1
|
Teli M, Thato R, Hasan F, Rias YA. Effectiveness of Family-Based Diabetes Management Intervention on Glycated Haemoglobin Among Adults With Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Biol Res Nurs 2024; 26:315-333. [PMID: 38063030 DOI: 10.1177/10998004231218887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
BACKGROUND Glycated hemoglobin (HbA1c) control is a crucial goal in the management of type 2 diabetes mellitus (T2DM), requiring lifelong commitment and family support. This study aimed to assess the effectiveness of family-based diabetes management intervention on HbA1c among adults with T2DM. METHODS From inception up to 2022, a comprehensive literature search was conducted across PubMed, ProQuest, Scopus, CORE, and the Cochrane Library. The quality of studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Effect sizes were calculated using standard deviations (SD), while the degree of heterogeneity was evaluated using the Higgins I2 test. Subgroup analyses were performed to explore factors contributing to sources of heterogeneity among trials. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed, and the protocol was registered with PROSPERO CRD42022384034. RESULTS A total of 18 randomized controlled trials (RCTs) involving 2815 participants indicated that family-based diabetes management intervention had a statistically significant impact on improving HbA1c (Mean Difference [MD] = -.47; 95% Confidence Interval [CI]: -.64 to -.30, p < .001) with a moderate level of heterogeneity (I2 = 59%). Subgroup analysis indicated that family-based diabetes management intervention among adults with T2DM in developing regions was more effective in improving HbA1c levels compared to developed countries. CONCLUSION Family-based diabetes management interventions improved HbA1c. Further research is required to develop diabetes management strategies with a family focus that clearly defines the family's involvement.
Collapse
Affiliation(s)
- Margareta Teli
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
- Nursing School, Polytechnic of Health Ministry of Health Kupang, Kupang, Indonesia
| | - Ratsiri Thato
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
| | - Faizul Hasan
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
| | - Yohanes Andy Rias
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
- Faculty of Health, College of Nursing, Institut Ilmu Kesehatan Bhakti Wiyata, Kediri, Indonesia
| |
Collapse
|
2
|
Erbakan AN, Arslan Bahadir M, Kaya FN, Güleç B, Vural Keskinler M, Faydaliel Ö, Mesçi B, Oğuz A. The effect of close and intensive therapeutic monitoring of patients with poorly controlled type 2 diabetes with different glycemic background. Medicine (Baltimore) 2023; 102:e36680. [PMID: 38115271 PMCID: PMC10727544 DOI: 10.1097/md.0000000000036680] [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: 10/12/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023] Open
Abstract
Patients with type 2 diabetes who have HbA1c values ≥ 10% have different previous glycemic trends, including new diagnosis of diabetes. We aimed to assess the efficacy of 3 months of intensive and facilitated antihyperglycemic treatment in patients with different glycemic backgrounds. In this observational study, patients with type 2 diabetes and poor glycemic control (indicated by an HbA1c level of > = 10%) were divided into groups based on their previous HbA1c levels (group 1; newly diagnosed type 2 diabetics, group 2; patients with previously controlled but now deteriorated HbA1c levels, group 3; patients whose HbA1c was not previously in the target range but was now above 10%, and group 4; patients whose HbA1c was above 10% from the start). Patients received intensive diabetes management with close monitoring and facilitated hospital visits. For further analysis, patients who were known to have previously had good metabolic control (either did not have diabetes or had previously had an HbA1c value < =7) and patients who had prior poor metabolic control were analyzed separately. Of the 195 participants [female, n = 84 (43.1%)], the median age was 54 years (inter-quantile range [IQR] = 15, min = 29, max = 80) and the median baseline HbA1c was 11.8% (IQR = 2.6%, min = 10%, max = 18.3%). The median duration of diabetes was 10 years (IQR = 9, min = 1, max = 35) when newly diagnosed patients were excluded. The ≥ 20% reduction in HbA1c at month 3 was observed in groups 1 to 4 in 97%, 88.1%, 69.1%, and 55.4%, respectively. The percentage of patients who achieved an HbA1c level of 7% or less was 60.6%, 38.1%, 16.4%, and 6.2% in the groups, respectively. The rate of those who achieved an HbA1c of 7% or less was nearly 50% of patients with type 2 diabetes mellitus who had previously had good metabolic control, whereas successful control was achieved in only 1 in 10 patients with persistently high HbA1c levels. Patients' glycemic history played an important role in determining their HbA1c levels at 3 months, suggesting that previous glycemic management patterns may indicate future success in diabetes control.
