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Li YQ, Zhang LY, Zhao YC, Xu F, Hu ZY, Wu QH, Li WH, Li YN. Vascular endothelial growth factor B improves impaired glucose tolerance through insulin-mediated inhibition of glucagon secretion. World J Diabetes 2023; 14:1643-1658. [DOI: 10.4239/wjd.v14.i11.1643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/11/2023] [Accepted: 09/06/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Impaired glucose tolerance (IGT) is a homeostatic state between euglycemia and hyperglycemia and is considered an early high-risk state of diabetes. When IGT occurs, insulin sensitivity decreases, causing a reduction in insulin secretion and an increase in glucagon secretion. Recently, vascular endothelial growth factor B (VEGFB) has been demonstrated to play a positive role in improving glucose metabolism and insulin sensitivity. Therefore, we constructed a mouse model of IGT through high-fat diet feeding and speculated that VEGFB can regulate hyperglycemia in IGT by influencing insulin-mediated glucagon secretion, thus contributing to the prevention and cure of prediabetes.
AIM To explore the potential molecular mechanism and regulatory effects of VEGFB on insulin-mediated glucagon in mice with IGT.
METHODS We conducted in vivo experiments through systematic VEGFB knockout and pancreatic-specific VEGFB overexpression. Insulin and glucagon secretions were detected via enzyme-linked immunosorbent assay, and the protein expression of phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) was determined using western blot. Further, mRNA expression of forkhead box protein O1, phosphoenolpyruvate carboxykinase, and glucose-6 phosphatase was detected via quantitative polymerase chain reaction, and the correlation between the expression of proteins was analyzed via bioinformatics.
RESULTS In mice with IGT and VEGFB knockout, glucagon secretion increased, and the protein expression of PI3K/AKT decreased dramatically. Further, in mice with VEGFB overexpression, glucagon levels declined, with the activation of the PI3K/AKT signaling pathway.
CONCLUSION VEGFB/vascular endothelial growth factor receptor 1 can promote insulin-mediated glucagon secretion by activating the PI3K/AKT signaling pathway to regulate glucose metabolism disorders in mice with IGT.
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Affiliation(s)
- Yu-Qi Li
- Department of Pathophysiology, School of Basic Medicine, Binzhou Medical University, Yantai 264000, Shandong Province, China
| | - Lu-Yang Zhang
- Department of Rheumatology and Immunology, Yantaishan Hospital, Yantai 264000, Shandong Province, China
| | - Yu-Chi Zhao
- Department of Surgery, Yantaishan Hospital, Yantai 264000, Shandong Province, China
| | - Fang Xu
- Department of Pathophysiology, School of Basic Medicine, Binzhou Medical University, Yantai 264000, Shandong Province, China
| | - Zhi-Yong Hu
- School of Public Health and Management, Binzhou Medical University, Yantai 264000, Shandong Province, China
| | - Qi-Hao Wu
- The First School of Clinical Medicine, Binzhou Medical University, Yantai 264000, Shandong Province, China
| | - Wen-Hao Li
- Department of Pathophysiology, School of Basic Medicine, Binzhou Medical University, Yantai 264000, Shandong Province, China
| | - Ya-Nuo Li
- Department of Pathophysiology, School of Basic Medicine, Binzhou Medical University, Yantai 264000, Shandong Province, China
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Akhtar S, Ali A, Asghar M, Hussain I, Sarwar A. Prevalence of type 2 diabetes and pre-diabetes in Sri Lanka: a systematic review and meta-analysis. BMJ Open 2023; 13:e068445. [PMID: 37640460 PMCID: PMC10462943 DOI: 10.1136/bmjopen-2022-068445] [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: 09/19/2022] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE The purpose of this research was to determine the prevalence of diabetes and pre-diabetes in Sri Lanka. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE (via PubMed), Web of Science, Sri Lankan Journals online and Google Scholar were searched for relevant articles published between January 1990 and June 2022 investigating the prevalence of pre-diabetes and diabetes in Sri Lanka. METHODS Random effect meta-analyses were conducted to derive the pooled prevalence of pre-diabetes and diabetes and their 95% CIs. Heterogeneity was explored by subgroup and meta-regression analyses. Sensitivity analyses were used to evaluate the impact of any single study on the pooled estimates. Two authors screened articles, extracted data and evaluated the quality of selected studies. RESULTS A total of 479 articles were reviewed, and 15 studies (n=30 137 participants) were selected in the final analysis. The overall pooled prevalence of diabetes was 12.07% (95% CI, 8.71% to 15.89%; prediction interval: 1.28-31.35). The pooled pre-diabetes prevalence was 15.57% (95% CI, 9.45% to 22.88%; prediction interval: 0.02-49.87). The pooled type 2 diabetes prevalence was the highest in the latest period of 2011-2021 (17.25%) than in the period of 2000s (11.84%) and 1990s (5.62%). CONCLUSIONS The growing trend of diabetes and pre-diabetes over the last 30 years is alarming in Sri Lanka. The government of Sri Lanka needs to take steps to improve diabetes education, screening, diagnosis and treatment. PROSPERO REGISTRATION NUMBER CRD42021288591.
