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Parikh RV, Nau CL, Tan TC, Tucher E, Vallejo JD, Jimenez JJ, Horiuchi KM, Allen AR, Stehr P, Alexeeff SE, Han B, Lo JC, Mozaffarian D, Go AS, Grant RW. Rationale and design of the KP ENRICH trial: A food is medicine intervention in low-income high-risk adults with diabetes within Kaiser Permanente. Contemp Clin Trials 2024; 143:107601. [PMID: 38851480 DOI: 10.1016/j.cct.2024.107601] [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: 03/04/2024] [Revised: 05/11/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Food insecurity is associated with poor glycemic control and increased risk for diabetes-related complications. The clinical benefit of addressing these challenges through a medically supportive grocery prescription (GRx) program in patients with type 2 diabetes mellitus (T2D) remains unclear. We report the aims and design of a randomized clinical trial to evaluate the effectiveness of a 6-month GRx intervention on hemoglobin A1c (HbA1c) levels among low-income adults with T2D. METHODS The Kaiser Permanente Evaluating Nutritional Interventions in Food-Insecure High-Risk Adults (KP ENRICH) Study is a pragmatic randomized trial enrolling 1100 participants within Kaiser Permanente Northern California and Southern California, two integrated health care delivery systems serving >9 million members. Medicaid-insured adults with T2D and baseline HbA1c ≥7.5% will be randomized at a 1:1 ratio to either GRx, delivered as $100 per month for select items from among a curated list of healthful food groups in an online grocery ordering and home-delivery platform along with biweekly digital nutrition educational materials, or control, consisting of free membership and deliveries from the online grocery platform but without curated food groups or purchasing dollars. The primary outcome is 6-month change in HbA1c. Secondary outcomes include 12-month change in HbA1c, and 6- and 12-month change in medical resource utilization, food security, nutrition security, dietary habits, diabetes-related quality of life, and dietary self-efficacy. CONCLUSIONS The results of this large randomized clinical trial of GRx will help inform future policy and health system-based initiatives to improve food and nutrition security, disease management, and health equity among patients with T2D.
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Affiliation(s)
- Rishi V Parikh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Claudia L Nau
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emma Tucher
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jessica D Vallejo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jennifer J Jimenez
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Kate M Horiuchi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Amanda R Allen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Peter Stehr
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Bing Han
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Joan C Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Dariush Mozaffarian
- Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, USA
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Lee MJ, Seo BJ, Kim YS. Impact of Education as a Social Determinant on the Risk of Type 2 Diabetes Mellitus in Korean Adults. Healthcare (Basel) 2024; 12:1446. [PMID: 39057589 PMCID: PMC11276317 DOI: 10.3390/healthcare12141446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/06/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
Education is correlated with health literacy, which is a combination of reading and listening skills, data analysis, and decision-making during the necessary health situations. This study aims to evaluate the effect of education on the risk of type 2 diabetes mellitus (T2DM). This is a population-based cross-sectional study using the 2019 nationwide survey data in Korea. There were 3951 study subjects, after excluding participants with missing data for key exposures and outcome variables. Descriptive statistics, χ2 (chi-square) test, and logistic regression were performed to analyze the data. The prevalence of T2DM was associated with educational attainment, sex, age, smoking status, physical activity, carbohydrate intake, and obesity. In the logistic regression model, the odds ratio (OR) of having T2DM was much lower among people educated in college or higher (OR = 0.49, 95% confidence interval [95% CI] = 0.34-0.64) than those with only or without primary education after adjusting for biological factors (sex, age) and health behaviors (smoking status, physical activity, carbohydrate intake, and obesity). This study shows that educational attainment is a significant social determinant influencing health outcomes both directly and indirectly. Therefore, it is necessary to develop policies to reduce the health inequity of T2DM caused by differences in educational attainment.
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Affiliation(s)
- Mi-Joon Lee
- Department of Medical Information, Kongju National University, 56 Gongjudaehak-ro, Gongju-si 32588, Republic of Korea;
| | - Bum-Jeun Seo
- Department of Medical Information, Kongju National University, 56 Gongjudaehak-ro, Gongju-si 32588, Republic of Korea;
| | - Yeon-Sook Kim
- Department of Nursing, California State University San Bernardino, San Bernardino, CA 92407, USA;
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Lopez J, Liu Y, Butler J, Del Prato S, Ezekowitz JA, Lam CSP, Marwick TH, Rosenstock J, Tang WHW, Perfetti R, Urbinati A, Zannad F, Januzzi JL, Ibrahim NE. Racial Differences in Diabetic Cardiomyopathy: The ARISE-HF Trial. J Am Coll Cardiol 2024; 84:233-243. [PMID: 38986667 DOI: 10.1016/j.jacc.2024.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Diabetic cardiomyopathy (DbCM) increases risk of overt heart failure in individuals with diabetes mellitus. Racial and ethnic differences in DbCM remain unexplored. OBJECTIVES The authors sought to identify racial and ethnic differences among individuals with type 2 diabetes mellitus, structural heart disease, and impaired exercise capacity. METHODS The ARISE-HF (Aldolase Reductase Inhibitor for Stabilization of Exercise Capacity in Heart Failure) trial is assessing the efficacy of an aldose reductase inhibitor for exercise capacity preservation in 691 persons with DbCM. Baseline characteristics, echocardiographic parameters, and functional capacity were analyzed and stratified by race and ethnicity. RESULTS The mean age of the study participants was 67.4 years; 50% were women. Black and Hispanic patients had lower use of diabetes mellitus treatments. Black patients had poorer baseline ventricular function and more impaired global longitudinal strain. Overall, health status was preserved, based on Kansas City Cardiomyopathy Questionnaire scores, but reduced exercise capacity was present as evidenced by reduced Physical Activity Scale for the Elderly (PASE) scores. When stratified by race and ethnicity and compared with the entire cohort, Black patients had poorer health status, more reduced physical activity, and a greater impairment in exercise capacity during cardiopulmonary exercise testing, whereas Hispanic patients also displayed compromised cardiopulmonary exercise testing functional capacity. White patients demonstrated higher physical activity and functional capacity. CONCLUSIONS Racial and ethnic differences exist in baseline characteristics of persons affected by DbCM, with Black and Hispanic study participants demonstrating higher risk features. These insights inform the need to address differences in the population with DbCM. (Safety and Efficacy of AT-001 in Patients With Diabetic Cardiomyopathy [ARISE-HF]; NCT04083339).
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Affiliation(s)
- Jose Lopez
- Division of Cardiovascular Disease, University of Miami Miller School of Medicine, JFK Hospital, Lantana, Florida, USA
| | - Yuxi Liu
- Division of Cardiology, Massachusetts General Hospital, Baim Institute for Clinical Research, Harvard Medical School, Boston, Massachusetts, USA
| | - Javed Butler
- University of Mississippi Medical Center, Jackson, Mississippi, USA; Baylor Scott and White Institute, Dallas, Texas, USA
| | - Stefano Del Prato
- Department of Clinical & Experimental Medicine, Section of Diabetes, University of Pisa, Pisa, Italy
| | - Justin A Ezekowitz
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - W H Wilson Tang
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Faiez Zannad
- Université de Lorraine, Inserm CIC and CHRU, Nancy, France
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Baim Institute for Clinical Research, Harvard Medical School, Boston, Massachusetts, USA
| | - Nasrien E Ibrahim
- Division of Cardiology, Brigham's and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Gonzalgo MR, Nackeeran S, Mouzannar A, Blachman-Braun R. Socioeconomic differences associated with consumption of a plant-based diet: Results from the national health and nutrition examination survey. Nutr Health 2024; 30:253-259. [PMID: 35730206 DOI: 10.1177/02601060221109669] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND A plant-based diet (PBD) has been associated with potential health benefits, but factors that may affect access to and consumption of a PBD are not well defined. AIM To determine the association between socioeconomic status and plant-based dietary consumption among participants enrolled in the National Health and Nutrition Examination Survey (NHANES). METHODS This was a cross-sectional study using data obtained from the NHANES database. The following covariates were assessed: age, sex, race/ethnicity, educational level, marital status, smoking status, physical activity, alcohol use, history of diabetes, and hypertension. Socioeconomic status was categorized according to poverty-income ratio (PIR). Food frequency questionnaires were used to calculate previously validated plant-based diet index (PDI) and healthful plant-based diet index (hPDI). Multivariable-adjusted logistic regression was performed to determine the association between PIR, clinical, demographic, and plant-based diet indices. RESULTS A total of 5037 participants were in the final analytic sample. Median age of participants was 51 ± 18.5 years. Overall PDI and hPDI were 50 [46-54] and 52 [47-57], respectively. Median PDI index was significantly different among PIR groups (PDI, p = 0.018; hPDI, p < 0.001). On multivariable analysis, participants in the poorest socioeconomic group (PIR ≤ 130%) were more likely to have lower consumption of a healthful PBD (hPDI). CONCLUSION Lower socioeconomic status (PIR ≤ 130%) was associated with decreased consumption of a healthful plant-based diet. These data suggest that socioeconomic disparities may limit consumption of healthier food and contribute to the high prevalence of adverse health conditions that exist in certain population groups.
