Diabetes mellitus is a major global public health challenge. Insulin adherence is crucial to prevent complications, yet poor adherence remains common. This study assessed insulin adherence and associated factors among diabetic patients in Wolaita Zone Hospitals, Southern Ethiopia.
Methods
A multicenter cross-sectional study was conducted from November 2023 to January 2024 among 394 diabetic patients. Participants were selected using proportional allocation and systematic random sampling. Logistic regression was used to identify factors associated with insulin adherence, with results reported as adjusted odds ratios (AORs) and 95 % confidence intervals (CIs).
Results
The prevalence of insulin adherence was 40.1 % (95 % CI: 35.5–44.9 %). Higher adherence was associated with college education or above (AOR=3.03; 95 % CI: 1.36–7.18), owning a glucometer (AOR=2.79; 95 % CI: 1.35–5.75), good knowledge (AOR=3.14; 95 % CI: 1.71–5.77), positive attitude toward insulin (AOR=6.12; 95 % CI: 3.38–11.09), and regular monthly follow-up (AOR=3.81; 95 % CI: 1.73–8.40). Conversely, having comorbidities (AOR=0.42; 95 % CI: 0.23–0.77) and diabetes duration ≥15 years (AOR=0.27; 95 % CI: 0.11–0.67) were negatively associated with adherence.
Conclusion
Insulin adherence was low. Patient-centered interventions focusing on education, attitude improvement, and promote regular follow-up are vital to enhance adherence and reduce complications.
{"title":"Insulin therapy adherence and associated factors among diabetes mellitus patients in Southern Ethiopia","authors":"Mulualem Gete Feleke, Tadele Lankrew Ayalew, Kidist Ashager, Bizuayehu Atinafu Ataro, Hailu Asmare Beyene","doi":"10.1016/j.deman.2025.100284","DOIUrl":"10.1016/j.deman.2025.100284","url":null,"abstract":"<div><h3>Introduction</h3><div>Diabetes mellitus is a major global public health challenge. Insulin adherence is crucial to prevent complications, yet poor adherence remains common. This study assessed insulin adherence and associated factors among diabetic patients in Wolaita Zone Hospitals, Southern Ethiopia.</div></div><div><h3>Methods</h3><div>A multicenter cross-sectional study was conducted from November 2023 to January 2024 among 394 diabetic patients. Participants were selected using proportional allocation and systematic random sampling. Logistic regression was used to identify factors associated with insulin adherence, with results reported as adjusted odds ratios (AORs) and 95 % confidence intervals (CIs).</div></div><div><h3>Results</h3><div>The prevalence of insulin adherence was 40.1 % (95 % CI: 35.5–44.9 %). Higher adherence was associated with college education or above (AOR=3.03; 95 % CI: 1.36–7.18), owning a glucometer (AOR=2.79; 95 % CI: 1.35–5.75), good knowledge (AOR=3.14; 95 % CI: 1.71–5.77), positive attitude toward insulin (AOR=6.12; 95 % CI: 3.38–11.09), and regular monthly follow-up (AOR=3.81; 95 % CI: 1.73–8.40). Conversely, having comorbidities (AOR=0.42; 95 % CI: 0.23–0.77) and diabetes duration ≥15 years (AOR=0.27; 95 % CI: 0.11–0.67) were negatively associated with adherence.</div></div><div><h3>Conclusion</h3><div>Insulin adherence was low. Patient-centered interventions focusing on education, attitude improvement, and promote regular follow-up are vital to enhance adherence and reduce complications.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100284"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.deman.2025.100289
Roland Muhindo Muyisa (Laros) M.D. , Jacques Katsuva Wahangire M.D. , Célestin Kaputu Malu M.D., Ph.D.
Introduction
Depression among patients with diabetes is a major public health problem, but it is not well described in our region. The objective of this survey was to determine the prevalence and identify predictive factors of depression in individuals with diabetes in our region.
Method
It was a cross-sectional and analytic study of patients under regular medical consultations at Matanda Hospital. Data collection involved a structured questionnaire covering socio-demographic parameters, clinical characteristics, depression assessment using the PHQ-9, and glycemic control through HbA1c levels.
Results
Among 294 diabetic patients, 170 (57.8 %) exhibited depressive symptoms. Major risk factors for depression included age ≥45 years, illiteracy, unemployment, low income (<30 USD/month), alcohol use, tobacco use, diabetes duration <5 years, hygiene measures-only therapy, acute complications, and hypertension. Protective factors included age 30–44 years, marriage, university education, employment, diabetes duration 5–9 years, and combined hygiene measures plus oral antidiabetic therapy. Depression was significantly associated with poor glycemic control (HbA1c >6.5 %; p = 0.0043).
Conclusion
There is a high prevalence of depression among patients with diabetes in our region. The implementation of routine screening for depression is necessary to improve the quality of life of patients with diabetes.
