Maternal Education Level Among People with Diabetes and Associated Adverse Outcomes

OBJECTIVE

 The aim of the study is to determine the relation between education and adverse outcomes in individuals with pregestational or gestational diabetes.

STUDY DESIGN

 This population-based cohort study, using the U.S. vital statistics datasets, evaluated individuals with pregestational or gestational diabetes who delivered between 2016 and 2019. The primary outcome was composite neonatal adverse outcome including any of the following: large for gestational age (LGA), Apgar's score 6 hours, neonatal seizure, or neonatal death. The secondary outcome was composite maternal adverse outcomes including any of the following: admission to intensive care unit, transfusion, uterine rupture, or unplanned hysterectomy. Multivariable analysis was used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CIs).

RESULTS

 Of 15,390,962 live births in the United States, 858,934 (5.6%) were eligible for this analysis. Compared with individuals with a college education and above, the risk of composite neonatal adverse outcome was higher in individuals with some college (aRR = 1.08, 95% CI = 1.07-1.09), high school (aRR = 1.06, 95% CI = 1.04-1.07), and less than high school (aRR = 1.05, 95% CI = 1.03-1.07) education. The components of composite neonatal adverse outcome that differed significantly between the groups were LGA, Apgar's score 6 hours. Infant death differed when stratified by education level. An increased risk of composite maternal adverse outcome was also found with a lower level of education.

CONCLUSION

 Among individuals with diabetes, lower education was associated with a modestly higher risk of adverse neonatal and maternal outcomes.

KEY POINTS

· Education levels were associated with adverse outcomes among individuals with diabetes.. · Lower education is associated with multiple neonatal complications, including infant death.. · Individuals with varying levels of education are at higher risk for adverse maternal outcomes..

Socioeconomic inequalities in health-related functioning among people with type 2 Diabetes: longitudinal analyses in the Maastricht Study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a common chronic disease that disproportionally affects disadvantaged groups. People with a low socioeconomic position (SEP) have increased risk of T2DM and people with a low SEP and T2DM have higher HbA1c-levels compared to people with T2DM and high SEP. The aim of this study is to analyze longitudinal socioeconomic differences in health-related functioning in people with T2DM.

METHODS

Longitudinal data from 1,537 participants of The Maastricht Study with T2DM were used (32.6% female, mean (SD) age 62.9 (7.7) years). SEP was determined by baseline measures of education, occupation and income. Health-related functioning (physical, mental and social) was measured with the Short-Form Health Survey and the Impact on Participation and Autonomy survey (all scored from 0 to 100). Associations of SEP and health-related functioning were studied annually over a 10-year period (median (IQR) 7.0 (5.0) years, baseline 2010-2018) using linear mixed methods adjusting for demographics, HbA1c-levels and lifestyle factors.

RESULTS

Participants with a low SEP had significantly worse health-related functioning compared to those with a high SEP. For example, participants with low income had lower scores for physical (-4.49[CI -5.77;-3.21]), mental (-2.61[-3.78,-1.44]) and social functioning (-9.76[-12.30;-7.23]) compared to participants with high income on a scale from 0 to 100. In addition, participants with a low education significantly declined more over time in mental (score for interaction education with time - 0.23[-0.37;-0.09]) and social functioning (-0.44[-0.77;-0.11]) compared to participants with high education. Participants with low and intermediate incomes significantly declined more over time in physical functioning (-0.17 [-0.34, -0.01 and - 0.18 [-0.36, 0.00]) compared to participants with high income.

CONCLUSIONS

Among people with T2DM, those with a lower SEP had worse health-related functioning in general than people with a higher SEP. Additionally, people with T2DM and low education developed poorer mental and social functioning over time compared to people with T2DM and high education. People with T2DM and low or intermediate income declined more in physical functioning over time than those with high incomes. In addition to HbA1c-levels and lifestyle patterns, more attention is needed for socioeconomic differences in health-related functioning for people living with T2DM.

An evaluation of lower urinary tract symptoms in diabetic patients: a cross-sectional study

BACKGROUND

Lower urinary tract symptoms (LUTS) are common among diabetic patients and represent hidden and mysterious morbidity. The pathophysiology of LUTS among diabetes mellitus (DM) patients is multifactorial. Importantly, LUTS is known to cause physical and psychological distress. Thus, this study describes LUTS among DM patients, investigates factors that may associate with it, and assesses the possible relationship between LUTS and the quality of life of diabetics.

METHODS

Over 6 months, data were collected from 378 diabetic patients in primary health care clinics. Demographic and clinical characteristics, Urogenital Distress Inventory-6 (UDI-6), and Incontinence Impact Questionnaire-7 (IIQ-7) were used to collect data. Univariate and multivariate analyses were performed.