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Affiliation(s)
- Mia R Gonzalgo
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sirpi Nackeeran
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ali Mouzannar
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ruben Blachman-Braun
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Presley CA, Khodneva Y, Howell CR, Riggs KR, Huang L, Levitan EB, Cherrington AL. Patient-level factors associated with hemoglobin A1C testing in Alabama Medicaid beneficiaries with diabetes. Prim Care Diabetes 2023; 17:612-618. [PMID: 37858401 PMCID: PMC10841383 DOI: 10.1016/j.pcd.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023]
Abstract
AIM We evaluated patient-level factors associated with receipt of hemoglobin A1c (HbA1c) testing among Alabama Medicaid beneficiaries with type 2 diabetes. METHODS We conducted a retrospective analysis of person-year observations from Medicaid claims data from 2011 to 2020. Adults aged 19-64 years with type 2 diabetes and continuous enrollment in Medicaid for study year and year prior were included. Primary outcomes were ≥ 1 and ≥ 2 HbA1c test(s) per year. We conducted multivariable Poisson regression stratified by Medicaid eligibility reason (disability, poverty) examining the association of study year, demographics, clinical factors, and healthcare utilization with HbA1c testing. RESULTS We analyzed 288,379 observations, 51% with disability-based, 49% poverty-based eligibility. Overall, 57% observations had ≥ 1 HbA1c, 35% had ≥ 2 HbA1c tests. More observations with disability-based than poverty-based eligibility had ≥ 1 (76% vs. 38%) and ≥ 2 HbA1c tests (49% vs. 20%). Patient-level factors were associated with a higher likelihood of having ≥ 1 HbA1c: Black race and older age (disability-based eligibility); year after 2011, female sex, and younger age (poverty-based eligibility); and rurality, insulin use, endocrinology care, diabetes complications, and ambulatory care visits (both groups). CONCLUSIONS Just over one-third of adult Alabama Medicaid beneficiaries with diabetes had ≥ 2 HbA1c tests per year; testing frequency differed by Medicaid eligibility.
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Affiliation(s)
- Caroline A Presley
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States.
| | - Yulia Khodneva
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Carrie R Howell
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Kevin R Riggs
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Lei Huang
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andrea L Cherrington
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
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Kollányi Z, Bálint L, Susovits K, Csépe P, Kovács K. Inequalities in Diabetes Mortality Between Microregions in Hungary. Int J Public Health 2023; 68:1606161. [PMID: 38024213 PMCID: PMC10643225 DOI: 10.3389/ijph.2023.1606161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives: Regional differences in diabetes mortality are high in Hungary. In our cross-sectional study, we aim to reveal the drivers of the inequalities in diabetes mortality across the 197 microregions of Hungary. To account for the influence of changes in healthcare and social conditions, we compared two periods (2009-12 and 2013-16). Methods: Traditional and re-conceptualized deprivation- and healthcare provison measures were used in OLS regression models. Results: Microregions with a high proportion of population living in "service deserts," especially in regard to the lack of grocery stores, suffer the highest rates of diabetes mortality. Alcohol-related mortality has been proven to be a similarly and surprisingly strong predictor of diabetes mortality. Conclusion: Food provision should be supported in areas characterized by low service density, and alcohol policy should be strengthened and targeted.
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Affiliation(s)
- Zsófia Kollányi
- Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Lajos Bálint
- Hungarian Demographic Research Institute (HDRI), Budapest, Hungary
- Department of Sociology, Faculty of Humanities and Social Sciences, University of Pécs, Pécs, Hungary
| | - Kitti Susovits
- National Institute of Pharmacy and Nutrition (Hungary), Budapest, Hungary
| | - Péter Csépe
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Katalin Kovács
- Hungarian Demographic Research Institute (HDRI), Budapest, Hungary
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Ye Q, Wang Z, Deng T, Lou Q, Wu H, Tang W, Xu F. Association of socioeconomic status with metabolic syndrome and its components among adult population: a community-based cross-sectional study in Nanjing Municipality of China. BMJ Open 2023; 13:e074059. [PMID: 37844993 PMCID: PMC10582845 DOI: 10.1136/bmjopen-2023-074059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVES To investigate the association of metabolic syndrome (MetS) and its components with socioeconomic status (SES) among general and gender-specific adult population in Nanjing municipality, China. DESIGN Cross-sectional study. PARTICIPANTS 13287 participants completed the survey. A participant: (1) must be a local registered resident, (2) aged 18+ years, (3) had no literal or physical/mental problems and (4) was not pregnant. STUDY MEASURES MetS was the outcome variable, which was defined based on the diagnostic criteria released by the Chinese Diabetes Society. SES was the main explanatory measure, which was indicated with educational attainment and family average income (FAI), separately. RESULTS The prevalence of MetS was 19.7% (95% CI=19.0% to 20.4%) among overall participants, and 24.6% (95% CI=23.5% to 25.6%) and 15.5% (95% CI=14.7% to 16.4%) for men and women, respectively. After controlling for potential confounders, participants with either college level (OR=0.51, 95% CI=0.43 to 0.60) or high school level education (OR=0.78, 95% CI=0.70 to 0.90) were at lower odds to experience MetS compared with those with primary education, while only those within upper FAI tertile were at significantly lower risk of MetS relative to their counterparts within lower FAI category (OR=0.85, 95% CI=0.76 to 0.97) among overall participants. Meanwhile, with respect to the five components of MetS, higher educational level predicted lower waist circumference (WC), triglycerides, systolic blood pressure (SBP) and diastolic blood pressure (DBP) and fasting glucose concentration among all participants. And higher FAI was associated with lower WC and SBP and DBP in women, and with lower SBP and DBP in men. CONCLUSIONS Education and FAI each were inversely associated with MetS and its components at the present stage of economic development in Nanjing Municipality of China. It has important public health implications that the tailored prevention strategies for MetS should be put into consideration of the intervention of MetS components and subgroups of people with different SES.
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Affiliation(s)
- Qing Ye
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, China
- Dept. of Epidemiology, Nanjing Medical University School of Public Health, Nanjing, Jiangsu, China
| | - Zhenglin Wang
- Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Tianrui Deng
- Dept. of Epidemiology, Nanjing Medical University School of Public Health, Nanjing, Jiangsu, China
| | - Qinglin Lou
- Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Haidi Wu
- Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Wei Tang
- Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Fei Xu
- Dept. of Epidemiology, Nanjing Medical University School of Public Health, Nanjing, Jiangsu, China
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, China
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Sidahmed S, Geyer S, Beller J. Socioeconomic inequalities in diabetes prevalence: the case of Egypt between 2008 and 2015. BMC Public Health 2023; 23:1669. [PMID: 37648975 PMCID: PMC10469408 DOI: 10.1186/s12889-023-16606-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 08/24/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND There is a steady increase in diabetes prevalence globally and many studies imply that high socioeconomic status (SES) is inversely related to diabetes prevalence. However, there is scarcity in literature from countries like Egypt regarding this topic. METHODS This study aims to investigate prevalence of diabetes in Egypt between 2008 and 2015, and the effect of SES. Diabetes prevalence -based on self-reports of past diagnosis- was measured using two datasets Egypt DHS 2008 (10,917 participants) and EHIS 2015 (16,485 participants). Logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) were applied for diabetes controlling for age, gender, educational level, employment status and place of residence. Extend of difference in diabetes prevalence between the two time points was measured by combining the two datasets using the EDHS 2008 as reference. RESULTS Diabetes prevalence was higher in 2015 (4.83%) compared to 2008 (3.48%). It was more in women at both time points (4.08% and 5.16% in 2008 and 2015 respectively) compared to men (2.80% and 4.43% in 2008 and 2015 respectively). Older age and living in urban areas were positively related to diabetes prevalence at both time points. Men had a significant higher chance of developing diabetes in 2015 (OR = 1.45, p-value = 0.001). Men with higher education had higher chance of developing diabetes (OR = 1.76), in contrast to women (OR = 0.59). Employment decreased the chance of developing diabetes for men (OR = .72), but had minimal effect on women (OR = 1.06). CONCLUSION Diabetes prevalence in Egypt has increased between the years 2008 and 2015 and evident social inequalities were found. Women had more diabetes than men and were more affected with low SES. Unlike women, highly educated men had higher chance of developing diabetes in 2015 compared to 2008. This might be attributed to behavioral and sociocultural factors.
