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Huang Z, Han Y, Hu H, Cao C, Liu D, Wang Z. Triglyceride to high-density lipoprotein cholesterol ratio is associated with regression to normoglycemia from prediabetes in adults: a 5-year cohort study in China. J Transl Med 2023; 21:868. [PMID: 38037094 PMCID: PMC10688482 DOI: 10.1186/s12967-023-04752-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE The current body of evidence on the association between the ratio of triglycerides to high-density lipoprotein cholesterol (TG/HDL-c) and the reversal of prediabetes to normoglycemia remains limited. The aim of this study is to investigate the association between TG/HDL-c and the reversion to normoglycemia in patients with prediabetes. METHODS This retrospective cohort study included 15,107 individuals with prediabetes from 32 Chinese districts and 11 cities who completed health checks from 2010 to 2016. The Cox proportional-hazards regression model examined baseline TG/HDL-c and reversion to normoglycemia from prediabetes. Cox proportional hazards regression with cubic spline functions and smooth curve fitting determined the non-linear connection between TG/HDL-c and reversion to normoglycemia. We also ran sensitivity and subgroup analysis. By characterizing progression to diabetes as a competing risk for the reversal of prediabetes to normoglycemic event, a multivariate Cox proportional hazards regression model with competing risks was created. RESULTS Upon adjusting for covariates, the findings indicate a negative association between TG/HDL-c and the likelihood of returning to normoglycemia (HR = 0.869, 95%CI:0.842-0.897). Additionally, a non-linear relationship between TG/HDL-c and the probability of reversion to normoglycemia was observed, with an inflection point of 1.675. The HR on the left side of the inflection point was 0.748 (95%CI:0.699, 0.801). The robustness of our results was confirmed through competing risks multivariate Cox's regression and a series of sensitivity analyses. CONCLUSION The present study reveals a negative and non-linear correlation between TG/HDL-c and the reversion to normoglycemia among Chinese individuals with prediabetes. The findings of this study are anticipated to serve as a valuable resource for clinicians in managing dyslipidemia in prediabetic patients. Interventions aimed at reducing the TG/HDL-c ratio through the reduction of TG or elevation of HDL-c levels may substantially enhance the likelihood of achieving normoglycemia in individuals with prediabetes.
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Affiliation(s)
- Zhiqiang Huang
- Department of Emergency, Futian District, Shenzhen Second People's Hospital, No. 3002 Sungang Road, Shenzhen, 518000, Guangdong Province, China
| | - Yong Han
- Department of Emergency, Futian District, Shenzhen Second People's Hospital, No. 3002 Sungang Road, Shenzhen, 518000, Guangdong Province, China
| | - Haofei Hu
- Department of Nephrology, Guangdong Province, Shenzhen Second People's Hospital, Shenzhen, 518000, China
| | - Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, 518000, Guangdong Province, China
| | - Dehong Liu
- Department of Emergency, Futian District, Shenzhen Second People's Hospital, No. 3002 Sungang Road, Shenzhen, 518000, Guangdong Province, China.
| | - Zhibin Wang
- Department of Emergency, Futian District, Shenzhen Second People's Hospital, No. 3002 Sungang Road, Shenzhen, 518000, Guangdong Province, China.
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Teoh KW, Ng CM, Chong CW, Bell JS, Cheong WL, Lee SWH. Knowledge, attitude, and practice toward pre-diabetes among the public, patients with pre-diabetes and healthcare professionals: a systematic review. BMJ Open Diabetes Res Care 2023; 11:11/1/e003203. [PMID: 36792169 PMCID: PMC9933769 DOI: 10.1136/bmjdrc-2022-003203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
The prevalence of pre-diabetes is increasing globally, affecting an estimated 552 million people by 2030. While lifestyle interventions are the first line of defense against progression toward diabetes, information on barriers toward pre-diabetes management and how to overcome these barriers are scarce. This systematic review describes the publics' and healthcare professionals' knowledge, attitude and practice (KAP) toward pre-diabetes and determines the barriers toward pre-diabetes management. A systematic search for studies examining KAP towards pre-diabetes was conducted in six databases from inception to September 2022. Studies that quantitatively assessed at least two KAP elements using questionnaires were included. The quality of studies was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Barriers and enablers were identified and mapped onto the Capability, Motivation, and Behaviour model to identify factors that influence behavior change. Twenty-one articles that surveyed 8876 participants were included in this review. Most of the reviews (n=13) were directed to healthcare professionals. Overall, positive attitudes toward diabetes prevention efforts were observed, although there were still knowledge deficits and poor behavior toward pre-diabetes management. Barriers and enablers were detected at patients (eg, goals and intention), healthcare professionals (eg, clinical judgement) and system (eg, access and resources) levels. The use of different survey instruments to assess KAP prevented a head-to-head comparison between studies. Most studies conducted among patients were from middle-income countries, while among healthcare professionals (HCPs) were from high-income countries, which may produce some biasness. Nevertheless, the development of pre-diabetes intervention should focus on: (1) increasing knowledge on pre-diabetes and its management; (2) imparting practical skills to manage pre-diabetes; (3) providing resources for lifestyle management; (4) improving the accessibility of lifestyle management programs; and (5) other HCPs and human support to pre-diabetes management.
