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Bountouvis N, Koumpa E, Skoutarioti N, Kladitis D, Exadaktylos AK, Anitsakis C. Burden of Disease in Refugee Patients with Diabetes on the Island of Lesvos-The Experience of a Frontline General Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:828. [PMID: 39063405 PMCID: PMC11276869 DOI: 10.3390/ijerph21070828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/11/2024] [Accepted: 06/22/2024] [Indexed: 07/28/2024]
Abstract
Diabetes mellitus is a non-communicable disease which poses a great burden on refugee populations, who are confronted with limited access to healthcare services and disruption of pre-existing pharmacological treatment. AIMS We sought to evaluate the degree of hyperglycaemia in refugees with known or recently diagnosed diabetes, to assess cardiovascular comorbidities and diabetes complications, to review and provide available therapeutic options, and to compare, if possible, the situation in Lesvos with other locations hosting refugee populations, thus raising our awareness towards barriers to accessing healthcare and managing diabetes in these vulnerable populations and to propose follow-up strategies. METHODS We retrospectively studied 69 refugee patients (68% of Afghan origin, 64% female) with diabetes mellitus (81% with type 2 diabetes), who were referred to the diabetes outpatient clinics of the General Hospital of Mytilene, Lesvos, Greece, between June 2019 and December 2020. Age, Body Mass Index, diabetes duration, glycaemic control (HbA1c and random glucose), blood pressure, estimated renal function, lipid profile, diabetes complications and current medication were documented at presentation and during subsequent visits. RESULTS For all patients with type 1 diabetes and type 2 diabetes, age at presentation was 17.7 and 48.1 years, BMI 19.6 kg/m2 and 28.9 kg/m2 and HbA1c 9.6% and 8.7%, respectively (all medians). One-third (29%) of patients with type 2 diabetes presented either with interrupted or with no previous pharmacological treatment. Insulin was administered to only 21% of refugees with poorly controlled type 2 diabetes. Only half of the patients (48%) with hypertension were taking antihypertensive medication and one-sixth (17%) were taking lipid-lowering medication. Forty-two per cent (42%) of patients were lost to follow-up. CONCLUSIONS Our results showed that a significant portion of refugees with diabetes have either no treatment at all or have had their treatment discontinued, that insulin is still underutilised and that a significant portion of patients are lost to follow-up. It is essential to enhance our ability to identify refugees who may be at risk of developing diabetes or experiencing complications related to the disease. Additionally, it is important to expand access to crucial treatment and monitoring services. By improving our policies for managing non-communicable diseases, we can better support the health and well-being of these vulnerable populations. Furthermore, it is vital to recognize that Greece cannot bear the burden of the refugee crisis alone; international support and collaboration are necessary to address these challenges effectively.
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Affiliation(s)
- Nikolaos Bountouvis
- Department of Internal Medicine, Diabetes Outpatient Clinics, General Hospital of Mytilene “Vostanio”, 83100 Mytilene, Lesvos, Greece
- Department of Emergency Medicine (Research), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Eirini Koumpa
- Department of Internal Medicine, Diabetes Outpatient Clinics, General Hospital of Mytilene “Vostanio”, 83100 Mytilene, Lesvos, Greece
| | - Niki Skoutarioti
- Department of Internal Medicine, Diabetes Outpatient Clinics, General Hospital of Mytilene “Vostanio”, 83100 Mytilene, Lesvos, Greece
| | - Dimitrios Kladitis
- Department of Internal Medicine, Diabetes Outpatient Clinics, General Hospital of Mytilene “Vostanio”, 83100 Mytilene, Lesvos, Greece
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine (Research), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Charalampos Anitsakis
- Department of Internal Medicine, Diabetes Outpatient Clinics, General Hospital of Mytilene “Vostanio”, 83100 Mytilene, Lesvos, Greece
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Neuman V, Vavra D, Drnkova L, Pruhova S, Plachy L, Kolouskova S, Obermannova B, Amaratunga SA, Konecna P, Vyzralkova J, Venhacova P, Pomahacova R, Paterova P, Stichova L, Skvor J, Kocourkova K, Romanova M, Vosahlo J, Strnadel J, Polockova K, Neumann D, Slavenko M, Sumnik Z. Introduction of continuous glucose monitoring (CGM) is a key factor in decreasing HbA1c in war refugee children with type 1 diabetes. Diabetes Res Clin Pract 2024; 208:111118. [PMID: 38309536 DOI: 10.1016/j.diabres.2024.111118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/05/2024]
Abstract
AIMS Our aim was to describe the changes in therapy and diabetes control in Ukrainian war refugee children with diabetes (CwD) during the first year of their stay in Czechia. METHODS A total of 124 CwD (62 male, 62 female) were enrolled into this observational study. Anthropometric, laboratory and diabetes management data were acquired at baseline and at 3 months intervals for 12 months. All CwD were offered a CGM device during their first visit. Generalized Estimating Equation models were fitted in order to estimate the dynamics of studied characteristics. RESULTS Median baseline HbA1c was 58 mmol/mol (IQR [48; 73]mmol/mol) (7.5 %, IQR[6.5;8.8]%). The HbA1c decreased significantly throughout the course of the study at a pace of - 2.2 mmol/mol (-0.2 %pt.) per visit (P = 0.01, CI[-3.2;-1.1]). The pace of the decrease in the average HbA1c was significantly higher in the group of CwD who received CGM in Czechia than in those who already had it from Ukraine by 2.9 mmol/mol (0.27 %pt.) per visit (P < 0.001, CI [-4.4; -1.3]). CONCLUSIONS The steepest decrease in HbA1c was observed in CwD with newly initiated CGM underlining its vital role in improving the glucose control of CwD regardless of their background.