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Affiliation(s)
- Sahar Sidahmed
- Hannover Medical School, Medical Sociology Unit, Carl-Neuberg-Str. 1, Hannover, 30625, Germany.
| | - Siegfried Geyer
- Hannover Medical School, Medical Sociology Unit, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
| | - Johannes Beller
- Hannover Medical School, Medical Sociology Unit, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
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Francis M, Lindrose A, O'Connell S, Tristano RI, McGarvey C, Drury S. The interaction of socioeconomic stress and race on telomere length in children: A systematic review and meta-analysis. SSM Popul Health 2023; 22:101380. [PMID: 37065841 PMCID: PMC10102414 DOI: 10.1016/j.ssmph.2023.101380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
Rationale Proposed mechanisms relating early life exposures to poor health suggest that biologic indicators of risk are observable in childhood. Telomere length (TL) is a biomarker of aging, psychosocial stress, and a range of environmental exposures. In adults, exposure to early life adversity, including low socioeconomic status (SES), is predictive of shorter TL. However, results in pediatric populations have been mixed. Defining the true relation between TL and SES in childhood is expected to enhance the understanding of the biological pathways through which socioeconomic factors influence health across the life span. Objective The aim of this meta-analysis was to systematically review and quantitatively assess the published literature to better understand how SES, race, and TL are related in pediatric populations. Methods Studies in the United States in any pediatric population with any measure of SES were included and identified through the following electronic databases: PubMed, EMBASE, Web of Science, Medline, Socindex, CINAHL, and Psychinfo. Analysis utilized a multi-level random-effects meta-analysis accounting for multiple effect sizes within a study. Results Thirty-two studies were included with a total of 78 effect sizes that were categorized into income-based, education-based, and composite indicators. Only three studies directly tested the relation between SES and TL as the primary study aim. In the full model, there was a significant relation between SES and TL (r = 0.0220 p = 0.0286). Analysis by type of SES categorization identified a significant moderating effect of income on TL (r = 0.0480, 95% CI: 0.0155 to 0.0802, p = 0.0045) but no significant effect for education or composite SES. Conclusions There is an overall association between SES and TL that is predominately due to the association with income-based SES measures implicating income disparities as a key target for efforts to address health inequity across the life span. Identification of associations between family income and biological changes in children that predict life-span health risk provides key data to support public health policies addressing economic inequality in families and presents a unique opportunity to assess the effect of prevention efforts at the biologic level.
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Affiliation(s)
- Mariza Francis
- Neuroscience Program, Tulane Brain Institute and School of Science and Engineering, Tulane University, 6823 St. Charles Ave., New Orleans, LA, USA
| | - Alyssa Lindrose
- Department of Psychiatry and Behavioral Science, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Samantha O'Connell
- Office of Academic Affairs and Provost, Tulane University, New Orleans, LA, USA
| | - Renee I. Tristano
- Department of Pediatrics, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Cecile McGarvey
- Neuroscience Program, Tulane Brain Institute and School of Science and Engineering, Tulane University, 6823 St. Charles Ave., New Orleans, LA, USA
| | - Stacy Drury
- Department of Psychiatry and Behavioral Science, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
- Department of Pediatrics, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
- Neuroscience Program, Tulane Brain Institute and School of Science and Engineering, Tulane University, 6823 St. Charles Ave., New Orleans, LA, USA
- Corresponding author. Department of Psychiatry and Behavioral Science, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
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Hazarika CR, Babu BV. Prevalence of diabetes mellitus in Indian tribal population: a systematic review and meta-analysis. ETHNICITY & HEALTH 2023; 28:544-561. [PMID: 35469488 DOI: 10.1080/13557858.2022.2067836] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Diabetes mellitus (DM), a significant public health problem across the nations, is among the top ten leading causes of death. More than 370 million indigenous people (referred to as tribal people in India) are spread across 90 countries. India has the largest tribal people of 104 million. Tribal populations are not exceptional to the threat of type 2 DM (T2DM) and other non-communicable diseases, and hence, public health programmes are addressing this problem. This paper reports the systematic review and meta-analysis of the literature on the prevalence of T2DM. METHODS We conducted a systematic review and meta-analysis of the literature to understand the prevalence of T2DM among the tribal populations of India, following the guidelines of the PRISMA Statement for Reporting Systematic Reviews and Meta-Analysis. The gender-wise prevalence was recalculated by extracting the data wherever possible. Forest plots were depicted based on the prevalence, and other analyses were performed. RESULTS On initial searches from three databases, 5422 citations were identified, and ultimately 27 studies were included in the review. These studies were undertaken amongst different tribes in different parts of India. The pooled prevalence of T2DM among men, women and combined were 6.04% (95% confidence interval (CI): 5.55% to 6.57%), 6.48% (95% CI: 6.01% to 6.99%) and 4.94% (95% CI: 4.72% to 5.17%), respectively. Considerable heterogeneity was found among these studies. CONCLUSION This systematic review provides an overview of the prevalence of T2DM among the Indian tribal population. The pooled overall prevalence is slightly lower than the general population. This situation is worrisome as the epidemic of T2DM will affect the poor tribal communities, who can least afford to bear the health care costs. Hence, the public health care services must be strengthened in all tribal areas. This review further warrants establishing surveillance of T2DM in tribal areas.
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Affiliation(s)
- Chaya R Hazarika
- Socio-Behavioral & Health Systems Research Division, Indian Council of Medical Research, New Delhi, India
| | - Bontha V Babu
- Socio-Behavioral & Health Systems Research Division, Indian Council of Medical Research, New Delhi, India
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Hopper W, Ruane P, DiMucci-Ward J, Ables AZ. A Multidisciplinary Quality Improvement Program to Improve Diabetes Care at a Free Clinic. Cureus 2023; 15:e36745. [PMID: 37123722 PMCID: PMC10132326 DOI: 10.7759/cureus.36745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness of an intensive, multidisciplinary patient-centered approach involving a pharmacist and a dietician in a population of uninsured free clinic patients with diabetes and hypertension. METHODS A single-center retrospective chart review of a quality improvement project. All patients had diagnoses of diabetes and hypertension and a most recent hemoglobin A1c ≥ 9.0%. Patients met individually with a pharmacist and a dietician during 6 encounters over 12 months. The pharmacist made medication changes, encouraged lifestyle reflections, and helped patients create and track self-management goals. The dietician helped patients plan strategies for diet and exercise. The primary outcome was a change in mean hemoglobin A1c. RESULTS Of 30 enrolled patients, 17 completed three months of treatment, and seven completed 12 months. The 17 patients who completed three months of treatment had the following characteristics: mean age 55.5 years; mean hemoglobin A1c 11.5%; 82% were taking two or more antidiabetic medications; 59% were taking two or more antihypertensive medications. Significant reductions in mean hemoglobin A1c values were observed at three months (-3.4%, P<0.0001) and twelve months (-4.0%, P=0.0156). Reductions in systolic blood pressure were also observed at three months (-6 mmHg, P=0.1060) and twelve months (-17 mmHg, P=0.2188). CONCLUSIONS Large and significant hemoglobin A1c reductions were observed in free clinic patients with diabetes refractory to traditional medical management. Goal-oriented patient empowerment effectively improves a wide range of patient outcomes in the free clinic setting. Other free clinics can implement this collaborative, multidisciplinary model with access to similar personnel.
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Khatun MM, Rahman M, Islam MJ, Haque SE, Adam IF, Chau Duc NH, Sarkar P, Haque MN, Islam MR. Socio-economic inequalities in undiagnosed, untreated, and uncontrolled diabetes mellitus in Bangladesh: is there a gender difference? Public Health 2023; 218:1-11. [PMID: 36933353 DOI: 10.1016/j.puhe.2023.01.035] [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: 06/08/2022] [Revised: 11/13/2022] [Accepted: 01/31/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES We aimed to determine: (1) the prevalence and socio-economic distribution of undiagnosed, untreated, and uncontrolled diabetes mellitus (DM); (2) the relationship between socio-economic status (SES) and undiagnosed, untreated, and uncontrolled DM; and (3) if this relationship is mediated by gender. STUDY DESIGN Cross-sectional nationally representative household-based survey. METHODS We used data from the Bangladesh Demographic Health Survey from 2017 to 18. Our findings were based on the responses of 12,144 individuals aged 18 years and older. As a measure of SES, we focused on standard of living (hereinafter referred to as wealth). The study's outcome variables were prevalence of total (diagnosed + undiagnosed), undiagnosed, untreated, and uncontrolled DM. We used three regression-based approaches-adjusted odds ratio, relative inequality index, and slope inequality index-to assess different aspects of SES differences in the prevalence of total, undiagnosed, untreated, and uncontrolled DM. We used logistic regression analysis to look at the adjusted association between SES and the outcomes after gender stratification to see whether gender status moderates the association between SES and the targeted outcomes. RESULTS In our sample analysis, the age-adjusted prevalence of total, undiagnosed, untreated, and uncontrolled DM was 9.1%, 61.4%, 64.7%, and 72.1%, respectively. Females had a higher prevalence of DM and undiagnosed, untreated, and uncontrolled DM than males. When compared to people in the poor SES group, people in the rich and middle SES groups had 2.60 times (95% confidence interval [CI] 2.05-3.29) and 1.47 times (95% CI 1.18-1.83) higher chance of developing DM. When compared to individuals in the poor SES group, those in the rich SES groups were 0.50 (95% CI 0.33-0.77) and 0.55 times (95% CI 0.36-0.85) less likely to have undiagnosed and untreated DM. CONCLUSIONS In Bangladesh, rich SES groups were more likely than poor SES groups to have DM, whereas poor SES groups with DM were less likely than rich SES groups to be aware of their disease and obtain treatment. The government and other concerned parties are urged by this study to pay more attention to developing suitable policy measures to reduce the risk of DM, particularly among rich SES groups, as well as targeted efforts to screen for and diagnose DM in socio-economically disadvantaged groups.