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Affiliation(s)
- Kah Woon Teoh
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Choon Ming Ng
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - J Simon Bell
- School of Pharmacy and Pharmaceutical Sciences, Monash University - Parkville Campus, Parkville, Victoria, Australia
| | - Wing Loong Cheong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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Pi L, Yan J, Fei D, Zheng Y, Shi X, Wang Z, Zhou Z. Primary care providers' knowledge, attitudes, and practices related to prediabetes in China: A cross-sectional study. Front Public Health 2023; 11:1086147. [PMID: 36908444 PMCID: PMC9995854 DOI: 10.3389/fpubh.2023.1086147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
Background The management of prediabetes has great clinical significance, and primary care providers (PCPs) play important roles in the management and prevention of diabetes in China. Nevertheless, little is known about PCPs' knowledge, attitudes, and practices (KAP) regarding prediabetes. This cross-sectional study aimed to assess the KAP regarding prediabetes among PCPs in the Central China region. Methods This cross-sectional study was conducted using self-administered KAP questionnaires among PCPs from Central China region. Results In total, 720 PCPs completed the survey. Most physicians (85.8%) claimed to be aware of the adverse effects of prediabetes and reported positive attitudes toward prediabetes prevention, but the PCPs' knowledge of prediabetes and management practices showed substantial gaps. The prediabetes knowledge level and practice subscale scores of the PCPs were only 54.7% and 32.6%, respectively, of the corresponding optimal scores. Female PCPs showed higher prediabetes knowledge level scores (p = 0.04) and better practice scores (p = 0.038). Knowledge and attitude scores were inversely correlated with participants' age and duration of practice (p < 0.001). The PCPs who served in township hospitals had significantly higher knowledge and attitude scores than those who served in village clinics (p < 0.001). Furthermore, knowledge and practice scores increased with increasing professional titles. Recent continuing medical education (CME) attendance had a significant positive influence on knowledge of prediabetes (p = 0.029), but more than four-fifths of the surveyed PCPs did not participate in diabetes-related CME in the past year. Conclusions Substantial gaps were observed in PCPs' knowledge and practices regarding prediabetes in the Central China region. CME programmes were under-utilized by PCPs. Structured programmes are required to improve PCPs' prediabetes-related knowledge and practices in China.
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Affiliation(s)
- Linhua Pi
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Jianru Yan
- Department of Metabolic Endocrinology, The First People's Hospital of Pingjiang, Yueyang, China
| | - Dongxue Fei
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying Zheng
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Center for Medical Research, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiajie Shi
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Zhen Wang
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
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Harcke K, Graue M, Skinner TC, Olsson CB, Stattin NS. Prediabetes screening, treatment, and follow‐up in primary health care: a cross‐sectional survey. PRACTICAL DIABETES 2022. [DOI: 10.1002/pdi.2425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Katri Harcke
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet Huddinge Sweden
- Academic Primary Health Care Centre Stockholm Sweden
| | - Marit Graue
- Department of Health and Caring Sciences Western Norway University of Applied Sciences Bergen Norway
| | - Timothy Charles Skinner
- Institute of Psychology University of Copenhagen Copenhagen Denmark
- La Trobe Rural Health School La Trobe University Bendigo Australia
- Australian Centre for Behavioural Research in Diabetes Melbourne Australia
| | - Christina B Olsson
- Academic Primary Health Care Centre Stockholm Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet Huddinge Sweden
| | - Nouha Saleh Stattin
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet Huddinge Sweden
- Academic Primary Health Care Centre Stockholm Sweden
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Pedrero V, Manzi J, Alonso LM. A Cross-Sectional Analysis of the Stigma Surrounding Type 2 Diabetes in Colombia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12657. [PMID: 34886383 PMCID: PMC8656822 DOI: 10.3390/ijerph182312657] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022]
Abstract
Type 2 diabetes is a global epidemic, and many people feel stigmatized for having this disease. The stigma is a relevant barrier to diabetes management. However, evidence in this regard is scarce in Latin America. This study aimed to analyze the level of stigma surrounding type 2 diabetes in the Colombian population and its relationships with sociodemographic, clinical, psychosocial variables and behaviors related to management of the disease (self-management behaviors). This cross-sectional study included 501 Colombian adults with type 2 diabetes. We estimated the relation between stigma and selected variables through linear regression models. Additionally, we analyzed the mediator role of psychosocial variables in the relationship between stigma and self-management behaviors through structural equation models. A total of 16.4% of patients showed concerning levels of stigma. The time elapsed since diagnosis (β = -0.23) and socioeconomic status (β = -0.13) were significant predictors of the level of stigma. Stigma was negatively correlated with self-efficacy (β = -0.36), self-esteem (β = -0.37), and relationship with health care provider (β = -0.46), and positively correlated with stress (β = 0.23). Self-efficacy, self-esteem, and the relationships with health care providers had a mediation role in the relationship between stigma and self-management behaviors. These variables would be part of the mechanisms through which the perception of stigma harms self-management behaviors. The stigma of type 2 diabetes is frequent in the Colombian population and negatively associated with important aspects of disease management.
