The Burden of Undiagnosed Diabetes Mellitus in Adult African Population: A Systematic Review and Meta-Analysis

Social and health service-related factors associated with undiagnosed diabetes mellitus- a population-based survey in a highly urbanized Chinese setting

BACKGROUND

Undiagnosed diabetes mellitus (UDM) is associated with poorer health outcomes compared to diagnosed DM. We investigated factors associated with UDM in a highly urbanized Chinese setting to facilitate UDM detection.

METHODS

We analysed data from the cross-sectional Hong Kong Population Health Survey. We defined UDM by blood glucose and HbA1c levels and a negative history of self-reported doctor-diagnosed DM. We categorized diabetes status into UDM, incident DM (IDM, i.e. recently diagnosed) and individuals without diabetes and used multinomial logistic regression models to investigate the relationship between diabetes status and social and health service-related factors.

RESULTS

We included 98 IDM cases, 101 UDM cases, and 2,153 individuals without diabetes. Individuals aged 35-44 years (aOR 12.65, 95% C.I. 2.54-62.97) and those living in subsidized-sale housing (aOR 2.01, 95% C.I. 1.14-3.56) had a higher risk of UDM relative to not having diabetes, but not IDM. Males who were economically active (aOR 4.22, 95% C.I. 1.25-14.30), and males who did not have regular check-ups (aOR 3.05, 95% C.I. 1.16-8.00) had higher risks of UDM relative to not having diabetes, whereas males with a higher household income had a lower risk of UDM (aOR 0.94, 95% C.I. 0.89-0.99). Compared to individuals without diabetes, UDM cases had comparable physical activity levels but most were work- and transport-related rather than recreational.

CONCLUSIONS

Compared to individuals without diabetes or IDM cases, economically active males, males without regular check-ups and males with lower household income had a higher risk of UDM. Targeted active DM screening can reduce UDM. However, further research on the benefits of different types of physical activity is needed.

Nutritional Diet Knowledge and Barriers to Dietary Recommendations Adherence Among Diabetic Patients in Central Region, Ghana: A Cross-Sectional Study

Background and Aim

Diabetes mellitus (DM) presents significant health risks due to elevated blood sugar levels, necessitating adherence to dietary recommendations for effective management. However, diabetic patients often encounter barriers hindering their adherence to dietary guidelines. This study sought to investigate the determinants of good nutritional diet knowledge and adherence to dietary recommendations beyond the barriers faced by diabetic patients in Ghana.

Methods

This was a cross-sectional prospective study that collected data using a tested and structured questionnaire from 100 diabetic patients from January 2024 to June 2024. Data was entered and analyzed using Microsoft Excel 2019 and SPSS (version 26). Bivariate and multivariable logistic regression was used to identify associations between dependent and independent variables. Statistical significance was set at a p-value ≤ 0.05.

Results

The mean age of the participants was 56.97 ± 11.98 years. Overall, about 74.44% had good nutritional diet knowledge. Being female (adjusted odds ratio [AOR] = 0.65, 95% confidence interval [CI] = [0.41-0.83]), and having complete tertiary education (AOR = 2.05, 95% CI = 0.96-3.82) were the factors associated with good nutritional diet knowledge. About 39% stopped their dietary plan without informing their doctor, and 60% stopped when they felt their condition was under control. The overall adherence to dietary recommendations was poor as only 48% adhered to the recommendations. Being female (AOR = 0.83, 95% CI = [0.49-2.11]), being 75 years or older (AOR = 2.74, 95% CI = 0.99-4.14), and having good nutritional knowledge (AOR = 2.80, 95% CI = 1.61-4.16) were the factors associated with good adherence to dietary recommendation.

Conclusion

The participants had good nutritional diet knowledge but poor adherence to dietary recommendations. Being female and having completed tertiary education were the determinants of good nutritional diet knowledge while being female, being 75 years or older, and having good nutritional knowledge were the factors associated with good adherence. The leading adherence barriers were the discomforts associated with cooking meals that meet their dietary requirements, dietary restrictions, and financial difficulties.

Prevalence and Determinants of Undiagnosed Diabetes Mellitus Among Adults in Zakho City, Kurdistan Region, Iraq: A Community-Based Cross-Sectional Study

Objective This study aimed to study the prevalence of undiagnosed diabetes mellitus (DM) and its associated factors in adults aged over 18 in Zakho City, Kurdistan Region, Iraq. Methods A cross-sectional study was conducted recruiting 537 participants with a mean age of 35.43±13.88 years. Data on sociodemographic characteristics, health behaviors, clinical history, and anthropometric measurements, including body mass index (BMI) and waist circumference, were collected. Results The study sample comprised 345 (64.2%) men and 192 (35.8%) women, with 324 (60.3%) being married and 246 (45.8%) having a university-level education or higher. Regarding health behaviors, 218 (40.6%) participants engaged in physical activity, 180 (33.5%) were smokers, and 196 (36.5%) reported sleep disturbances, averaging 7.10±2.02 hours per night. Anthropometric assessments revealed that 209 (38.9%) were overweight, 131 (24.4%) were obese, and 273 (50.8%) had high waist circumference. The prevalence of abnormal glucose levels was 51 (9.5%) (95% CI: 7.02-11.98) including 14 (2.6%) (95% CI: 1.26-3.95) with undiagnosed DM and 37 (6.9%) (95% CI: 4.75-9.03) with prediabetes mellitus (pre-DM). Multivariate analysis showed significant associations between abnormal glucose levels and increased age (p<0.0001), high BMI (≥25 kg/m²) (p<0.0001), and high waist circumference (p<0.0001). Specifically, age was a significant predictor for pre-DM (adjusted odds ratio (aOR) 1.04; 95% CI: 1.01-1.07), while age and high waist circumference predicted undiagnosed DM (aOR 1.90; 95% CI: 1.03-1.16). Conclusion This study provided the first estimate of undiagnosed DM in the Kurdistan Region. The current study showed that the prevalence of undiagnosed DM and impaired fasting glucose were significant emphasizing age, BMI, and waist circumference as significant risk factors. These findings suggest the need for targeted screening and preventive strategies in this population to improve DM detection and management.

Promotion of Cardiovascular Health in Africa: The Alliance for Medical Research in Africa (AMedRA) Expert Panel

This proposed scientific statement is focused on providing new insights regarding challenges and opportunities for cardiovascular health (CVH) promotion in Africa. The statement includes an overview of the current state of CVH in Africa, with a particular interest in the cardiometabolic risk factors and their evaluation through metrics. The statement also explains the main principles of primordial prevention, its relevance in reducing noncommunicable disease and the different strategies that have been effective worldwide. Also, the statement addresses challenges for implementing primordial prevention strategies in Africa, such as socioeconomic, cultural, lifestyle, and environmental factors, and highlights the importance of adapting strategies to the context. Finally, the statement recommends fundamental approaches for promoting CVH with the help of various partnerships and the involvement of communities.

Prevalence of undiagnosed diabetes mellitus and its associated factors in urban Burkina Faso

Background

Community screening could be an effective strategy for identifying people with undiagnosed type 2 diabetes mellitus (T2DM) in low-income countries.

Aim

This study aimed to estimate the prevalence of undiagnosed T2DM and its risk factors.

Setting

This study was conducted in Ouagadougou, the capital of Burkina Faso.

Methods

This was a cross-sectional study, including consenting population (≥ 18 years). Data were collected from 11 November 2020 to 16 November 2020, in five fix sites after a 10-day information campaign on T2DM. The SD CodeFreeTM glucose analyser was used to diagnose T2DM. Multivariable logistic regression was used to identify the associate factors.

Results

A total of 1200 (95%) volunteered out of 1330 people were enrolled, which included 667 (52.27%) women. The mean age was 34.16 years (standard deviation: 12.42). Overall, 40.28% were abdominally obese and 31.43% hypertensive. The prevalence of T2DM was 10.74% (95% confidence interval [95% CI]: 9.15; 12.56). In multivariate analysis, being aged or greater than 35 years (adjusted odds ratio [ORa]: 2.30; 95% CI: 1.42; 3.72), having a family history of diabetes (ORa = 1.55; 95% CI: 1.006; 2.40), being overweight (ORa = 1.69; 95% CI: 1.09; 2.62), being obese (ORa = 1.80; 95% CI: 1.08; 3.00), being a known hypertensive (ORa = 2.92 95% CI: 1.64; 5.19) and having high blood pressure on the day of the survey (ORa = 1.86; 95% CI: 1.22; 2.85) increased significantly the probability to present T2DM.

Conclusion

Community screening is useful to identify T2DM. A national programme to control diabetes mellitus and its associated risk factors is urgently needed in Burkina Faso.

Contribution

This study will enable early detection of diabetes mellitus and its management in order to prevent or delay the onset of complications.

Disparities in metabolic dysfunction-associated steatotic liver disease and cardiometabolic conditions in low and lower middle-income countries: a systematic analysis from the global burden of disease study 2019

OBJECTIVE

Metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiometabolic conditions affect populations across economic strata. Nevertheless, there are limited epidemiological studies addressing these diseases in low (LICs) and lower-middle-income countries (lower MICs). Therefore, an analysis of the trend of MASLD and cardiometabolic conditions in these countries is necessary.

METHODS

From 2000 to 2019, jointpoint regression analysis was employed to calculate the prevalence, mortality, and disability-adjusted life years (DALYs) for cardiometabolic conditions including MASLD, type 2 diabetes mellitus (T2DM), dyslipidemia (DLP), hypertension (HTN), obesity, peripheral artery disease (PAD), atrial fibrillation and flutter (AF/AFL), ischemic heart disease (IHD), stroke, and chronic kidney disease from HTN and T2DM, in LICs and lower MICs (according to the World Bank Classification 2019) using the Global Burden of Disease 2019 data.