RESULTS

Three hundred seventy-eight participants were included in this study. (29.9%) were (58-67) years old. 49% were female. Half of the cohort was overweight, and a third were obese. 81% were Type 2 DM. Almost all of them are on medical treatment. A median score of 5.50 (2.00-8.00) for the UDI-6 scale and a median score of 5 (0.00-10.00) for the IIQ-7 scale were reported. Multiple linear regression models showed that residency (p = 0.038) and regular exercise (p = 0.001) were significantly and negatively correlated with the UDI-6 score, while female gender (p = 0.042), insulin use (p = 0.009) and the presence of comorbidities (p = 0.007) were positively correlated with this score. Furthermore, age (p = 0.040) and body mass index (BMI) (p < 0.001) were significantly and positively associated with the IIQ-7 score.

CONCLUSION

LUTS is significant morbidity among DM patients. Factors such as age, BMI, and co-morbidities exacerbate LUTS, which can be modified and controlled. On the other hand, regular exercise and weight loss strategies help diabetic patients to improve LUTS.

Effect of COVID-19 lockdown on Moroccan patients with type 1 and type 2 diabetes

BACKGROUND

The implementation of coronavirus disease of 2019 (COVID-19) lockdown has affected the daily practices of subjects with chronic diseases such as diabetes and caused negative impact on their lifestyle and habits such as physical activity, dietary habits and accessibility to medications. Diabetic people are considered the most vulnerable groups to COVID-19, and the lockdown measure has disturbed the diabetes self-management. In our study, we aimed to assess, for the first time at the regional level (Souss Massa Region), the COVID-19 lockdown impact on HbA1c levels in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). We carried out a cross-sectional quantitative analysis at the health center of the industrial district in Agadir City.

RESULTS

We found a significant improvement in post-lockdown mean ± SD HbA1c in 150 subjects suffering from T1D and T2D; p = 0.005). Our analysis revealed a significant association of HbA1c deviation with educational level and medical coverage (p = 0.01). No significant association was detected between HbA1c deviation and age, gender, weight, height, current BMI status, fasting blood sugar, family history, urban or rural areas, marital status, professional activity, socioeconomic income, type of diabetes, dietary, comorbidities, diabetic complications, housing, adherence to the dietary recommendations, physical activity, medical appointments, stopping medication, self-monitoring, fasting and anxiety about getting COVID-19.

CONCLUSIONS

COVID-19 lockdown had no deleterious effect on HbA1c levels in Moroccan patients with T1D and T2D.

Health-related quality of life and glycaemic control among adults with type 1 and type 2 diabetes - a nationwide cross-sectional study

Background

Health-related quality of life and glycaemic control are some of the central outcomes in clinical diabetes care and research. The purpose of this study was to describe the health-related quality of life and assess its association with glycaemic control in adults with type 1 and type 2 diabetes in a nationwide setting.

Methods

In this cross-sectional survey, people with type 1 (n = 2479) and type 2 diabetes (n = 2469) were selected at random without replacement from the Swedish National Diabetes Register. Eligibility criteria were being aged 18–80 years with at least one registered test of glycated haemoglobin (HbA_1c) the last 12 months. The generic 36-item Short Form version 2 (SF-36v2) was answered by 1373 (55.4%) people with type 1 diabetes and 1353 (54.8%) with type 2 diabetes.

Results

Correlation analyses showed weak correlations between scores on the SF-36v2 and glycaemic control for both diabetes types. After the participants were divided into three groups based on their levels of HbA_1c, multivariate regression analyses adjusted for demographics, other risk factors and diabetes complications showed that among participants with type 1 diabetes, the high-risk group (≥70 mmol/mol/8.6%) had statistically significantly lower means in five out of eight domains of the SF-36v2 and the mental component summary measure, as compared with the well-controlled group (< 52 mmol/mol/6.9%). Among the participants with type 2 diabetes, the high-risk group had the lowest statistically significantly means in seven domains and both summary measures.

Conclusions

Among people with type 1 and type 2 diabetes, adults with high-risk HbA_1c levels have lower levels of health-related quality of life in most but not all domains of the SF-36v2. This finding was not explained by demographics, other risk factors, or diabetes complications. The weak individual-level correlations between HRQOL scores and levels of glycaemic control argues for the need to not focus exclusively on either HbA_1c levels or HRQOL scores but rather on both because both are important parts of a complex, life-long, challenging condition.

Electronic supplementary material

The online version of this article (10.1186/s12955-019-1212-z) contains supplementary material, which is available to authorized users.

Relationship between hyperbaric oxygen therapy and quality of life in participants with chronic diabetic foot ulcers: data from a randomized controlled trial

AIMS

To investigate the effect of hyperbaric oxygen therapy on health-related quality of life (HRQoL) in participants with diabetes and chronic foot ulcers.

METHODS

Using data from a randomized controlled trial, we included 103 participants (49 in hyperbaric oxygen therapy group and 54 in sham group) for analyses. The primary outcome was HRQoL as measured by the EQ-5D-3L instrument, while secondary outcomes included quality of life evaluated by the Short Form 36 (SF-36) and Diabetic Foot Ulcers Scale-Short Form (DFS-SF). We used the analysis of covariance to assess whether the EQ-5D index values in hyperbaric oxygen therapy group differed from the sham group. Logistic regression was used to assess the relationship between hyperbaric oxygen therapy and the responses of 'problems' for the EQ-5D health states.