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Affiliation(s)
- M M Khatun
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi 6205, Bangladesh
| | - M Rahman
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi 6205, Bangladesh.
| | - M J Islam
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD 4122, Australia
| | - S E Haque
- Uchicago Research Bangladesh, Bangladesh
| | - I F Adam
- Faculty of Public Health, University of Khartoum, Sudan
| | - N H Chau Duc
- Hue University of Medicine and Pharmacy, Hue University, Viet nam
| | - P Sarkar
- Dr. Wazed Research and Training Institute, Begum Rokeya University, Rangpur, Bangladesh
| | - M N Haque
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi 6205, Bangladesh
| | - M R Islam
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi 6205, Bangladesh
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Risk of developing type 2 diabetes according to FINDRISC and socioeconomic status. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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De Souza LR, Chan KT, Kobayashi K, Karasiuk A, Fuller-Thomson E. The prevalence and management of diabetes among Vietnamese Americans: A population-based survey of an understudied ethnic group. Chronic Illn 2022; 18:306-319. [PMID: 33054356 DOI: 10.1177/1742395320959422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Although obesity remains relatively rare among Vietnamese Americans, the prevalence of diabetes has increased in this population. This study aims to: 1. Estimate the prevalence of diabetes among non-obese Vietnamese American adults compared to non-obese non-Hispanic whites (NHW). 2. Identify factors associated with diabetes among non-obese Vietnamese Americans. 3. Examine whether Vietnamese Americans and NHW with diabetes are equally as likely to receive optimal frequency of diabetes care (i.e., hemoglobin A1C monitoring, foot care, eye care). METHODS We conducted a secondary analysis of non-obese adult Vietnamese Americans using pooled data from the 2007, 2009, 2011 and 2013-2016 waves of the California Health Interview Survey (CHIS). RESULTS Only 9% of Vietnamese Americans with diabetes are obese. Non-obese Vietnamese Americans have 60% higher adjusted odds of diabetes compared to non-obese NHW. Among non-obese Vietnamese Americans, those who were older, ever smokers and born outside US had a higher prevalence of diabetes. We found both Vietnamese Americans and NHW with diabetes received similar levels of care. DISCUSSION Non-obese Vietnamese Americans have much higher odds of diabetes than NHW. Health professionals can effectively minimize disparities between Vietnamese Americans and NHW with diabetes through appropriate monitoring of foot care, eye care and A1C levels.
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Affiliation(s)
- Leanne R De Souza
- Institute for Life Course and Aging, University of Toronto, Toronto, Canada
| | - Keith T Chan
- School of Social Welfare, University at Albany, Albany, USA
| | - Karen Kobayashi
- Department of Sociology, University of Victoria, Victoria, Canada
| | - Alexis Karasiuk
- Institute for Life Course and Aging, University of Toronto, Toronto, Canada
| | - Esme Fuller-Thomson
- Institute for Life Course and Aging, University of Toronto, Toronto, Canada.,Factor-Inwentash Faculty of Social Work and Department of Family & Community Medicine, University of Toronto, Toronto, Canada
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15
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Cornely RM, Subramanya V, Owen A, McGee RE, Kulshreshtha A. A mixed-methods approach to understanding the perspectives, experiences, and attitudes of a culturally tailored cognitive behavioral therapy/motivational interviewing intervention for African American patients with type 2 diabetes: a randomized parallel design pilot study. Pilot Feasibility Stud 2022; 8:107. [PMID: 35597972 PMCID: PMC9123732 DOI: 10.1186/s40814-022-01066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/06/2022] [Indexed: 11/12/2022] Open
Abstract
Background African American (AA) adults are 60% more likely to be diagnosed with diabetes mellitus (DM) and experience more complications than non-Hispanic White adults. Cognitive behavioral therapy (CBT) has shown to be an effective modality for helping patients improve health behaviors and regulate emotional states. Motivational interviewing (MI) addresses participant engagement and motivation. Therefore, MI was combined with CBT as an approach to the process of learning using CBT skills to promote healthy lifestyle choices. We aimed to assess the effects of a culturally tailored CBT/MI intervention on glycemic control in AA participants and understand their perspectives, attitudes, and experiences while participating in this intervention. Methods Using a randomized, parallel design pilot study (web-based group vs in-person group), 20 participants aged ≥ 18 years, identifying as AA and having a glycosylated hemoglobin (HbA1c) > 8%, were recruited. A CBT/MI intervention was administered in six sessions over 3 months. Participants completed baseline and follow-up assessments on measures for diabetes control (HbA1c), self-efficacy, generalized anxiety, depression, perceived stress, health-related quality of life, and cognitive ability. Post-CBT/MI intervention focus groups were conducted to determine patient perspectives regarding the intervention. Results Fourteen participants completed the study, their mean HbA1c improved from 10.0 to 8.9% (t(26) = 0.5, p-value = 0.06). The Diabetes Distress Scale demonstrated decreased distress overall (t(26) = 2.6; p-value = 0.02). The Generalized Anxiety Disorder Scale demonstrated decreased generalized anxiety for all participants (t(26) = 2.2; p = 0.04). Themes identified in focus groups included (1) intervention group social support through information sharing, (2) mental health and personal identities in diabetes understanding and management, and (3) receptivity to CBT/MI intervention positively impacts self-efficacy through improved health literacy. Conclusion This group-based, culturally tailored CBT/MI intervention for type 2 DM care was positively received by AA participants and helped improve diabetes control, as demonstrated by the change in HbA1c. There were additional benefits of social support through group interactions and a stronger sense of self-efficacy due to health education. A comprehensive treatment plan using a CBT/MI intervention may be useful in promoting healthy diabetes self-management. Trial registration ClinicalTrials.gov, NCT03562767. Registered on 19 June 2018
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Affiliation(s)
- Ronald M Cornely
- Behavioral, Social, & Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Vinita Subramanya
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ashley Owen
- Department of Family and Preventive Medicine, Emory University School of Medicine, 4500 North Shallowford Rd
- Suite 134, Atlanta, GA, 30338, USA
| | - Robin E McGee
- Behavioral, Social, & Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ambar Kulshreshtha
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. .,Department of Family and Preventive Medicine, Emory University School of Medicine, 4500 North Shallowford Rd
- Suite 134, Atlanta, GA, 30338, USA.
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Bavuma CM, Niyibizi JB, Bitunguhari L, Musafiri S, McQuillan R, Wild S. Prevalence and characteristics associated with diabetes mellitus and impaired fasting glucose among people aged 15 to 64 years in rural and urban Rwanda: secondary data analysis of World Health Organization surveillance data. Pan Afr Med J 2022; 41:115. [PMID: 35465373 PMCID: PMC8994463 DOI: 10.11604/pamj.2022.41.115.30682] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/19/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction diabetes mellitus is an increasing public health burden in developing countries. The magnitude of diabetes association with traditional risk factors for diabetes have been given less attention in rural population. This study aims to determine the prevalence of diabetes and impaired fasting glucose and to assess associated characteristics to hyperglycemia in rural and urban Rwanda. Methods this is a secondary analysis of data from a population-based cross-sectional study of 7240 people describing risk factors for non-communicable diseases using the WHO stepwise methods (STEPS). Relative frequencies of variables of interest were compared in rural and urban residence using Pearson chi-square tests. Diabetes and impaired fasting glucose were combined in a single hyperglycemia variable and odds ratios with 95% confidence intervals were used to explore associations between hyperglycemia, socio-demographic and health factors in urban and rural populations. Results the prevalence in rural and urban areas was 7.5% and 9.7% (p.005) for diabetes and 5.0% and 6.2% for impaired fasting glucose (p.079) respectively. Obesity (AOR 2.57: CI: 0.86-7.9), high total cholesterol (AOR 3.83: CI: 2.03-7.208), hypertension (AOR 1.18: CI: 0.69-2.00), increasing age were associated with hyperglycemia in urban participants but only high total cholesterol and low high density lipoproteins (HDL) cholesterol were risk factors for hyperglycemia in rural participants. Conclusion approximately one in six people in Rwanda have hyperglycemia. The magnitude of the association with traditional risk factors for diabetes differ in rural and urban settings. Different approaches to primary and secondary prevention of diabetes may be needed in rural populations.
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Affiliation(s)
- Charlotte Munganyinka Bavuma
- Kigali University Teaching Hospital, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Berchmans Niyibizi
- Single Project Implementation Unit, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Leopold Bitunguhari
- Kigali University Teaching Hospital, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Sanctus Musafiri
- Kigali University Teaching Hospital, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Ruth McQuillan
- Usher Institute, University of Edinburgh, Scotland, United Kingdom
| | - Sarah Wild
- Usher Institute, University of Edinburgh, Scotland, United Kingdom
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Vipin VA, Blesson CS, Yallampalli C. Maternal low protein diet and fetal programming of lean type 2 diabetes. World J Diabetes 2022; 13:185-202. [PMID: 35432755 PMCID: PMC8984567 DOI: 10.4239/wjd.v13.i3.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/30/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
Maternal nutrition is found to be the key factor that determines fetal health in utero and metabolic health during adulthood. Metabolic diseases have been primarily attributed to impaired maternal nutrition during pregnancy, and impaired nutrition has been an immense issue across the globe. In recent years, type 2 diabetes (T2D) has reached epidemic proportion and is a severe public health problem in many countries. Although plenty of research has already been conducted to tackle T2D which is associated with obesity, little is known regarding the etiology and pathophysiology of lean T2D, a variant of T2D. Recent studies have focused on the effects of epigenetic variation on the contribution of in utero origins of lean T2D, although other mechanisms might also contribute to the pathology. Observational studies in humans and experiments in animals strongly suggest an association between maternal low protein diet and lean T2D phenotype. In addition, clear sex-specific disease prevalence was observed in different studies. Consequently, more research is essential for the understanding of the etiology and pathophysiology of lean T2D, which might help to develop better disease prevention and treatment strategies. This review examines the role of protein insufficiency in the maternal diet as the central driver of the developmental programming of lean T2D.