RESULTS

Among the eleven cardiometabolic conditions, MASLD (533.65 million), T2DM (162.96 million), and IHD (76.81 million) had the highest prevalence in LICs and Lower MICs in 2019. MASLD represented the largest proportion of global prevalence in these countries (43 %). From 2000 to 2019, mortality in LICs and lower MICs increased in all cardiometabolic conditions, with obesity-related mortality having the highest increase (+134 %). During this timeframe, there were increased age-standardized death rates (ASDR) from obesity, PAD, and AF/AFL. From all conditions, the DALYs-to-prevalence ratio was higher in LICs and lower MICs than the global average.

CONCLUSION

The burden of MASLD and cardiometabolic conditions is increasing worldwide, with LICs and lower MICs experiencing higher (DALYs) disability per prevalence. As these conditions are preventable, counteracting these trends requires not only the modification of ongoing actions but also the strategizing of immediate interventions.

Prevalence of undiagnosed diabetes mellitus and associated factors among adult residents of Mizan Aman town, Southwest Ethiopia: Community-based cross-sectional study

BACKGROUND

Diabetes mellitus continues to be a significant global public health concern, and it is currently a public health issue in developing nations. In Ethiopia, about three fourth of adult population with diabetes are unaware of their diabetic condition. However, there is a limited research on this specific topic particularly in the study area.

OBJECTIVE

To assess prevalence of undiagnosed diabetes mellitus and its associated factor among adult residents of Mizan Aman town, south West Ethiopia.

METHODS AND MATERIAL

A community-based cross-sectional study was conducted from May 23 to July 7, 2022, on 627 adult residents of Mizan Aman town. A multi stage sampling technique was used to obtain 646 study units. Interviewer-administered structured questionnaires were employed to gather socio-demographic and behavioral data. Anthropometric measurements were obtained and blood samples were taken from each participants. The fasting blood glucose level was measured after an 8-hour gap following a meal, using a digital glucometer to analyze a blood sample. Data were cleaned and entered into Epi-data v 3.1 and exported to SPSS v. 26 for analysis. Bi-variable analysis was done to select candidate variables and multivariable logistic regression model was fitted to identify independent predictors of undiagnosed diabetes mellitus. Adjusted odds ratio (AOR) with 95% CI was computed and variables with p-value < 0.05 were declared to be predictors of undiagnosed diabetes mellitus.

RESULTS

The study revealed that, the overall magnitude of undiagnosed diabetes mellitus was 8.13% (95% CI: 6.1, 10.6). Predictors of undiagnosed diabetes mellitus were; physical activity level less than 600 Metabolic equivalent/min per week (AOR = 3.39, 95%CI 1.08 to 10.66), family history of diabetes mellitus (AOR = 2.87, 95% CI 1.41, 5.85), current hypertension(AOR = 2.9, 95% CI 1.26, 6.69), fruit consumption of fewer than three servings per week(AOR = 2.64, 95% CI 1.18 to 5.92), and sedentary life(AOR = 3.33, 95% CI 1.63 to 6.79).

CONCLUSION

The prevalence of undiagnosed diabetes mellitus was 8.13%. Physical inactivity, family history of diabetes mellitus, current hypertension, sedentary life, and fruit servings fewer than three per week were independent predictors of undiagnosed diabetes mellitus.

Association of body iron stores and anemia in a Ghanaian type-2 diabetes mellitus population: A multicentered cross-sectional study

Background and Aims

Anemia has been a common comorbidity in most chronic diseases, but has not been well monitored in type 2 diabetes mellitus (T2DM) patients. In this study, we investigated the prevalence of anemia and its nexus with iron stores among T2DM patients in health facilities in the Ashanti Region of Ghana.

Methods

This multicenter cross-sectional study recruited 213 T2DM out-patients attending the diabetic clinics at the Kumasi South Hospital and St. Michaels Hospital, Jachie Pramso, Ghana, for routine check-ups. Self-reported questionnaires were used to collect sociodemographic, lifestyle, and clinical data from study participants. Blood samples were collected to estimate hematological parameters and iron stores. Mann-Whitney U test was used to assess the difference in hematological parameters and iron stores between anemic and nonanemic patients. All p < 0.05 were considered statistically significant.

Results

Of the 213 T2DM participants, the prevalence of anemia was 31.9%. More females 145 (68.1%) were registered than males 68 (31.9%). Anemic patients had significantly lower levels of mean cell volume [79.30/fL vs. 82.60/fL, p = 0.001], mean cell hemoglobin [26.60/pg vs. 27.90/pg, p < 0.0001], and mean cell hemoglobin concentration [33.10/g/dL) vs. 33.80/g/dL, p < 0.0001] than those without anemia. Serum levels of ferritin (p = 0.1140), transferrin (p = 0.5070), iron (p = 0.7950), and total iron binding capacity (p = 0.4610) did not differ significantly between T2DM patients with or without anemia.

Conclusion

Despite the high prevalence of anemia among the T2DM patients in our cohort, patients present with apparently normal iron stores. This unrecognized mild anemia must be frequently monitored among T2DM patients.

Biochemical Alterations Associated With the Severity of COVID-19 in Sub-Saharan Black African Individuals

BACKGROUND

Biochemical markers are essential in the monitoring and the clinical care of patients as they inform clinicians. Here, we characterized biochemical alterations in sub-Saharan Black African individuals with COVID-19.

METHODS

The study includes COVID-19 patients cared for at the Akanda Army Hospital in Libreville (Gabon). A total of 2237 patient records were extracted and reviewed. Patients were classified based on hospital admission (intensive care unit [ICU], internal medicine ward, and outpatient).

RESULTS

One thousand six hundred seventy-one were included in the study. ICU patients were significantly older than non-ICU hospitalized patients (P < 0.001) and outpatients (P < 0.0001). Hyperglycemic patients had 6.4 odds of being in ICU (P < 0.0001). Patients with abnormally high urea had 54.7 odds of being in ICU (P < 0.0001). Patients with abnormally high aspartate aminotransferase (AST) (>33 IU/L) had 3.5 odds of being in ICU (P < 0.0001). Hyperlactatemia (>246 IU/L) odds in ICU patients were 14 (P < 0.0001). The odds of abnormally high alkaline phosphatase (ALP) (>147 IU/L) in ICU patients were 4.6 (P < 0.0001). Odds for hypochloremia (<98 mmol/L) were 1.6 in ICU (P < 0.05). Dysnatremia patients (<135 or >145 mmol/L) had 9.5 odds of being found in ICU patients (P < 0.0001). The odds of potassium imbalance (<3.6 or >5 mmol/L) in ICU patients were 12.2 (P < 0.0001).

CONCLUSIONS

COVID-19-associated biochemical alterations observed in the Black African population are similar to those observed in other populations, and the association between COVID-19 severity, hyperglycemia, and multi-organ affection is confirmed.

Prevalence of Diabetes and Associated Factors Among Government Employees of Mizan-Aman Town and Zonal Sector Office, Bench Sheko Zone, Southwest Ethiopia Region, 2022

Introduction

Diabetes mellitus (DM) is a serious non-communicable disease (NCD) that represents a major health and development challenge of the 21st century. Ethiopia is the leading country among the top five high-burden African countries for the number of people with diabetes. To address problems within the population, it is important to assess the prevalence of diabetes and identify the risk factors associated with its diagnosis.

Objective

The study aims to determine the prevalence of diabetes and identify its associated factors among office workers of Mizan-Aman Town administration and Bench Sheko Zone Sector Office.

Methods

A sector office-based cross-sectional study was conducted on 559 randomly selected employees of Mizan Aman Town Administration and Zonal Office from June 5 to June 30, 2022. Fasting plasma glucose was tested, and the result ≥126 mg/dL was used to diagnose DM. Data were entered using Epi Data version 4.0.2 and exported to the Statistical Package for the Social Sciences (SPSS version 26) for analysis. Bivariate analyses were included in the multivariable model with p <0.25. Adjusted odds ratios (AOR) with a confidence interval (CI) of 95% are reported, with a significance level of p < 0.05.

Results

The overall prevalence of Diabetes was 9.4% with 95%CI(7.1,12.1)). Among the participants,60.8% were men, 58.2% of workers were aged 40 years or older, and the mean age was 39.7 ± 9.9 years. Having hypertension (AOR 3.85, 95% CI (1.7,7.4), family history of diabetes (AOR 4.5, 95% CI (1.2, 15.8), physical inactivity defined as failure to participate in moderate intensity activities at work, sitting ≥180 minutes per day (AOR = 3.57, 95% CI (1.1, 11.0)) and having central obesity AOR: 3.25, 95% CI (1.5, 6.7) independently associated with higher odds of DM. However, those having good knowledge of DM (AOR=0.26, 95% CI: (0.10, 0.6)) and consuming fruits and vegetables greater than five servings per week (AOR=0.32 95% CI (0.1, 0.7)) predicted lower odds of DM.

Conclusions and Recommendations

The prevalence of DM among office workers was high and is associated with lifestyle, family history, dietary practices, and knowledge about DM. Therefore, arranging regular screening programs at the workplace and promotion of healthy diet, exercise, and awareness creation are needed to lower the prevalence.

Uncovering the Burden of Diabetes in Ekiti State, Nigeria: Insights From a Statewide, Household-Based, Cross-Sectional Study

INTRODUCTION

Diabetes mellitus (DM) is an important global public health challenge, and the burden of the disease is huge, particularly in low- and middle-income countries (LMICs), where the majority of people with this condition reside. Undiagnosed DM is more prevalent in LMICs. The aim of this study is to determine the prevalence and associated factors for DM in Ekiti State.