糖尿病患者的抑郁症是一个重大的公共卫生问题，但在我们地区并没有得到很好的描述。本调查的目的是确定患病率，并确定抑郁症的预测因素，个人糖尿病在我们的地区。方法对在马坦达医院定期就诊的患者进行横断面分析研究。数据收集包括一份结构化问卷，包括社会人口统计学参数、临床特征、使用PHQ-9进行抑郁评估以及通过HbA1c水平进行血糖控制。结果294例糖尿病患者中有170例（57.8%）出现抑郁症状。抑郁症的主要危险因素包括年龄≥45岁、文盲、失业、低收入（每月30美元）、饮酒、吸烟、糖尿病病程≥5年、仅采取卫生措施的治疗、急性并发症和高血压。保护因素包括年龄30-44岁、婚姻、大学教育、就业、糖尿病病程5-9年、综合卫生措施加口服降糖治疗。抑郁与血糖控制不良显著相关（HbA1c > 6.5%; p = 0.0043）。结论我区糖尿病患者抑郁患病率较高。实施抑郁症的常规筛查对改善糖尿病患者的生活质量是必要的。
{"title":"Comorbidity depression – diabetes in Eastern DR Congo: insights from a cross-sectional study","authors":"Roland Muhindo Muyisa (Laros) M.D. , Jacques Katsuva Wahangire M.D. , Célestin Kaputu Malu M.D., Ph.D.","doi":"10.1016/j.deman.2025.100289","DOIUrl":"10.1016/j.deman.2025.100289","url":null,"abstract":"<div><h3>Introduction</h3><div>Depression among patients with diabetes is a major public health problem, but it is not well described in our region. The objective of this survey was to determine the prevalence and identify predictive factors of depression in individuals with diabetes in our region.</div></div><div><h3>Method</h3><div>It was a cross-sectional and analytic study of patients under regular medical consultations at Matanda Hospital. Data collection involved a structured questionnaire covering socio-demographic parameters, clinical characteristics, depression assessment using the PHQ-9, and glycemic control through HbA1c levels.</div></div><div><h3>Results</h3><div>Among 294 diabetic patients, 170 (57.8 %) exhibited depressive symptoms. Major risk factors for depression included age ≥45 years, illiteracy, unemployment, low income (<30 USD/month), alcohol use, tobacco use, diabetes duration <5 years, hygiene measures-only therapy, acute complications, and hypertension. Protective factors included age 30–44 years, marriage, university education, employment, diabetes duration 5–9 years, and combined hygiene measures plus oral antidiabetic therapy. Depression was significantly associated with poor glycemic control (HbA1c >6.5 %; p = 0.0043).</div></div><div><h3>Conclusion</h3><div>There is a high prevalence of depression among patients with diabetes in our region. The implementation of routine screening for depression is necessary to improve the quality of life of patients with diabetes.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100289"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.deman.2025.100290
Karin Engström , Magnus Sandberg , Anna Axmon
Aims
To assess the prevalence and prevalence relative risk (PRR) of Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM) among people with intellectual disabilities (ID) compared to the general population using a register-based cohort in Sweden.
Methods
The study included 14,716 people with ID and 1226,955 people from the general population in Skåne, Sweden, on January 1st, 2014. Data on health care contacts were collected from the Skåne Healthcare Register for the entire study period (2014–2021). PRRs with 95 % confidence intervals (CIs) were estimated using Poisson regression, with the general population serving as the reference group.
Results
The PRR for T1DM was higher among people with ID (PRR 1.63, 95 % CI 1.36–1.95), particularly among children and adolescents. The PRR for T2DM was also higher (PRR 1.53, 95 % CI 1.43–1.63) across all age groups, except for children. Women had higher PRRs (T1DM: PRR 1.88, 95 % CI 1.42–2.47; T2DM: PRR 1.80, 95 % CI 1.63–1.99) than men (T1DM: PRR 1.44, 95 % CI 1.13–1.82; T2DM: PRR 1.34, 95 % CI 1.22–1.48). The PRR increased with ID severity for T1DM, whereas a higher PRR was observed among people with mild or moderate ID for T2DM, but not among those with severe/profound ID.
Conclusions
People with ID have higher prevalence relative risks for both T1DM and T2DM, indicating a higher diabetes burden than in the general population. Differences in PRR between T1DM and T2DM, according to age, sex, and ID severity, underscore the need for targeted interventions.
