The increasing prevalence of diabetes in South Australia: The relationship with population ageing and obesity

Chitosan and Cellulose-Based Hydrogels for Wound Management

Wound management remains a challenge worldwide, although there are several developed wound dressing materials for the management of acute and chronic wounds. The wound dressings that are currently used include hydrogels, films, wafers, nanofibers, foams, topical formulations, transdermal patches, sponges, and bandages. Hydrogels exhibit unique features which make them suitable wound dressings such as providing a moist environment for wound healing, exhibiting high moisture content, or creating a barrier against bacterial infections, and are suitable for the management of exuding and granulating wounds. Biopolymers have been utilized for their development due to their non-toxic, biodegradable, and biocompatible properties. Hydrogels have been prepared from biopolymers such as cellulose and chitosan by crosslinking with selected synthetic polymers resulting in improved mechanical, biological, and physicochemical properties. They were useful by accelerating wound re-epithelialization and also mimic skin structure, inducing skin regeneration. Loading antibacterial agents into them prevented bacterial invasion of wounds. This review article is focused on hydrogels formulated from two biopolymers-chitosan and cellulose-for improved wound management.

Bio Micro-Nano Technologies of Antioxidants Optimised Their Pharmacological and Cellular Effects, ex vivo, in Pancreatic β-Cells

Introduction

Recent formulation and microencapsulation studies of probucol (PB) using the polymer sodium alginate (SA) and bile acids have shown promising results but PB stability, and pharmacology profiles remain suboptimal. This study aimed to investigate novel polymers for the nano and micro encapsulation of PB, with the anti-inflammatory bile acid ursodeoxycholic acid (UDCA).

Material and methods

Six formulations using three types of polymers were investigated with and without UDCA. The polymers were NM30D, RL30D, and RS30D and they were mixed with SA and PB at set ratios and microencapsulated using oscillating-voltage-mediated nozzle technology coupled with ionic gelation. The microcapsules were examined for physical and biological effects using pancreatic β-cells.

Results and discussion

UDCA addition did not adversely affect the morphology and physical features of the microcapsules. Despite thermal stability remaining unchanged, bile acid incorporation did enhance the electrokinetic stability of the formulation system for NM30D and RL30D polymers. Mechanical stability remained similar in all groups. Enhanced uptake of PB from the microcapsule by pancreatic β-cells was only seen with NM30D-UDCA-intercalated microcapsules and this effect was sustained at both glucose levels of 5.5 and 35.5 mM.

Conclusion

UDCA addition enhanced PB delivery and biological effects in a formulation-dependent manner.

Efficacy and safety of liraglutide added to insulin therapy in elderly patients with type 2 diabetes

INTRODUCTION

The combination of GLP-1 receptor agonists and insulin is effective in type 2 diabetes (T2D) treatment. However, its longitudinal efficacy and safety in elderly patients have not been established. We evaluated whether liraglutide (Lira) added to insulin therapy safely improved glycaemic control in T2D patients aged >65 years.

METHODS

Twenty T2D patients receiving insulin were recruited, and Lira was added to their treatment regimen. Before and 6 months after Lira was added, we assessed the metabolic parameters and continuous glucose monitoring (CGM) data.

RESULTS

Six months after Lira was added, the levels of HbA1c and glycated albumin and body weight were significantly improved, despite the daily doses and number of insulin injections per day being reduced. CGM analysis revealed that the SD and AUC of glucose >180 mg/dL were significantly decreased; the proportion of hypoglycaemic events was not increased.

CONCLUSION

Lira administration safely improved glycaemic control and reduced body weight. Lira added to insulin therapy may improve the quality of life in elderly T2D patients undergoing insulin therapy, especially those requiring social support.

Type 2 Diabetes Mellitus Treatment Patterns Across Europe: A Population-based Multi-database Study

PURPOSE

The aim of this study was to determine the similarities and differences of type 2 diabetes mellitus (T2DM) treatment patterns in daily practice in 5 European countries and whether these reflect differences in guidelines.

METHODS

Prescriptions for drugs used in diabetes treatment during a 5-year study period were obtained from electronic databases. Patients initiating T2DM treatment during the study period were included. An SAS analysis tool was developed to create episodes of use of drug classes, which resulted in treatment patterns.

FINDINGS

A total of 253,530 patients initiating T2DM treatment during the study period were included; 52% to 55% were male, and the mean age ranged from 62 to 67 years. Metformin was the most common initial treatment in all countries. After initial therapy, most patients in the Netherlands, Spain, and the United Kingdom switched to a combination of metformin + a sulfonylurea derivative (SU). In Italy, metformin in combination with an SU was outnumbered by "other treatment," mainly because of repaglinide use. In France, treatments including dipeptidyl peptidase-4 inhibitors were most frequent as second- and fourth-line treatment. Metformin monotherapy was again most commonly observed as the third line of treatment in all countries. Fourth treatment was a combination of metformin + an SU in the Netherlands and Spain; in the United Kingdom and France, dipeptidyl peptidase-4 inhibitors were the most frequently used fourth line of treatment.