MATERIALS AND METHODS

A cross-sectional, household-based survey using a four-stage multistage sampling design and the World Health Organization (WHO)-STEPS survey manual was conducted from July to September 2020 as a part of the Ekiti State coronavirus disease 2019 (COVID-19) survey. Of the 5,145 sampled households, 4,726 individuals gave consent to participate in the survey. Out of these, 3043 had fasting plasma glucose results available and were included in the analysis.

RESULTS

There were 2257 (74.2%) women and 786 (25.8%) men. The prevalence of DM was 6.5% (6.5% in males and 6.6% in females, P = 0.946). Diabetes was found to be more prevalent among those with a secondary school education or higher (10.9%); employed in the formal sector (13.4%); separated, divorced, or widowed (8.5%); with raised blood pressure (9.3%); and who were aged 30-59 years (all P < 0.05). Multivariable logistic regression showed that age, education, occupation, and hypertension were all positively and significantly associated with an increased risk of DM.

CONCLUSION

The prevalence of DM in Ekiti State is high, and its predictors include advancing age, hypertension, education, and occupation. This calls for scaling up public health interventions for controlling DM, targeting the identified risk factors among the people of Ekiti.

The Association Between Malignant Otitis Externa and Diabetes Mellitus in Africa: A Systematic Review

Diabetes mellitus is one of the risk factors for malignant otitis externa. There are very few studies on the disease in Africa and there is a need to pool the prior studies to highlight the characteristics of the disease. The study type is a systematic review and the PRISMA guidelines were followed. Using the appropriate terms, relevant medical databases were systematically searched. Thirty-two studies met the eligibility criteria with a total sample size of 848, who were mainly elderly. Diabetes mellitus was present in 94% of the participants. Average duration of diabetes diagnosis in the participants was 12.4 years. The pooled HbA1c was 9.8%. The most common symptoms were otalgia (96.1%), otorrhoea (75.8%) and hearing loss (56.1%). Pseudomonas was the most common isolate (72%). Fluoroquinolones and the 3rd-generation cephalosporins were the preferred antibiotics. The pooled cure rate from antimicrobial usage was 76.2%. In addition to medications, 24.6% of the affected individuals required debridement. About 1.6% of the participants died from malignant otitis externa. Malignant otitis externa is associated with poorly controlled diabetes. Pseudomonas is the most common cause and a significant proportion gets cured with prolonged antibiotherapy.

Red Cell Distribution Width and Prediabetes in Adults in Northern Sudan: A Case-Control Study

Diabetes mellitus (DM) is a major public health issue worldwide. Red cell distribution width (RDW) has been reported to have predictive value in several diseases, including DM. Few data exist on the association between RDW and the prediabetic stage. Thus, the present study aimed to investigate the association between RDW and prediabetes in adults in Sudan. This case-control study was conducted in Northern Sudan in 2022. The cases (n = 107) were prediabetic patients categorized according to the level of glycated hemoglobin (HbA1c), which ranged from 5.7% to 6.4%, while the controls (n = 107) were healthy participants. A questionnaire was used to collect the data. Standard methods were used to measure the HbAIc level and RDW. Logistic regression analysis was performed. The median (interquartile range (IQR)) of the RDW was significantly higher in prediabetic patients than in the controls (14.5% [13.8-15.3%] vs. 14.1% [13.6-14.7%], p = 0.003). Sex, educational level, occupational status, marital status, cigarette smoking, alcohol consumption, family history of DM, and body mass index were not associated with prediabetes. In the multivariate-adjusted model, higher age and higher RDW were associated with prediabetes. A positive correlation was found between RDW and HbA1c levels (r = 0.19, p = 0.006). In conclusion, this study supports the use of RDW as a predictor of DM.

The magnitude of undiagnosed diabetes mellitus, prediabetes, and associated factors among adults living in Debre Tabor town, northcentral Ethiopia: A community-based cross-sectional study

Background

Diabetes mellitus (DM) is a worldwide public health problem. The burden of diabetes has been continuously increasing from day to day, especially in developing countries like Ethiopia. Globally, half of all cases of diabetes mellitus are undiagnosed. Diabetes mellitus can be easily handled if it is detected early. There is limited evidence on the magnitude of undiagnosed diabetics and prediabetes at the community level in Ethiopia, particularly in the study area.

Objective

To assess the magnitude of undiagnosed diabetes mellitus, prediabetes, and associated factors among adults living in Debre Tabor town.

Methods

A community-based cross-sectional study was conducted in Debre Tabor town from October to December 2021. A total of 407 participants were selected using a multistage sampling technique. A pretested structural questionnaire was used to collect demographic, behavioral, and clinical data. Anthropometric measurements were taken with standardized and calibrated equipment. A fasting venous blood sample was collected for blood glucose level determination. Logistic regression was used to identify risk factors. A P-value ≤0.05 was considered statistically significant.

Result

The magnitude of undiagnosed diabetes mellitus and prediabetes was found to be 4.5% (95% CI: 2.9-7.4) and 14.5% (95% CI: 11.1-18.1), respectively. Older age (AOR: 6.50, 95% CI: 1.82-23.21), abnormal body mass index (AOR: 6.84, 95% CI: 1.91-24.54), systolic hypertension (AOR: 8.74, 95% CI: 2.53-30.19), and family history of diabetes mellitus (FHDM) (AOR: 12.45, 95% CI: 3.63-42.65) were significantly associated with undiagnosed diabetes mellitus. Using saturated oil (AOR: 1.97, 95% CI: 1.09-3.55), having a high waist circumference (AOR: 2.16, 95% CI: 1.20-3.87), and being hypertensive (AOR: 2.26, 95% CI: 1.04-4.96) were all significantly associated with Prediabetes.

Conclusion

Adults in Debre Tabor town have a high prevalence of undiagnosed diabetes and prediabetes. A variety of modifiable risk factors were also identified. As a result, focusing the prevention strategy on such modifiable risk factors may help to minimize the prevalence of undiagnosed diabetes mellitus and prediabetes as well as future disease complications.

Magnitude of impaired fasting glucose and undiagnosed diabetic mellitus and associated risk factors among adults living in Woreta town, northwest Ethiopia: a community-based cross-sectional study, 2021

BACKGROUND

Impaired fasting glucose (IFG) is an early warning system that provides prior information to prevent the future development of DM and diabetes-related problems, but early detection of DM is not practically applicable in Ethiopia. This study was aimed to assess the magnitude of impaired fasting glucose and undiagnosed diabetes mellitus (DM) and associated factors.

METHODS

A community-based, cross-sectional study was conducted from May to June 30, 2021. A structured interviewer-administered questionnaire was used to collect data. Anthropometric measurements were also recorded. A fasting blood sugar (FBS) test was assessed by samples taken early in the morning. Epi-Info 7.2.5.0 was used to enter data, which was then exported to SPSS 25 for analysis. To identify factors associated with IFG, logistics regression was used. The level of statistical significance was declared at p 0.05.

RESULT

Three hundred and twenty-four (324) participants with a mean age of 43.76 ± 17.29 years were enrolled. The overall magnitude of impaired fasting glucose (IFG) and undiagnosed diabetes mellitus (DM) were 43.2% and 10.0%, respectively. Waist circumference (AOR: 1.72, 95% CI 1.23-3.14), hypertension (AOR: 3.48, 95% CI 1.35-8.89), family history of Diabetic mellitus (AOR: 2.34, 95% CI 1.37-5.79) and hypertriglyceridemia (AOR: 2.35, 95% CI 1.41-5.43) were found to be independently associated with impaired fasting glucose.

CONCLUSION

Individuals who are overweight, hypertriglyceridemia, and are hypertensive should have regular checkups and community-based screening.

Non-invasive type 2 diabetes risk scores do not identify diabetes when the cause is β-cell failure: The Africans in America study

Background

Emerging data suggests that in sub-Saharan Africa β-cell-failure in the absence of obesity is a frequent cause of type 2 diabetes (diabetes). Traditional diabetes risk scores assume that obesity-linked insulin resistance is the primary cause of diabetes. Hence, it is unknown whether diabetes risk scores detect undiagnosed diabetes when the cause is β-cell-failure.

Aims

In 528 African-born Blacks living in the United States [age 38 ± 10 (Mean ± SE); 64% male; BMI 28 ± 5 kg/m²] we determined the: (1) prevalence of previously undiagnosed diabetes, (2) prevalence of diabetes due to β-cell-failure vs. insulin resistance; and (3) the ability of six diabetes risk scores [Cambridge, Finnish Diabetes Risk Score (FINDRISC), Kuwaiti, Omani, Rotterdam, and SUNSET] to detect previously undiagnosed diabetes due to either β-cell-failure or insulin resistance.

Methods

Diabetes was diagnosed by glucose criteria of the OGTT and/or HbA1c ≥ 6.5%. Insulin resistance was defined by the lowest quartile of the Matsuda index (≤ 2.04). Diabetes due to β-cell-failure required diagnosis of diabetes in the absence of insulin resistance. Demographics, body mass index (BMI), waist circumference, visceral adipose tissue (VAT), family medical history, smoking status, blood pressure, antihypertensive medication, and blood lipid profiles were obtained. Area under the Receiver Operator Characteristics Curve (AROC) estimated sensitivity and specificity of each continuous score. AROC criteria were: Outstanding: >0.90; Excellent: 0.80-0.89; Acceptable: 0.70-0.79; Poor: 0.50-0.69; and No Discrimination: 0.50.