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Affiliation(s)
- Vidyadharan Alukkal Vipin
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Chellakkan Selvanesan Blesson
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, United States
- Family Fertility Center, Texas Children's Hospital, Houston, TX 77030, United States
| | - Chandra Yallampalli
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, United States
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Impact of Income and Industry on New-Onset Diabetes among Employees: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031090. [PMID: 35162114 PMCID: PMC8834605 DOI: 10.3390/ijerph19031090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 12/04/2022]
Abstract
The purpose of this study was to investigate the impact of income and industry type on the risk of developing diabetes among Japanese workers, including how this impact is affected by sex. A total of 24,516 employees at small- and medium-sized enterprises in Japan aged 40–74 years who underwent health examinations in fiscal years 2010–2015 were included in this retrospective cohort study. Generalized linear regression models were used to assess the association between new-onset diabetes and income and industry. In men, the cumulative incidence rate was significantly higher in the low-income group; it was highest in the transportation and postal service industries. Although income and industry were independent risk factors for developing diabetes in men, an interaction was found between income and industry, which was affected by participants’ sex: in specific industries (i.e., lifestyle-related, personal services, and entertainment services), men had a significantly higher risk of developing diabetes in the high-income group, and women had a significantly higher risk of developing diabetes in the low-income group. These findings highlight important factors to consider in assessing diabetes risk and suggest that efficient primary and secondary prevention should be encouraged in industries where workers have a high risk of diabetes.
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del-Sueldo MA, Mendonça-Rivera MA, Sánchez-Zambrano MB, Zilberman J, Múnera-Echeverri AG, Paniagua M, Campos-Alcántara L, Almonte C, Paix-Gonzales A, Anchique-Santos CV, Coronel CJ, Castillo G, Parra-Machuca MG, Duro I, Varletta P, Delgado P, Volberg VI, Puente-Barragán AC, Rodríguez A, Rotta-Rotta A, Fernández A, Izeta-Gutiérrez AC, Ancona-Vadillo AE, Aquieri A, Corrales A, Simeone A, Rubilar B, Artucio C, Pimentel-Fernández C, Marques-Santos C, Saldarriaga C, Chávez C, Cáceres C, Ibarrola D, Barranco D, Muñoz-Ortiz E, Ruiz-Gastelum ED, Bianco E, Murguía E, Soto E, Rodríguez-Caballero F, Otiniano-Costa F, Valentino G, Rodríguez-Cermeño IB, Rivera IR, Gándara-Ricardo JA, Velásquez-Penagos JA, Torales J, Scavenius K, Dueñas-Criado K, García L, Roballo L, Kazelian LR, Coussirat-Liendo M, Costa-Almeida MC, Drever M, Lujambio M, Castro ML, Rodríguez-Sifuentes M, Acevedo M, Giambruno M, Ramírez M, Gómez N, Gutiérrez-Castillo N, Greatty O, Harwicz P, Notaro P, Falcón R, López R, Montefilpo S, Ramírez-Flores S, Verdugo S, Murguía S, Constantini S, Vieira TC, Michelis V, Serra CM. Clinical practice guideline of the Interamerican Society of Cardiology on primary prevention of cardiovascular disease in women. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2022; 92:1-68. [PMID: 35666723 PMCID: PMC9290436 DOI: 10.24875/acm.22000071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Claudia Almonte
- Sociedad Dominicana de Cardiología, Santo Domingo, República Dominicana
| | | | | | | | | | | | - Ivanna Duro
- Sociedad Uruguaya de Cardiología, Montevideo, Uruguay
| | - Paola Varletta
- Sociedad Chilena de Cardiología y Cirugía Cardiovascular, Santiago, Chile
| | | | | | | | | | | | | | | | | | - Analía Aquieri
- Sociedad Argentina de Cardiología, Buenos Aires, Argentina
| | - Andrea Corrales
- Federación Argentina de Cardiología, Buenos Aires, Argentina
| | | | | | | | | | | | - Clara Saldarriaga
- Sociedad Colombiana de Cardiología y Cirugía Cardiovascular, Medellín, Colombia
| | | | | | | | | | - Edison Muñoz-Ortiz
- Sociedad Colombiana de Cardiología y Cirugía Cardiovascular, Medellín, Colombia
| | | | | | - Elena Murguía
- Sociedad Uruguaya de Cardiología, Montevideo, Uruguay
| | - Enrique Soto
- Sociedad Uruguaya de Cardiología, Montevideo, Uruguay
| | | | | | - Giovanna Valentino
- Sociedad Chilena de Cardiología y Cirugía Cardiovascular, Santiago, Chile
| | | | - Ivan R. Rivera
- Sociedad Brasileña de Cardiología, Río de Janeiro, Brasil
| | | | | | | | | | - Karen Dueñas-Criado
- Sociedad Colombiana de Cardiología y Cirugía Cardiovascular, Medellín, Colombia
| | - Laura García
- Sociedad Paraguaya de Cardiología, Asunción, Paraguay
| | - Laura Roballo
- Sociedad Uruguaya de Cardiología, Montevideo, Uruguay
| | | | | | | | | | | | | | | | - Mónica Acevedo
- Sociedad Chilena de Cardiología y Cirugía Cardiovascular, Santiago, Chile
| | | | - Mónica Ramírez
- Federación Argentina de Cardiología, Buenos Aires, Argentina
| | - Nancy Gómez
- Sociedad Paraguaya de Cardiología, Asunción, Paraguay
| | | | | | - Paola Harwicz
- Sociedad Argentina de Cardiología, Buenos Aires, Argentina
| | | | - Rocío Falcón
- Sociedad Paraguaya de Cardiología, Asunción, Paraguay
| | - Rosario López
- Sociedad Chilena de Cardiología y Cirugía Cardiovascular, Santiago, Chile
| | | | | | | | | | | | | | | | - César M. Serra
- Federación Argentina de Cardiología, Buenos Aires, Argentina
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Risk and outcomes of diabetes in patients with epilepsy. Sci Rep 2021; 11:18888. [PMID: 34556733 PMCID: PMC8460720 DOI: 10.1038/s41598-021-98340-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/06/2021] [Indexed: 01/15/2023] Open
Abstract
The risk and outcomes of diabetes in patients with epilepsy remains unclear. We evaluated these risks using an epilepsy cohort analysis and a diabetes admission analysis. In the epilepsy cohort analysis, we identified 2854 patients with newly diagnosed epilepsy in 2000–2008 from the research data of National Health Insurance in Taiwan. Using Propensity-score matching by sociodemographic factors and medical conditions, we selected 22,832 people without epilepsy as a non-exposed cohort for comparison. Follow-up events of diabetes from January 1, 2000 until December 31, 2013 were ascertained from medical claims. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of diabetes associated with epilepsy were calculated using multiple Cox proportional hazard models. In the diabetes admission analysis, we identified 92,438 hospitalized diabetes patients, 930 of whom had a history of epilepsy. Adjusted odds ratios (ORs) and 95% CIs of adverse events after diabetes associated with previous epilepsy were calculated using multiple logistic regressions. The adjusted HR of diabetes in the cohort with epilepsy was 1.31 (95% CI 1.14–1.50) compared to the non-epilepsy cohort. Previous epilepsy was associated with post-diabetes adverse events, such as pneumonia (OR 1.68, 95% CI 1.37–2.07), urinary tract infection (OR 1.83, 95% CI 1.55–2.16), and septicemia (OR 1.34, 95% CI 1.09–1.65). In conclusion, epilepsy was associated with higher risk of diabetes and adverse post-diabetes outcomes. Diabetes prevention and attention to post-diabetes adverse events are needed for this susceptible population.
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Wang NC, Bagheri M, Olszewski T, Friese KA, Smith HM, Robles ME, Wang C, Brooks A, Bordenstein SR, Ferguson JF, Silver HJ. New-onset vegetarian diet shows differences in fatty acid metabolites in European American and African American women. Nutr Metab Cardiovasc Dis 2021; 31:2436-2448. [PMID: 34176710 PMCID: PMC10317312 DOI: 10.1016/j.numecd.2021.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The type of fat consumed in animal-based western diets, typically rich in the saturated fat palmitate, has been implicated in cardiometabolic disease risk. In contrast, the most abundant mono- and polyunsaturated fats, more typical in a vegetarian or plant-based diet, potentiate less deleterious effects. This study determined differences in plasma and urine metabolites when switching from omnivorous to vegetarian diet, including metabolites involved in fatty acid utilization. METHODS AND RESULTS A prospective cohort of 38 European (EA) and African American (AA) omnivorous females were matched by age (25.7 ± 5.3y) and BMI (22.4 ± 1.9 kg/m2). Pre-intervention samples were collected while subjects consumed habitual animal-based diet. Changes in metabolites were assessed by ultra-high-performance liquid chromatography-tandem mass spectroscopy (Metabolon, Inc.) upon completing four days of novel vegetarian diet provided by the Vanderbilt Metabolic Kitchen. Changes in several diet-derived metabolites were observed, including increases in compounds derived from soy food metabolism along with decreases in metabolites of xanthine and histidine. Significant changes occurred in metabolites of saturated, monounsaturated and polyunsaturated fatty acids along with significant differences between EA and AA women in changes in plasma concentrations of acylcarnitines, which reflect the completeness of fatty acid oxidation (versus storage). CONCLUSION These data suggest improvements in fatty acid metabolism (oxidation vs storage), a key factor in energy homeostasis, may be promoted rapidly by adoption of a vegetarian (plant-based) diet. Mechanistic differences in response to diet interventions must be understood to effectively provide protection against the widespread development of obesity and cardiometabolic disease in population subgroups, such as AA women.