目的：通过瑞典的一项基于登记的队列研究，评估智力残疾（ID）人群中1型糖尿病（T1DM）和2型糖尿病（T2DM）的患病率和患病率相对危险度（PRR）。方法选取2014年1月1日在瑞典sk内的14716名ID人群和1226955名普通人群为研究对象。在整个研究期间（2014-2021年），从skamatne医疗保健登记册收集医疗保健接触者的数据。使用泊松回归估计95%置信区间（ci）的PRRs，以一般人群作为参照组。结果ID患者T1DM的PRR较高（PRR为1.63,95% CI为1.36-1.95），尤其是儿童和青少年。除儿童外，T2DM的PRR在所有年龄组中也较高（PRR 1.53, 95% CI 1.43-1.63）。女性的PRR （T1DM: PRR 1.88, 95% CI 1.42-2.47; T2DM: PRR 1.80, 95% CI 1.63-1.99）高于男性（T1DM: PRR 1.44, 95% CI 1.13-1.82; T2DM: PRR 1.34, 95% CI 1.22-1.48）。T1DM患者的PRR随着ID严重程度的增加而增加，而T2DM轻度或中度ID患者的PRR更高，而重度/重度ID患者的PRR则不高。结论ID患者患T1DM和T2DM的相对风险较高，表明其糖尿病负担高于一般人群。根据年龄、性别和ID严重程度，T1DM和T2DM之间PRR的差异强调了有针对性干预的必要性。
{"title":"Type 1 and type 2 diabetes mellitus among people with intellectual disability in comparison to the general population: A register study (IDcare)","authors":"Karin Engström , Magnus Sandberg , Anna Axmon","doi":"10.1016/j.deman.2025.100290","DOIUrl":"10.1016/j.deman.2025.100290","url":null,"abstract":"<div><h3>Aims</h3><div>To assess the prevalence and prevalence relative risk (PRR) of Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM) among people with intellectual disabilities (ID) compared to the general population using a register-based cohort in Sweden.</div></div><div><h3>Methods</h3><div>The study included 14,716 people with ID and 1226,955 people from the general population in Skåne, Sweden, on January 1st, 2014. Data on health care contacts were collected from the Skåne Healthcare Register for the entire study period (2014–2021). PRRs with 95 % confidence intervals (CIs) were estimated using Poisson regression, with the general population serving as the reference group.</div></div><div><h3>Results</h3><div>The PRR for T1DM was higher among people with ID (PRR 1.63, 95 % CI 1.36–1.95), particularly among children and adolescents. The PRR for T2DM was also higher (PRR 1.53, 95 % CI 1.43–1.63) across all age groups, except for children. Women had higher PRRs (T1DM: PRR 1.88, 95 % CI 1.42–2.47; T2DM: PRR 1.80, 95 % CI 1.63–1.99) than men (T1DM: PRR 1.44, 95 % CI 1.13–1.82; T2DM: PRR 1.34, 95 % CI 1.22–1.48). The PRR increased with ID severity for T1DM, whereas a higher PRR was observed among people with mild or moderate ID for T2DM, but not among those with severe/profound ID.</div></div><div><h3>Conclusions</h3><div>People with ID have higher prevalence relative risks for both T1DM and T2DM, indicating a higher diabetes burden than in the general population. Differences in PRR between T1DM and T2DM, according to age, sex, and ID severity, underscore the need for targeted interventions.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100290"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.deman.2025.100280
Zhong Yuan , Jill Hardin , James P. Gilbert , Jordy Mehawej , Saberi Rana Ali , Carolyn Jeffcoat , Sergio Fonseca
Aims
Real-world data were analyzed to evaluate the incidence and risk of sarcopenia for canagliflozin compared with other antihyperglycemic agents (AHAs) including dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), empagliflozin, and dapagliflozin.
Materials and methods
This retrospective cohort analysis of patients with type 2 diabetes mellitus (T2DM) included new users of canagliflozin or the AHAs (2016 to 2023) in 7 United States healthcare databases. Large-scale regularized regression generated propensity scores (PS) were used for matching and controlling confounding. A conditional Cox proportional hazards model assessed the treatment effect, presented as hazard ratios (HR). A self-controlled case series (SCCS) analysis assessed the incidence rate ratio between exposed and non-exposed periods among canagliflozin users.
Results
The PS-matched analyses showed no statistically significant increased risk of sarcopenia with canagliflozin versus any AHA comparator, though confidence intervals (CIs) were wide due to low event rates. The calibrated HRs (95 % CI) were 0.71 (0.26, 1.91) for canagliflozin versus empagliflozin, 1.16 (0.28, 4.70) for canagliflozin versus dapagliflozin, 8.79 (0.66, 116.96) for canagliflozin versus GLP-1RAs, and 0.88 (0.26, 2.98) for canagliflozin versus DPP-4 inhibitors. The crude incidence rates of sarcopenia (per 10,000 person-years) varied across databases: canagliflozin (0.0 to 1.0), dapagliflozin (0.4 to 7.9), empagliflozin (0.7 to 3.4), DPP-4 inhibitors (0.4 to 4.8), and GLP-1RAs (0.5 to 3.4). The SCCS analysis indicated an incidence ratio of 0.83 (0.50, 1.37).
Conclusions
The incidence rates of sarcopenia were low among patients with T2DM treated with canagliflozin or other comparator AHAs. There is no evidence suggesting an increased risk of sarcopenia associated with canagliflozin compared with other AHAs.