IMPLICATIONS

This study provides a comprehensive overview of T2DM treatment patterns among patients initiating T2DM treatment in 5 European countries. There were differences, especially regarding the uptake of newer incretin-based treatments, which are usually prescribed as a second and/or third treatment in agreement with local guidelines. These variations reflect the differences between the national guidelines of these countries.

Factors that could explain the increasing prevalence of type 2 diabetes among adults in a Canadian province: a critical review and analysis

BACKGROUND

The prevalence of diabetes has increased since the last decade in New Brunswick. Identifying factors contributing to the increase in diabetes prevalence will help inform an action plan to manage the condition. The objective was to describe factors that could explain the increasing prevalence of type 2 diabetes in New Brunswick since 2001.

METHODS

A critical literature review was conducted to identify factors potentially responsible for an increase in prevalence of diabetes. Data from various sources were obtained to draw a repeated cross-sectional (2001-2014) description of these factors concurrently with changes in the prevalence of type 2 diabetes in New Brunswick. Linear regressions, Poisson regressions and Cochran Armitage analysis were used to describe relationships between these factors and time.

RESULTS

Factors identified in the review were summarized in five categories: individual-level risk factors, environmental risk factors, evolution of the disease, detection effect and global changes. The prevalence of type 2 diabetes has increased by 120% between 2001 and 2014. The prevalence of obesity, hypertension, prediabetes, alcohol consumption, immigration and urbanization increased during the study period and the consumption of fruits and vegetables decreased which could represent potential factors of the increasing prevalence of type 2 diabetes. Physical activity, smoking, socioeconomic status and education did not present trends that could explain the increasing prevalence of type 2 diabetes. During the study period, the mortality rate and the conversion rate from prediabetes to diabetes decreased and the incidence rate increased. Suggestion of a detection effect was also present as the number of people tested increased while the HbA1c and the age at detection decreased. Period and birth cohort effect were also noted through a rise in the prevalence of type 2 diabetes across all age groups, but greater increases were observed among the younger cohorts.

CONCLUSIONS

This study presents a comprehensive overview of factors potentially responsible for population level changes in prevalence of type 2 diabetes. Recent increases in type 2 diabetes in New Brunswick may be attributable to a combination of some individual-level and environmental risk factors, the detection effect, the evolution of the disease and global changes.

Effects of different exercise programs and minimal detectable changes in hemoglobin A1c in patients with type 2 diabetes

BACKGROUND

The incidence of diabetes mellitus is increasing worldwide, resulting in a global epidemic. The most common type, the type 2 diabetes mellitus, constitutes of 90-95 % of the cases and is characterized by the action of and/or impaired insulin secretion. Regular exercise is a recommended strategy in several studies and guidelines for type 2 diabetes control and complications associated with it. Therefore, we evaluated and compared the effects of aerobic and strength exercise programs on the glycemic control in patients with type 2 diabetes.

METHODS

The selected patients were divided into groups which performed moderate strength training (ST) and aerobic training (AT). The study lasted 20 weeks and was divided into two 10 week phases with anthropometric (body mass index, waist, abdomen and hips circumferences, waist/hip ratio) and biochemical (glycemic and lipid profile) assessments at baseline, 10 weeks and 20 weeks. For intra and inter analyses a mixed ANOVA model was used. Individual changes were calculated using the minimum detectable change, based on a 90 % confidence interval.

RESULTS

Eleven patients (five men and six women) completed the 20 weeks of training; five from the ST group and six from the AT. No significant changes were observed in any anthropometric variable in either group. Statistically significant differences were found in mean hemoglobin A1c in both groups between baseline (AT: 8.6 ± 2.5; ST: 9.2 ± 1.9) and 10 weeks (AT: 7.2 ± 1.7; ST: 7.9 ± 1.2) (p = 0.03), and baseline (AT: 8.6 ± 2.5; ST: 9.2 ± 1.9) and 20 weeks (AT: 7.5 ± 1.7; ST: 7.4 ± 0.9) (p = 0.01). For the minimal detectable changes, 40 % of the ST and 33 % of AT achieved these changes for hemoglobin A1c.

CONCLUSION

Both aerobic and strength exercises can help the metabolic control in patients with type 2 diabetes, even without significant changes in anthropometry over the 20 weeks of training. However, this period was sufficient to cause changes in hemoglobin A1c values and the estimated average glucose, which are important parameters in controlling diabetes, thus signaling an important consequence of adhering to an exercise routine for type 2 diabetic patients.