RESULTS

No significant differences in EQ-5D index values were found between the hyperbaric oxygen therapy and sham groups: 0.01 (95% CI -0.25, 0.28; p = 0.93) at week 12; 0.07 (95% CI -0.21, 0.34; p = 0.64) at week 6. Hyperbaric oxygen therapy was found to be associated with fewer participants reporting 'problems' in mobility (OR 0.24, 95% CI 0.07, 0.85 at week 12) and pain or discomfort (OR 0.20, 95% CI 0.07, 0.61 at week 6; OR 0.32, 95% CI 0.11, 0.97 at week 12), compared with the sham group. No significant differences in SF-36 or DFS-SF were observed.

CONCLUSIONS

No significant effect of hyperbaric oxygen therapy on HRQoL measured by EQ-5D index value was found in this study. Due to the potential insufficient power to assess statistical difference, more large-scale research is needed to further evaluate the effect of hyperbaric oxygen therapy on HRQoL in participants with chronic diabetic foot ulcers.

Knowledge, Attitude and Practices (KAP) Regarding Chronic Complications of Diabetes among Patients with Type 2 Diabetes in Dhaka

BACKGROUND

To reduce morbidity and mortality, awareness regarding diabetes and its complications is necessary. This study aimed at assessing the level of knowledge, attitude, and practices (KAP) regarding complications of diabetes mellitus among patients with type 2 diabetes in Dhaka, Bangladesh.

METHODS

A cross-sectional study was carried out recruiting patients with diabetes from the outpatient department of BIRDEM hospital in Dhaka. Overall, 425 patients with diabetes were enrolled in this study. A pretested questionnaire was filled by the interviewer with face to face interview. Levels of KAP were determined by calculating the scores. Multivarable linear regression was used to determine significant predictors for knowledge, attitude, and practices.

RESULTS

On average, the level of knowledge, attitude, and practices were 9.2 (out of 14), 7.9 (out of 13), and 16.9 (out of 27), respectively. Age and gender were significant predictors of knowledge and attitude. Females had better level of knowledge and attitude compared to males (βs = 0.55 and 1.24, respectively). Patients with graduate degrees and above compared to illiterates reported significantly greater knowledge and practice (βs = 1.27 and 1.44, respectively), after adjustments for covariates. Educational program was the most important significant predictor of KAP. Higher duration of diabetes (β = 0.07) and positive marital status (β = 1.21) had influenced better practice.

CONCLUSIONS

Lack of knowledge, poor attitude, and inadequate practice were found in this surveyed communinty. Level of education and educational program on diabetes were the most significant contributing factors. The current study suggests the need of structured educational programs on diabetes and its complications on a regular basis to assist patients in living a productive life.

Application of salutogenic concept in social work with diabetic patients

In the context of salutogenesis, coping with diabetes is perceived as a dynamic process of changes in all aspects of biopsychosocial model of health/disease. Understanding of salutoprotective factors allows for estimation of client's extent of vulnerability and ability to cope with the disease. The objective of the study is to assess selected salutoprotective factors in diabetic clients (SOC-type hardiness, well-being-subjective feelings and states scale [SUPOS], perceived social support scale [PSSS]). Low values of SOC, PSSS, and SUPOS suggest an increased need in psychosocial care. The possibility to strengthen an individual's hardiness and to influence perceived social support adverts to the irreplaceable role of social workers at counseling and educational levels as well as that of a form of social support.

Diabetes Mellitus in Middle-aged People Is Associated with Increased Sick Leave: The BELSTRESS Study

In a prospective study of the association between self-reported diabetes mellitus and sick leave from work, 21,149 men and women, aged 35-59 years, participated. Prevalence of diabetes was obtained by questionnaire. Sick leave was prospectively obtained from departments of human resources in the year after the baseline survey. Outcome variables related to duration of sick leave, repetitive absences, and long absences of at least seven consecutive days. In gender-specific multivariate analyses the relation between diabetes and sick leave was studied independent of age, body mass index, physical activity, alcohol intake, education, job title, and smoking habit. Prevalence rates of self reported diabetes were 2.8% and 2.2% in men and women, respectively. For each outcome variable a significant association between diabetes and sick leave was observed. Significant associations were found between diabetes and duration of sick leave and repetitive absences in men. In women a similar trend was observed for duration, and a significant association was found for repetitive absences.

Assessment of the magnitude of contextual and individual demographic effects on diabetes mellitus and glucose intolerance in rural Southwest China: a multilevel analysis

OBJECTIVE

This study aimed to determine the contribution of individual and contextual socioeconomic status (SES) to the prevalence of diabetes mellitus and glucose intolerance in the adult population in rural southwest China.

METHODS

A population-based cross-sectional study of diabetes was performed in 4801(2152 men) Chinese adults (≥ 25 years old). Multilevel logistic regression model was used to examine the association between individuals' and townships' variables and the prevalence of diabetes mellitus and glucose intolerance.

