Age and glycemic control among low-income Latinos

Characteristics associated with optimal blood sugar in individuals living with type 2 diabetes in hard-to-reach rural communities: results of a cross-sectional study in Esmeraldas, Ecuador

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a pressing public health challenge in Latin America, with an increasing prevalence and negative impacts on population health. Achieving optimal blood glucose levels is critical for preventing complications, yet significant socioeconomic inequities persist in disease management and optimal glucose control. We aimed to investigate the patient characteristics associated with optimal fasting capillary glucose in individuals living with T2DM in a hard-to-reach setting in Esmeraldas, Ecuador.

METHODS

We carried out a cross-sectional study of individuals with T2DM in the Eloy Alfaro health district of Esmeraldas, using a complex sample design with some limitations. Data collection took place between October 2020 and May 2022 and involved face-to-face interviews to collect sociodemographic and clinical data and a Fasting Capillary Blood Glucose test. Perceived social support was measured with the Multidimensional Scale of Perceived Social Support (MSPSS). We estimated the prevalence of optimal glucose levels according to patient characteristics and calculated odds ratios (OR) with 95% confidence intervals using multivariable logistic regression.

RESULTS

Of the 474 participants surveyed, only 18.1% (86; 95%CI: 14.9-21.9) had optimal fasting capillary glucose levels. In this sample, optimal glucose was nearly four times more frequent among men compared to women (aOR = 3.92, 95%CI: 2.08-7.40, p < 0.001). Furthermore, older age (aOR = 1.03, 95%CI: 1.01-1.05, p = 0.006), living in an urbanised setting (aOR = 2.04, 95%CI: 1.22-3.40, p = 0.006) and unemployment (aOR = 0.48, 95%CI: 0.25-0.94, p = 0.031) were also linked to optimal blood glucose levels. While perceived social support in this population was moderate (median = 2.33, on a scale of 1 to 4), high family support appeared to reduce optimal glycaemic levels (aOR = 0.35, 95%CI: 0.18-0.70, p = 0.003).

CONCLUSIONS

The intricate interplay of factors influencing diabetes management and optimal blood sugar suggests that targeted, context-specific and gender-sensitive public health strategies may be needed to address diabetes disparities in vulnerable populations.

The association between early maladaptive schemas and glycaemic control in patients with type 2 diabetes mellitus: A cross-sectional study

INTRODUCTION

Diabetes is a disease with high prevalence and causes heavy economic burden. Mental and physical health are tied together and their interaction determines one's health or sickness. Early maladaptive schemas (EMSs) are suitable indicators of mental health. We investigated the association between EMSs and glycaemic control in type 2 diabetes mellitus (T2DM) patients.

METHODS

We conducted a cross-sectional study in 2021 on 150 patients with T2DM. We used two questionnaires a demographic data questionnaire, and a Young Schema Questionnaire 2 - Short Form for gathering the data. We also performed laboratory tests on our participants and used the results of fasting blood sugar and haemoglobin A1 c to evaluate glycaemic control.

RESULTS

Most of our participants were females (66%). Most of our patients were 41-60 years old (54%). There were only three single participants, and 86.6% of our individuals did not have a university degree. Total mean ± SD for EMSs score was 192.45 ± 55.66; self-sacrifice (19.09 ± 4.64) and defectiveness/shame (8.72 ± 4.45) had the highest and lowest EMSs scores, respectively. None of the demographic data had any significant impact on EMSs scores or glycaemic control, but generally, younger patients with higher levels of education had better glycaemic control. Participants with higher scores for defectiveness/shame and insufficient self-control had significantly worse glycaemic control.

CONCLUSION

Mental and physical health are tied together, and paying attention to psychological aspects in prevention and management of physical disorders is crucial. EMSs, especially defectiveness/shame and insufficient self-control are associated with glycaemic control of T2DM patients.

Initial Glycemic Control and Care Among Younger Adults Diagnosed With Type 2 Diabetes

OBJECTIVE

The prevalence of type 2 diabetes is increasing among adults under age 45. Onset of type 2 diabetes at a younger age increases an individual's risk for diabetes-related complications. Given the lasting benefits conferred by early glycemic control, we compared glycemic control and initial care between adults with younger onset (21-44 years) and mid-age onset (45-64 years) of type 2 diabetes.

RESEARCH DESIGN AND METHODS

Using data from a large, integrated health care system, we identified 32,137 adults (aged 21-64 years) with incident diabetes (first HbA_1c ≥6.5% [≥48 mmol/mol]). We excluded anyone with evidence of prior type 2 diabetes, gestational diabetes mellitus, or type 1 diabetes. We used generalized linear mixed models, adjusting for demographic and clinical variables, to examine differences in glycemic control and care at 1 year.