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Affiliation(s)
- Sohail Akhtar
- Mathematics and Statistics, The University of Haripur, Haripur, Pakistan
| | - Aqsa Ali
- Department of Statistics, GCU, Lahore, Pakistan
| | | | | | - Aqsa Sarwar
- Department of Statistics, Forman Christian College, Lahore, Pakistan
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Rannan-Eliya RP, Wijemunige N, Perera P, Kapuge Y, Gunawardana N, Sigera C, Jayatissa R, Herath HMM, Gamage A, Weerawardena N, Sivagnanam I, Dalpatadu S, Samarage S, Samarakoon U, Samaranayake N, Pullenayegam C, Perera B. Prevalence of diabetes and pre-diabetes in Sri Lanka: a new global hotspot-estimates from the Sri Lanka Health and Ageing Survey 2018/2019. BMJ Open Diabetes Res Care 2023; 11:11/1/e003160. [PMID: 36796852 PMCID: PMC9936281 DOI: 10.1136/bmjdrc-2022-003160] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION This study's objective was to produce robust, comparable estimates of the prevalence of diabetes and pre-diabetes in the Sri Lankan adult population, where previous studies suggest the highest prevalence in South Asia. RESEARCH DESIGN AND METHODS We used data on 6661 adults from the nationally representative 2018/2019 first wave of the Sri Lanka Health and Ageing Study (SLHAS). We classified glycemic status based on previous diabetes diagnosis, and either fasting plasma glucose (FPG), or FPG and 2-hour plasma glucose (2-h PG). We estimated crude and age-standardized prevalence of pre-diabetes and diabetes and by major individual characteristics weighting the data to account for study design and subject participation. RESULTS Crude prevalence of diabetes in adults was 23.0% (95% CI 21.2% to 24.7%) using both 2-h PG and FPG, and age-standardized prevalence was 21.8% (95% CI 20.1% to 23.5%). Using only FPG, prevalence was 18.5% (95% CI 7.1% to 19.8%). Previously diagnosed prevalence was 14.3% (95% CI 13.1% to 15.5%) of all adults. The prevalence of pre-diabetes was 30.5% (95% CI 28.2% to 32.7%). Diabetes prevalence increased with age until ages ≥70 years and was more prevalent in female, urban, more affluent, and Muslim adults. Diabetes and pre-diabetes prevalence increased with body mass index (BMI) but was as high as 21% and 29%, respectively, in those of normal weight. CONCLUSIONS Study limitations included using only a single visit to assess diabetes, relying on self-reported fasting times, and unavailability of glycated hemoglobin for most participants. Our results indicate that Sri Lanka has a very high diabetes prevalence, significantly higher than previous estimates of 8%-15% and higher than current global estimates for any other Asian country. Our results have implications for other populations of South Asian origin, and the high prevalence of diabetes and dysglycemia at normal body weight indicates the need for further research to understand the underlying drivers.