RESULTS

The age-and gender-standardized prevalence of diabetes mellitus and glucose intolerance were 7.1% (3.6% for undiagnosed) and 8.8% in adults aged ≥ 25 years, respectively, and increasing with age. Females were more likely to develop diabetes than males. The probability of developing diabetes increased with BMI. Both contextual and individual educational level and yearly household income were found to be negatively associated with the prevalence of diabetes. Residence in communities with a higher percentage of ethnic minorities was associated with higher prevalence of diabetes. Smoking had a protective effect for diabetes, drinking had a positive association with diabetes mellitus and glucose intolerance.

CONCLUSIONS

Diabetes mellitus and glucose intolerance are common in rural adults of southwest China by international standards. These results indicate that diabetes mellitus has become a major public health problem in rural areas in southwest China, and strategies aimed at the prevention and treatment of diabetes mellitus and glucose intolerance are needed.

Impact of diabetes mellitus onset on sickness absence from work--a 15-year follow-up of the GAZEL Occupational Cohort Study

AIMS

Previous studies do not provide an accurate estimate of the burden of diabetes on sickness absence. The aim of this study was to measure the impact of diabetes onset on absenteeism starting from the earliest occurrence of the disease.

METHODS

The authors used data from a subsample of the French GAZEL cohort of 506 employees with incident diabetes and 2530 matched diabetes-free participants. Medically certified sickness absence data were obtained from company records (1989-2007). Number of sickness absence days and incidence rates of overall and cause-specific absence spells were compared according to diabetes status across three 5-year periods ranging from 10 years before to 5 years after onset of cases' diabetes.

RESULTS

The mean number of sickness absence days was persistently higher in participants with diabetes compared with those without diabetes. This difference increased from 16.4 days (95% confidence interval 7.2-25.5) during the 5-year period preceding diabetes onset to 28.5 days (95% CI 16.1-40.9) during the following 5-year period (P = 0.04). This was due to a steeper relative increase in the incidence of long (but not short) absence spells in participants with diabetes versus those without diabetes [incidence rate ratios 1.33 (95% CI 1.08-1.64) and 1.75 (95% CI 1.43-2.14), respectively; P = 0.02]. Diabetes onset was associated with increased rates of circulatory and metabolic absence spells.

CONCLUSIONS

Onset of diabetes is associated with a substantial increase in sickness absence. This suggests that in addition to its burden on work cessation, diabetes weighs heavily on working ability among people who manage to remain employed.

Health disparities in endocrine disorders: biological, clinical, and nonclinical factors--an Endocrine Society scientific statement

OBJECTIVE

The aim was to provide a scholarly review of the published literature on biological, clinical, and nonclinical contributors to race/ethnic and sex disparities in endocrine disorders and to identify current gaps in knowledge as a focus for future research needs. PARTICIPANTS IN DEVELOPMENT OF SCIENTIFIC STATEMENT: The Endocrine Society's Scientific Statement Task Force (SSTF) selected the leader of the statement development group (S.H.G.). She selected an eight-member writing group with expertise in endocrinology and health disparities, which was approved by the Society. All discussions regarding the scientific statement content occurred via teleconference or written correspondence. No funding was provided to any expert or peer reviewer, and all participants volunteered their time to prepare this Scientific Statement.

EVIDENCE

The primary sources of data on global disease prevalence are from the World Health Organization. A comprehensive literature search of PubMed identified U.S. population-based studies. Search strategies combining Medical Subject Headings terms and keyword terms and phrases defined two concepts: 1) racial, ethnic, and sex differences including specific populations; and 2) the specific endocrine disorder or condition. The search identified systematic reviews, meta-analyses, large cohort and population-based studies, and original studies focusing on the prevalence and determinants of disparities in endocrine disorders. consensus process: The writing group focused on population differences in the highly prevalent endocrine diseases of type 2 diabetes mellitus and related conditions (prediabetes and diabetic complications), gestational diabetes, metabolic syndrome with a focus on obesity and dyslipidemia, thyroid disorders, osteoporosis, and vitamin D deficiency. Authors reviewed and synthesized evidence in their areas of expertise. The final statement incorporated responses to several levels of review: 1) comments of the SSTF and the Advocacy and Public Outreach Core Committee; and 2) suggestions offered by the Council and members of The Endocrine Society.

CONCLUSIONS

Several themes emerged in the statement, including a need for basic science, population-based, translational and health services studies to explore underlying mechanisms contributing to endocrine health disparities. Compared to non-Hispanic whites, non-Hispanic blacks have worse outcomes and higher mortality from certain disorders despite having a lower (e.g. macrovascular complications of diabetes mellitus and osteoporotic fractures) or similar (e.g. thyroid cancer) incidence of these disorders. Obesity is an important contributor to diabetes risk in minority populations and to sex disparities in thyroid cancer, suggesting that population interventions targeting weight loss may favorably impact a number of endocrine disorders. There are important implications regarding the definition of obesity in different race/ethnic groups, including potential underestimation of disease risk in Asian-Americans and overestimation in non-Hispanic black women. Ethnic-specific cut-points for central obesity should be determined so that clinicians can adequately assess metabolic risk. There is little evidence that genetic differences contribute significantly to race/ethnic disparities in the endocrine disorders examined. Multilevel interventions have reduced disparities in diabetes care, and these successes can be modeled to design similar interventions for other endocrine diseases.

