Diabetes epidemiology and management最新文献

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

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.

Introduction

The decision to fast or not is quite complex. Personal, medical and religious matters may influence it for individuals with diabetes. However, a diagnosis of diabetes does not constitute an automatic exemption from Ramadan fasting. We aimed to evaluate the characteristics of the non-fasting cohort and explore the potential reasons during Ramadan through the global Ramadan surveys of 2020 and 2022.

Method

The Diabetes and Ramadan (DaR) Global Study is an observational retrospective survey conducted between 2020 and 2022, which included adult patients (18 and older) who fasted and those who opted not to fast. The survey captured demographic data and patient characteristics (co-morbidities, duration and type of diabetes, diabetes-related complications and medications, development of acute complications during Ramadan, hospitalisations and ER visits) for both groups.

Results

Of 12,059 patients, 1822 (14.5 %) did not fast during Ramadan; that population leaned towards females (54.6 %). They had an average age of 60.58 years (SD=12.12) with a statistically significant difference from the fasting population, averaging 54.29±11.45 (p = 0.000). Also of note was the more significant average duration of diabetes in the non-fasting cohort (12.54 years vs 9.44). There are notable regional differences in rates of fasting that ranged between 6.3 % and up to 51.2 % of patients opting not fast in certain regions (Chart 1). The risk factors that showed apparent differences of high statistical significance (p ≤ 0.001) included: long duration of diabetes of over ten years, age above 60+ years, HbA1c value over 9 %, use of insulin therapy, and being affected by one or more vascular complications (these include CKD, CVD, and diabetic foot problems).

Conclusions

Many factors and comorbidities might influence patients’ decisions when planning Ramadan fasting. The non-fasting population's demographic and clinical profiles reveal distinctive features, emphasising a need for tailored risk assessments. Furthermore, regional disparities in the decision to fast underscore the multifaceted nature of this decision-making process. The new IDF-DAR risk assessment tool can help to stratify patients’ risk during Ramadan fasting and bridge the gap among different populations and cultures.

Introduction

Mellitus diabetes is an endocrine trouble characterized by chronic high glycemia caused by a relative or absolute insulin deficiency. It is a public health problem because of its frequency associated with high morbi-mortality. The objective of this research was to determine the frequency of mellitus diabetes in under 15-year-old patients in Butembo Town.

Method

it was a cross-sectional descriptive study realized at the University Clinics of Graben from January 1st, 2017 to December 31st, 2021.

Results

Between 2017 and 2021, 3,681 children and adolescents were hospitalized at the University Clinics of the Graben Pediatrics Department. Out of them, 49 were diagnosed with mellitus diabetes, which indicates a prevalence of 1.331 %. The majority of patients were males, with high frequencies observed between the ages of 2 to 12 years. Common complaints included coma, polyurea-polydipsia, vision troubles, fever, weight loss, and growth retardation. Complications in infants and adolescents with diabetes included retinopathies, neuropathies, coma, infection, and ketoacidosis. The patients were admitted with extreme glycemia, with many suffering from hypoglycemia. Forty-three out of the 49 patients received insulin, and five of them died.

Conclusion

Mellitus diabetes in young remains a health problem in Butembo. Effective healthcare must include medical professionals, the population, and the state.

Background

The rising prevalence of type 2 diabetes (T2D) in Syria emphasizes the urgent requirement for effective management approaches. The ABC goals, which include maintaining glycated hemoglobin levels below 7 %, blood pressure below 140/90 mmHg, and low-density lipoprotein cholesterol levels below 100 mg/dl, serve as crucial benchmarks for managing T2D and its associated comorbidities.

Methods

In this cross-sectional study, the achievement of ABC goals was retrospectively examined among 681 clinically diagnosed T2D patients (not on Insulin) who participated in a six-year online lifestyle intervention program for diabetes management at the Freedom from Diabetes Clinic in Syria between January 2016 and December 2022.

Results

Out of the participants, 152 (22.3 %) successfully achieved all three ABC goals, while 306 (45.0 %) and 183 (26.9 %) achieved two or one goal(s) respectively. The factors influencing the attainment of all three ABC goals revealed a significant association with older age (>50 years), lower body mass index (<25 kg/m2), and lower insulin resistance (Homeostatic Model Assessment of Insulin Resistance < 2.5). Furthermore, patients who successfully achieved all three ABC goals exhibited lower insulin resistance, improved lipid profiles, and higher insulin sensitivity and beta cell function.

Conclusion

This study offers new insights into the relationship between insulin resistance/sensitivity and the achievement of ABC goals in the Syrian population with T2D, underscoring the necessity for tailored strategies to enhance comprehensive diabetes management.

Background

Diabetes and tobacco use are well-established risk factors for stroke. However, the intersection of prediabetes, tobacco use, and stroke among young individuals remains underexplored. This study aims to investigate the association between pre-diabetes and stroke risk in young tobacco users.