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Affiliation(s)
| | | | - Prasadini Perera
- Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | | | - Renuka Jayatissa
- Medical Research Institute, Ministry of Health, Colombo, Sri Lanka
| | - H M M Herath
- Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Anuji Gamage
- Faculty of Medicine, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka
| | | | | | | | | | | | | | | | - Bilesha Perera
- Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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Pinidiyapathirage J, Kasthuriratne A, Bennie JA, Pathmeswaran A, Biddle SJH, De Silva HJ, Chackrewarthy S, Dassanayake AS, Ranawaka U, Kato N, Wickremasinghe AR. Physical Activity Tracking Among Sri Lankan Adults: Findings From a 7-Year Follow-up of the Ragama Health Study. Asia Pac J Public Health 2021; 33:205-212. [PMID: 33577353 DOI: 10.1177/1010539520971179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Limited data are available on physical activity tracking among adults in low- and middle-income countries. Using a longitudinal design, we assessed trends and correlates of physical activity among Sri Lankan adults. Individuals selected through age-stratified random sampling, were screened initially in 2007 (n = 2986) and reevaluated in 2014 (n = 2148). On both occasions, structured interviews and clinical measurements were completed. Approximately 40% of the participants engaged in recommended levels of physical activity both at baseline and follow-up. One-fifth reported increased physical activity at follow-up, a similar proportion reported being persistently inactive or a reduction in physical activity. In the adjusted analysis, being persistently active was associated with male sex, a lower educational level and income, being free of any chronic disease conditions, better self-rated health, and sitting time <8 hours. Our findings support public health interventions to help maintain recommended physical activity levels over time, particularly for subgroups at high-risk of physical inactivity.
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Affiliation(s)
- Janani Pinidiyapathirage
- University of Southern Queensland, Toowoomba, Queensland, Australia.,University of Kelaniya, Ragama, Sri Lanka.,Griffith University, Gold Coast, Queensland, Australia
| | | | - Jason A Bennie
- University of Southern Queensland, Toowoomba, Queensland, Australia
| | | | | | | | | | | | | | - Norihiro Kato
- National Centre for Global Health and Medicine Research Institute, Shinjuku-ku, Tokyo, Japan
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Abolhasani M, Maghbouli N, Sazgara F, Karbalai Saleh S, Tahmasebi M, Ashraf H. Evaluation of Several Anthropometric and Metabolic Indices as Correlates of Hyperglycemia in Overweight/Obese Adults. Diabetes Metab Syndr Obes 2020; 13:2327-2336. [PMID: 32753917 PMCID: PMC7342503 DOI: 10.2147/dmso.s254741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
AIM Rapid and growing rise in obesity and diabetes mellitus, as serious human health-threatening issues, is alarming. The aim of the present study was assessing the accuracy of several obesity indices to predict hyperglycemia in overweight and obese Iranian populations and determining the value of such indices in comparison to the conventional parameters. We also evaluated new latent combined scores in this matter. PATIENTS AND METHODS Overall, there were 2088 patients recruited from the weight loss clinic of Sina Hospital, an educational hospital of Tehran University of Medical Sciences for this cross-sectional study. Demographic information, anthropometric indices and biochemical measurements were collected and calculated. The multivariable regression modeling as well as area under the receiver-operating characteristic (ROC) analysis was used. To detect the existence of new combined scores, we used SEM (structural equation modeling) analysis through SmartPLS. RESULTS Combined latent scores and WHtR (waist-to-height ratio) gave us a higher area under the curve in predicting hyperglycemia associated with WC (waist circumference) in women, whereas FFMI (fat-free mass index) gave low values. Additionally, BRI (body roundness index) and latent scores had slightly higher AUC values in predicting hyperglycemia in men. According to the age-adjusted odds ratio (OR) in the presence of hyperglycemia, OR was the highest for WHR (waist to hip ratio) in women (OR, 7.74; 95% confidence interval [CI], 1.71-15.13). The association of WHR and hyperglycemia remained significant by adjusting for BMI (body mass index), WC and menopausal status. CONCLUSION WHR had the strongest association with hyperglycemia in women with only sufficient discrimination ability. However, neither BSI (body shape index) and BAI (body adiposity index) nor FMI (fat mass index) and FFMI were superior to BMI (body mass index), WC or WHtR in predicting hyperglycemia. It was revealed that BRI and combined scores had a more predictive power compared to the BSI, BAI, FMI and FFMI, simplifying hyperglycemia evaluation.
