Furthermore, in the poorly controlled HbA1c group, a significant U-shaped pattern was observed with an inflection point at 59 mg/dl.

Conclusion

This study found a nonlinear, gender-specific relationship between HDL and HbA1c in T2DM patients. Males with higher HDL are more likely to achieve glycemic control, while a U-shaped relationship is observed in females. Further research is needed to understand the differing correlation between well-controlled and poorly controlled groups.

Introduction

Measuring what it tends to measure makes a tool powerful and useful for decision-making. As the Amharic version summary of the diabetes self-care activity scale construct hasn't yet been validated, there is an urgent need for validation. This study aims to validate the Amharic version of the summary of the diabetes self-care activity scale among type 2 diabetes mellitus patients in Addis Ababa hospitals.

Methods

A facility-based cross-sectional study design was used to recruit 600 participants. The data was collected using open-data-kit and exported to SPSS and STATA for analysis. Both exploratory and confirmatory factor analysis was performed on 300 randomly allocated separate samples.

Result

A total of four factors with an eigenvalue greater than one, constituting nine items, were identified. The average variance executed (AVE) becomes 0.78, with a composite reliability of 0.97. Hence there is convergence between the items and the new construct. The overall internal consistency of the new construct was 0.853, which is greater than 0.7, affirming the reliability of the construct.

Conclusion

We can conclude that this 4-factor structure with a 9-item Amharic version of SDSCA is highly valid and reliable. Researchers and clinicians are highly recommended to use this validated tool.