Results

Prevalence of diabetes was 9% (46/528). Of the diabetes cases, β-cell-failure occurred in 43% (20/46) and insulin resistance in 57% (26/46). The β-cell-failure group had lower BMI (27 ± 4 vs. 31 ± 5 kg/m² P < 0.001), lower waist circumference (91 ± 10 vs. 101 ± 10cm P < 0.001) and lower VAT (119 ± 65 vs. 183 ± 63 cm³, P < 0.001). Scores had indiscriminate or poor detection of diabetes due to β-cell-failure (FINDRISC AROC = 0.49 to Cambridge AROC = 0.62). Scores showed poor to excellent detection of diabetes due to insulin resistance, (Cambridge AROC = 0.69, to Kuwaiti AROC = 0.81).

Conclusions

At a prevalence of 43%, β-cell-failure accounted for nearly half of the cases of diabetes. All six diabetes risk scores failed to detect previously undiagnosed diabetes due to β-cell-failure while effectively identifying diabetes when the etiology was insulin resistance. Diabetes risk scores which correctly classify diabetes due to β-cell-failure are urgently needed.

Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis

BACKGROUND

There is an increased burden of diabetes globally including in sub-Saharan Africa. The literature shows that glycaemic control among type 2 diabetes patients is poor in most countries in sub-Saharan Africa. Understanding the factors influencing glycaemic control in this region is therefore important to develop interventions to optimize glycaemic control. We carried out a systematic review to determine the prevalence and factors associated with glycaemic control in sub-Saharan Africa to inform the development of a glycaemic control framework in the Democratic Republic of the Congo.

METHODS

We searched five databases (African Index Medicus, Africa-Wide Information, Global Health, PubMed, and Web of Science) using the following search terms: type-2 diabetes, glycaemic control, and sub-Saharan Africa. Only peer-reviewed articles from January 2012 to May 2022 were eligible for this review. Two reviewers, independently, selected articles, assessed their methodological quality using Joanna Briggs checklists, and extracted data. A meta-analysis was performed to estimate the prevalence of glycaemic control. Factors associated with glycaemic control were presented as a narrative synthesis due to heterogeneity as assessed by the I2.

RESULTS

A total of 74 studies, involving 21,133 participants were included in the review. The pooled prevalence of good glycaemic control was 30% (95% CI:27.6-32.9). The glycaemic control prevalence ranged from 10-60%. Younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family history of diabetes, longer duration of diabetes, pill burden, treatment regimen, side effects, use of statins or antihypertensives, alcohol consumption, smoking, presence of comorbidities/complications, and poor management were associated with poor glycaemic control. On the other hand, positive perceived family support, adequate coping strategies, high diabetes health literacy, dietary adherence, exercise practice, attendance to follow-up, and medication adherence were associated with good glycaemic control.

CONCLUSION

Suboptimal glycaemic control is pervasive among patients with type-2 diabetes in sub-Saharan Africa and poses a significant public health challenge. While urgent interventions are required to optimize glycaemic control in this region, these should consider sociodemographic, lifestyle, clinical, and treatment-related factors. This systematic review and meta-analysis protocol is registered in PROSPERO under CRD 42021237941.

Glycated haemoglobin and fasting plasma glucose tests in the screening of outpatients for diabetes and abnormal glucose regulation in Uganda: A diagnostic accuracy study

BACKGROUND AND OBJECTIVES

To understand the utility of glycated haemoglobin (HBA1C) in screening for diabetes and Abnormal Glucose Regulation (AGR) in primary care, we compared its performance to that of the fasting plasma glucose (FPG) test.

METHODS

This was a prospective diagnostic accuracy study conducted in eastern Uganda. Patients eligible for inclusion were consecutive adults, 30-75 years, receiving care at the outpatient department of a general hospital in eastern Uganda. We determined the sensitivity, specificity and optimum cut-off points for HBA1C and FPG tests using the oral glucose tolerance test (OGTT) as a clinical reference standard.

RESULTS

A total of 1659 participants underwent FPG testing of whom 310 were also HBA1C and OGTT tested. A total of 113 tested positive for diabetes and 168 for AGR on the OGTT. At recommended cut-off points for diabetes, the HBA1C and FPG tests had comparable sensitivity [69.8% (95% CI 46.3-86.1) versus 62.6% (95% CI 41.5-79.8), respectively] and specificity [98.6% (95% CI 95.4-99.6) versus 99.4% (95% CI 98.9-99.7), respectively]. Similarly, the sensitivity of HBA1C and the FPG tests for Abnormal Glucose Regulation (AGR) at ADA cut-offs were comparable [58.9% (95% CI 46.7-70.2) vs 47.7% (95% CI 37.3-58.4), respectively]; however, the HBA1C test had lower specificity [70.7% (95% CI 65.1-75.8)] than the FPG test [93.5% (95% CI 88.6-96.4)]. At the optimum cut-offs points for diabetes [45.0 mmol/mol (6.3%) for HBA1C and 6.4 mmol/L (115.2 mg/dl) for FPG], HBA1C and FPG sensitivity [71.2% (95% CI 46.9-87.8) versus 72.7% (95% CI 49.5-87.8), respectively] and specificity [95.1% (95% CI91.8 97.2) versus 98.7% (95% CI 98.0 99.2), respectively] were comparable. Similarly, at the optimum cut-off points for AGR [42.0 mmol/mol (6.0%) for the HBA1C and 5.5 mmol/l (99.0 mg/dl) for the FPG test], HBA1C and FPG sensitivity [42.3% (95% CI 31.8-53.6) and 53.2 (95% CI 43.1-63.1), respectively] and specificity [89.1% (95% CI 84.1 92.7) and 92.7% (95% CI 91.0 94.1), respectively] were comparable.

DISCUSSION

HBA1C is a viable alternative diabetes screening and confirmatory test to the FPG test; however, the utility of both tests in screening for prediabetes in this outpatient population is limited.

Prevalence of chronic non-communicable diseases in Ethiopia: A systematic review and meta-analysis of evidence

Background

Non-communicable diseases (NCDs) are a growing global health challenge disproportionately impacting low- and middle-income settings, including Ethiopia. Currently, the body of evidence describing the burden of NCDs is fragmented, inconsistent, health facility- or institution-based, and out-dated in Ethiopia. We conducted a systematic review of the literature and meta-analysis of the prevalence of NCDs in community settings in Ethiopia.

Review methodology

Community-based quantitative studies published in English between January 1st, 2012, and June 30th, 2022, that reported on the prevalence of NCDs in Ethiopia were included. A systematic search of Medline, Embase, Scopus, CINAHL, and Global Health using pretested search terms related to NCDs was conducted, and data were extracted using a piloted data extraction proforma adapted from the Joanna Briggs Institute tool. Meta-analysis was performed using Stata 16. While the pooled prevalence of Diabetes Mellitus (DM) and undiagnosed (DM) was computed and presented using forest plots, then overall prevalence of NCDs and other various types of NCDs were narratively synthesized. I2 was used to assess heterogeneity. Studies that did not fulfill the criteria (used similar tool to measure the types of NCDs) for meta-analysis were narratively synthesized.

Results

Twenty-two studies met the inclusion criteria. Five studies measured the prevalence of NCDs (all NCDs together), ranging from 29 to 35% (prevalence estimates not pooled). The pooled prevalence of Diabetes Mellitus (DM) across ten studies was 5% (95% CI: 4–7%). Three studies each reported on the prevalence of undiagnosed DM (pooled prevalence 5%, 95% CI: 4–7%) and pre-DM (pooled prevalence 7%, 95% CI: 3–14%%). In a narrative analysis the prevalence of cardiovascular conditions ranged from 13.4 to 32.2% (n = 3 studies), cancer mortality ranged from 4 to 18% (n = 3 studies) and respiratory conditions ranged from 1 to 18% (n = 3 studies). Some studies have determined more than one NCDs and that is why the total number of studies are exceeding more than twenty studies.

Conclusion and recommendations

Our analysis found that approximately one-third of Ethiopians have an NCD, with cardiovascular diseases the most common of all NCDs. The prevalence of respiratory conditions also appears high, but there are insufficient data for a pooled estimate. Whilst the prevalence of DM appears relatively low, there is evidence that the magnitude is increasing. Public health actions to address the high burden of cardiovascular and respiratory diseases, as well as the increasing magnitude of DM in Ethiopia, must be prioritized.

Systematic review registration

PROSPERO [CRD42020196815].

Bayesian Spatial Modeling of Diabetes and Hypertension: Results from the South Africa General Household Survey

Determining spatial links between disease risk and socio-demographic characteristics is vital in disease management and policymaking. However, data are subject to complexities caused by heterogeneity across host classes and space epidemic processes. This study aims to implement a spatially varying coefficient (SVC) model to account for non-stationarity in the effect of covariates. Using the South Africa general household survey, we study the provincial variation of people living with diabetes and hypertension risk through the SVC model. The people living with diabetes and hypertension risk are modeled using a logistic model that includes spatially unstructured and spatially structured random effects. Spatial smoothness priors for the spatially structured component are employed in modeling, namely, a Gaussian Markov random field (GMRF), a second-order random walk (RW2), and a conditional autoregressive (CAR) model. The SVC model is used to relax the stationarity assumption in which non-linear effects of age are captured through the RW2 and allow the mean effect to vary spatially using a CAR model. Results highlight a non-linear relationship between age and people living with diabetes and hypertension. The SVC models outperform the stationary models. The results suggest significant provincial differences, and the maps provided can guide policymakers in carefully exploiting the available resources for more cost-effective interventions.

Combining HbA1c and glycated albumin improves detection of dysglycaemia in mixed-ancestry South Africans

BACKGROUND

Combining HbA_1c with glycated albumin (GA) may improve detection of dysglycaemia. As BMI correlates positively with HbA_1c and negatively with GA, HbA_1c may be more effective in obese and GA in nonobese individuals.