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Affiliation(s)
- Maryam Abolhasani
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Maghbouli
- Physical Medicine and Rehabilitation Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Faeze Sazgara
- Department of Radiology, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Shahrokh Karbalai Saleh
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tahmasebi
- Amir Al Momenin Hospital, Department of Cardiology, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Haleh Ashraf
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Correspondence: Haleh Ashraf Research Development Center,Sina Hospital, Emam Khomeini Street, Tehran1136746911, IranFax +66348553 Email
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Biswas T, Magalhaes RJS, Townsend N, Das SK, Mamun A. Double Burden of Underweight and Overweight among Women in South and Southeast Asia: A Systematic Review and Meta-analysis. Adv Nutr 2020; 11:128-143. [PMID: 31634389 PMCID: PMC7442413 DOI: 10.1093/advances/nmz078] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/08/2018] [Accepted: 06/27/2019] [Indexed: 12/12/2022] Open
Abstract
The double burden of malnutrition (DBM) is characterized by the coexistence of underweight and overweight individuals in a population. The objective of this study was to assess the level of DBM, as well as its main determinants, in women in South and Southeast Asia. We searched scientific literature databases, including PubMed, EMBASE, CINAHL, and Google Scholar; gray literature; and reference lists from primary research published between 1969 and September 30, 2017. In total, 128 studies met our inclusion criteria, representing data of ∼5 million women >15 y of age from South and Southeast Asia. The findings show that prevalence rates of underweight and overweight varied by study from 7.0% to 61.0% and 1.0% to 64.0%, respectively. For the total study period, the pooled prevalence of underweight and overweight was 28% (95% CI: 25%, 31%) and 17% (95% CI: 15%, 19%) in South Asia, respectively, and 20% (95% CI: 15%, 26%) and 20% (95% CI: 15%, 24%) in Southeast Asia, respectively. In both regions, underweight was more prevalent in rural areas, among women of the youngest age group (15-19 y), and among those in the poorest wealth quintile. In contrast, overweight was higher in urban areas, among women of older age, and among those in the wealthiest households. This study also found that prevalence of overweight has recently exceeded that for underweight in this population.
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Affiliation(s)
- Tuhin Biswas
- Institute for Social Science Research, University of Queensland, Indooroopilly, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Indooroopilly, Australia
| | - R J Soares Magalhaes
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, University of Queensland, Gatton, Australia
- Children's Health and Environment Program, Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Nick Townsend
- Department for Health, University of Bath, Bath, United Kingdom
| | - Sumon Kumar Das
- Institute for Social Science Research, University of Queensland, Indooroopilly, Australia
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Child Health Division, Menzies School of Health Research, Tiwi, Australia
| | - Abdullah Mamun
- Institute for Social Science Research, University of Queensland, Indooroopilly, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Indooroopilly, Australia
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Herath HMM, Weerasinghe NP, Weerarathna TP, Hemantha A, Amarathunga A. Potential use of telephone-based survey for non-communicable disease surveillance in Sri Lanka. BMC Public Health 2017; 17:984. [PMID: 29284464 PMCID: PMC5747075 DOI: 10.1186/s12889-017-4993-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/12/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Telephone survey (TS) has been a popular tool for conducting health surveys, particularly in developed countries. However, the feasibility, and reliability of TS are not adequately explored in Sri Lanka. The main aim of this study is to assess the effectiveness of telephone-based survey in estimating the prevalence of common non-communicable diseases (NCDs) in Sri Lanka. METHODS We carried out an observational cross-sectional study using telephone interview method in Galle district, Sri Lanka. The study participants were selected randomly from the residents living in the households with fixed land telephone lines. The prevalence of the main NCDs was estimated using descriptive statistics. RESULTS Overall, 975 telephone numbers belonging to six main areas of Galle district were called, and 48% agreed to participate in the study. Of the non-respondents, 22% actively declined to participate. Data on NCDs were gathered from 1470 individuals. The most common self-reported NCD was hypertension (17.%), followed by diabetes (16.3%) and dyslipidaemia (15.6%). Smoking was exclusively seen in males (7.4%), and regular alcohol use was significantly more common in males (19.2%) than females (0.4%, P < .001). CONCLUSIONS Our study revealed average response rate for telephone based interview in Sri Lankan setting. Overall prevalence of main NCDs in this study showed a comparable prevalence to studies used face to face interview method. This study supports the potential use of telephone-based survey to assess heath related information in Sri Lanka.