Collapse
Affiliation(s)
- Ayşe Naciye Erbakan
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Müzeyyen Arslan Bahadir
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Fatoş Nimet Kaya
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Büşra Güleç
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Miraç Vural Keskinler
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Özge Faydaliel
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Banu Mesçi
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Aytekin Oğuz
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| |
Collapse
|
3
|
Sahadevan P, Kamal VK, Sasidharan A, Bagepally BS, Kumari D, Pal A. Prevalence and risk factors associated with undiagnosed diabetes in India: Insights from NFHS-5 national survey. J Glob Health 2023; 13:04135. [PMID: 38063336 PMCID: PMC10704946 DOI: 10.7189/jogh.13.04135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Background Undiagnosed diabetes is a significant public health concern in India, considering the accumulative burden of diabetes and its long-term complications. We have estimated the prevalence and factors associated with undiagnosed diabetes in India. Methods We used data from the fifth round of the National Family Health Survey (NFHS-5, 2019-21) to estimate undiagnosed diabetes prevalence aged under 50 (15-49) years. A log-binomial model with survey-adjusted Poisson regression was used to estimate the prevalence risk ratio (PR) between undiagnosed diabetes and various factors. Multinomial logistic regression analysis was performed to examine the factors associated with diagnosed diabetes (vs. healthy) and undiagnosed diabetes (vs. healthy). All the analyses were survey-weighted and stratified by gender and reported with 95% confidence intervals. Results The prevalence of diabetes for individuals aged 15-49 years was found to be 4.90% (4.80 to 5.00%) from the NFHS-5. Among them, the proportion of individuals with undiagnosed diabetes was 24.82% (24.07 to 25.59%), with higher among males (28.82% (26.45 to 31.30%)) than females (24.22% (23.44 to 25.01%)). The overall prevalence of undiagnosed diabetes was 1.22% (1.18 to 1.26%), with a higher prevalence among males (1.60% (1.46 to 1.76%)) than females (1.17% (1.13 to 1.21%)). Individuals who are middle-aged (45-49), have a higher body mass index (BMI), and are in a lower wealth index group, or live in the southern regions of India are at a higher risk of being undiagnosed for diabetes. Conclusion One in every four having diabetes is undiagnosed. The study highlights the need for public health interventions to improve diabetes screening and access to health care, particularly among middle-aged individuals, and those with higher BMI, as well as addressing lifestyle and dietary factors. The findings also reveal disparities in diabetes burden among population subgroups in India, underscoring the need for targeted efforts.
Collapse
Affiliation(s)
| | | | | | | | - Dolly Kumari
- Asian Development Research Institute, Patna, India
- Bihar Institute of Public Finance and Policy (BIPFP), Patna, India
| | - Anita Pal
- University of Hyderabad, Hyderabad, India
| |
Collapse
|
4
|
Singh K, Kondal D, Menon VU, Varthakavi PK, Viswanathan V, Dharmalingam M, Bantwal G, Sahay RK, Masood MQ, Khadgawat R, Desai A, Prabhakaran D, Narayan KMV, Phillips VL, Tandon N, Ali MK. Cost-effectiveness of a multicomponent quality improvement care model for diabetes in South Asia: The CARRS randomized clinical trial. Diabet Med 2023; 40:e15074. [PMID: 36815284 DOI: 10.1111/dme.15074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To assess the cost-effectiveness of a multicomponent strategy versus usual care in people with type 2 diabetes in South Asia. DESIGN Economic evaluation from healthcare system and societal perspectives. SETTING Ten diverse urban clinics in India and Pakistan. PARTICIPANTS 1146 people with type 2 diabetes (575 in the intervention group and 571 in the usual care group) with mean age of 54.2 years, median diabetes duration: 7 years and mean HbA1c: 9.9% (85 mmol/mol) at baseline. INTERVENTION Multicomponent strategy comprising decision-supported electronic health records and non-physician care coordinator. Control group received usual care. OUTCOME MEASURES Incremental cost-effectiveness ratios (ICERs) per unit achievement in multiple risk factor control (HbA1c <7% (53 mmol/mol) and SBP <130/80 mmHg or LDLc <2.58 mmol/L (100 mg/dL)), ICERs per unit reduction in HbA1c, 5-mmHg unit reductions in systolic BP, 10-unit reductions in LDLc (mg/dl) (considered as clinically relevant) and ICER per quality-adjusted life years (QALYs) gained. ICERs were reported in 2020 purchasing power parity-adjusted international dollars (INT$). The probability of ICERs being cost-effective was considered depending on the willingness to pay (WTP) values as a share of GDP per capita for India (Int$ 7041.4) and Pakistan (Int$ 4847.6). RESULTS Compared to usual care, the annual incremental costs per person for intervention group were Int$ 1061.9 from a health system perspective and Int$ 1093.6 from a societal perspective. The ICER was Int$ 10,874.6 per increase in multiple risk factor control, $2588.1 per one percentage point reduction in the HbA1c, and $1744.6 per 5 unit reduction in SBP (mmHg), and $1271 per 10 unit reduction in LDLc (mg/dl). The ICER per QALY gained was $33,399.6 from a societal perspective. CONCLUSIONS In a trial setting in South Asia, a multicomponent strategy for diabetes care resulted in better multiple risk factor control at higher costs and may be cost-effective depending on the willingness to pay threshold with substantial uncertainty around cost-effectiveness for QALYs gained in the short term (2.5 years). Future research needs to confirm the long-term cost-effectiveness of intensive multifactorial intervention for diabetes care in diverse healthcare settings in LMICs.