METHODS

To relate these findings to Africans, we assessed in 1274 South Africans living in CapeTown (male 26%; age 48±16y; BMI 28.7 kg/m² (range 15.6-73.8); obesity 39.9% and no prior diabetes history) the: (1) correlation of BMI with HbA_1c and GA, (2) ability of HbA_1c and GA separately and jointly, to detect OGTT-diagnosed dysglycaemia (diabetes plus prediabetes). Data collection took place between 2014 and 2016 in the City of Cape Town. Dysglycaemia was diagnosed by glucose criteria for the OGTT. Youden index was used to optimize diagnostic thresholds for HbA_1c and GA.

FINDINGS

Normal glucose tolerance, prediabetes and diabetes occurred in 76%, 17% and 7%, respectively. BMI positively correlated with HbA_1c [r = 0·34 [95%CI: 0·29,0·39)] and negatively with GA [-0·08 (0·13,0·03)]. For HbA_1c the optimal threshold by Youden-index for dysglycaemia diagnosis was: 6·0% (95%CI: 5·8,6·2) and for GA: 13·44% (12·72,14·71). In the nonobese, obese and total cohort, HbA_1c-alone detected: 51% (42-60), 72% (65,78), 63% (57,68), respectively; GA-alone detected 55% (52% (46,63), 52% (44, 59) and 53% (47,53), respectively; whereas: HbA_1c+GA detected: 69% (60,76), 82% (75,87) and 76% (71, 81). Therefore, for the total cohort detection of dysglycaemia HbA_1c-alone vs HbA_1c+GA detected 63% (57,68) vs 76% (71,81).

INTERPRETATION

The opposite correlations of HbA_1c and GA with BMI have now been demonstrated in an African-based population. Improving detection of dysglycaemia by combining HbA_1c and GA has important implications for diabetes risk screening.

FUNDING

AES is supported by the intramural programs of the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Minority Health and Health Disparities of the National Institutes of Health (NIH, Bethesda, Maryland, USA). DBS is supported by the intramural program of the Clinical Center of NIH. The South African Medical Research Council (SAMRC) funded the VMH study with funds from the National Treasury under its Economic Competitiveness and Support Package (MRC-RFA-UFSP-01-2013/VMH Study).

Undiagnosed Diabetes Mellitus and Its Predictors Among Socially Marginalized Menja Communities in Southwest Ethiopia

Background

Diabetes mellitus (DM) is a metabolic disorder marked by a persistently high blood glucose level over a prolonged period of time linked to either defects in insulin secretion, insulin action, or both. It is responsible for 537 million adult cases and 6.7 million deaths in 2021. However, about half of the people with diabetes go undiagnosed. Low-income and socially disadvantaged communities are the most vulnerable to the disease. Despite this fact, nothing has been done among these communities, so this study aimed to assess the extent of undiagnosed diabetes and its predictors among the socially marginalized Menja communities of Southwest Ethiopia, 2021.

Methods

A community-based cross-sectional study was done in the Menja communities from April 21/2021 to June 30/2021. The required sample size was calculated using the single population proportion formula and systematic sampling techniques were employed to select the households. Data were collected through face-to-face interviews utilizing an interviewer-administered questionnaire to collect socio-demographic and behavioral characteristics, and anthropometric measurements were taken from each participant. Diabetes was defined as participants who had an FBG ≥ 126 mg/dL or RBG > 200 mg/dL. The multivariate logistic regression model was used to identify the predictors of diabetes; adjusted OR with a 95% CI was computed to assess the strength of associations.

Results

The prevalence of undiagnosed DM among the socially marginalized Menja communities was 14.7% [95% CI: (11.1-18.3)], and sex-specific prevalence was 16.8%, and 11.1% for men and women respectively. Factors like alcohol consumption (AOR = 3.0, 95% CI 1.49 to 6.05), family history of DM 4.4 (AOR = 4.37, 95% CI 2.04 to 9.35), lower vegetable consumption 3.5 (1.19-10.31) (AOR = 3.5, 95% CI 1.19 to 10.31), and less physical exercise 3.3 (AOR = 3.34, 95% CI 1.61 to 6.90) were the independent predictors that increase the risk of diabetes among Menja communities.

Conclusion and Recommendations

Undiagnosed diabetes was high as compared to other settings. Alcohol use, family history of diabetes, vegetable consumption, and physical exercise were predictors of diabetes. Hence, the study suggests frequent screening and treatment for high-risk groups. Minimizing alcohol drinking, frequent vegetable consumption, and physical exercises were recommended measures for the prevention and control of DM among the population of Ethiopia.

Randomised controlled trials on prevention, diagnosis and treatment of diabetes in African countries: a systematic review

OBJECTIVES

The epidemiological transition from infectious to chronic diseases leads to novel challenges in African health systems. The prevalence of diabetes mellitus (DM) is increasing dramatically. Undiagnosed and undertreated DM leads to numerous complications including end-organ damage and death. Our objectives were to collect the best locally generated evidence on DM interventions, identify knowledge gaps and determine underexplored research areas.

DESIGN

A systematic review and meta-analysis of randomised controlled trials.

PARTICIPANTS AND SETTING

African patients in primary, secondary and tertiary prevention, diagnosis and treatment DM type 1 (DM1), type 2 (DM2) and gestational DM (GDM).

OUTCOME

All-cause mortality, glycaemic control, complications, quality of life, hospital admission, treatment adherence and costs.

DATA SOURCES

Articles published in MEDLINE Ovid, CENTRAL, CINAHL, African Journals Online and African Index Medicus and the International Clinical Trials Registry Platform in English language without time restrictions. The systematic search was last updated in October 2020.

RESULTS

Out of 3736 identified publications, we included 60 eligible studies conducted in 15 countries, 75% were conducted in urban healthcare settings, including 10 112 participants. We included 8 studies on DM1, 6 on GDM, 2 on pre-DM, 37 on mainly DM2 including 7 on DM-related complications. The design of the studied intervention was heterogeneous with a focus on educational strategies. The other studies investigated the efficacy of nutritional strategies including food supplementations, pharmacological strategies and strategies to enhance physical activity. Seven studies included interventions on DM-related complications.

CONCLUSIONS

Research activities increased in recent years, but available evidence is still not representative for all African countries. There is a big lack of evidence in primary healthcare and rural settings, implementation research, pharmacological interventions, especially in poorer countries. Nevertheless, the identified studies offer a variety of effective interventions that can inform medical care and future research.

PROSPERO REGISTRATION NUMBER

CRD42019122785.

Prevalence of diabetes mellitus and associated risk factors in Nepal: findings from a nationwide population-based survey

OBJECTIVES

The burden of diabetes mellitus (DM) has increased globally, particularly in low-income and middle-income countries, including Nepal. Population-based nationally representative data on the prevalence of DM is limited. This paper presents the prevalence of DM and its associated risk factors in Nepal.

RESEARCH DESIGNS AND METHODS

This population-based study sampled 13 200 participants aged 20 years and above in 400 clusters of 72 districts of Nepal. The study used a standardised questionnaire adapted from the WHO STEPwise approach to non-communicable disease risk factor surveillance instrument and digitalised in Android-compatible mobile phones. Fasting and 2 hours postprandial blood samples were taken to test various biochemical parameters. Descriptive followed by multivariate analyses were done to assess the association between explanatory variables and the outcome variable.

PRIMARY OUTCOME MEASURES

Prevalence of DM.

RESULTS

The prevalence of DM was found to be 8.5% (95% CI 7.8% to 9.3%). The odds of DM occurrence were higher in the upper age groups (40-59 years at adjusted OR (AOR) 3.1 (95% CI2.3 to 4.2) and 60+ years at AOR 4.7 (95% CI 3.3 to 6.6)), compared with the group aged 20-39 years. Men were found to have higher odds of DM (AOR 1.3, 95% CI 1.1 to 1.6) compared with women. Urban residents had almost twice higher odds of DM (AOR 1.7, 95% CI 1.4 to 2.2) compared with rural residents. Participants with raised blood pressure (BP) (AOR 2.2, 95% CI 1.8 to 2.7), those who were overweight and obese (AOR 2.0, 95% CI 1.6 to 2.4) and those who had high triglycride level (≥150 mg/dL) (AOR 2.1, 95% CI 1.8 to 2.6) also had twice higher odds of DM compared with those with normal BP, an average body mass index and normal triglyceride level, respectively.

CONCLUSIONS

Targeted interventions to higher risk groups as well as prevention and control of other associated biological risk factors might help to reduce the prevalence of DM in Nepal.

High rates of undiagnosed diabetes mellitus among patients with active tuberculosis in Addis Ababa, Ethiopia

Background

Tuberculosis (TB) and diabetes mellitus (DM) have negative synergistic impact on each other. Global guidelines recommend collaborative efforts to address this synergy, but implementation has been slow. Part of the reason is lack of adequate evidence on the operational feasibility of existing tools and mechanisms of collaboration. The objective of this study was to assess the yield of DM screening among TB patients using risk scoring tools combined with blood tests as a feasible strategy for early detection to improve TB/DM treatment outcomes.

Methods

Between September 2020 and December 2021, we conducted a cross-sectional study among patients receiving TB treatment in public health facilities in Addis Ababa, Ethiopia. Trained health workers collected data on symptoms and risk scoring checklists before testing for random and fasting blood glucose levels. We used logistic regression analyses techniques to determine factors associated with increased DM detection. A receiver-operating characteristic curve was constructed to determine the performance of the risk scoring checklist.