Methods

Using the National Inpatient Sample (2019) and relevant ICD-10 codes, we identified young patients with tobacco use disorder and pre-diabetes. Regression analysis considered risk factors (gender, demographics, income, comorbidities) to assess stroke odds.

Results

Among 1,017,540 stroke hospitalizations, 1.9 % were pre-diabetic. Pre-diabetics were often older (median age 36 vs. 31), male (59.4 %), Black (33.8 %), and Hispanic (12.2 %), with higher rates of comorbidities, including drug abuse, alcohol abuse, COPD, and CKD (p < 0.001). They also exhibited higher rates of stroke events (1.9 % vs. 0.5 %, p < 0.001). Multivariable analysis after adjusting for confounders, young metabolically healthy smokers with pre-diabetes had a higher risk of stroke (aOR 3.31, 95 % CI [1.67–6.55], p < 0.001).

Conclusion

Prediabetes could potentially triple stroke risk in young tobacco smokers. Prospective research is warranted to explore the causal association between pre-diabetes and stroke in the setting of tobacco use.

Background

There remains a paucity of research comparing the diagnostic and therapeutic outcomes between Magnetic Resonance Imaging (MRI) and x-ray modalities for Charcot neuro-osteoarthropathy CNO. This retrospective study investigates the use of offloading devices, duration of offloading and final footwear outcomes dependent on imaging at diagnosis.

Methods

Medical records from a secondary hospital high-risk foot clinic in Perth, Western Australia, were systematically reviewed. Data collected included baseline medical history, location of CNO, Eichenholtz stage or Chantelau and Grutznel grade at diagnosis, type and duration of offloading, and final footwear outcomes.

Results

Twenty-eight patients met the inclusion criteria. All had diabetes and peripheral neuropathy. All patients received either an MRI (43%) or x-ray (57%) to confirm the diagnosis of active CNO. Five (17.9%) patients who were diagnosed on MRI had grade 0 CNO whilst 23 (82.1%) patients who were diagnosed on x-ray had stage 1 CNO. No statistical significance was found between the type and duration of offloading, resolution of CNO, footwear and transtibial amputation (TTA) outcomes across those diagnosed with MRI or x-ray.

Conclusion

No statistical significance in patient outcomes was found between those diagnosed with grade 0 on MRI and those diagnosed with stage 1 on x-ray.

Background

Type 2 diabetes (T2DM) is associated with high burden of atherosclerotic macrovascular disease which could be diagnosed with ankle-brachial index (ABI). Phase angle (PhA) from bioelectric impedance analysis is associated with the development of cardiovascular diseases. We investigated the association between low ABI and phase angle in T2DM patients in Ghana.

Method

In a cross-sectional study, 462 T2DM patients were systematically recruited for the study. ABI was measured using an 8 Hz continuous Doppler and ABI≤0.9 was considered to be low ABI. PhA was obtained from resistance and reactance from Bioelectric impedance analysis.

Results

The prevalence of low ABI was 16 % in the study population. T2DM patients with low ABI have decreased PhA (7.5 ± 1.9 vs 8.3 ± 2.2 units, p = 0.004) compared to those with normal ABI. An increase in phase angle by 1° was associated with a decrease in odds of having low ABI in unadjusted [OR (95 % CI) = 0.79 (0.48 – 0.95), p = 0.007] and adjusted models [0.88 (0.43 – 0.98), p = 0.036].

Conclusion

The prevalence of low ABI in T2DM patients in this study was 16 %. Also, PhA was lower in patients with low ABI compared to those with normal ABI.

Aims

To compare obstetric and neonatal outcomes in patients with type 2 diabetes mellitus (T2DM) who had scheduled delivery at full term (≥ 39 0/7 weeks) compared to early term (37 0/7 – 38 6/7 weeks) for T2DM indications.

Methods

This was a retrospective cohort study that included all singletons with T2DM with a scheduled delivery at a single tertiary care center between January 2008 and March 2022. Outcomes were compared using Fisher's exact test.

Results

107 singleton pregnancies were included. There was no significant difference in primary cesarean delivery between the two groups. The early term group had significantly higher rates of NICU admission compared to the term group (52% vs 32%, p = 0.05, OR 2.3, 95% CI 1.0–5.0), a finding that remained statistically significant on adjusted analysis (adjusted OR 2.81, 95% CI 1.04–7.58).

Conclusions

In singleton pregnancies undergoing scheduled delivery for T2DM-specific indications, early term deliveries were associated with significantly increased odds of NICU admission when compared to term deliveries, even after adjusting for surrogate markers of glycemic control. These findings suggest that early term delivery contributes to risk of NICU admission, rather than the indication for delivery itself. These findings should be replicated in a larger cohort.