Distinct trajectories of perinatal depressive symptomatology: evidence from growth mixture modeling

Although heterogeneity in the timing and persistence of maternal depressive symptomatology has implications for screening and treatment as well as associated maternal and child health outcomes, little is known about this variability. A prospective observational study of 1,735 low-income, multiethnic, inner-city women recruited in pregnancy from 2000 to 2002 and followed prospectively until 2004 (1 prenatal and 3 postpartum interviews) was used to determine whether distinct trajectories of depressive symptomatology can be defined from pregnancy through 2 years postpartum. Analysis was carried out through general growth mixture modeling. A model with 5 trajectory classes characterized the heterogeneity seen in the timing and magnitude of depressive symptoms among the study participants from Philadelphia, Pennsylvania. These classes included the following: 1) always or chronic depressive symptomatology (7%); 2) antepartum only (6%); 3) postpartum, which resolves after the first year postpartum (9%); 4) late, present at 25 months postpartum (7%); and 5) never having depressive symptomatology (71%). Women in these trajectory classes differed in demographic (nativity, education, race, parity) health, health behavior, and psychosocial characteristics (ambivalence about pregnancy and high objective stress). This heterogeneity should be considered in maternal depression programs. Additional research is needed to determine the association of these trajectory classes with maternal and child health outcomes.

Health-related quality of life in type 2 diabetic patients

BACKGROUND AND OBJECTIVES

Health-related quality of life (HRQOL) is an important health outcome, representing one of the most important goals of all health interventions. The objectives of this study were to determine HRQOL and the factors affecting it in type 2 diabetic patients.

PATIENTS AND METHODS

This cross-sectional study was conducted in five primary health care (PHC) centers in the Al-Khobar area. From a random sample of 225 type 2 diabetic patients, 216 patients were included in the study along with 216 age- , sex- and nationality-matched controls. Nine patients refused to participate. Type 2 diabetic patients and controls were interviewed with the translated Arabic SF-12 questionnaire.

RESULTS

The mean ages were 50.0A+/-10.0 years for cases and of 49.3+/-10.3 years for controls (P=.526). Type 2 diabetic patients had lower socioeconomic status and educational level than controls. Obesity was significantly higher in diabetics than controls. HRQOL in type 2 diabetic patients was significantly lower than controls. The mean physical component score was 41.3+/-8.9 for cases vs. 47.5+/-9.5 for controls (P<.001), and the mean mental component score 47.8+/-9.1 in cases vs. 51.5+/-9.4 in controls (P<.001). HRQOL was significantly lower in females than males (P<.001). HRQOL was impaired in uncontrolled patients (fasting plasma glucose [FPG]>130 mg/dL) in comparison with controlled patients (FPG</=130 mg/dL) (P<.05).

CONCLUSIONS

HRQOL was lower in type 2 diabetic patients than controls and was affected by many factors. Females had lower HRQOL than males, possibly because of a higher incidence of obesity. Uncontrolled diabetic patients had a lower HRQOL than controlled diabetics. Improving HRQOL in diabetic patients is important.

Clinical characteristics of patients with diabetic polyneuropathy: the role of clinical and electromyographic evaluation and the effect of the various types on the quality of life

OBJECTIVE

This study was performed to identify the relationship between the quality of life and polyneuropathy which is one of the complications of diabetes.

METHODS

Total 111 patients with diabetes mellitus were taken into the study as type 1 and type 2. Patients were accepted having polyneuropathy according to their electroneuromyography (ENMG) results. To evaluate the quality of life in the patients Short Form 36 (SF-36) and World Health Organization Quality of Life Questionnaire abbreviated version (WHOQOL-BREF) were used.

RESULTS

Clinical polyneuropathy was found in 46% of the patients, while polineuropathy was found in 63% of the patients with evaluation ENMG. The patients with polyneuropathy had poor quality of life according to SF-36 and WHOQOL-BREF (p < 0.001). The mean quality of life scores of patients who had sensoriomotor and mix polyneuropathy, were lower than sensory type and axonal polyneuropathy.

CONCLUSION

Diabetic polyneuropathy influences the quality of life in a negative way. The quality of life scores of patients who had polyneuropathy continuing with mixed pathogenesis and sensoriomotor type, become worse for this reason, even if the patients do not have any clinical polyneuropathy, this being evaluated with ENMG.

Integrating conventional science and aboriginal perspectives on diabetes using fuzzy cognitive maps

There is concern among Aboriginal communities in Canada that conventional approaches to the treatment of diabetes are ineffective in part because they fail to recognize the local Aboriginal perspective on the causal determinants of diabetes. While this shortcoming has been recognized, there have been no explicit attempts to practically define these perspectives and prescribe how conventional health management might be altered to incorporate them. In part, this may be due to difficulties in communicating Aboriginal perspectives in a manner which permits incorporation into conventional science-based frameworks. Here we use fuzzy cognitive mapping (FCM) as a technique to represent and compare Canadian Aboriginal and conventional science perspectives on the determinants of diabetes as contained in published articles drawn from a search of Medline and PubMed (1966-2005). The FCM allows for a detailed description of the complex system of culture, spirituality and balance at the root of the Aboriginal view. It also highlights how, for these less tangible factors, it is possible to identify more concrete stressors and outcomes which are amenable to management and monitoring. This preliminary comparison of conventional and Aboriginal views also demonstrates the potential for FCM as a technique to extract, compare and integrate perspectives of different knowledge systems into health management and policy development.