Patterns of glucose lowering drugs utilization in Portugal and in the Netherlands. Trends over time

AIMS

To compare the temporal trends in the consumption patterns of glucose lowering drugs (GLD) between Portugal and the Netherlands from 2004 to 2013 and to examine possible reasons behind the cross-national variation found.

METHODS

All GLD (ATC pharmacological subgroup A10B) were selected for analysis. Consumption data were obtained for the 10-year period. Portuguese and Dutch drug estimates were obtained from nationwide databases.

RESULTS

The consumption of GLD increased in Portugal from 52.9 defined daily dose per 1000 inhabitants per day (DHD) in 2004 to 70.0 DHD in 2013 and in the Netherlands from 44.9 DHD in 2004 to 50.7 DHD in 2013. In Portugal, the use of fixed-dose combinations, especially with dipeptidyl peptidase-4 inhibitors (DPP-4) increased remarkably and in 2013 represented almost a quarter of total GLD consumption. In the Netherlands, the use of combinations was residual.

CONCLUSIONS

The consumption of GLD rose over the 10-year period in both countries. However, Portuguese overall consumption and costs of GLD were higher. The differentially rapid uptake of DPP-4 inhibitors in Portugal was the main driver of the cost difference.

Estimates of over-diagnosis of breast cancer due to population-based mammography screening in South Australia after adjustment for lead time effects

OBJECTIVE

To estimate over-diagnosis due to population-based mammography screening using a lead time adjustment approach, with lead time measures based on symptomatic cancers only.

SUBJECTS

Women aged 40-84 in 1989-2009 in South Australia eligible for mammography screening.

METHODS

Numbers of observed and expected breast cancer cases were compared, after adjustment for lead time. Lead time effects were modelled using age-specific estimates of lead time (derived from interval cancer rates and predicted background incidence, using maximum likelihood methods) and screening sensitivity, projected background breast cancer incidence rates (in the absence of screening), and proportions screened, by age and calendar year.

RESULTS

Lead time estimates were 12, 26, 43 and 53 months, for women aged 40-49, 50-59, 60-69 and 70-79 respectively. Background incidence rates were estimated to have increased by 0.9% and 1.2% per year for invasive and all breast cancer. Over-diagnosis among women aged 40-84 was estimated at 7.9% (0.1-12.0%) for invasive cases and 12.0% (5.7-15.4%) when including ductal carcinoma in-situ (DCIS).

CONCLUSIONS

We estimated 8% over-diagnosis for invasive breast cancer and 12% inclusive of DCIS cancers due to mammography screening among women aged 40-84. These estimates may overstate the extent of over-diagnosis if the increasing prevalence of breast cancer risk factors has led to higher background incidence than projected.

Novel chenodeoxycholic acid-sodium alginate matrix in the microencapsulation of the potential antidiabetic drug, probucol. An in vitro study

CONTEXT

We previously designed, developed and characterized a novel microencapsulated formulation as a platform for the targeted delivery of Probucol (PB) in an animal model of Type 2 Diabetes.

OBJECTIVE

The objective of this study is to optimize this platform by incorporating Chenodeoxycholic acid (CDCA), a bile acid with good permeation-enhancing properties, and examine its effect in vitro. Using sodium alginate (SA), we prepared PB-SA (control) and PB-CDCA-SA (test) microcapsules.

RESULTS AND DISCUSSION

CDCA resulted in better structural and surface characteristics, uniform morphology, and stable chemical and thermal profiles, while size and rheological parameters remained unchanged. PB-CDCA-SA microcapsules showed good excipients' compatibilities, as evidenced by differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy, scanning electron microscopy and energy dispersive X-ray spectroscopy studies. CDCA reduced microcapsule swelling at pH 7.8 at both 37 °C and 25 °C and improved PB-release.

CONCLUSION

CDCA improved the characteristics and release properties of PB-microcapsules and may have potential in the targeted oral delivery of PB.

Predicting absolute risk of type 2 diabetes using age and waist circumference values in an aboriginal Australian community

OBJECTIVES

To predict in an Australian Aboriginal community, the 10-year absolute risk of type 2 diabetes associated with waist circumference and age on baseline examination.

METHOD

A sample of 803 diabetes-free adults (82.3% of the age-eligible population) from baseline data of participants collected from 1992 to 1998 were followed-up for up to 20 years till 2012. The Cox-proportional hazard model was used to estimate the effects of waist circumference and other risk factors, including age, smoking and alcohol consumption status, of males and females on prediction of type 2 diabetes, identified through subsequent hospitalisation data during the follow-up period. The Weibull regression model was used to calculate the absolute risk estimates of type 2 diabetes with waist circumference and age as predictors.