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Affiliation(s)
- Naomi C Wang
- Vanderbilt University Medical Center, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, USA
| | - Minoo Bagheri
- Vanderbilt University Medical Center, Department of Medicine, Division of Cardiology Medicine, USA
| | - Timothy Olszewski
- Vanderbilt University Medical Center, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, USA
| | | | - Holly M Smith
- Vanderbilt University Medical Center, Department of Medicine, Division of Cardiology Medicine, USA
| | - Michelle E Robles
- Vanderbilt University Medical Center, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, USA
| | - Chuan Wang
- Vanderbilt University Medical Center, Department of Medicine, Division of Cardiology Medicine, USA
| | - Andrew Brooks
- Stanford University, School of Medicine, Department of Genetics, USA
| | - Seth R Bordenstein
- Vanderbilt University, College of Arts and Sciences, Department of Biological Sciences, USA
| | - Jane F Ferguson
- Vanderbilt University Medical Center, Department of Medicine, Division of Cardiology Medicine, USA
| | - Heidi J Silver
- Vanderbilt University Medical Center, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, USA; Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, USA.
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Zhang DD, Liu JN, Ye Q, Chen Z, Wu L, Peng XQ, Lu G, Zhou JY, Tao R, Ding Z, Xu F, Zhou L. Association between socioeconomic status and chronic obstructive pulmonary disease in Jiangsu province, China: a population-based study. Chin Med J (Engl) 2021; 134:1552-1560. [PMID: 34250960 PMCID: PMC8280072 DOI: 10.1097/cm9.0000000000001609] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common public health problem worldwide. Recent studies have reported that socioeconomic status (SES) is related to the incidence of COPD. This study aimed to investigate the association between SES and COPD among adults in Jiangsu province, China, and to determine the possible direct and indirect effects of SES on the morbidity of COPD. METHODS A cross-sectional study was conducted among adults aged 40 years and above between May and December of 2015 in Jiangsu province, China. Participants were selected using a multistage sampling approach. COPD, the outcome variable, was diagnosed by physicians based on spirometry, respiratory symptoms, and risk factors. Education, occupation, and monthly family average income (FAI) were used to separately indicate SES as the explanatory variable. Mixed-effects logistic regression models were introduced to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for examining the SES-COPD relationship. A pathway analysis was conducted to further explore the pulmonary function impairment of patients with different SES. RESULTS The mean age of the 2421 participants was 56.63 ± 9.62 years. The prevalence of COPD was 11.8% (95% CI: 10.5%-13.1%) among the overall sample population. After adjustment for age, gender, residence, outdoor and indoor air pollution, body weight status, cigarette smoking, and potential study area-level clustering effects, educational attainment was negatively associated with COPD prevalence in men; white collars were at lower risk (OR: 0.60, 95% CI: 0.43-0.83) of experiencing COPD than blue collars; compared with those within the lower FAI subgroup, participants in the upper (OR: 0.68, 95% CI: 0.49-0.97) tertiles were less likely to experience COPD. Such negative associations between all these three SES indicators and COPD were significant among men only. Education, FAI, and occupation had direct or indirect effects on pulmonary function including post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC), FEV1, FVC, and FEV1 percentage of predicted. Education, FAI, and occupation had indirect effects on pulmonary function indices of all participants mainly through smoking status, indoor air pollution, and outdoor air pollution. We also found that occupation could affect post-bronchodilator FEV1/FVC through body mass index. CONCLUSIONS Education, occupation, and FAI had an adverse relationship with COPD prevalence in Jiangsu province, China. SES has both direct and indirect associations with pulmonary function impairment. SES is of great significance for COPD morbidity. It is important that population-based COPD prevention strategies should be tailored for people with different SES.
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Affiliation(s)
- Dan-Dan Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
- Chronic Airway Disease Research Office, Department of Respiratory Medicine, Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu 210024, China
| | - Jian-Nan Liu
- Department of Respiratory Medicine, Jiangsu Province Geriatric Hospital, Nanjing, Jiangsu 210024, China
| | - Qing Ye
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu 210037, China
| | - Zi Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Ling Wu
- Department of Pharmacy, Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu 210024, China
| | - Xue-Qing Peng
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Gan Lu
- Chronic Airway Disease Research Office, Department of Respiratory Medicine, Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu 210024, China
| | - Jin-Yi Zhou
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu 210009, China
| | - Ran Tao
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu 210009, China
| | - Zhen Ding
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu 210009, China
| | - Fei Xu
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu 210037, China
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Linfu Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
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Jaffiol C, Thomas F, Spira A, Pannier B, Danchin N. Prediabetes and deprivation: A couple at high risk of diabetes. Rev Epidemiol Sante Publique 2021; 69:361-365. [PMID: 34053795 DOI: 10.1016/j.respe.2021.04.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 11/27/2022] Open
Abstract
AIM The higher prevalence of diabetes in deprived populations is well documented but little is known about the risk of diabetes associated with deprivation among pre-diabetic subjects. The aim of the study was to evaluate the risk of diabetes in a population of deprived pre-diabetic patients. METHODS 2743 pre-diabetic subjects identified using the American Diabetes Association (ADA) criteria, 16 to 85 years old, 1656 non-deprived and 1087 deprived, had at least two health check-ups at an interval of 4.95 (2.04) vs 3.20 (1.71) years, P<0.0001, respectively. At the first visit, socioeconomic status was assessed using the EPICES score to differentiate deprived and non-deprived subjects. RESULTS At the second visit, the prevalence of overt diabetes was 9.5% among deprived vs 5.1% in the non-deprived group (P<0.001). After adjustment on confounding factors, deprivation was found independently associated with occurrence of diabetes [1.70 (1.15-2.51), P=0.01]. Beyond social deprivation, Fasting Plasma Glucose and waist circumference were the main independent predictors of new-onset diabetes. CONCLUSION After 4 years of follow-up, among subjects with prediabetes, prevalence of diabetes was twice as high among deprived compared with non-deprived subjects. Deprived populations with pre-diabetes may require specific public health approaches to avoid the occurrence of overt diabetes.
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Affiliation(s)
- C Jaffiol
- National Academy of Medicine, Paris, France
| | - F Thomas
- Research department, The Investigations Préventives et Cliniques (IPC) Center, 6, rue La Perouse, 75116 Paris, France.
| | - A Spira
- National Academy of Medicine, Paris, France
| | - B Pannier
- Research department, The Investigations Préventives et Cliniques (IPC) Center, 6, rue La Perouse, 75116 Paris, France
| | - N Danchin
- Research department, The Investigations Préventives et Cliniques (IPC) Center, 6, rue La Perouse, 75116 Paris, France; University, Paris Descartes, Faculty of Medicine, Paris, France
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He Y, Chiang C, Gebremariam LW, Hirakawa Y, Yatsuya H, Aoyama A. Factors Associated With Prediabetes and Diabetes Among Public Employees in Northern Ethiopia. Asia Pac J Public Health 2020; 33:242-250. [PMID: 33289398 DOI: 10.1177/1010539520974848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The increasing burden of diabetes mellitus is one of the major public health challenges in African countries, including Ethiopia. This is the first study aimed to identify factors associated with prediabetes and diabetes defined by both fasting blood glucose and glycated hemoglobin in Ethiopians. We analyzed data of a cross-sectional survey (1372 adults aged 25-64 years) conducted between October 2015 and February 2016; multinomial logistic regression models were applied. Abdominal obesity, total cholesterol, and non-high-density lipoprotein cholesterol were independently associated with prediabetes and diabetes in both sexes. Increased triglycerides and religious fasting practices were independently associated with prediabetes and diabetes only in men; hypertension was associated with prediabetes and diabetes only in women, while high-density lipoprotein cholesterol was not associated with prediabetes and diabetes in either sex. Sex differences in the association of triglycerides, hypertension, and dietary habit suggest that different approaches of lifestyle modification may be required for men and women.