Health status assessed by the SF-36 along the diabetes continuum in an Australian population

OBJECTIVE

To examine the association of health status with stage along the diabetes continuum.

DESIGN, SETTING AND PARTICIPANTS

Self-reported health status (SF-36) was assessed in the North West Adelaide Health Study, a representative population cohort (n = 4060) aged 18 years and over in metropolitan South Australia. Impaired fasting glucose (IFG), undiagnosed diabetes, diagnosed diabetes, glycaemic control and cardiovascular disease were determined from fasting blood and self-reported data.

RESULTS

The prevalence of diagnosed diabetes was 5.6% (95% CI: 4.9-6.3), with an additional 1.0% (95% CI: 0.7-1.4) previously undiagnosed. When compared to those with normal glucose, those with diabetes were significantly impaired on all SF-36 dimensions except Mental Health, and those with IFG (4.3%) were significantly impaired in terms of Physical Functioning and Bodily Pain when controlling for the effects of age, sex and cardiovascular disease. Poor glycaemic control (HbA1c >or= 7.0%) was also associated with impaired health status.

CONCLUSIONS

Health status is impaired not only among those with diagnosed diabetes but also those with IFG and undiagnosed diabetes.

Weighing the Relevant Issues

The obesity epidemic has touched all segments of society and every health care sector including the nursing home industry. Understanding the issues related to the care of obese nursing home residents is important in light of this epidemic. Such issues include the difficulties related to access to nursing homes, the structural preparedness of nursing homes to care for obese patients, and the potential for staff injuries. Policies regarding strategies to improve nursing home access for obese patients, mitigate disparities in quality of care and health outcomes owing to obesity, and better prepare for the growing obesity epidemic are needed.

The influence of ethnicity on health-related quality of life in diabetes mellitus: a population-based, multiethnic study

OBJECTIVES

The aims of this study were to evaluate the influence of ethnicity on health-related quality of life (HRQoL) in diabetic participants using both profile [the Short-Form 36 (SF-36)] and single-index (the SF-6D) instruments and to evaluate the usefulness of the SF-6D as a summary measure for the SF-36.

RESEARCH DESIGN AND METHODS

Using data from a cross-sectional, population-based survey of Chinese, Malay, and Indians in Singapore, we analyzed the influence of ethnicity and other variables on each SF-36 scale and SF-6D scores using linear regression models to adjust for the influence of known determinants of HRQoL.

RESULTS

Data from 309 diabetic respondents were analyzed. Compared with other ethnicities, Indians were most likely to report impaired HRQoL. The unadjusted influence of ethnicity on HRQoL exceeded the minimum clinically important difference (MCID) for all SF-36 scales (MCID: 5 points) and the SF-6D (MCID: 0.033 points). After adjusting for gender, age, and education, the influence of Chinese ethnicity exceeded the MCID for all SF-36 scales, except vitality (VT) and mental health (MH), as well as for the SF-6D. The influence of Malay ethnicity exceeded the MCID only for the SF-36 MH scale and the SF-6D. The influence of ethnicity on HRQoL persisted after adjusting further for other determinants of HRQoL. The SF-6D reflected the ethnic trends for some but not all SF-36 scales.

CONCLUSIONS

After adjusting for demographic, socioeconomic, and other factors known to influence HRQoL, ethnicity remained an important factor influencing HRQoL in this population-based multiethnic sample of diabetic Asians. Further studies to identify modifiable factors explaining the ethnic disparities in HRQoL among diabetic participants are needed. The SF-6D may be a useful summary measure for the SF-36.

Physical activity and sports participation in children and adolescents with type 1 diabetes mellitus

BACKGROUND AND AIM

Regular physical activity is of great importance in the management of type 1 diabetes mellitus (T1DM). We investigate here the levels of moderate/vigorous physical activity (MVPA) and participation in sporting activity in a sample of children and adolescents with T1DM and analyse whether they differed from healthy subjects. The family variables associated with MVPA or sports participation and the influence of exercise on metabolic parameters are also explored.

METHODS AND RESULTS

In this cross-sectional case control study, 138 children and adolescents with T1DM (of which 67 were boys, age 13.6+/-4.1 years; duration of diabetes 6.1+/-3.8 years) and 269 (of which 120 were boys) healthy controls were studied. Weekly levels of MVPA and sports participation were investigated using a questionnaire. Body mass index standard deviation score (BMI-SDS) values, plasma total cholesterol, serum triglycerides and the mean glycated haemoglobin (A1c) levels over the past year were assessed in T1DM subjects. MVPA scores in T1DM patients were lower than in controls (p=0.0004). MVPA was higher in boys than in girls, both in diabetic and control subjects; T1DM girls were less frequently engaged in MVPA than control girls. MVPA scores were significantly and independently correlated with sex, age and diabetic status. Lower triglyceride levels and fewer subjects with poor metabolic control were found more among physically active patients (MVPA>5 days/week) than in inactive patients (weekly MVPA=0). Sports participation was lower in T1DM patients than in controls (p=0.002) and was significantly and independently correlated with sex, father's education level and diabetic status. Triglyceride levels and the percentage of subjects with poor metabolic control were significantly lower in sports participants than in non-participants.