{"title":"Relationship between canagliflozin use and sarcopenia: Real-world data from the United States","authors":"Zhong Yuan , Jill Hardin , James P. Gilbert , Jordy Mehawej , Saberi Rana Ali , Carolyn Jeffcoat , Sergio Fonseca","doi":"10.1016/j.deman.2025.100280","DOIUrl":"10.1016/j.deman.2025.100280","url":null,"abstract":"<div><h3>Aims</h3><div>Real-world data were analyzed to evaluate the incidence and risk of sarcopenia for canagliflozin compared with other antihyperglycemic agents (AHAs) including dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), empagliflozin, and dapagliflozin.</div></div><div><h3>Materials and methods</h3><div>This retrospective cohort analysis of patients with type 2 diabetes mellitus (T2DM) included new users of canagliflozin or the AHAs (2016 to 2023) in 7 United States healthcare databases. Large-scale regularized regression generated propensity scores (PS) were used for matching and controlling confounding. A conditional Cox proportional hazards model assessed the treatment effect, presented as hazard ratios (HR). A self-controlled case series (SCCS) analysis assessed the incidence rate ratio between exposed and non-exposed periods among canagliflozin users.</div></div><div><h3>Results</h3><div>The PS-matched analyses showed no statistically significant increased risk of sarcopenia with canagliflozin versus any AHA comparator, though confidence intervals (CIs) were wide due to low event rates. The calibrated HRs (95 % CI) were 0.71 (0.26, 1.91) for canagliflozin versus empagliflozin, 1.16 (0.28, 4.70) for canagliflozin versus dapagliflozin, 8.79 (0.66, 116.96) for canagliflozin versus GLP-1RAs, and 0.88 (0.26, 2.98) for canagliflozin versus DPP-4 inhibitors. The crude incidence rates of sarcopenia (per 10,000 person-years) varied across databases: canagliflozin (0.0 to 1.0), dapagliflozin (0.4 to 7.9), empagliflozin (0.7 to 3.4), DPP-4 inhibitors (0.4 to 4.8), and GLP-1RAs (0.5 to 3.4). The SCCS analysis indicated an incidence ratio of 0.83 (0.50, 1.37).</div></div><div><h3>Conclusions</h3><div>The incidence rates of sarcopenia were low among patients with T2DM treated with canagliflozin or other comparator AHAs. There is no evidence suggesting an increased risk of sarcopenia associated with canagliflozin compared with other AHAs.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100280"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144840847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.deman.2025.100281
Hind Maher Alenzi , Raghad Abdullah Alsagri , Manal Alfakhri , Safa Alqudah , Margaret Zuriekat , Manal Alshareef , Aseel Hamad Alkhamees
Background
Type 2 diabetes mellitus (T2DM) has been associated with sensorineural hearing loss through microvascular and neural pathways. Although T2DM prevalence is high in Saudi Arabia, limited research has examined the relationship between glycemic control and auditory function in this population.
Objective
To investigate the association between glycated hemoglobin (HbA1c) levels and hearing threshold levels (HTL) in Saudi adults with T2DM.
Methods
This retrospective cross-sectional study analyzed medical records of 41 Saudi adults with T2DM (aged 20–57 years, 27 males, 14 females) who underwent pure tone audiometry and HbA1c testing at Royal Commission Medical Center, Yanbu, between 2021–2024. Linear regression analyses examined associations between HbA1c and HTL across low-frequency (0.25–2 kHz) and high-frequency (4–8 kHz) ranges.
Results
Mean participant age was 49.1 ± 7.8 years, with mean HbA1c of 6.9 ± 1.2 %. Linear regression revealed significant positive associations between HbA1c and HTL in both low-frequency (β = 0.93, 95 % CI: 2.30–2.98, p < 0.001) and high-frequency ranges (β = 0.91, 95 % CI: 4.05–5.46, p < 0.001). Age was also significantly associated with HTL in both frequency ranges (p < 0.001).
Conclusion
Elevated HbA1c levels are significantly associated with increased hearing thresholds in Saudi adults with T2DM, suggesting that poor glycemic control may contribute to auditory dysfunction. These findings support incorporating routine audiological assessments into diabetes care protocols.
{"title":"Association between glycated hemoglobin (HbA1c) levels and hearing threshold elevation in Saudi adults with type 2 diabetes: a cross-sectional study","authors":"Hind Maher Alenzi , Raghad Abdullah Alsagri , Manal Alfakhri , Safa Alqudah , Margaret Zuriekat , Manal Alshareef , Aseel Hamad Alkhamees","doi":"10.1016/j.deman.2025.100281","DOIUrl":"10.1016/j.deman.2025.100281","url":null,"abstract":"<div><h3>Background</h3><div>Type 2 diabetes mellitus (T2DM) has been associated with sensorineural hearing loss through microvascular and neural pathways. Although T2DM prevalence is high in Saudi Arabia, limited research has examined the relationship between glycemic control and auditory function in this population.</div></div><div><h3>Objective</h3><div>To investigate the association between glycated hemoglobin (HbA1c) levels and hearing threshold levels (HTL) in Saudi adults with T2DM.</div></div><div><h3>Methods</h3><div>This retrospective cross-sectional study analyzed medical records of 41 Saudi adults with T2DM (aged 20–57 years, 27 males, 14 females) who underwent pure tone audiometry and HbA1c testing at Royal Commission Medical Center, Yanbu, between 2021–2024. Linear regression analyses examined associations between HbA1c and HTL across low-frequency (0.25–2 kHz) and high-frequency (4–8 kHz) ranges.</div></div><div><h3>Results</h3><div>Mean participant age was 49.1 ± 7.8 years, with mean HbA1c of 6.9 ± 1.2 %. Linear regression revealed significant positive associations between HbA1c and HTL in both low-frequency (β = 0.93, 95 % CI: 2.30–2.98, <em>p</em> < 0.001) and high-frequency ranges (β = 0.91, 95 % CI: 4.05–5.46, <em>p</em> < 0.001). Age was also significantly associated with HTL in both frequency ranges (<em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Elevated HbA1c levels are significantly associated with increased hearing thresholds in Saudi adults with T2DM, suggesting that poor glycemic control may contribute to auditory dysfunction. These findings support incorporating routine audiological assessments into diabetes care protocols.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100281"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.deman.2025.100277
Ahmed Raza , FNU Kalpina , Shabnam Ijaz , Manayiel Rehmat , Eman Alamgir , Mateen Ahmad , Meha Munir , Junaid Ali , Mustafa Turkmani , Ubaid Khan
Background
Hypertension is a leading contributor to cardiovascular morbidity and mortality, particularly among individuals with diabetes mellitus (DM). We aim to assess hypertensive mortality trends among middle-aged (45–64 years) and older US adults (≥65 years) with DM from 1999 to 2019.