Collapse
Affiliation(s)
- Kavita Singh
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, India
| | - V Usha Menon
- Amrita Institute of Medical Sciences, Department of Endocrinology & Diabetes, Kochi, Kerala, India
| | - Premlata K Varthakavi
- TNM College & BYL Nair Charity Hospital, Department of Endocrinology, Mumbai, Maharashtra, India
| | - Vijay Viswanathan
- MV Hospital for Diabetes & Diabetes Research Centre, Chennai, Tamil Nadu, India
| | - Mala Dharmalingam
- Bangalore Endocrinology & Diabetes Research Centre, Bangalore, Karnataka, India
| | - Ganapati Bantwal
- Department of Endocrinology, St. John's Medical College & Hospital, Bangalore, Karnataka, India
| | - Rakesh Kumar Sahay
- Department of Endocrinology, Osmania General Hospital, Hyderabad, Telangana, India
| | - Muhammad Qamar Masood
- Department of Medicine, Section of Endocrinology and Diabetes, Aga Khan University, Karachi, Pakistan
| | - Rajesh Khadgawat
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ankush Desai
- Endocrine Unit, Department of Medicine, Goa Medical College, Bambolim, Goa, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
- Centre for Chronic Disease Control, New Delhi, India
| | - K M Venkat Narayan
- Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Mohammed K Ali
- Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
| |
Collapse
|
5
|
Mazumder H, Islam KF, Rahman F, Gain EP, Saha N, Eva IS, Shimul MMH, Das J, Hossain MM. Prevalence of anemia in diabetes mellitus in South Asia: A systematic review and meta-analysis. PLoS One 2023; 18:e0285336. [PMID: 37163539 PMCID: PMC10171606 DOI: 10.1371/journal.pone.0285336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE Anemia and Diabetes Mellitus (DM) are amongst major clinical and public health challenges in South Asia that influence the progression of chronic health problems in this population. Despite a growing body of research on these problems, there is a lack synthesized evidence on the burden of anemia among people with DM in this region. This meta-analytic review was conducted to estimate the prevalence of anemia among people with DM in South Asia. METHODS A systematic search of the literature was conducted in five primary databases and additional sources up to July 29, 2022, that reported the prevalence of anemia among DM patients in any of the eight South Asian countries. Observational studies that met pre-determined eligibility criteria according to the protocol registered in PROSPERO (CRD42022348433) were included in this meta-analysis. Random effect models were used to estimate pooled prevalence. RESULTS Of the 40 eligible studies, 38 underwent meta-analysis representing 14,194 participants with DM. The pooled prevalence of anemia was 45% (95% CI: 37.0-54.0, I2 = 99.28%, p = 0.00) among diabetic people in South Asia. In sub-group analysis, the pooled prevalence of anemia was higher in females (48%, 95% CI: 37.0-60.0, I2 = 98.86%, p = 0.00) compared to males (39%, 95% CI: 29.0-48.0, I2 = 98.18%, p = 0.00). Diabetic patients with older age (≥ 50 years) reported higher pooled estimates of anemia (48%, 95% CI: 38.0-58.0, I2 = 99.07%) than younger age group (< 50 years) (34%, 95% CI: 21.0-47.0, I2 = 98.83%). In addition, we found variation in pooled prevalence estimates of anemia considering the type of DM, such as type 1 reported 2% (95% CI: 0.00-4.00), type-2 reported 48% (95% CI: 40.0-56.0, I2 = 98.94%), and Gestational diabetes mellitus (GDM) reported 6% (95% CI: 3.00-12.0). CONCLUSION High pooled estimates of anemia among diabetic patients in South Asia, including publication bias, warrants further clinical and public health research following standard research methods to understand the more context-specific epidemiological insights and evidence.
Collapse
Affiliation(s)
| | - Kazi Faria Islam
- Research Initiative for Health Equity (RiHE), Khulna, Bangladesh
| | - Farzana Rahman
- Research Initiative for Health Equity (RiHE), Khulna, Bangladesh
| | | | - Nobonita Saha
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | | | | | - Jyoti Das
- North South University, Dhaka, Bangladesh
| | | |
Collapse
|