RESULTS

Of 803 participants, 110 were recorded as having developed type 2 diabetes, in subsequent hospitalizations over a follow-up of 12633.4 person-years. Waist circumference was strongly associated with subsequent diagnosis of type 2 diabetes with P<0.0001 for both genders and remained statistically significant after adjusting for confounding factors. Hazard ratios of type 2 diabetes associated with 1 standard deviation increase in waist circumference were 1.7 (95%CI 1.3 to 2.2) for males and 2.1 (95%CI 1.7 to 2.6) for females. At 45 years of age with baseline waist circumference of 100 cm, a male had an absolute diabetic risk of 10.9%, while a female had a 14.3% risk of the disease.

CONCLUSIONS

The constructed model predicts the 10-year absolute diabetes risk in an Aboriginal Australian community. It is simple and easily understood and will help identify individuals at risk of diabetes in relation to waist circumference values. Our findings on the relationship between waist circumference and diabetes on gender will be useful for clinical consultation, public health education and establishing WC cut-off points for Aboriginal Australians.

Wound management of chronic diabetic foot ulcers: from the basics to regenerative medicine

BACKGROUND

Hospital-based studies have shown that mortality rates in individuals with diabetic foot ulcers are about twice those observed in individuals with diabetes without foot ulcers.

OBJECTIVE

To assess the etiology and management of chronic diabetic foot ulcers.

STUDY DESIGN

Literature review.

METHODS

Systematic review of the literature discussing management of diabetic foot ulcers. Since there were only a few randomized controlled trials on this topic, articles were selected to attempt to be comprehensive rather than a formal assessment of study quality.

RESULTS

Chronic nonhealing foot ulcers occur in approximately 15% of patients with diabetes. Many factors contribute to impaired diabetic wound healing. Risk factors include peripheral neuropathy, peripheral arterial disease, limited joint mobility, foot deformities, abnormal foot pressures, minor trauma, a history of ulceration or amputation, and impaired visual acuity. With the current treatment for nonhealing diabetic foot ulcers, a significant number of patients require amputation.

CONCLUSION

Diabetic foot ulcers are optimally managed by a multidisciplinary integrated team. Offloading and preventative management are important. Dressings play an adjunctive role. There is a critical need to develop novel treatments to improve healing of diabetic foot ulcers. The goal is to have wounds heal and remain healed.

CLINICAL RELEVANCE

Diabetic neuropathy and peripheral arterial disease are major factors involved in a diabetic foot ulcer. Despite current treatment modalities for nonhealing diabetic foot ulcers, there are a significant number of patients who require amputations. No known therapy will be effective without concomitant management of ischemia, infection, and adequate offloading.

Prevalence of Obesity and Overweight in an Indigenous Population in Central Brazil: A Population-Based Cross-Sectional Study

OBJECTIVE

To estimate the prevalence of obesity and overweight and associated factors in indigenous people of the Jaguapiru village in Central Brazil.

METHODS

We conducted a population-based cross-sectional study between January 2009 and July 2011 in the adult native population of the Jaguapiru village, Central Brazil. Sociodemographic and lifestyle data were obtained; anthropometric measures, arterial blood pressure, and blood glucose were measured. The independent variables were tested by Poisson regression, and the interactions between them were analyzed.

RESULTS

1,608 indigenous people (982 females, mean age 37.7 ± 15.1 years) were included. The prevalence of obesity was 23.2% (95% CI 20.9-25.1%). Obesity was more prevalent among 40- to 49-year-old and overweight among 50- to 59-year-old persons. Obesity was positively associated with female sex, higher income, and hypertension. Among indigenous people, interactions were found with hypertension and sedentary lifestyle - hypertension in males and sedentary lifestyle in females.

CONCLUSIONS

The prevalence of obesity and overweight in indigenous people of the Jaguapiru village is high. Males as well as hypertensive and higher family income individuals have higher rates. Sedentary lifestyle and hypertension leverage the rates of obesity. Prevention and adequate public health policies can be critical for the control of excess weight and its comorbidities among Brazilian indigenous people.

Population attributable risk (PAR) of overweight and obesity on chronic diseases: South Australian representative, cross-sectional data, 2004-2006

SUMMARY

BACKGROUND

To determine the contribution of overweight and obesity to five chronic conditions using the population attributable risk (PAR) statistic.

METHOD

Self-reported data were collected in Australia using a representative, ongoing monthly risk factor surveillance system using computer assisted telephone interviewing (CATI) for the period 2004-2006 (n = 15,261). The PAR, adjusted for various demographic and health-related risk factors, was used to determine the contribution of overweight and obesity to diabetes, asthma, cardiovascular disease (CVD), arthritis and osteoporosis for people aged 18 years and over.