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Affiliation(s)
| | | | | | | | - Hiroshi Yatsuya
- Nagoya University, Nagoya, Japan.,Fujita Health University, Toyoake, Aichi, Japan
| | - Atsuko Aoyama
- Nagoya University, Nagoya, Japan.,Nagoya University of Arts and Sciences, Nisshin, Aichi, Japan
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25
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Iwundu C, Pang D, Pappas Y. Childhood Maternal School Leaving Age (Level of Education) and Risk Markers of Metabolic Syndrome in Mid-Adulthood: Results from the 1958 British Birth Cohort. Diabetes Metab Syndr Obes 2020; 13:3761-3771. [PMID: 33116725 PMCID: PMC7573814 DOI: 10.2147/dmso.s263332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the relationship between childhood maternal level of education (CMLE) and changes in anthropometric and laboratory risk markers of metabolic syndrome (MetS) in mid-adulthood using results from the 1958 British Birth Cohort Study. DESIGN Cohort study. PARTICIPANTS A total of 9376 study samples consisting of subjects that participated in the biomedical survey of the national child development study (NCDS) carried out between 2002 and 2004 were used for the analysis. MAIN OUTCOME MEASURES Five risk markers of MetS: (i) HDL-cholesterol (ii) triglyceride (iii) blood pressure (BP) including systolic (SBP) and diastolic (DBP) (iv) waist circumference (WC) and (v) glycated haemoglobin (HbA1c). METHODS The NCDS or the 1958 British birth cohort data deposited in the UK data service by the centre for longitudinal studies were used for analyses. Ordinary least squares regression was used to determine unit changes in the outcome variables given CMLE. RESULTS The estimates for unadjusted regression analysis of individual risk markers indicated a significant relationship between CMLE and alterations in the five risk markers of MetS (HDL-cholesterol, triglyceride, WC, HbA1c, and BP) in midlife. After adjustment for birth and lifestyle characteristics/health behaviours, the relationship between CMLE and the risk markers was attenuated for HDL-cholesterol, triglycerides, and HbA1c but remained significant for WC 0.70 (95% confidence interval (CI) 0.065-1.30, p<0.001) and SBP 1.48 (95% CI 0.48-2.47 p<0.001). CONCLUSION There was a positive association between lower CMLE and the risk of MetS using the NCDS data. Lifestyle characteristics may be influential determinants of MetS risk in mid-adulthood.
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Affiliation(s)
- Chukwuma Iwundu
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Dong Pang
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, UK
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Presley C, Agne A, Shelton T, Oster R, Cherrington A. Mobile-Enhanced Peer Support for African Americans with Type 2 Diabetes: a Randomized Controlled Trial. J Gen Intern Med 2020; 35:2889-2896. [PMID: 32700215 PMCID: PMC7572958 DOI: 10.1007/s11606-020-06011-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 06/23/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Peer support has been shown to improve diabetes self-management and control, but no standard exists to link peer support interventions to clinical care. OBJECTIVE To compare a community-based diabetes self-management education (DSME) plus mobile health (mHealth)-enhanced peer support intervention to community-based diabetes self-management education (DSME) alone for African American adults with poorly controlled type 2 diabetes. DESIGN A randomized controlled trial. PARTICIPANTS African American adults, age > 19 years, receiving care within a safety-net healthcare system in Jefferson County, Alabama, with a diagnosis of type 2 diabetes and a hemoglobin A1c (A1C) ≥ 7.5%. INTERVENTIONS Participants in the intervention group received community-based diabetes self-management education (DSME) plus 6 months of mHealth-enhanced peer support, including 12 weekly phone calls, then 3 monthly calls from community health workers, who used a novel web application to communicate with participants' healthcare teams. In the control group, participants received community-based DSME alone. MAIN MEASURES The primary outcome was A1C; secondary outcomes included diabetes distress, depressive symptoms, self-efficacy or confidence in their ability to manage diabetes, and social support. We used mixed models repeated measures analyses to assess for between-arm differences and baseline to follow-up changes. KEY RESULTS Of 120 participants randomized, 97 completed the study. Participants in intervention and control groups experienced clinically meaningful reduction in A1C, 10.1 (SD 1.7) to 9.6 (SD 1.9) and 9.8 (SD 1.7) to 9.1 (SD 1.9) respectively, p = 0.004. Participants in the intervention group experienced a significantly larger reduction in diabetes distress compared to the control, 2.7 (SD 1.2) to 2.1 (1.0) versus 2.6 (SD 1.1) to 2.3 (SD 1.0) p = 0.041. CONCLUSIONS Community-based DSME with and without peer support led to improved glycemic control. Peer support linked to clinical care led to a larger reduction in diabetes distress, which has important implications for the overall wellbeing of adults with type 2 diabetes.
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Affiliation(s)
- Caroline Presley
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - April Agne
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Tanya Shelton
- Cooper Green Mercy Health Services, Birmingham, AL USA
| | - Robert Oster
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Andrea Cherrington
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
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27
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Hu W, Liu Z, Hao HR, Yu WN, Wang XQ, Shao XJ, Wu XJ, Wen SR, Fan YQ, Ni YJ. Correlation between income and non-alcoholic fatty liver disease in a Chinese population. ANNALES D'ENDOCRINOLOGIE 2020; 81:561-566. [PMID: 32987003 DOI: 10.1016/j.ando.2020.07.1109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/01/2020] [Accepted: 07/25/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the study was to analyze the correlation between income and non-alcoholic fatty liver disease (NAFLD) in a Chinese population. METHOD subjects were divided into three groups according to liver fat content (LFC). (1) normal: LFC < 9.15%, 197 cases; (2) low LFC: LFC 9.15-20%, 532 cases; and (3) high LFC: LFC > 20%, 201 cases. Participants' clinical and social background were collected, including a routine fasting test to assess the relevant indices. Intergroup differences were compared on 1-way ANOVA, to analyze the relation between income and each index on Pearson correlation, and independent factors for LFC were identified on binary logistic regression. RESULTS (1) In retired persons, prevalence of NAFLD was greater in females (81.2%) than males (75%), but fell with age: the highest prevalence was between 40 and 49 years of age (87.5%), and the lowest above 70 years (68%). (2) Income correlated positively with triglyceride and serum uric acid levels and LFC (P < 0.05) and negatively with alanine aminotransferase (P = 0.01). (3) As income increased from level I to V, prevalence of NAFLD increased progressively (P < 0.05). In the study, LFC was taken as the dependent variable, and the traditional NAFLD risk factors and income level (I-V) were taken as independent variables. Income emerged as an independent risk factor for NAFLD. Risk in group V was 1.964-fold higher than in group I. CONCLUSION Prevalence of NAFLD was closely related to socio-economic level. Demographic risk factors include female gender, age 40-49 years, and monthly income > 5,000 RMB. Thus, if income is increased without improving educational level and health awareness, NAFLD prevalence will rise.
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Affiliation(s)
- Wen Hu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, 223001 Huai'an, China.
| | - Ziyu Liu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, 223001 Huai'an, China
| | - Hai-Rong Hao
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, 223001 Huai'an, China.
| | - Wei-Nan Yu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, 223001 Huai'an, China.
| | - Xiao-Qing Wang
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, 223001 Huai'an, China.
| | - Xiao-Juan Shao
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, 223001 Huai'an, China.
| | - Xiao-Juan Wu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, 223001 Huai'an, China.
| | - Su-Rong Wen
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, 223001 Huai'an, China.
| | - Yun-Qing Fan
- Department of Color Doppler Ultrasound, Huai'an Hospital Affiliated to Xuzhou Medical College, and Huai'an Second People's Hospital, Huai'an, Jiangsu, China.
| | - Yao-Jun Ni
- Department of Cardiothoracic Surgery, Hospital Affiliated to Nanjing Medical College and Huai'an First People's Hospital, 223001 Huai'an, China.
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Jakoby MG, Schleder M, Luff V, Yergler C, Botchway A, Burns C. A 2-Hour Diabetes Self-Management Education Program for Patients With Low Socioeconomic Status Improves Short-Term Glycemic Control. J Patient Cent Res Rev 2020; 7:275-281. [PMID: 32760759 DOI: 10.17294/2330-0698.1745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Diabetes self-management education (DSME) improves glycemic control, but patients with low socioeconomic status face institutional and personal barriers to receiving DSME. A retrospective single cohort study of a 2-hour group DSME program prioritizing accessibility and completion of a tightly focused curriculum was performed to determine if glycemic control improved and whether a longer, more comprehensive, prospective evaluation of the program is indicated. All patients who participated in the program from September 2017 to December 2018 were included in the analysis. The primary study endpoint was change in hemoglobin A1c (HbA1c) from baseline. A total of 58 out of 94 patients (61.7%) had paired measurements of HbA1c. Mean HbA1c improved from 9.8% ± 2.2% (83.5 ± 24.2 mmol/mol) to 8.3% ± 2.0% (67.7 ± 22.0 mmol/mol) at a median of 4 months after participation in the program (P<0.001). The proportion of patients with any improvement in HbA1c was 75.9% (44 of 58; P=0.003), and 65.5% of patients (38 of 58; P=0.066) had an improvement in HbA1c of ≥0.5%. These results demonstrate the benefit of highly targeted DSME for low-income patients and justify a longer-term and prospective evaluation of the program.