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Affiliation(s)
- H M M Herath
- Department of Medicine, Faculty of Medicine, University of Ruhuna, University Unit, Teaching Hospital, Karapitiya, P.O. Box 70, Galle, Sri Lanka.
| | - N P Weerasinghe
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - T P Weerarathna
- Department of Medicine, Faculty of Medicine, University of Ruhuna, University Unit, Teaching Hospital, Karapitiya, P.O. Box 70, Galle, Sri Lanka
| | - A Hemantha
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - A Amarathunga
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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Gamlath L, Nandasena S, Hennadige Padmal de Silva S, Linhart C, Ngo A, Morrell S, Nathan S, Sharpe A, Taylor R. Differentials in Cardiovascular Risk Factors and Diabetes by Socioeconomic Status and Sex in Kalutara, Sri Lanka. Asia Pac J Public Health 2017; 29:401-410. [DOI: 10.1177/1010539517709028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Christine Linhart
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Anh Ngo
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
- Department of Student Health, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen Morrell
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Sally Nathan
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Albie Sharpe
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Richard Taylor
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Walatara KNW, Athiththan LV, Hettiaratchi UK, Perera PR. Effect of Demographic Status and Lifestyle Habits on Glycaemic Levels in Apparently Healthy Subjects: A Cross-Sectional Study. J Diabetes Res 2016; 2016:5240503. [PMID: 27995147 PMCID: PMC5141318 DOI: 10.1155/2016/5240503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/16/2016] [Indexed: 01/15/2023] Open
Abstract
Aim. To identify the effects of sociodemographic status, family history, and lifestyle habits on fasting blood glucose (FBG) and fasting serum insulin (FSI) levels in apparently healthy subjects. Methods. Information was gathered using an interviewer-administered questionnaire from 227 apparently healthy nondiabetic subjects residing in a suburban area in Sri Lanka. Venous blood samples were collected after an overnight fast for FBG and FSI analysis. Correlations and differences were analyzed using SPSS (ver. 17) software. Results. The majority of the subjects were females, having secondary or tertiary education, monthly income ≥Rs. 25,000 (USD 175), and a positive family history of diabetes. Among the subjects, 10.1% were identified as prediabetics and the majority had familial diabetes with monthly income ≥Rs. 25,000 (USD 175). Subjects with high income had significantly higher mean FBG. In addition FBG had a significant correlation with age. Males and subjects with less than 6 hours/day sleeping duration at night had significantly higher FBG. Subjects with less vigorous physical activity and longer sitting duration had significantly higher FSI levels. Conclusions. Increasing age, higher income, positive familial history of diabetes, sedentary lifestyle, and short sleep at night have positive impact on glycaemic status in apparently healthy subjects.
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Affiliation(s)
| | | | - Usha Kumari Hettiaratchi
- Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Sri Lanka
| | - Pradeep Rasika Perera
- Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Sri Lanka
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Sagner M, Arena R, McNeil A, Brahmam GN, Hills AP, De Silva HJ, Karunapema RPP, Wijeyaratne CN, Arambepola C, Puska P. Creating a pro-active health care system to combat chronic diseases in Sri Lanka: the central role of preventive medicine and healthy lifestyle behaviors. Expert Rev Cardiovasc Ther 2016; 14:1107-17. [DOI: 10.1080/14779072.2016.1227703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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De Silva AP, De Silva SHP, Haniffa R, Liyanage IK, Jayasinghe KSA, Katulanda P, Wijeratne CN, Wijeratne S, Rajapakse LC. A survey on socioeconomic determinants of diabetes mellitus management in a lower middle income setting. Int J Equity Health 2016; 15:74. [PMID: 27145835 PMCID: PMC4857262 DOI: 10.1186/s12939-016-0363-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/27/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Information on socioeconomic determinants in the management of diabetes mellitus is scarce in lower middle income countries. The aim of this study is to describe the socioeconomic determinants of management and complications of diabetes mellitus in a lower middle income setting. METHODS Cross sectional descriptive study on a stratified random sample of 1300 individuals was conducted by an interviewer administered questionnaire, clinical examinations and blood investigations. A single fasting venous blood sugar of ≥126 mg/dl was considered diagnostic of new diabetics and poor control of diabetes mellitus as HbA1C > 6.5 %. RESULTS There were 202 (14.7 %) with diabetes mellitus. Poor control was seen in 130 (90.7 %) while 71 (49.6 %) were not on regular treatment. Highest proportions of poor control and not on regular medication were observed in estate sector, poorest social status category and poorest geographical area. The annual HbA1C, microalbuminuria, retinal and neuropathy examination were performed in less than 6.0 %. Social gradient not observed in the management lapses. Most (76.6 %) had accessed private sector while those in estate (58.1 %) accessed the state system. The microvascular complications of retinopathy, neuropathy and microalbuminuria observed in 11.1 %, 79.3 % and 54.5 % respectively. Among the macrovascular diseases, angina, ischaemic heart disease and peripheral arterial disease seen in 15.5 %, 15.7 % and 5.5 % respectively. These complications do not show a social gradient. CONCLUSIONS Diabetes mellitus patients, irrespective of their socioeconomic status, are poorly managed and have high rates of complications. Most depend on the private healthcare system with overall poor access to care in the estate sector.