RESULTS

In total, 19.0% of South Australians aged 18 years and over were obese, and 36.0% were overweight. The PAR of overweight and obesity was highest among those with diabetes (17.3% and 28.4%). After adjusting for demographic and risk factors, overweight and obesity had a significantly high PAR for diabetes (11.3% and 23.1%), asthma (4.0% and 10.3%) and arthritis (6.7% and 8.1%). The unadjusted PAR of overweight and obesity for CVD was significant (10.8% and 11.7%) but was reduced when controlled for other factors. The PAR of overweight and obesity was significant for osteoporosis but the association was protective.

CONCLUSIONS

The use of PAR contributes to the understanding of how overweight and obesity are related to various chronic conditions however the size of this association depends on the chronic disease and other socio-demographic and health-related risk factors that may or may not be modifiable. The information provides evidence of the association of overweight and obesity with chronic disease and the potential for reducing the burden of chronic disease by addressing the obesity epidemic.

Validating self-report of diabetes use by participants in the 45 and Up Study: a record linkage study

BACKGROUND

Prevalence studies usually depend on self-report of disease status in survey data or administrative data collections and may over- or under-estimate disease prevalence. The establishment of a linked data collection provided an opportunity to explore the accuracy and completeness of capture of information about diabetes in survey and administrative data collections.

METHODS

Baseline questionnaire data at recruitment to the 45 and Up Study was obtained for 266,848 adults aged 45 years and over sampled from New South Wales, Australia in 2006-2009, and linked to administrative data about hospitalisation from the Admitted Patient Data Collection (APDC) for 2000-2009, claims for medical services (MBS) and pharmaceuticals (PBS) from Medicare Australia data for 2004-2009. Diabetes status was determined from response to a question 'Has a doctor EVER told you that you have diabetes' (n = 23,981) and augmented by examination of free text fields about diagnosis (n = 119) or use of insulin (n = 58). These data were used to identify the sub-group with type 1 diabetes. We explored the agreement between self-report of diabetes, identification of diabetes diagnostic codes in APDC data, claims for glycosylated haemoglobin (HbA1c) in MBS data, and claims for dispensed medication (oral hyperglycaemic agents and insulin) in PBS data.

RESULTS

Most participants with diabetes were identified in APDC data if admitted to hospital (79.3%), in MBS data with at least one claim for HbA1c testing (84.7%; 73.4% if 2 tests claimed) or in PBS data through claim for diabetes medication (71.4%). Using these alternate data collections as an imperfect 'gold standard' we calculated sensitivities of 83.7% for APDC, 63.9% (80.5% for two tests) for MBS, and 96.6% for PBS data and specificities of 97.7%, 98.4% and 97.1% respectively. The lower sensitivity for HbA1c may reflect the use of this test to screen for diabetes suggesting that it is less useful in identifying people with diabetes without additional information. Kappa values were 0.80, 0.70 and 0.80 for APDC, MBS and PBS respectively reflecting the large population sample under consideration. Compared to APDC, there was poor agreement about identifying type 1 diabetes status.

CONCLUSIONS

Self-report of diagnosis augmented with free text data indicating diabetes as a chronic condition and/or use of insulin among medications used was able to identify participants with diabetes with high sensitivity and specificity compared to available administrative data collections.

Recent advances on the development of wound dressings for diabetic foot ulcer treatment--a review

Diabetic foot ulcers (DFUs) are a chronic, non-healing complication of diabetes that lead to high hospital costs and, in extreme cases, to amputation. Diabetic neuropathy, peripheral vascular disease, abnormal cellular and cytokine/chemokine activity are among the main factors that hinder diabetic wound repair. DFUs represent a current and important challenge in the development of novel and efficient wound dressings. In general, an ideal wound dressing should provide a moist wound environment, offer protection from secondary infections, remove wound exudate and promote tissue regeneration. However, no existing dressing fulfills all the requirements associated with DFU treatment and the choice of the correct dressing depends on the wound type and stage, injury extension, patient condition and the tissues involved. Currently, there are different types of commercially available wound dressings that can be used for DFU treatment which differ on their application modes, materials, shape and on the methods employed for production. Dressing materials can include natural, modified and synthetic polymers, as well as their mixtures or combinations, processed in the form of films, foams, hydrocolloids and hydrogels. Moreover, wound dressings may be employed as medicated systems, through the delivery of healing enhancers and therapeutic substances (drugs, growth factors, peptides, stem cells and/or other bioactive substances). This work reviews the state of the art and the most recent advances in the development of wound dressings for DFU treatment. Special emphasis is given to systems employing new polymeric biomaterials, and to the latest and innovative therapeutic strategies and delivery approaches.