RESULTS

Of identified individuals, 26.4% had younger-onset and 73.6% had mid-age-onset type 2 diabetes. Adults with younger onset had higher initial mean HbA_1c values (8.9% [74 mmol/mol]) than adults with onset in mid-age (8.4% [68 mmol/mol]) (P < 0.0001) and lower odds of achieving an HbA_1c <7% (<53 mmol/mol) 1 year after the diagnosis (adjusted odds ratio [aOR] 0.70 [95% CI 0.66-0.74]), even after accounting for HbA_1c at diagnosis. Adults with younger onset had lower odds of in-person primary care contact (aOR 0.82 [95% CI 0.76-0.89]) than those with onset during mid-age, but they did not differ in telephone contact (1.05 [0.99-1.10]). Adults with younger onset had higher odds of starting metformin (aOR 1.20 [95% CI 1.12-1.29]) but lower odds of adhering to that medication (0.74 [0.69-0.80]).

CONCLUSIONS

Adults with onset of type 2 diabetes at a younger age were less likely to achieve glycemic control at 1 year following diagnosis, suggesting the need for tailored care approaches to improve outcomes for this high-risk patient population.

MPV in Uncontrolled & Controlled Diabetics- Its Role as an Indicator of Vascular Complication

INTRODUCTION

Platelets are tiny, disc-shaped, non-nucleated structures derived from megakaryocytes. The morphological differences in measuring Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) of platelets have important implications for assessing the functional expressions of platelets. Electron microscopy reveals the presence of glycogen as prominent masses in platelets. MPV values have been generally reported to be very high in individuals with uncontrolled diabetes mellitus (DM).

AIM

This study aimed to determine and compare the MPV values in uncontrolled and controlled group of Type-2 Diabetics along with healthy non-diabetic people and to correlate MPV values with age, sex and glycosylated haemoglobin (HbA1c) levels in diabetic groups. This study also aimed to determine the prevalence of retinopathy in uncontrolled and controlled group of diabetic patients.

MATERIALS AND METHODS

This case control study was carried out in our institution for 1 year. The patients were grouped as uncontrolled group of diabetic patients and controlled group of diabetic patients based on their HbA1c levels. 106 uncontrolled diabetic patients and 100 controlled diabetic patients were included, with 100 non-diabetic subjects as controls. Patient's profile which included all demographic particulars and medical history was obtained. Fundus examination and other ophthalmic findings of 50 uncontrolled and 50 controlled diabetic cases were recorded. The findings were analysed statistically using IBM SPSS software.

RESULTS

In uncontrolled group of 106 diabetic patients, 54 patients were males and 52 patients were females and the mean age was 51.63±11.04, mean HbA1c was 9.86±1.91% and mean MPV was 8.93±0.90fl. In controlled group of 100 diabetic patients, 49 patients were males and 51 patients were females and the mean age was 47.88±15.17, mean HbA1c was 6.08±0.49% and mean MPV was 8.106 ± 0.72fl. In 100 non-diabetic controls 77 patients were males and 23 patients were females and the mean age was 37.97±9.69 and mean MPV was 8.02±0.86fl. Among 50 cases of uncontrolled DM, 14 uncontrolled DM patients had diabetic retinopathy with an average MPV of about 9.2±0.61fl and mean HbA1c of 10.6±1.98% whereas, 30 uncontrolled patients with no evidence of retinopathy with an average MPV of about 8.39±0.676 fl and mean HbA1C of 9.18±1.91%.

CONCLUSION

MPV values are higher in uncontrolled DM patients when compared with controlled DM patients and a higher percentage of them develop microvascular complications like Diabetic Retinopathy suggesting that mean platelet volume could indicate and play a more important role in the detection of vascular complications of Diabetes.

Health and psychosocial outcomes in U.S. adult patients with diabetes from diverse ethnicities

Within the United States, diabetes is a serious public health concern and patients with diabetes are more likely to experience clinical depression, psychological distress, and depressive symptoms than those without. Negative psychosocial factors are associated with poorer diabetes management and glycemic control. Overall, both the rates of diabetes and related psychological distress are greater for persons of diverse ethnicities than for non-Latino whites, and have reached epidemic proportions in certain groups. The following article will provide an overview across ethnicities of the rates of diabetes, health outcomes, psychosocial outcomes, and unique cultural and linguistic challenges that contribute to disparities within US diabetes patients of diverse ethnicities. Using this information, our hope is that health care practitioners and researchers alike can better respond to the psychosocial needs of ethnically diverse patients.