Methods
The data was extracted from the CDC WONDER multiple-cause-of-death database using ICD-10 codes E10-E14 for DM as the underlying cause of death and I10-I15 for hypertensive diseases as the contributing cause. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 100,000 individuals were used, stratified by sex, race/ethnicity, age group, and geographic region. AAMRs and CMRs were further analyzed using Joinpoint Regression to calculate annual percentage changes (APCs) and average APCs (AAPCs).
Results
From 1999 to 2019, 538,649 deaths occurred among adults ≥45 years with DM and hypertension. Overall, AAMR increased from 8.30 to 25.76, showing an increasing trend with a 4.69% annual rise in mortality. Males (AAMR 25.16) demonstrated a higher burden and greater rise in mortality (AAPC: 5.83%) than females (AAMR 19.33; AAPC 3.52%). Non-Hispanic Blacks had the highest AAMR (52.79), while non-Hispanic Whites showed the steepest mortality increase (AAPC: 4.97%). The South and non-metropolitan areas exhibited the most significant regional mortality burden.
Conclusion
Hypertensive mortality among US adults with DM rose significantly from 1999 to 2019, with pronounced disparities by sex, race, geography, and urbanization. Targeted healthcare interventions and improved access to hypertension management in high-risk subpopulations are needed to mitigate this growing burden.
{"title":"Hypertensive disease mortality trends among middle-aged and older adults with diabetes mellitus in the United States, 1999–2019: a nationwide analysis","authors":"Ahmed Raza , FNU Kalpina , Shabnam Ijaz , Manayiel Rehmat , Eman Alamgir , Mateen Ahmad , Meha Munir , Junaid Ali , Mustafa Turkmani , Ubaid Khan","doi":"10.1016/j.deman.2025.100277","DOIUrl":"10.1016/j.deman.2025.100277","url":null,"abstract":"<div><h3>Background</h3><div>Hypertension is a leading contributor to cardiovascular morbidity and mortality, particularly among individuals with diabetes mellitus (DM). We aim to assess hypertensive mortality trends among middle-aged (45–64 years) and older US adults (≥65 years) with DM from 1999 to 2019.</div></div><div><h3>Methods</h3><div>The data was extracted from the CDC WONDER multiple-cause-of-death database using ICD-10 codes E10-E14 for DM as the underlying cause of death and I10-I15 for hypertensive diseases as the contributing cause. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 100,000 individuals were used, stratified by sex, race/ethnicity, age group, and geographic region. AAMRs and CMRs were further analyzed using Joinpoint Regression to calculate annual percentage changes (APCs) and average APCs (AAPCs).</div></div><div><h3>Results</h3><div>From 1999 to 2019, 538,649 deaths occurred among adults ≥45 years with DM and hypertension. Overall, AAMR increased from 8.30 to 25.76, showing an increasing trend with a 4.69% annual rise in mortality. Males (AAMR 25.16) demonstrated a higher burden and greater rise in mortality (AAPC: 5.83%) than females (AAMR 19.33; AAPC 3.52%). Non-Hispanic Blacks had the highest AAMR (52.79), while non-Hispanic Whites showed the steepest mortality increase (AAPC: 4.97%). The South and non-metropolitan areas exhibited the most significant regional mortality burden.</div></div><div><h3>Conclusion</h3><div>Hypertensive mortality among US adults with DM rose significantly from 1999 to 2019, with pronounced disparities by sex, race, geography, and urbanization. Targeted healthcare interventions and improved access to hypertension management in high-risk subpopulations are needed to mitigate this growing burden.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100277"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145570934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.deman.2025.100283
Yasser Alghanmi, Hanan Alothmani, Sami Alruhaily, Haifa Sindi, Adel Elgawish, Ebrahim Abdelfattah Alkashlan, Mohammed Mostafa Shaaban
Background
Type 1 diabetes mellitus (T1DM) is one of the most common metabolic disorders in children and adolescents. Saudi Arabia is among the countries with the highest reported incidence of T1DM worldwide.
Objective
To estimate the incidence of T1DM among children and adolescents in Yanbu province, Saudi Arabia; characterize the clinical presentation and severity of diabetic ketoacidosis (DKA) at diagnosis; and analyze the distribution of cases by age group, sex, and season.