Earlier age of dementia onset and shorter survival times in dementia patients with diabetes

Diabetes is a risk factor for dementia, but relatively little is known about the epidemiology of the association. A retrospective population study using Western Australian hospital inpatient, mental health outpatient, and death records was used to compare the age at index dementia record (proxy for onset age) and survival outcomes in dementia patients with and without preexisting diabetes (n = 25,006; diabetes, 17.3%). Inpatient records from 1970 determined diabetes history in this study population with incident dementia in years 1990-2005. Dementia onset and death occurred an average 2.2 years and 2.6 years earlier, respectively, in diabetic compared with nondiabetic patients. Age-specific mortality rates were increased in patients with diabetes. In an adjusted proportional hazard model, the death rate was increased with long-duration diabetes, particularly with early age onset dementia. In dementia diagnosed before age 65 years, those with a ≥15-year history of diabetes died almost twice as fast as those without diabetes (hazard ratio = 1.9, 95% confidence interval: 1.3, 2.9). These results suggest that, in patients with diabetes, dementia onset occurs on average 2 years early and survival outcomes are generally poorer. The effect of diabetes on onset, survival, and mortality is greatest when diabetes develops before middle age and after 15 years' diabetes duration. The impact of diabetes on dementia becomes progressively attenuated in older age groups.

[Diabetes mellitus: reasons for prevalence in different geographic regions of Brazil, 2002 2007]

Awareness of Diabetes Mellitus (DM) as a relevant health problem in Brazil and realizing the importance of estimates of prevalence for public health planning and strategies, gave rise to this work seeking to estimate the reason for the prevalence of Diabetes Mellitus (DM) in different Brazilian states in the periods from 2002 to 2004 and 2005 to 2007. It involves a descriptive study based on Brazilian population data with a diagnosis of DM recorded in the Basic Care Information System (SIAB) of the Brazilian Ministry of Health. The prevalence rates were calculated for the periods from 2002 to 2004 and 2005 to 2007 and the Prevalence Ratios were then estimated per location and per reliability interval of 95% (RI95%). A high prevalence of DM was observed in Brazilian states with a significant increase (R>1; RI95%>1) for the periods in all Brazilian states, especially the Federal District (R=1.9800; RI95%=1.97241.9876) and the state of Maranhão (R=1.5217; RI95%=1.51981.5235). The conclusion drawn was that there was a significant increase in the prevalence of DM in Brazil between 2002 and 2007, highlighting the need for the formulation of strategies for prevention and control of the disease.

Living with diabetes: rationale, study design and baseline characteristics for an Australian prospective cohort study

Background

Diabetes mellitus is a major global public health threat. In Australia, as elsewhere, it is responsible for a sizeable portion of the overall burden of disease, and significant costs. The psychological and social impact of diabetes on individuals with the disease can be severe, and if not adequately addressed, can lead to the worsening of the overall disease picture. The Living With Diabetes Study aims to contribute to a holistic understanding of the psychological and social aspects of diabetes mellitus.

Methods/Design

The Living With Diabetes Study is a 5-year prospective cohort study, based in Queensland, Australia. The first wave of data, which was collected via a mailed self-report survey, was gathered in 2008, with annual collections thereafter. Measurements include: demographic, lifestyle, health and disease characteristics; quality of life (EQ-5D, ADDQoL); emotional well-being (CES-D, LOT-R, ESSI); disease self-management (PAM); and health-care utilisation and patient-assessed quality of care (PACIC). 29% of the 14,439 adults who were invited to participate in the study agreed to do so, yielding a sample size of 3,951 people.

Discussion

The data collected by the Living With Diabetes Study provides a good representation of Australians with diabetes to follow over time in order to better understand the natural course of the illness. The study has potential to further illuminate, and give a comprehensive picture of the psychosocial implications of living with diabetes. Data collection is ongoing.

The relationship between body mass index across the life course and knee pain in adulthood: results from the 1958 birth cohort study

OBJECTIVES

To determine whether a high BMI in childhood or early adulthood has a long-term influence on the likelihood of knee pain.

METHODS

A birth cohort study of persons born during first week of 1958 in Great Britain. Participants were followed up throughout childhood and adulthood, most recently at 45 years, when information was collected on knee pain. Information on BMI was collected at follow-up intervals throughout childhood and adulthood. RESULTS; A total of 8579 individuals participated and the prevalence of being overweight and obesity increased throughout life from 0.2% at the age of 7 years to 65.5% at the age of 45 years. A total of 1636 individuals reported knee pain at the age of 45 years, giving a prevalence of 19.1% (95% CI 18.2, 19.9%). BMI was associated with knee pain: persons with a BMI of >30 kg/m(2) at 23, 33 or 45 years experienced approximately a doubling in the risk of knee pain at 45 years. There was a significant association with knee pain at the age of 45 years with high BMI from as early as age 11 years, but the association was stronger at the age of 16 years [relative risk (RR)(BMI 20-25) (v)(s) (<20) = 1.2 (95% CI 1.1, 1.3); RR(25-30) = 1.3 (95% CI 1.1, 1.6); RR(>30) = 1.6 (95% CI 1.05, 2.4)].