Results

Of 2381 TB patients screened, 197 (8.3%) had DM of which 48.7% were newly diagnosed. Having a family history of DM predicted DM with Odds Ratio (OR) of 5.36 (95% Confidence Interval, [3.67, 7.83]) followed by age ≥ 45 years (OR = 4.64, [3.18, 6.76]). Having one or more “symptoms” of DM was a significant predictor (OR 2.88, 95% CI, 2.06–4.01). Combining risk scores with symptoms predicted DM diagnosis with sensitivity of 94.7%, but specificity was low at 29.4%. In patients with known treatment outcome status, death rate was high.

Conclusions

Almost a half of TB patients with DM did not know their status. A simple tool that combined risk factors with symptoms accurately predicted a subsequent diagnosis of DM. Such tools can help avoid high rates of death among TB patients suffering from DM through early detection.

Development and validation of a machine learning-augmented algorithm for diabetes screening in community and primary care settings: A population-based study

BACKGROUND

Opportunely screening for diabetes is crucial to reduce its related morbidity, mortality, and socioeconomic burden. Machine learning (ML) has excellent capability to maximize predictive accuracy. We aim to develop ML-augmented models for diabetes screening in community and primary care settings.

METHODS

8425 participants were involved from a population-based study in Hubei, China since 2011. The dataset was split into a development set and a testing set. Seven different ML algorithms were compared to generate predictive models. Non-laboratory features were employed in the ML model for community settings, and laboratory test features were further introduced in the ML+lab models for primary care. The area under the receiver operating characteristic curve (AUC), area under the precision-recall curve (auPR), and the average detection costs per participant of these models were compared with their counterparts based on the New China Diabetes Risk Score (NCDRS) currently recommended for diabetes screening.

RESULTS

The AUC and auPR of the ML model were 0·697and 0·303 in the testing set, seemingly outperforming those of NCDRS by 10·99% and 64·67%, respectively. The average detection cost of the ML model was 12·81% lower than that of NCDRS with the same sensitivity (0·72). Moreover, the average detection cost of the ML+FPG model is the lowest among the ML+lab models and less than that of the ML model and NCDRS+FPG model.

CONCLUSION

The ML model and the ML+FPG model achieved higher predictive accuracy and lower detection costs than their counterpart based on NCDRS. Thus, the ML-augmented algorithm is potential to be employed for diabetes screening in community and primary care settings.

Role of Circulating Microparticles in Type 2 Diabetes Mellitus: Implications for Pathological Clotting

Type 2 diabetes mellitus (T2DM) is a multifactorial chronic metabolic disease characterized by chronic hyperglycemia due to insulin resistance and a deficiency in insulin secretion. The global diabetes pandemic relates primarily to T2DM, which is the most prevalent form of diabetes, accounting for over 90% of all cases. Chronic low-grade inflammation, triggered by numerous risk factors, and the chronic activation of the immune system are prominent features of T2DM. Here we highlight the role of blood cells (platelets, and red and white blood cells) and vascular endothelial cells as drivers of systemic inflammation in T2DM. In addition, we discuss the role of microparticles (MPs) in systemic inflammation and hypercoagulation. Although once seen as inert by-products of cell activation or destruction, MPs are now considered to be a disseminated storage pool of bioactive effectors of thrombosis, inflammation, and vascular function. They have been identified to circulate at elevated levels in the bloodstream of individuals with increased risk of atherothrombosis or cardiovascular disease, two significant hallmark conditions of T2DM. There is also general evidence that MPs activate blood cells, express proinflammatory and coagulant effects, interact directly with cell receptors, and transfer biological material. MPs are considered major players in the pathogenesis of many systemic inflammatory diseases and may be potentially useful biomarkers of disease activity and may not only be of prognostic value but may act as novel therapeutic targets.

Incidence and Predictors of Acute Kidney Injury Among Newly Diagnosed Type 2 Diabetes Patients at Chronic Follow-Up Clinic of University of Gondar Comprehensive Specialized Hospital: A Retrospective Follow-Up Study

Background

Acute kidney injury is a common disorder worldwide, occurring in more than 13 million per year, 85% of whom live in developing countries. The high incidence of acute kidney injury among type 2 diabetic patients is a major cause of morbidity and mortality. There is limited data that address the incidence and predictors of acute kidney injury to apply evidence-based interventions in developing countries including Ethiopia specifically in the study area.

Methods

Institution-based retrospective follow-up study was conducted among 420 adults with newly diagnosed type 2 diabetes patients from January 1, 2014, to December 31, 2019. Log rank test and Kaplan–Meier curve were used to compare different categories of survival probability. In a multivariable analysis, variable having a p-value <0.05 in the Cox, proportional hazard model was considered as independent predictors.

Results

Overall, 19.76% (95% CI; 16.2–23.8) of the study population developed acute kidney injury, with a median follow-up period of 30.75 months. Congestive heart failure [adjusted hazard ratio (AHR): 2.89 (95% CI; 1.62, 5.13)], chronic kidney disease [AHR: 2.92 (95% CI; 1.56, 5.48)], hypertension [AHR: 2.87 (95% CI; 1.20, 6.90)], and diabetic nephropathy [AHR: 2.04 (95% CI; 1.13, 3.68)] were found to be predictors of acute kidney injury.

Conclusion

The incidence of acute kidney injury among type 2 diabetes patients was high in the study area. In patients with hypertension congestive heart failure, chronic kidney disease, and diabetic nephropathy efforts should be made to diagnose AKI early and treat it – in addition to better control accordingly among type 2 diabetes mellitus patients.

The Current Situation Regarding Long-Acting Insulin Analogues Including Biosimilars Among African, Asian, European, and South American Countries; Findings and Implications for the Future

Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers. Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders. Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries. Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production. Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities.

Integration of non-communicable disease and HIV/AIDS management: a review of healthcare policies and plans in East Africa

Background

Low-income and middle-income countries are struggling to manage growing numbers of patients with chronic non-communicable diseases (NCDs), while services for patients with HIV infection are well established. There have been calls for integration of HIV and NCD services to increase efficiency and improve coverage of NCD care, although evidence of effectiveness remains unclear. In this review, we assess the extent to which National HIV and NCD policies in East Africa reflect the calls for HIV-NCD service integration.

Methods

Between April 2018 and December 2020, we searched for policies, strategies and guidelines associated with HIV and NCDs programmes in Burundi, Kenya, Rwanda, South Sudan, Tanzania and Uganda. Documents were searched manually for plans for integration of HIV and NCD services. Data were analysed qualitatively using document analysis.

Results

Thirty-one documents were screened, and 13 contained action plans for HIV and NCDs service integration. Integrated delivery of HIV and NCD care is recommended in high level health policies and treatment guidelines in four countries in the East African region; Kenya, Rwanda, Tanzania and Uganda, mostly relating to integrating NCD care into HIV programmes. The increasing burden of NCDs, as well as a move towards person-centred differentiated delivery of services for people living with HIV, is a factor in the recent adoption of integrated HIV and NCD service delivery plans. Both South Sudan and Burundi report a focus on building their healthcare infrastructure and improving coverage and quality of healthcare provision, with no reported plans for HIV and NCD care integration.

Conclusion

Despite the limited evidence of effectiveness, some East African countries have already taken steps towards HIV and NCD service integration. Close monitoring and evaluation of the integrated HIV and NCD programmes is necessary to provide insight into the associated benefits and risks, and to inform future service developments.

Warning signals of elevated prediabetes prevalence in the modern Iranian urban population

BACKGROUND

We sought to estimate the prevalence of diabetes mellitus (DM) and pre-DM and their associated factors among a sample of the Iranian urban population between 2017 and 2019.

METHODS

The present investigation is a sub-study on the HAMRAH cohort study, a longitudinal population-based cohort study to assess the 10-year risk of cardiovascular diseases and their related risk factors in the adult population of the Iranian capital, Tehran. Via a multistage cluster randomized sampling method, 2123 adults aged between 30 and 75 years who had no history of cardiovascular diseases were selected for the study. With the aid of the 2010 American Diabetes Association criteria for the definition of DM and pre-DM, age and sex-specific prevalence rates were estimated.

RESULTS

The estimated overall prevalence of DM was 14.3% (95% CI: 13.1%-15.8%): 10.4% known DM (95% CI: 9.1%-11.8%) and 4% newly diagnosed DM (95% CI: 3.1%-5.1%). Pre-DM was detected in about 29.2% of the study participants (95% CI: 22.9-36.3%). Our logistic regression analysis revealed that increasing age, higher systolic blood pressure, higher levels of triglycerides, and lower levels of high-density lipoprotein were significantly associated with DM.

CONCLUSIONS

DM and pre-DM follow a notable incremental pattern among the Iranian urban population. This finding underscores the significance of the need to improve prevention and screening strategies in the Iranian urban population.

Examining social determinants of undiagnosed diabetes in Namibia and South Africa using a behavioral model of health services use

AIMS

To examine factors associated with undiagnosed diabetes in Namibia and South Africa.

METHODS

This study used the most recent Demographic and Health Surveys (DHS) from Namibia (2013) and South Africa (2016). This study focused on adults at 35-64 years old. Using Andersen's Behavioral Model, potential contributing factors were categorized into predisposing factors (sex and education), enabling factors (wealth, health insurance, and residence), and a need factor (age, BMI, and high blood pressure). Separate multivariable logistic regression models were used to examine factors associated with undiagnosed diabetes in Namibia (N = 242) and South Africa (N = 525).

RESULTS

In Namibia, higher odds of having undiagnosed diabetes were associated with rural residence (adjusted odds ratio (aOR) = 2.21) and age younger than 45 years old (aOR = 3.20). In South Africa, odds of having undiagnosed diabetes were higher among the poorest-to-poorer group than it was in the richer-to-richest group (aOR = 2.33). In both countries, having high blood pressure was associated with lower odds of having undiagnosed diabetes (aOR = 0.31 in Namibia; aOR = 0.21 in South Africa).