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Affiliation(s)
- Ambepitiyawaduge Pubudu De Silva
- Department of Community Medicine, Faculty of Medicine, University of Colombo, No. 25, P.O. Box 271, Kynsey Road, Colombo 08, Sri Lanka.
| | | | - Rashan Haniffa
- Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Isurujith Kongala Liyanage
- Department of Para Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala University, Colombo, Sri Lanka
| | | | - Prasad Katulanda
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Sumedha Wijeratne
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Lalini Chandika Rajapakse
- Department of Community Medicine, Faculty of Medicine, University of Colombo, No. 25, P.O. Box 271, Kynsey Road, Colombo 08, Sri Lanka
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Danmusa UM, Terhile I, Nasir IA, Ahmad AA, Muhammad HY. Prevalence and healthcare costs associated with the management of diabetic foot ulcer in patients attending Ahmadu Bello University Teaching Hospital, Nigeria. Int J Health Sci (Qassim) 2016; 10:219-28. [PMID: 27103904 PMCID: PMC4825895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Diabetic foot ulcers (DFU) are non-traumatic lesions of the skin on feet of diabetic patients. DFU require appropriate investigations, dietary placement and clinical management. These constitute huge healthcare costs in DFU care. OBJECTIVE This study sought to determine the prevalence of DFU in relation to clinical, socio-demographic variables and healthcare costs expended. METHODS This was a retrospective study. Hence, medical records and healthcare costs of 1573 DFU-diagnosed patients who visited the diabetic clinic and medical wards of Ahmadu Bello University Teaching Hospital, Nigeria were reviewed and analyzed for relevant data. RESULTS The prevalence of DFU in patients with diabetic mellitus (DM) was 6.0% with more cases in men (67.2%) than women (32.8%). The prevalence of DFU in relation to type of DM was 6.5% and 0% for DM type-II and DM type-I respectively. The distribution of DFU in relation to clinical stages was 40%, 25.7%, 17.1% and 11.4% for stages-IV, III, II and I. Patients in the age group 51-60 years had the highest frequency of DFU (28.6%), but there was no DFU in those 10-20 years and > 80 years. It required an average of 1808 US$ to successfully treat patients with DFU stage IV, while 1104 US$ and 556 US$ was required to treat DFU stage III and II respectively. Cost of procuring drugs covered the highest burden of total healthcare cost in managing DFU (35%-46%). CONCLUSION The prevalence of DFU in DM patients attending ABUTH was high. Healthcare costs associated with DFU especially cost of drugs procurement contributed the highest financial burden in managing DFU.
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Affiliation(s)
- Umar Mukhtar Danmusa
- Faculty of pharmaceutical Sciences, Usmanu Danfodiyo University, Sokoto, Sokoto State, Nigeria
| | - Iorliam Terhile
- Department of Pharmaceutical Services Ahmadu Bello University Teaching Hospital, Shika 06, Kaduna State, Nigeria
| | - Idris Abdullahi Nasir
- Department of Medical Laboratory Services, University of Abuja Teaching Hospital, PMB 228 Gwagwalada, FCT Abuja, Nigeria
| | - Auwal Alkasim Ahmad
- Faculty of Pharmacy, Ahmadu Bello University, Zaria, PMB 05, Zaria, Kaduna State, Nigeria
| | - Habiba Yahaya Muhammad
- Department of Chemical Pathology, Aminu Kano Teaching Hospital, PMB 3452 Zaria road, Kano state, Nigeria
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13
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Jayasuriya R, Pinidiyapathirage MJ, Jayawardena R, Kasturiratne A, de Zoysa P, Godamunne P, Gamage S, Wickremasinghe AR. Translational research for Diabetes Self-Management in Sri Lanka: A randomized controlled trial. Prim Care Diabetes 2015; 9:338-345. [PMID: 25733343 DOI: 10.1016/j.pcd.2015.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 05/17/2014] [Accepted: 01/29/2015] [Indexed: 11/25/2022]
Abstract
AIMS The study tested the hypothesis that a theory driven Diabetes Self-Management (DSM) intervention delivered by trained nurses would result in a clinically significant improvement in glycaemic control. METHODS Patients with an HbA1c >7.5% (58mmol/mol) and free of diabetes complications were enrolled into a randomized controlled trial (n=85). Intervention consisted of four sessions and monthly follow up for 6 months. Biochemical tests, and diet and physical activity assessments were done in both groups. Analysis of covariance was used to test the effectiveness of the intervention. RESULTS At 6 months, there was a significant difference (P=0.001) in HbA1c between the groups controlling for baseline values and other variables. Based on the primary outcome, 28% in the intervention group achieved the target value of 6.5% HbA1c, compared to 8% in the "usual care" group (P<0.001; η(2)=0.65). The reduction in total energy intake and increase in physical activity was significant in the intervention group between baseline and follow up. CONCLUSIONS The DSM intervention has resulted in a clinically significant impact on glycaemia, change in diet and physical activity, and has demonstrated the feasibility of using it within existing care arrangements in a developing country setting.