CONCLUSION

This study has demonstrated the long-term effects of childhood and early adult obesity and the importance of early intervention programmes to try to reduce weight and maintain weight loss.

A Transaction Cost Assessment of a Pervasive Technology Solution for Gestational Diabetes

Diabetes is one of the leading chronic diseases affecting Australians and its prevalence continues to rise. It is becoming a serious challenge for both the quality of healthcare and expenditure in the Australian healthcare system. The goal of this study is to investigate the development and application of a pervasive wireless technology solution to facilitate the effective management of diabetes in the context of women with gestational diabetes. Gestational diabetes is a form of diabetes that affects up to 8% of pregnant women. A transactions cost assessment of this solution is also provided. Integral to the success of this solution is the pervasive technology solution which serves to support and facilitate superior diabetes self-management.

The decline in coronary heart disease mortality is slowing in young adults (Australia 1976-2006): a time trend analysis

BACKGROUND

To examine whether the recent flattening of mortality rates for coronary heart disease (CHD) observed among young adults in the UK and the US is also occurring in the Australian population.

METHODS

Mortality data from 1976 to 2006 were used to calculate overall age-adjusted and age-specific mortality rates for Australian adults aged ≥ 25 years. Joinpoint regression was fitted to estimate the annual change and detect points in time where significant changes in the trends occur.

RESULTS

Between 1976 and 2006 age-adjusted CHD mortality rates declined by 73% in men and 70% in women. A steady decline continued in older groups. Beginning in 1991, a slowing of the fall in mortality rates was observed in younger men, and CHD mortality rates were essentially flat in men 25-34 years. Among men aged 35-44, a reduction of the decline in CHD mortality was observed from 1992, and likewise in men aged 45-54 years from 1994. Very similar patterns were observed in women with significant slowdowns starting in 1980, 1988 and 1991 for those aged 25-34 years, 35-44 years and 45-54 years respectively.

CONCLUSIONS

In Australian men and women aged 25-54 years, the CHD mortality decline has slowed since the early 1990s. The most likely explanations for reduction of the CHD mortality decline are attenuations or reversal of the earlier declines in major traditional risk factors (tobacco smoking, serum cholesterol, blood pressure) and diabetes mellitus.

Achievement of management targets associated with incident and long-term diagnosed diabetes among a representative population sample

AIM

To assess achievement of management targets among participants with diagnosed diabetes.

METHODS

Participants in the North West Adelaide Health Study (n=4060), a representative cohort aged 18+ years, were assessed at baseline in 2000-03 and follow-up in 2004-06. Diagnosed and undiagnosed diabetes were determined from fasting plasma glucose (> or =7.0 mmol/L) and self-reported data.

RESULTS

Baseline prevalences were 5.6% (95% CI 4.9-6.3) diagnosed and 1.0% (95% CI 0.7-1.4) undiagnosed diabetes. Annual incidences were 5.1 per 1000 diagnosed and 1.7 per 1000 undiagnosed diabetes. Among those with long-term diagnosed diabetes, 45.8% had HbA1c< or =7.0%, 26.8% had blood pressure<130/85 mmHg, 14.1% had body mass index< or =25, 88.5% were non- or ex-smokers, 19.2% had total cholesterol<4 mmol/L, 61.9% had triglycerides<2.0 mmol/L, 83.0% had HDL> or =1.0 mmol/L, and 45.6% had LDL<2.5 mmol/L. Participants with incident diagnosed diabetes were more likely to achieve HbA1c and less likely to achieve LDL targets than those with long-term diagnosed diabetes. Few people treated with hypoglycaemics, antihypertensives or statins were achieving targets.

CONCLUSIONS

Many people with diabetes are at risk of developing or worsening complications because they are not meeting recommended targets. Treatment with medication is also suboptimal, indicating a continued role for public health programs to reduce risk factors.

Gender-specific epidemiology of diabetes: a representative cross-sectional study

Background

Diabetes and its associated complications are part of a chronic disease global epidemic that presents a public health challenge. Epidemiologists examining health differences between men and women are being challenged to recognise the biological and social constructions behind the terms 'sex' and/or 'gender', together with social epidemiology principles and the life course approach. This paper examines the epidemiology of a population with diabetes from the north-west metropolitan region of South Australia.