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Affiliation(s)
- V Neuman
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - D Vavra
- 3(rd) Faculty of Medicine, Charles University, Prague, Czech Republic
| | - L Drnkova
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - S Pruhova
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - L Plachy
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - S Kolouskova
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - B Obermannova
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - S A Amaratunga
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - P Konecna
- Department of Pediatrics, University Hospital Brno, Brno, Czech Republic
| | - J Vyzralkova
- Department of Pediatrics, University Hospital Brno, Brno, Czech Republic
| | - P Venhacova
- Department of Pediatrics, University Hospital Olomouc, Olomouc, Czech Republic
| | - R Pomahacova
- Department of Pediatrics, University Hospital Pilsen, Pilsen, Czech Republic
| | - P Paterova
- Department of Pediatrics, University Hospital Pilsen, Pilsen, Czech Republic
| | - L Stichova
- Department of Pediatrics, Masaryk Hospital, Usti nad Labem, Czech Republic
| | - J Skvor
- Department of Pediatrics, Masaryk Hospital, Usti nad Labem, Czech Republic
| | - K Kocourkova
- Department of Pediatrics, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic
| | - M Romanova
- Department of Pediatrics, 3(rd) Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - J Vosahlo
- Department of Pediatrics, 3(rd) Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - J Strnadel
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czech Republic
| | - K Polockova
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czech Republic
| | - D Neumann
- Department of Pediatrics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - M Slavenko
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Z Sumnik
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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Ray MK, McMichael A, Rivera-Santana M, Noel J, Hershey T. Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies. JMIR Diabetes 2021; 6:e27027. [PMID: 34081017 PMCID: PMC8212634 DOI: 10.2196/27027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/26/2021] [Accepted: 04/03/2021] [Indexed: 11/13/2022] Open
Abstract
Type 1 diabetes (T1D) is one of the most common chronic childhood diseases, and its prevalence is rapidly increasing. The management of glucose in T1D is challenging, as youth must consider a myriad of factors when making diabetes care decisions. This task often leads to significant hyperglycemia, hypoglycemia, and glucose variability throughout the day, which have been associated with short- and long-term medical complications. At present, most of what is known about each of these complications and the health behaviors that may lead to them have been uncovered in the clinical setting or in laboratory-based research. However, the tools often used in these settings are limited in their ability to capture the dynamic behaviors, feelings, and physiological changes associated with T1D that fluctuate from moment to moment throughout the day. A better understanding of T1D in daily life could potentially aid in the development of interventions to improve diabetes care and mitigate the negative medical consequences associated with it. Therefore, there is a need to measure repeated, real-time, and real-world features of this disease in youth. This approach is known as ecological momentary assessment (EMA), and it has considerable advantages to in-lab research. Thus, this viewpoint aims to describe EMA tools that have been used to collect data in the daily lives of youth with T1D and discuss studies that explored the nuances of T1D in daily life using these methods. This viewpoint focuses on the following EMA methods: continuous glucose monitoring, actigraphy, ambulatory blood pressure monitoring, personal digital assistants, smartphones, and phone-based systems. The viewpoint also discusses the benefits of using EMA methods to collect important data that might not otherwise be collected in the laboratory and the limitations of each tool, future directions of the field, and possible clinical implications for their use.
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Affiliation(s)
- Mary Katherine Ray
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Alana McMichael
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Maria Rivera-Santana
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Jacob Noel
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Tamara Hershey
- Department of Psychiatry, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, United States
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