Methods
This retrospective study included all children aged 0–14 years newly diagnosed with T1DM at the Royal Commission Medical Center in Yanbu between July 2020 and June 2023. Data were extracted from medical records. Patients were categorized by age group, clinical presentation, DKA severity, and season of diagnosis. Incidence rates were calculated using 2022 Saudi Census data. Statistical analysis was performed using SPSS v26.0.
Results
A total of 108 children and adolescents aged 0–14 years were newly diagnosed with T1DM during the three-year study period. The average annual incidence was 30.8 per 100,000 (95 % CI: 26.7–35.8). The median age at diagnosis was 6.9 years (IQR: 4–9.8), with the highest proportion in the 6–<11 year age group (46.3 %). Males and females were equally represented. Most patients (68.5 %) presented with hyperglycemic symptoms, while 31.5 % had DKA; of the DKA cases, 70.6 % were mild to moderate and 29.4 % were severe. A significant association was observed between age group and clinical presentation (p = 0.009), with younger children (0–<3 years) contributing disproportionately to severe DKA cases. Seasonal variation showed more cases diagnosed in summer and spring, though not statistically significant. No mortality or major morbidity was documented.
Conclusions
Yanbu province demonstrates a high incidence of T1DM among children and adolescents. Most cases presented with hyperglycemic symptoms rather than DKA, and the majority of DKA cases were of mild to moderate severity. These findings highlight the importance of early recognition and timely management of T1DM to prevent severe complications.
{"title":"Incidence and clinical presentation of Type 1 Diabetes Mellitus among children and adolescents in Yanbu, Saudi Arabia","authors":"Yasser Alghanmi, Hanan Alothmani, Sami Alruhaily, Haifa Sindi, Adel Elgawish, Ebrahim Abdelfattah Alkashlan, Mohammed Mostafa Shaaban","doi":"10.1016/j.deman.2025.100283","DOIUrl":"10.1016/j.deman.2025.100283","url":null,"abstract":"<div><h3>Background</h3><div>Type 1 diabetes mellitus (T1DM) is one of the most common metabolic disorders in children and adolescents. Saudi Arabia is among the countries with the highest reported incidence of T1DM worldwide.</div></div><div><h3>Objective</h3><div>To estimate the incidence of T1DM among children and adolescents in Yanbu province, Saudi Arabia; characterize the clinical presentation and severity of diabetic ketoacidosis (DKA) at diagnosis; and analyze the distribution of cases by age group, sex, and season.</div></div><div><h3>Methods</h3><div>This retrospective study included all children aged 0–14 years newly diagnosed with T1DM at the Royal Commission Medical Center in Yanbu between July 2020 and June 2023. Data were extracted from medical records. Patients were categorized by age group, clinical presentation, DKA severity, and season of diagnosis. Incidence rates were calculated using 2022 Saudi Census data. Statistical analysis was performed using SPSS v26.0.</div></div><div><h3>Results</h3><div>A total of 108 children and adolescents aged 0–14 years were newly diagnosed with T1DM during the three-year study period. The average annual incidence was 30.8 per 100,000 (95 % CI: 26.7–35.8). The median age at diagnosis was 6.9 years (IQR: 4–9.8), with the highest proportion in the 6–<11 year age group (46.3 %). Males and females were equally represented. Most patients (68.5 %) presented with hyperglycemic symptoms, while 31.5 % had DKA; of the DKA cases, 70.6 % were mild to moderate and 29.4 % were severe. A significant association was observed between age group and clinical presentation (<em>p</em> = 0.009), with younger children (0–<3 years) contributing disproportionately to severe DKA cases. Seasonal variation showed more cases diagnosed in summer and spring, though not statistically significant. No mortality or major morbidity was documented.</div></div><div><h3>Conclusions</h3><div>Yanbu province demonstrates a high incidence of T1DM among children and adolescents. Most cases presented with hyperglycemic symptoms rather than DKA, and the majority of DKA cases were of mild to moderate severity. These findings highlight the importance of early recognition and timely management of T1DM to prevent severe complications.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100283"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The global prevalence of diabetes has quadrupled between 1980 and 2014, paralleled by a rise in mortality due to end-organ damage. Since their introduction in 2013, SGLT2 inhibitors (SGLT2i) have become a central component of diabetes management, supported by landmark cardiovascular outcome trials and randomized controlled studies that demonstrated significant cardiovascular and renal benefits. Although generally well tolerated, SGLT2i use has been associated with dermatologic adverse effects, ranging from mild rashes to severe conditions like Fournier’s gangrene. However, drug reaction with eosinophilia and systemic symptoms (DRESS) has not been previously reported in association with this drug class. DRESS, though rare, is a serious hypersensitivity reaction linked to several commonly prescribed medications.
Case Presentation
We report a 52-year-old man with type 2 diabetes who developed DRESS syndrome one month after initiating dapagliflozin. He presented with a morbilliform rash affecting >50 % of body surface area, mucosal involvement, fever, acute kidney injury, and elevated liver enzymes. Skin biopsy confirmed the diagnosis. Treatment with topical corticosteroids led to rapid improvement within 48 h.
Conclusion
This case highlights a rare adverse effect of dapagliflozin—DRESS syndrome—underscoring the importance of vigilance even with medications that typically have favorable safety profiles.