DISCUSSION

Different enabling and need factors were associated with undiagnosed diabetes in these two countries, which implies potentially-different mechanisms driving the high prevalence of undiagnosed diabetes, as well as the needs for different solutions.

HIV sero-positivity and risk factors for ischaemic and haemorrhagic stroke in hospitalised patients in Uganda: A prospective-case-control study

Objectives

We examined HIV sero-positivity and risk factors in patients admitted with ischaemic stroke (IS) and haemorrhagic stroke (HS) in Kampala, Uganda.

Study design

We conducted a matched case-control study between December 2016 and December 2018 ​at ​St Francis Hospital, Nsambya.

Methods

The study population comprised of stroke cases (adults aged ≥18 years with IS or HS confirmed by neuroimaging) and controls (age- and sex-matched stroke-free adults aged ≥18 years who were recruited from the same hospital as the cases). A comprehensive assessment for sociodemographic, lifestyle and clinical factors was performed using the World Health Organization (WHO) STEP-wise approach to Surveillance (STEPS) for stroke risk factor surveillance. We used conditional logistic regression to identify risk factors associated with IS or HS.

Results

We enrolled 137 matched case-control pairs; 48 (35%) were men, and the mean ages were 62.4 years (SD ​± ​14.8) for cases and 61.1 years (SD ​± ​14.1) for controls. Of stroke patients, 86 (63%) had IS and 51 (37%) had HS. Overall, HIV sero-positivity was 10% among stroke cases versus 7% among controls. HIV sero-positivity was not significantly associated with stroke (unadjusted odds ratio [uOR] ​= ​1.49, 95% confidence interval [CI] 0.59-3.78). A self-reported family history of diabetes mellitus was associated with an increased risk of all stroke (adjusted odds ratio [aOR] ​= ​4.41, 95% CI 1.47-13.2), as well as for IS and HS separately (aOR ​= ​3.66, 95% CI 1.09-12.4 and aOR ​= ​4.99, 95% CI 1.02-24.4, respectively). High blood pressure (≥140/90 ​mmHg) was associated with an increased risk of all stroke (aOR ​= ​12.3, 95% CI 42-44.1), and this was also true for IS and HS individually (aOR ​= ​6.48, 95% CI 1.15-36.7 and aOR ​= ​5.63, 95% CI 1.74-18.2, respectively).

Conclusions

No association was found between HIV sero-positivity and stroke occurrence among Ugandan stroke patients. Hypertension and a self-reported family history of diabetes mellitus were significant risk factors for both IS and HS. Interventions to reduce hypertension and diabetes mellitus in the Ugandan population are urgently required. Much larger studies are required to demonstrate if any association exists between HIV and stroke.

Understanding the diagnostic delays and pathways for diabetes in eastern Uganda: A qualitative study

BACKGROUND

Type 2 diabetes is rapidly becoming a significant challenge in Uganda and other low and middle-income countries. A large proportion of the population remains undiagnosed. To understand diagnostic delay, we explored the diagnostic pathways for diabetes among patients receiving care at a semi-urban district hospital in eastern Uganda.

METHODS

Eligible participants were patients aged 35-70 years receiving care at the diabetes clinic of Iganga district hospital between April and May 2019 and their healthcare providers. Patients were interviewed using an interview guide to collect information on patients' symptoms and their diagnostic experience. A separate interview guide was used to understand the organisation of the diabetes services and the diabetes diagnostic process at the hospital. Using maximum variation purposive sampling, we selected 17 diabetes patients aged 35-68 years, diagnosed within the previous three years, and the three health workers managing the diabetes clinic at Iganga hospital. The data was analysed using ATLAS.ti version 8 to code, organise and track the data segments. We conducted template analysis using a priori themes derived from the intervals of Walter's model of Pathways to Treatment to identify the factors influencing diagnostic delay.

RESULTS

We identified four typologies: a short diagnostic pathway, protracted appraisal pathway, protracted appraisal and diagnostic interval pathway, and delayed treatment pathway. The pathways of patients with protracted appraisal or diagnostic intervals demonstrated strong socio-cultural influences. There was a firm reliance on traditional healers both before and after diagnosis which deferred enrolment into care. Other health system barriers implicated in delayed diagnosis included stock-out of diagnostic supplies, misdiagnosis, and missed diagnosis. Denial of diagnosis was also found to lead to delayed initiation of care.

CONCLUSION

Reducing diagnostic delay requires addressing both negative socio-cultural influences and the adoption of system-wide interventions to address barriers to timely diagnosis.

Prevalence of Prediabetes and Undiagnosed Diabetes Among Kuwaiti Adults: A Cross-Sectional Study

PURPOSE

This study aimed to estimate the prevalence of prediabetes and undiagnosed type 2 diabetes mellitus (T2DM) according to fasting plasma glucose (FPG), 2-h plasma glucose (PG) during oral glucose tolerance test (OGTT), and glycated hemoglobin (HbA1c) among a sample of Kuwaiti adults. In addition, associations of prediabetes and undiagnosed T2DM with sex, age, and body mass index (BMI) were assessed.

METHODS

A cross-sectional study enrolled 1238 subjects aged 18-65 years who reported no prior history of DM. After overnight fasting, FPG and HbA1c were measured in the total study sample, and 2-h PG during a 75-g OGTT was measured in a subsample of 155 subjects. Prediabetes and undiagnosed T2DM were defined according to the American Diabetes Association criteria. Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated.

RESULTS

We enrolled a total of 618 males and 620 females, with an average age of 43.0 years. The prevalence of prediabetes was estimated to be 47.9% (588/1228) by FPG, 36.8% (57/155) by 2-h PG OGTT, and 31.0% (355/1144) by HbA1c. The prevalence of undiagnosed T2DM was 6.9% (85/1228) by FPG, 11.0% (17/155) by 2-h PG OGTT, and 4.9% (56/1144) by HbA1c. Sex-related differences in the prevalence of prediabetes and undiagnosed T2DM were observed. Prediabetes and undiagnosed T2DM prevalence estimates showed increasing trends as age and BMI increased. For instance, obese subjects compared to under/normal weight subjects had an increased HbA1c-defined prediabetes prevalence (aPR = 1.62, 95% CI: 1.21-2.16).

CONCLUSION

Prediabetes and undiagnosed T2DM affect a considerable proportion of Kuwaiti adults, and variations across sex, age, and BMI exist. Hence, early identification and management of affected individuals may help reduce the public health burden.

A systematic analysis on prevalence and sub-regional distribution of undiagnosed diabetes mellitus among adults in African countries

BACKGROUND

Despite the high prevalence of diabetes in Africa, the extent of undiagnosed diabetes in the region is still poorly understood. This systematic review and meta-analysis was designed to determine the pooled prevalence of undiagnosed diabetes mellitus among adults in Africa.

METHODS

We conducted a systematic desk review and electronic web-based search of PubMed, Google Scholar, EMBASE, and the World Health Organization's Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases), identifying peer-reviewed research studies on the prevalence of undiagnosed diabetes among adult individuals using pre-defined quality and inclusion criteria. We ran our search from June 1, 2018 to Jun 14, 2020. We extracted relevant data and presented descriptive summaries of the studies in tabular form. The I² test was used to assess heterogeneity across studies. A random effects model was used to estimate the pooled prevalence of undiagnosed diabetes mellitus at a 95% confidence interval (CI). Funnel plot asymmetry and Egger's tests were used to check for publication bias. The final effect size was determined by applying a trim and fill analysis in a random-effects model.

RESULTS

Our search identified 1442 studies amongst which 23 articles were eligible for inclusion in the final meta-analysis. The average pooled prevalence of undiagnosed diabetes mellitus among adults was 3.85 (95% CI: 3.10-4.60). The pooled prevalence of undiagnosed diabetes mellitus based on geographic location was 4.43 (95% CI: 3.12-5.74) in Eastern Africa; 4.72 (95% CI: 2.64-6.80) in Western Africa; 4.27 (95% CI: 1.77-6.76) in Northern Africa and 1.46 (95%CI: 0.57-2.34) in southern Africa respectively.

CONCLUSION

Our findings indicate a high prevalence of undiagnosed diabetes in Africa and suggest that it may be more prevalent in Western Africa than the rest of the regions. Given the high levels of undiagnosed diabetes in the Africa region, more attention should be paid to incorporating diabetes screening and treatment services into existing diabetes related programs to reduce the prevalence of undiagnosed cases.

Prevalent, uncontrolled, and undiagnosed diabetes mellitus among urban adults in Dire Dawa, Eastern Ethiopia: A population-based cross-sectional study

OBJECTIVE

Globally, 8.8% of adults were estimated to have diabetes mellitus, with the low-and middle-income countries sharing the largest burden. However, the research evidence for targeted interventions is lacking in sub-Saharan Africa, particularly in Ethiopia. Therefore, this study aimed to assess the prevalence of diabetes mellitus, disaggregated by the epidemiology of diabetes mellitus morbidity and associated factors among adults in Dire Dawa town, Eastern Ethiopia.

METHODS

Data from a total of 872 randomly sampled adults aged 25-64 years were obtained for analysis using the World Health Organization STEPwise approach to non-communicable disease risk factors surveillance instruments. We estimated the prevalence of diabetes mellitus disaggregated by the previous diabetes mellitus diagnosis status and by the current blood sugar level control status. The bivariable and multivariable binary logistic regression model was used to identify correlates of diabetes mellitus, along with STATA version 14.2 for data management and analysis. All statistical tests were declared significant at p-value < 0.05.