Methods

Data were used from a sub-population with diabetes (n = 263), from 4060 adults aged 18 years and over living in the north-west suburbs of Adelaide, South Australia. Eligible respondents were asked to participate in a telephone interview, a self-report questionnaire and a biomedical examination. Diabetes (undiagnosed and diagnosed) was determined using self-reported information and a fasting blood test administered to participants. Data were analysed using SPSS (Version 10.0) and EpiInfo (Version 6.0).

Results

Factors associated with diabetes for both men and women were being aged 40 years and over, and having a low gross annual household income, obesity and a family history of diabetes. In addition, being an ex-smoker and having low cholesterol levels were associated with diabetes among men. Among women, having a high waist-hip ratio, high blood pressure and reporting a previous cardiovascular event or mental health problem were associated with diabetes.

Conclusion

The results found that men and women with diabetes face different challenges in the management of their condition. Public health implications include a need for quality surveillance data, including epidemiological life course, social, behavioural, genetic and environmental factors. This will enrich the evidence base for health promotion professionals and allow policy makers to draw inferences and conclusions for interventions and planning purposes.

Estimating prevalence of common chronic morbidities in Australia

OBJECTIVES

To estimate prevalence of selected diagnosed chronic diseases among patients attending general practice, in the general practice patient population, and in the Australian population, and to compare population estimates with those of the National Health Survey (NHS).

DESIGN, SETTING AND PARTICIPANTS

In late 2005, 305 general practitioners each provided data for about 30 consecutive patients (total, 9156) as part of the BEACH (Bettering the Evaluation And Care of Health) program, a continuous national study of general practice activity. GPs used their knowledge of the patient, patient self-report, and medical records as sources.

MAIN OUTCOME MEASURES

Crude prevalence of each listed condition currently under management among surveyed patients, and adjusted prevalence for the general practice patient population, and the national population.

RESULTS

39.6% of respondents had none of the listed conditions diagnosed; 30.0% had a cardiovascular problem (uncomplicated hypertension, 17.6%; ischaemic heart disease, 9.5%); 24.8% had a psychological problem (depression, 14.2%; anxiety, 10.7%); 22.8% had arthritis, mostly osteoarthritis (20.0%); 10.7% had asthma; and 8.3% had diabetes, mostly type 2 (7.2%). Adjustment to the population attending general practice resulted in lower estimates for cardiovascular disease, arthritis and diabetes but had little effect on prevalence of asthma and psychological problems. After adjusting for non-attenders, about one in five people in the population had a cardiovascular problem, a similar proportion had a psychological problem, 14.8% had arthritis, and about 10% had asthma, hyperlipidaemia and gastro-oesophageal reflux disease. Estimates were similar to NHS results for any arthritis, asthma, and malignant neoplasms; higher for any cardiovascular problem; far higher for specific cardiovascular diseases, cerebrovascular disease and hyperlipidaemia; and almost twice the NHS estimate for psychological problems (particularly depression and anxiety). Estimates for type 1 diabetes aligned with NHS results, but were far higher for "all diabetes" and type 2 diabetes.

CONCLUSIONS

This study offers an alternative, perhaps more accurate, approach to measurement of disease prevalence than the NHS approach, which relies on respondent self-report alone. It provides valid prevalence estimates with the help of GPs at a fraction of the cost of the NHS. This study could be repeated annually to augment other data sources and better define existing health needs in the population.

Chronic disease prevalence and associations in a cohort of Australian men: the Florey Adelaide Male Ageing Study (FAMAS)

Background

An increasing proportion of Australia's chronic disease burden is carried by the ageing male. The aim of this study was to determine the prevalence of asthma, cancer, diabetes, angina and musculoskeletal conditions and their relationship to behavioural and socio-demographic factors in a cohort of Australian men.

Methods

Self-reports of disease status were obtained from baseline clinic visits (August 2002 – July 2003 & July 2004 – May 2005) from 1195 randomly selected men, aged 35–80 years and living in the north-west regions of Adelaide. Initially, relative risks were assessed by regression against selected variables for each outcome. Where age-independent associations were observed with the relevant chronic disease, independent variables were fitted to customized multiadjusted models.

Results

The prevalence of all conditions was moderately higher in comparison to national data for age-matched men. In particular, there was an unusually high rate of men with cancer. Multiadjusted analyses revealed age as a predictor of chronic conditions (type 2 diabetes mellitus, angina, cancer & osteoarthritis). A number of socio-demographic factors, independent of age, were associated with chronic disease, including: low income status (diabetes), separation/divorce (asthma), unemployment (cancer), high waist circumference (diabetes), elevated cholesterol (angina) and a family history of obesity (angina).

Conclusion

Socio-demographic factors interact to determine disease status in this broadly representative group of Australian men. In addition to obesity and a positive personal and family history of disease, men who are socially disadvantaged (low income, unemployed, separated) should be specifically targeted by public health initiatives.