{"title":"DRESS syndrome with the use of dapagliflozin: A case report and review of literature","authors":"Rebecca Badawi , Layal Akl , Karima Chafai , Jean-Louis Nguewa , Jean-François Gautier","doi":"10.1016/j.deman.2025.100278","DOIUrl":"10.1016/j.deman.2025.100278","url":null,"abstract":"<div><h3>Background</h3><div>The global prevalence of diabetes has quadrupled between 1980 and 2014, paralleled by a rise in mortality due to end-organ damage. Since their introduction in 2013, SGLT2 inhibitors (SGLT2i) have become a central component of diabetes management, supported by landmark cardiovascular outcome trials and randomized controlled studies that demonstrated significant cardiovascular and renal benefits. Although generally well tolerated, SGLT2i use has been associated with dermatologic adverse effects, ranging from mild rashes to severe conditions like Fournier’s gangrene. However, drug reaction with eosinophilia and systemic symptoms (DRESS) has not been previously reported in association with this drug class. DRESS, though rare, is a serious hypersensitivity reaction linked to several commonly prescribed medications.</div></div><div><h3>Case Presentation</h3><div>We report a 52-year-old man with type 2 diabetes who developed DRESS syndrome one month after initiating dapagliflozin. He presented with a morbilliform rash affecting >50 % of body surface area, mucosal involvement, fever, acute kidney injury, and elevated liver enzymes. Skin biopsy confirmed the diagnosis. Treatment with topical corticosteroids led to rapid improvement within 48 h.</div></div><div><h3>Conclusion</h3><div>This case highlights a rare adverse effect of dapagliflozin—DRESS syndrome—underscoring the importance of vigilance even with medications that typically have favorable safety profiles.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100278"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.deman.2025.100260
Helen Chen , Lappui Chung , Michael Weiner , Mark Fu , Patrick Balius , Julian Wolfson
Objective
We assessed the association between insulin prescription characteristics and glycemic control.
Methods
Electronic health records (2017–2023) were used to identify adults with type 2 diabetes prescribed insulin from outpatient visits on the same day as a hemoglobin A1c (HbA1c) result in a Midwest US region. Insulin prescription characteristics were total daily dose, providing a maximum dose, and instruction types (dosing frequency, carbohydrate (carb) counting, correction, and sliding scale). Mixed-effects linear and logistic regression modeled HbA1c and meeting HbA1c target (<7 for age18–64 and <8 for age 65).
Results
Among 11,179 subjects, mean age was 53; 49 % were male, and 58 % White. Overall cohort glycemic control was low, median HbA1c was 9.3; 16 % met HbA1c target; mean HbA1c at last follow-up was 8.7 %. Instruction types were 88 % dosing frequency, 7 % correction, 3 % sliding scale, and 1 % carb counting. HbA1c reduction was associated with carb counting (−0.4, p = 0.009), correction (−0.2, p < 0.001), sliding scale (−0.1, p = 0.014), and providing a maximum daily insulin dose (−0.02, p < 0.001). An increase in total daily insulin dose by 10 units was associated with a 0.001 increase in HbA1c (p = 0.003). Correction instruction was 1.4 times more likely than dosing frequency to meet HbA1c target (p < 0.001).
Conclusion
Insulin instruction type was associated with glycemic control, but control was low.
{"title":"Characteristics of insulin prescriptions and their association with glycemic control in adults with type 2 diabetes mellitus","authors":"Helen Chen , Lappui Chung , Michael Weiner , Mark Fu , Patrick Balius , Julian Wolfson","doi":"10.1016/j.deman.2025.100260","DOIUrl":"10.1016/j.deman.2025.100260","url":null,"abstract":"<div><h3>Objective</h3><div>We assessed the association between insulin prescription characteristics and glycemic control.</div></div><div><h3>Methods</h3><div>Electronic health records (2017–2023) were used to identify adults with type 2 diabetes prescribed insulin from outpatient visits on the same day as a hemoglobin A1c (HbA1c) result in a Midwest US region. Insulin prescription characteristics were total daily dose, providing a maximum dose, and instruction types (dosing frequency, carbohydrate (carb) counting, correction, and sliding scale). Mixed-effects linear and logistic regression modeled HbA1c and meeting HbA1c target (<7 for age18–64 and <8 for age <span><math><mo>≥</mo></math></span> 65).</div></div><div><h3>Results</h3><div>Among 11,179 subjects, mean age was 53; 49 % were male, and 58 % White. Overall cohort glycemic control was low, median HbA1c was 9.3; 16 % met HbA1c target; mean HbA1c at last follow-up was 8.7 %. Instruction types were 88 % dosing frequency, 7 % correction, 3 % sliding scale, and 1 % carb counting. HbA1c reduction was associated with carb counting (−0.4, <em>p</em> = 0.009), correction (−0.2, <em>p</em> < 0.001), sliding scale (−0.1, <em>p</em> = 0.014), and providing a maximum daily insulin dose (−0.02, <em>p</em> < 0.001). An increase in total daily insulin dose by 10 units was associated with a 0.001 increase in HbA1c (<em>p</em> = 0.003). Correction instruction was 1.4 times more likely than dosing frequency to meet HbA1c target (<em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Insulin instruction type was associated with glycemic control, but control was low.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100260"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144749002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.deman.2025.100282
Zhilong Cai , Shuoyu Rui , Jianhua Chen , Nanqu Huang , Yong Luo , Fei Feng
Background
Falls represent a significant health burden among individuals with diabetes, yet the long-term relationship between diabetes status and fall risk remains inadequately characterized in Asian populations. This study aimed to investigate the association between diabetes status and incident falls among Chinese middle-aged and older adults using nationally representative longitudinal data.