CONCLUSIONS

Children and adolescents with T1DM appeared to spend less time in physical activity than their non-diabetic peers. Regular physical activity was associated with better metabolic control and lipid profile. Adolescents, particularly the girls, tended to be less active. Further efforts should be made to motivate patients with type 1 diabetes.

Obesity in Nursing Homes: An Escalating Problem

OBJECTIVES

To estimate trends in the prevalence of obesity in nursing homes, to characterize the obese nursing home population, and to evaluate the extent to which estimates of the prevalence of obesity varied by facility and geographic location.

DESIGN

Cross-sectional.

SETTING

One thousand six hundred twenty-five nursing homes in Kansas, Maine, Mississippi, New York, and South Dakota from 1992 to 2002; 16,110 nursing homes in the United States in 2002.

PARTICIPANTS

Newly admitted residents between 1992 and 2002 (n=847,601) in selected states and 1,448,046 residents newly admitted to a U.S. nursing home in 2002 with height and weight documented on the Minimum Data Set (MDS) assessment.

MEASUREMENTS

Data were from the Systematic Assessment of Geriatric Drug Use via Epidemiology database. Residents were classified as having a body mass index of less than 18.5 kg/m2, 18.5 to 24.9 kg/m2, 25.0 to 29.9 kg/m2, 30 to 34.9 kg/m2, or 35.0 kg/m2 or greater.

RESULTS

Adjusting for sociodemographics, in Kansas, Maine, Mississippi, New York, and South Dakota, fewer than 15% of newly admitted residents were obese in 1992, rising to more than 25% in 2002. In U.S. nursing homes, the distribution of obese residents is not shared equally across facilities. Nearly 30% of residents with a BMI of 35 kg/m2 or greater are younger than 65, and a disproportionate percentage of obese residents are non-Hispanic black. Residents identified as obese had a higher likelihood of comorbid conditions (e.g., diabetes mellitus, arthritis, hypertension, depression, and allergies).

CONCLUSION

Increasing prevalence of obesity in nursing homes and substantial variation of obesity prevalence within facilities raise concerns about nursing home preparedness and access.

Characteristics Associated with Neuropathy and/or Retinopathy in a Hospital Outpatient Diabetic Clinic

BACKGROUND

The incidence of diabetes is increasing worldwide and with it the risk of diabetic complications. The aim of this study was to characterise parameters associated with neuropathy and/or retinopathy in a hospital outpatient diabetic clinic population.

METHOD

A structured questionnaire addressing diabetes related factors and demography was administered to a cross-sectional sample of patients (n = 290) with type 1 and type 2 diabetes attending a hospital diabetic outpatient clinic. Additional clinical measures were obtained from patient medical files and computerised records. Logistic regression analysis was used to identify characteristics associated with the presence of complications.

RESULTS

When controlling for other predictors, increasing age (P < 0.01), type 1 diabetes (P = 0.05), longer duration of diabetes (P < 0.01), increased serum triglyceride levels (P = 0.03), HbA1c (>8%; P = 0.03), self-reported low physical activity levels (P = 0.05) and being a smoker (P = 0.01) were positively related to retinopathy and/or neuropathy. Patients within the study population had reasonably well controlled BP and serum lipids, thus explaining the absence of these particular variables from the list of predictor parameters. Other factors including diabetes knowledge, home blood glucose monitoring, gender, body mass index, clinic attendance and occupational status were not significantly associated with retinopathy or neuropathy in the present study population.

CONCLUSIONS

Pharmacists and other health practitioners who are in a position to be involved in the care and management of patients with diabetes should raise awareness of complications, particularly amongst patients who present with the above risk factors and provide necessary counselling and advice as required.

Cross-sectional study of care, socio-economic status and complications in young French patients with type 1 diabetes mellitus

OBJECTIVES

To describe the present status of type 1 diabetes care in France and study the relations between clinical and socio-economic variables on one hand and disease management and prevalence of complications on the other hand.

METHODS

A random sample of 365 French specialists in diabetes care performed a cross-sectional study and included consecutively 562 children aged 10-16 and 1691 adults aged 16-45, with more than 2 years of type 1 diabetes. The main outcome measures were the prevalence of complications (retinal, renal, lower-limb, cardiovascular, ketoacidosis); disease management parameters (blood pressure, HbA1c, daily number of insulin injections, frequency of visits to a specialist in diabetes, membership of a patient association); socio-economic status as a score, and treatments received.