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Affiliation(s)
- Victor Pedrero
- Nursing Faculty, Universidad Andrés Bello, Santiago 8370146, Chile
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Jorge Manzi
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Luz Marina Alonso
- Department of Public Health, Universidad del Norte, Barranquilla 081007, Colombia;
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Lopez-Jaramillo P, Lopez-Lopez J, Cohen D, Alarcon-Ariza N, Mogollon-Zehr M. Epidemiology of Hypertension and Diabetes Mellitus in Latin America. Curr Hypertens Rev 2020; 17:112-120. [PMID: 32942979 DOI: 10.2174/1573402116999200917152952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/15/2020] [Accepted: 07/26/2020] [Indexed: 11/22/2022]
Abstract
Hypertension and type 2 diabetes mellitus are two important risk factors that contribute to cardiovascular diseases worldwide. In Latin America hypertension prevalence varies from 30 to 50%. Moreover, the proportion of awareness, treatment and control of hypertension is very low. The prevalence of type 2 diabetes mellitus varies from 8 to 13% and near to 40% are unaware of their condition. In addition, the prevalence of prediabetes varies from 6 to 14% and this condition has been also associated with increased risk of cardiovascular diseases. The principal factors linked to a higher risk of hypertension in Latin America are increased adiposity, low muscle strength, unhealthy diet, low physical activity and low education. Besides being chronic conditions, leading causes of cardiovascular mortality, both hypertension and type 2 diabetes mellitus represent a substantial cost for the weak health systems of Latin American countries. Therefore, is necessary to implement and reinforce public health programs to improve awareness, treatment and control of hypertension and type 2 diabetes mellitus, in order to reach the mandate of the Unit Nations of decrease the premature mortality for CVD.
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Affiliation(s)
| | - Jose Lopez-Lopez
- Masira Research Institute, University of Santander, Bucaramanga. Colombia
| | - Daniel Cohen
- Masira Research Institute, University of Santander, Bucaramanga. Colombia
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Rajabi-Naeeni M, Dolatian M, Qorbani M, Vaezi AA. The effect of omega-3 and vitamin D co-supplementation on glycemic control and lipid profiles in reproductive-aged women with pre-diabetes and hypovitaminosis D: a randomized controlled trial. Diabetol Metab Syndr 2020; 12:41. [PMID: 32435279 PMCID: PMC7218636 DOI: 10.1186/s13098-020-00549-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prediabetes can predispose the individual to type 2 diabetes in the long-term. The present study was conducted to determine the effectiveness of vitamin D and omega-3 co-supplementation on glycemic control and serum lipid profiles in women of reproductive age with prediabetes and hypovitaminosis D. METHODS The present factorial, triple-blind, clinical trial was conducted on 168 women of reproductive age with prediabetes and hypovitaminosis D. The participants were assigned to four groups based on block randomization method: the placebo group received omega-3 and vitamin D placebos; the omega-3 group took omega-3 supplements and vitamin D placebos; the vitamin D group received omega-3 placebos and vitamin D supplements and the co-supplementation group. The groups received every 2 weeks 50,000 IU pearls of vitamin D and twice-daily doses of 1000-mg omega-3 tablets or placebos for 8 weeks. Dietary intake, physical activity, anthropometric indices and blood biochemical tests were measured at the beginning and end of the study. Analysis was performed using two-way mixed ANOVA. RESULTS A significant reduction was observed in fasting glucose, insulin, homeostasis model assessment-beta cell function, weight and waist circumference in the co-supplementation group compared to the other three groups (P < 0.05). Moreover, high-density lipoprotein-cholesterol levels increased significantly in the co-supplementation group compared to the other three groups (P < 0.05). Despite the fact that homeostasis model assessment-insulin resistance, total cholesterol, triglyceride and low-density lipoprotein-cholesterol levels decreased after intervention in the co-supplementation group, there was no significant difference between the groups in these outcomes. CONCLUSION Vitamin D and omega-3 co-supplementation improved fasting serum glucose, insulin, high-density lipoprotein-cholesterol level, homeostasis model assessment-beta cell function, weight and waist circumference in women of reproductive age with prediabetes and hypovitaminosis D. This co-supplementation can therefore be recommended for glycemic control in these women.Trial registration Iranian Registry of Clinical Trials Code: IRCT20100130003226N17. Registered on 9 Feb. 2019.
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Affiliation(s)
- Masoumeh Rajabi-Naeeni
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahrokh Dolatian
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Abbas Vaezi
- Department of Internal Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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