RESULTS

14.9% (95% confidence interval: 12.1, 17.4) of adults aged 25-64 years had diabetes mellitus in the study sample with 58.5% (95% confidence interval: 49.7, 66.7) on diabetes mellitus medication. Among adults currently taking diabetes mellitus medications, 30.3% (95% confidence interval: 19.8, 45.6) had uncontrolled diabetes mellitus. The magnitude of previously undiagnosed diabetes mellitus was 6.2% (95% confidence interval: 4.8, 8.0) in the study sample and 41.5% (95% confidence interval: 33.3, 50.3) among the diabetics. The odds of diabetes mellitus were higher among adults over the age of 55 years (adjusted odds ratio = 2.1, 95% confidence interval: 1.2, 3.6), currently married adults (adjusted odds ratio = 2.3, 95% confidence interval: 1.2, 4.4), and overweight adults (adjusted odds ratio = 1.6, 95% confidence interval: 1.1, 2.1). Adults with primary education (adjusted odds ratio = 0.4, 95% confidence interval: 0.2, 0.8) and no formal education (adjusted odds ratio = 0.5, 95% confidence interval: 0.2, 0.9) had lower odds of diabetes mellitus.

CONCLUSION

The prevalence of diabetes mellitus among adults was high in Dire Dawa, with a third of the diabetics having poor control of their blood sugar levels and, nearly four in ten were previously undiagnosed. Adults who were overweight, currently married, and those over 55 years need to be targeted for regular diabetes health checkups and community-based screening. Also, a mechanism should be instituted to track a patient's adherence to medications and promote diabetes self-care management.

Identifying Africans with undiagnosed diabetes: Fasting plasma glucose is similar to the hemoglobin A1C updated Atherosclerosis Risk in Communities diabetes prediction equation

AIMS

Seventy percent of Africans living with diabetes are undiagnosed. Identifying who should be referred for testing is critical. Therefore we evaluated the ability of the Atherosclerosis Risk in Communities (ARIC) diabetes prediction equation with A1C added (ARIC + A1C) to identify diabetes in 451 African-born blacks living in America (66% male; age 38 ± 10y (mean ± SD); BMI 27.5 ± 4.4 kg/m²).

METHODS

All participants denied a history of diabetes. OGTTs were performed. Diabetes diagnosis required 2-h glucose ≥200 mg/dL. The five non-invasive (Age, parent history of diabetes, waist circumference, height, systolic blood pressure) and four invasive variables (Fasting glucose (FPG), A1C, triglycerides (TG), HDL) were obtained. Four models were tested: Model-1: Full ARIC + A1C equation; Model-2: All five non-invasive variables with one invasive variable excluded at a time; Model-3: All five non-invasive variables with one invasive variable included at a time; Model-4: Each invasive variable singly. Area under the receiver operator characteristic curve (AROC) predicted diabetes. Youden Index identified optimal cut-points.

RESULTS

Diabetes occurred in 7% (30/451). Model-1, the full ARIC + A1C equation, AROC = 0.83. Model-2: With FPG excluded, AROC = 0.77 (P = 0.038), but when A1C, HDL or TG were excluded AROC remained unchanged. Model-3 with all non-invasive variables and FPG alone, AROC=0.87; but with A1C, TG or HDL included AROC declined to ≤0.76. Model-4: FPG as a single predictor, AROC = 0.87. A1C, TG, or HDL as single predictors all had AROC ≤ 0.74. Optimal cut-point for FPG was 100 mg/dL.

CONCLUSIONS

To detect diabetes, FPG performed as well as the nine-variable updated ARIC + A1C equation.

Burden of Undiagnosed Type 2 Diabetes in Diabetic Kidney Disease: A Japanese Retrospective Cohort Study

The risk of developing diabetic kidney disease (DKD) in patients with undiagnosed diabetes mellitus (UD) has never been evaluated. We studied the burden of UD on the risk of developing DKD in the Japanese population in a single-center retrospective cohort study. The patients with type 2 diabetes mellitus, but without DKD (estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² or proteinuria), were recruited from January 2018 to January 2019; medical records were scrutinized retrospectively from January 2003 until May 2019. The individuals, with diabetes that could not be denied based on past and current records, comprised the undiagnosed diabetes (UD) group whereas those with confirmed diagnosis comprised the diagnosed diabetes (DD) group. The group differences were tested using a Kaplan–Meier curve and Cox proportional hazards model. Among the 408 participants, 164 (40.2%) and 244 (59.8%) comprised the DD and UD groups, respectively. The baseline parameters, including age, male gender, and BMI were comparable between the groups, but the plasma glucose, HbA1c levels, and diabetic retinopathy prevalence were higher in the UD group. The risk of developing DKD (log rank test, p < 0.001), an eGFR of < 60 mL/min/1.73 m² (p = 0.001) and proteinuria (p = 0.007) were also higher in the UD group. The unadjusted and adjusted hazard ratios for DKD were 1.760 ((95% CI: 1.323–2.341), p < 0.001) and 1.566 ((95% CI: 1.159–2.115), p = 0.003), respectively, for the UD group. In conclusion, this is the first report showing that UD is a strong risk factor for DKD. The notion that a longer duration of untreated diabetes mellitus is involved strongly in the risk of developing DKD warrants the need for the identification and monitoring of UD patients.

Plasma Adipsin as a Biomarker and Its Implication in Type 2 Diabetes Mellitus

Diabetes mellitus (DM) is a worldwide health threat affecting millions of people, which is associated with different micro- and macro-vascular complications. Type 2 diabetes mellitus (T2DM) is one of the different types of DM caused by insulin resistance and/or reduced secretion of insulin from the pancreas. A validated novel biomarker is required to enhance the accuracy of disease prediction, provide novel insights into pathophysiology and contribute to future prevention of T2DM. Various newer diagnostic methods have been developed by targeting endogenous proteins among which Adipsin is one of the promising target. Therefore, this review discusses Adipsin as a potential biomarker and its implication in T2DM. Adipsin is one of the adipokines secreted by adipose tissues which is involved in maintaining adipose tissue homeostasis and increasing insulin secretion in response to glucose. According to different experimental and clinical studies, plasma Adipsin concentrations are low in animals and patients with DM which support its use as a biomarker in combination to the other diagnostic modalities for DM. Additionally, the existence of Adipsin could be important in improving hyperglycemia by preserving β-cell mass through improving β-cell survival and maintaining their transcriptional identity.

Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

Background

There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention.

Objective

Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases.

Our Approach

Contextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance.

Ongoing Activities

A number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities.

Conclusion

There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care.

Prevalence and Associated Factors of Diabetes Mellitus in Hosanna Town, Southern Ethiopia

Background/Objectives

Diabetes is a global public health problem, and its burden is rising, particularly in developing countries. However, limited data is available from sub-Sahara African communities to assess and monitor the disease burden. The study aimed to determine the prevalence and associated factors of diabetes in Hosanna, Ethiopia.

Methods

A community-based cross-sectional study was conducted among 634 randomly selected adults in Hosanna. The study participants were recruited by multi-stage stratified sampling. A face-to-face interview using a structured questionnaire was administered by trained nurses. Anthropometry, blood pressure and fasting blood glucose levels were measured. Diabetes mellitus was considered when the fasting blood glucose level was ≥126 mg/dl on two separate measurements or when the participant self-reported a previous diagnosis of diabetes by healthcare providers or when the participant was currently receiving treatment for diabetes. Multi-variable binary logistic regression was used to identify factors associated with diabetes mellitus.

Findings

The overall prevalence of diabetes was found to be 5.7% (95% CI; 4.0-7.7), out of which more than one third (36%) were not aware of it prior to the survey. Nearly two thirds (61.1%) of the diabetic participants were also found to be hypertensive. In the multi-variable analysis, diabetes was associated with current alcohol use, sitting on average of more than 8 hours/day, abnormal BMI and being hypertensive.

Conclusion

The prevalence of diabetes among the adult population in the town is alarming. If appropriate measures to address the burden are not emplaced, it might result in serious complications to the patients and unnecessarily high costs to the health system of the country. Active screening for raised blood glucose level should be given due consideration, particularly in the community setting. Designing health education programs on the importance of physical activity and the risks of alcohol use should also be considered.

Prevalence of undiagnosed diabetes mellitus and associated factors among adult residents of Bahir Dar city, northwest Ethiopia: a community-based cross-sectional study

OBJECTIVE

To assess the prevalence of undiagnosed diabetes mellitus (DM) and associated factors among adult inhabitants of Bahir Dar city, northwest Ethiopia.

DESIGN

A community-based cross-sectional study was conducted on adults (n=607) of Bahir Dar city from 10 March to 20 May 2018.

MEASUREMENTS

Data were collected using structured interviewer-administered questionnaire, and anthropometric measurements were taken from each participant. Fasting blood sugar (FBS) level was determined by samples taken early in the morning and readings of FBS≥126 mg/dL were classified as diabetes. The multivariate logistic regression model was fitted to identify the predictors of undiagnosed DM; adjusted OR (AOR) with a 95% CI was computed to assess the strength of associations.

RESULT

The study revealed that the prevalence of undiagnosed DM was 10.2% with 95% CI 7.9 to 12.9. Ever checked blood glucose level (AOR=1.91, 95% CI 1.03 to 3.51), don't know the symptoms of diabetes (AOR=2.06, 95% CI 1.08 to 3.89), family history of DM (AOR=2.5, 95% CI 1.21 to 5.18) and body mass index (BMI) ≥25 kg/m² (AOR=1.98, 95% CI 1.09 to 3.60) were factors associated with undiagnosed DM.

CONCLUSION

The magnitude of undiagnosed diabetes was high. Family history of DM, ever checked blood glucose level, don't know about the symptoms of diabetes and overweight BMI were predictors of undiagnosed DM. Hence, screening and treatment are mandatory for high-risk groups. In addition, this study suggests frequent screening for those with family history and awareness creating about the disease for early detection and treatment.