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Affiliation(s)
- R Jayasuriya
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - M J Pinidiyapathirage
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - R Jayawardena
- Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - A Kasturiratne
- Department of Public Health, University of Kelaniya, Faculty of Medicine, Ragama, Sri Lanka
| | - P de Zoysa
- Faculty of Medicine, University of Colombo, Colombo 9, Sri Lanka
| | - P Godamunne
- Medical Education Centre, University of Kelaniya, Faculty of Medicine, Ragama, Sri Lanka
| | - S Gamage
- Department of Psychiatry, University of Peradeniya, Peradeniya, Sri Lanka
| | - A R Wickremasinghe
- Department of Public Health, University of Kelaniya, Faculty of Medicine, Ragama, Sri Lanka
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14
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Cheema A, Adeloye D, Sidhu S, Sridhar D, Chan KY. Urbanization and prevalence of type 2 diabetes in Southern Asia: A systematic analysis. J Glob Health 2014; 4:010404. [PMID: 24976963 PMCID: PMC4073245 DOI: 10.7189/jogh.04.010404] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetes mellitus is one of the diseases considered to be the main constituents of the global non-communicable disease (NCD) pandemic. Despite the large impact that NCDs are predicted to have, particularly in developing countries, estimates of disease burden are sparse and inconsistent. This systematic review transparently estimates prevalence of type 2 diabetes mellitus in Southern Asia, its association with urbanization and provides insight into the policy challenges facing the region. METHODS The databases Medline and PubMed were searched for population-based studies providing estimates of diabetes prevalence in the Southern Asia region. Studies using WHO diagnostic criteria of fasting plasma glucose (FPG) ≥7.0mmol/L and/or 2h-plasma glucose (2hPG) ≥11.1mmol/L were included. Data from eligible studies was extracted into bubble graphs, and trend lines were applied to UNPD figures to estimate age-specific prevalence in the regional population. Estimates specific to sex, area of residency, and diagnostic method were compared and trends analysed. RESULTS A total of 151 age-specific prevalence estimates were extracted from 39 studies. Diabetes prevalence was estimated to be 7.47% for 2005 and 7.60% for 2010. Prevalence was strongly associated with increased age, male gender and urban residency (P < 0.001). CONCLUSION Diabetes prevalence in Southern Asia is high and predicted to increase in the future as life expectancy rises and the region continues to urbanise. Countries in this region need to improve NCD surveillance and monitoring so policies can be informed with the best evidence. Programs for prevention need to be put in place, and health system capacity and access needs to be assessed and increased to deal with the predicted rise in NCD prevalence.
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Affiliation(s)
- Arsalan Cheema
- Centre for Population Health Sciences and the World Health Organization's Collaboration Centre for Population Health Research and Training, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Davies Adeloye
- Centre for Population Health Sciences and the World Health Organization's Collaboration Centre for Population Health Research and Training, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Simrita Sidhu
- Centre for Population Health Sciences and the World Health Organization's Collaboration Centre for Population Health Research and Training, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Devi Sridhar
- Centre for Population Health Sciences and the World Health Organization's Collaboration Centre for Population Health Research and Training, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Kit Yee Chan
- Centre for Population Health Sciences and the World Health Organization's Collaboration Centre for Population Health Research and Training, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
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