Methods
Utilizing China Health and Retirement Longitudinal Study (CHARLS) 2011–2020 data, we included 9553 participants (aged ≥45 years) for a 9-year prospective cohort study. Diabetes was classified as normal glucose metabolism, prediabetes, or diabetes based on self-reported diagnosis, fasting plasma glucose (FPG), or HbA1c levels. Incident falls were assessed via self-reports across four survey waves from 2011 to 2020. Multivariable logistic regression models were to evaluate the independent association between diabetes and falls and subgroup/sensitivity analyses were conducted.
Results
The study included 7131 (74.6 %) participants with normal glucose levels, 1254 (13.1 %) with prediabetes, and 1168 (12.2 %) with diabetes. Mean age was 58.1 ± 9.0 years, with 46.9 % males. Fall incidence rates were significantly higher in the diabetes group (55.1 %) compared to prediabetes (48.3 %) and normal glucose groups (47.3 %) (P < 0.001). After full adjustment for potential confounders, diabetes was associated with a 27 % increased risk of incident falls (OR=1.27, 95 % CI: 1.11–1.45, P < 0.001), while prediabetes showed no significant association (OR=0.99, 95 % CI: 0.87–1.12, P = 0.817). Subgroup analyses revealed stronger associations in older adults aged ≥60 years (OR=1.45, 95 % CI: 1.18–1.78) compared to those <60 years (OR=1.17, 95 % CI: 0.98–1.39), with similar effects in both sexes. Sensitivity analyses confirmed the robustness of these findings.
Conclusions
Diabetes significantly increases the risk of incident falls among Chinese middle-aged and older adults, with a 27 % higher risk persisting after comprehensive adjustment. This association appears to be specific to established diabetes rather than prediabetes, suggesting a pathophysiological threshold effect. The findings support the integration of fall prevention strategies into routine diabetes care, particularly for older adults, and have important implications for clinical practice guidelines and public health policy in China's rapidly aging population.
{"title":"Association between diabetes status and falls: a 9-year prospective cohort study using the China health and retirement longitudinal study","authors":"Zhilong Cai , Shuoyu Rui , Jianhua Chen , Nanqu Huang , Yong Luo , Fei Feng","doi":"10.1016/j.deman.2025.100282","DOIUrl":"10.1016/j.deman.2025.100282","url":null,"abstract":"<div><h3>Background</h3><div>Falls represent a significant health burden among individuals with diabetes, yet the long-term relationship between diabetes status and fall risk remains inadequately characterized in Asian populations. This study aimed to investigate the association between diabetes status and incident falls among Chinese middle-aged and older adults using nationally representative longitudinal data.</div></div><div><h3>Methods</h3><div>Utilizing China Health and Retirement Longitudinal Study (CHARLS) 2011–2020 data, we included 9553 participants (aged ≥45 years) for a 9-year prospective cohort study. Diabetes was classified as normal glucose metabolism, prediabetes, or diabetes based on self-reported diagnosis, fasting plasma glucose (FPG), or HbA1c levels. Incident falls were assessed via self-reports across four survey waves from 2011 to 2020. Multivariable logistic regression models were to evaluate the independent association between diabetes and falls and subgroup/sensitivity analyses were conducted.</div></div><div><h3>Results</h3><div>The study included 7131 (74.6 %) participants with normal glucose levels, 1254 (13.1 %) with prediabetes, and 1168 (12.2 %) with diabetes. Mean age was 58.1 ± 9.0 years, with 46.9 % males. Fall incidence rates were significantly higher in the diabetes group (55.1 %) compared to prediabetes (48.3 %) and normal glucose groups (47.3 %) (<em>P</em> < 0.001). After full adjustment for potential confounders, diabetes was associated with a 27 % increased risk of incident falls (OR=1.27, 95 % CI: 1.11–1.45, <em>P</em> < 0.001), while prediabetes showed no significant association (OR=0.99, 95 % CI: 0.87–1.12, <em>P</em> = 0.817). Subgroup analyses revealed stronger associations in older adults aged ≥60 years (OR=1.45, 95 % CI: 1.18–1.78) compared to those <60 years (OR=1.17, 95 % CI: 0.98–1.39), with similar effects in both sexes. Sensitivity analyses confirmed the robustness of these findings.</div></div><div><h3>Conclusions</h3><div>Diabetes significantly increases the risk of incident falls among Chinese middle-aged and older adults, with a 27 % higher risk persisting after comprehensive adjustment. This association appears to be specific to established diabetes rather than prediabetes, suggesting a pathophysiological threshold effect. The findings support the integration of fall prevention strategies into routine diabetes care, particularly for older adults, and have important implications for clinical practice guidelines and public health policy in China's rapidly aging population.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100282"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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