RESULTS

Retinal complications were rare in children (0.7%) and common in adults (28.3%). 10.2% children and 15.2% adults had micro- or macro-albuminuria, 4.7% adults had plasma creatinine >or=150 micromol/L. Only 15% children and 26% adults had HbA1c<7%, 86.2% children and 62.7% adults had blood pressure<130/85 mmHg; 58% children and 80% adults had at least 3 daily insulin injections. In adults, the risk of experiencing at least one complication was linked significantly with diabetes duration, HbA1c, and socio-economic status. Age, sex, type of insulin therapy, tobacco consumption, and blood pressure control were not significant parameters. Ketoacidosis in the preceding year was only linked with HbA1C and socio-economic status.

CONCLUSION

Although this sample of patients had overall a fair socio-economic status and were followed-up by specialists of diabetes care, metabolic and blood pressure control were not optimal. The care of French type 1 diabetics could probably be improved by a stricter control of glycaemia and blood pressure, and an earlier use of intensive insulin treatment, with a particular focus on adolescents and patients with the lowest socio-economic status.

Diabetes mellitus and health-related quality of life among older adults. Findings from the behavioral risk factor surveillance system (BRFSS)

The aim of the present study was to examine associations between the presence of diabetes mellitus and health-related quality of life (HRQOL) among older adults. Using data from 37,054 adults aged 50 years or older who participated in the 2001 BRFSS, we examined the independent association between diabetes and four measures of HRQOL developed by the U.S. Centers for Disease Control and Prevention. Multivariate logistic regression was used to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs). On average, older adults with diabetes reported nearly twice as many unhealthy days (physical or mental) as those without the condition (mean: 10.1 [S.E.: 0.32] versus 5.7 [0.43]) after age adjustment. The proportion of older adults reporting 14 or more unhealthy days (physical or mental) was significantly higher among those with diabetes (n = 4032; 11%) compared to those without the condition (OR: 1.64; 95% CI: 1.20, 2.23) after multivariate adjustment. Among older diabetic adults, the adjusted relative odds of having 14 or more unhealthy days (physical or mental) was 1.71 (95% CI: 1.31, 2.22) times greater for those treated with insulin compared to those not treated with insulin. Diabetes is independently associated with lower levels of HRQOL among older adults. These results reinforce the importance of preventing diabetes and its complications through health education messages stressing a balanced diet and increased physical activity.

Health literacy and pregnancy preparedness in pregestational diabetes

OBJECTIVE

We investigated the association between functional health literacy and markers of pregnancy preparedness in women with pregestational diabetes.

RESEARCH DESIGN AND METHODS

English- and Spanish-speaking pregnant women with pregestational diabetes were recruited. Women completed the Test of Functional Health Literacy in Adults (TOFHLA) short form and a questionnaire. A TOFHLA score of < or =30 was defined as low functional health literacy.

RESULTS

Of 74 women participating in the study, 16 (22%) were classified as having low functional health literacy. Compared with women with adequate health literacy, those with low health literacy were significantly more likely to have an unplanned pregnancy (P = 0.02) and significantly less likely to have either discussed pregnancy ahead of time with an endocrinologist or obstetrician (P = 0.01) or taken folic acid (P = 0.001).

CONCLUSIONS

The results of this study suggest that low functional health literacy among women with pregestational diabetes is associated with several factors that may adversely impact birth outcomes.

The network of psychological variables in patients with diabetes and their importance for quality of life and metabolic control

OBJECTIVE

The primary goals in treating patients with diabetes are maintaining blood glucose levels as close to normal as possible and making a relatively normal quality of life achievable. Both of these goals are influenced by a multitude of somatic and psychological factors that should be seen as building a complex network. We examined whether a mathematical model can be construed that can depict the relative significance of each factor for achieving these treatment goals.

RESEARCH DESIGN AND METHODS

A total of 625 patients from 32 different treatment facilities were examined (224 type 1 and 401 type 2 diabetic patients) using HbA(1c) values (high-performance liquid chromatography), number of secondary illnesses, and standardized questionnaires with respect to health-related quality of life (World Health Organization Quality of Life questionnaire), coping behavior (Freiburger Illness-Coping Strategies questionnaire), diabetes-specific knowledge (Test of Diabetes-Specific Knowledge), doctor-patient relationship (Medical Interview Satisfaction Scale), and personality characteristics (Giessen Test and Assessment of Beliefs in Self-Efficacy and Optimism). The analyses were carried out by means of a structural equation model.

RESULTS

The model proved to be valid (chi(2) = 88.5, df = 76, P = 0.16), showing a sound fit (adjusted goodness of fit [AGFI] = 0.94). It explained 62% of the variance of the quality of life and 5% of the HbA(1c) values. Subjects characterized by strong beliefs in their self-efficacy and an optimistic outlook on life were more likely to be satisfied with their doctor-patient relationships. They demonstrated more active coping behavior and proved to have a higher quality of life. Active coping behavior was the only psychological variable significant for the HbA(1c) values.

CONCLUSIONS

It was possible to illustrate the various factors involved and their mutual dependency and significance for the treatment goals. Belief in self-efficacy and active coping behavior appear to have the greatest relevance for achieving the primary treatment goals.