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Affiliation(s)
- Michael G Jakoby
- Division of Endocrinology, SIU School of Medicine, Springfield, IL
| | | | - Vickie Luff
- Central Counties Health Center, Springfield, IL
| | | | | | - Cheryl Burns
- Diabetes Education, SIU School of Medicine, Springfield, IL
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Heisler M, Kullgren J, Richardson C, Stoll S, Alvarado Nieves C, Wiley D, Sedgwick T, Adams A, Hedderson M, Kim E, Rao M, Schmittdiel JA. Study protocol: Using peer support to aid in prevention and treatment in prediabetes (UPSTART). Contemp Clin Trials 2020; 95:106048. [PMID: 32497783 PMCID: PMC8059966 DOI: 10.1016/j.cct.2020.106048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is an urgent need to develop and evaluate effective and scalable interventions to prevent or delay the onset of type 2 diabetes mellitus (T2DM). METHODS In this randomized controlled pragmatic trial, 296 adults with prediabetes will be randomized to either a peer support arm or enhanced usual care. Participants in the peer support arm meet face-to-face initially with a trained peer coach who also is a patient at the same health center to receive information on locally available wellness and diabetes prevention programs, discuss behavioral goals related to diabetes prevention, and develop an action plan for the next week to meet their goals. Over six months, peer coaches call their assigned participants weekly to provide support for weekly action steps. In the final 6 months, coaches call participants at least once monthly. Participants in the enhanced usual care arm receive information on local resources and periodic updates on available diabetes prevention programs and resources. Changes in A1c, weight, waist circumference and other patient-centered outcomes and mediators and moderators of intervention effects will be assessed. RESULTS At least 296 participants and approximately 75 peer supporters will be enrolled. DISCUSSION Despite evidence that healthy lifestyle interventions can improve health behaviors and reduce risk for T2DM, engagement in recommended behavior change is low. This is especially true among racial and ethnic minority and low-income adults. Regular outreach and ongoing support from a peer coach may help participants to initiate and sustain healthy behavior changes to reduce their risk of diabetes. TRIAL REGISTRATION The ClinicalTrials.gov registration number is NCT03689530.
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Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America.
| | - Jeffrey Kullgren
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States of America; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States of America.
| | - Caroline Richardson
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America.
| | - Shelley Stoll
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America.
| | - Cristina Alvarado Nieves
- University of Michigan, Department of Internal Medicine- Metabolism, Endocrinology and Diabetes, United States of America.
| | - Deanne Wiley
- Kaiser Permanente Northern California, United States of America.
| | - Tali Sedgwick
- Kaiser Permanente Northern California Division of Research, United States of America.
| | - Alyce Adams
- Kaiser Permanente Northern California, United States of America.
| | | | - Eileen Kim
- The Permanente Medical Group (Kaiser Permanente, Northern California), United States of America.
| | - Megan Rao
- The Permanente Medical Group (Kaiser Permanente, Northern California), United States of America.
| | - Julie A Schmittdiel
- Kaiser Permanente Northern California Division of Research, United States of America.
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Can Health Disparity Be Eliminated? The Role of Family Doctor Played in Shanghai, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155548. [PMID: 32751946 PMCID: PMC7432843 DOI: 10.3390/ijerph17155548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/09/2020] [Accepted: 07/29/2020] [Indexed: 11/12/2022]
Abstract
Background: Globally, the elimination of health disparity is a significant policy target. Primary health care has been implemented as a strategy to achieve this target in China for almost 10 years. This study examined whether family doctor (FD) policy in Shanghai contributed to eliminating health disparity as expected. Methods: System dynamics modeling was performed to construct and simulate a system of health disparity formation (business-as-usual (BAU) scenario, without any interventions), a system with FD intervention (FD scenario), and three other systems with supporting policies (Policy 1/Policy 2/Policy hybrid scenario) from 2013 to 2050. Health disparities were simulated in different scenarios, making it possible to compare the BAU results with those of FD intervention and with other policy interventions. Findings: System dynamics models showed that the FD policy would play a positive role in reducing health disparities in the initial stage, and medical price control—rather than health management—was the dominant mechanism. However, in this model, the health gap was projected to expand again around 2039. The model examined the introduction of two intervention policies, with findings showing that the policy focused on socioeconomic status improvement would be more effective in reducing health disparities, suggesting that socioeconomic status is the fundamental cause of these disparities. Conclusions: The results indicate that health disparities could be optimized, but not eliminated, as long as differences in socioeconomic status persists.
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Abstract
Chronic kidney disease (CKD) hotspots are defined as countries, regions, communities, or ethnicities with a higher than average incidence of CKD when compared with the worldwide, country, or regional rates. Here, we describe what is known about socially determined CKD hotspots, that is, the burden of CKD among socially defined communities that often collocate geographically. We focus on the poor, the homeless, and the food insecure, and their intersection with other social determinants of health, including race/ethnicity. In addition to discussing the burden of CKD in these communities, we describe some efforts to mitigate this burden and identify gaps in current knowledge.
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Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Tessa K Novick
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland
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32
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Jiang P, Babazono A, Fujita T. Health Inequalities Among Elderly Type 2 Diabetes Mellitus Patients in Japan. Popul Health Manag 2019; 23:264-270. [PMID: 31657660 PMCID: PMC7301321 DOI: 10.1089/pop.2019.0141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The influence of socioeconomic status (SES) on health inequalities has received much attention worldwide. This study examined the effect of SES on the following older type 2 diabetes mellitus patient health outcomes: oral hypoglycemic agent (OHA) medication adherence (proportion of days covered, PDC), risk of hospitalization for diabetic macrovascular complications, and in-hospital death. A retrospective cohort design using 2013–2016 claims data was used. Subjects were 58,349 diabetes patients aged >74 years in 2013. Age, sex, residential area, and comorbidities were controlled for. Logistic regression was conducted to assess the effects of income on PDC; survival analysis was used to assess the effects on hospitalization and in-hospital death. Regressions were conducted separately by sex. Compared with the lowest income group, adjusted PDC odds ratios for medium- and high-income males, respectively, were 1.35 (95% CI: 1.27–1.43) and 1.41 (95% CI: 1.30–1.54); females: 1.17 (95% CI: 1.11–1.23) and 1.24 (95% CI: 1.13–1.35). Adjusted hazard ratios (AHRs) for male hospitalization were 0.88 (95% CI: 0.80–0.96) and 0.88 (95% CI: 0.79–0.99); females: 1.00 (95% CI: 0.93–1.07) and 0.95 (95% CI: 0.83–1.08). AHRs for male in-hospital death were 0.83 (95% CI: 0.75–0.91) and 0.62 (95% CI: 0.54–0.70); females: 0.94 (95% CI: 0.87–1.02) and 0.77 (95% CI: 0.65–0.92). Results revealed sex-specific health inequalities among older Japanese diabetes patients. Subjects with worse SES had significantly poorer OHA medication adherence (both sexes), higher hospitalization risk for diabetes complications (males), and higher in-hospital death risk (both sexes).
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Affiliation(s)
- Peng Jiang
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takako Fujita
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Vijay A, Ranganathan P, Vellingiri B. A survey to validate the traditional Siddha perception of diabetes mellitus. J Public Health (Oxf) 2019. [DOI: 10.1007/s10389-018-0980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Toselli S, Gualdi-Russo E, Mazzuca P, Campa F. Ethnic differences in body composition, sociodemographic characteristics and lifestyle in people with type 2 diabetes mellitus living in Italy. Endocrine 2019; 65:558-568. [PMID: 31368082 DOI: 10.1007/s12020-019-02031-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/19/2019] [Indexed: 01/02/2023]
Abstract
This study aimed to compare immigrants and Italian natives with type 2 diabetes mellitus (DM2) in terms of anthropometric parameters and lifestyle-related characteristics and to investigate the relationship between ethnicity and glycemic control in men and women with DM2 living in Italy. The sample included 100 immigrants (55 Albanians and 45 Africans) and 100 Italians, followed by the Public Health Clinics of Rimini. The association of ethnicity with sex, socioeconomic status, anthropometric and hematological characteristics, and lifestyle were examined. In addition, differences among groups in glycemic control were evaluated. Among males, African participants presented significantly lower values than other groups in adiposity parameters and triglycerides. The highest percentage of obesity and of normal weight was found in Italians and in Africans, respectively. Among females, there were scanty differences, but Italians presented higher WHR values than the other groups. No statistical differences appeared in hematological parameters among groups. There were no significant differences in glycemic control among groups and sexes. Also considering the differences between subjects with optimal (L) or nonoptimal (H) glycemic control, the differences in lifestyle, anthropometric, and hematological variables remained scarce. Among all groups, significantly higher values of glucose were detected in H than in L. A similar condition appeared for triglycerides in males. Immigrant and native Italian diabetics did not present any difference in their clinical characteristics, but Italians generally presented worst lifestyle habits. The percentage of subjects with poor metabolic control of diabetes was not low, but similar in immigrants and natives.
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Affiliation(s)
- Stefania Toselli
- Departments of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Emanuela Gualdi-Russo
- Department of Biomedical Sciences and Surgical Specialties, University of Ferrara, Ferrara, Italy
| | - Paolo Mazzuca
- Unit of Internal Medicine, Diabetes and Metabolic Disease Center, Romagna Health District, Rimini, Italy
| | - Francesco Campa
- Departments of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
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Chen Y, Wang T, Liu X, Shankar RR. Prevalence of type 1 and type 2 diabetes among US pediatric population in the MarketScan Multi-State Database, 2002 to 2016. Pediatr Diabetes 2019; 20:523-529. [PMID: 30861241 DOI: 10.1111/pedi.12842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of type 1 (T1DM) and type 2 diabetes mellitus (T2DM) among U.S. Medicaid pediatric population aged <18 years 2002 to 2016 by age, sex, and race/ethnicity. METHODS Participants aged <18 years old from 2002 to 2016 were identified from the MarketScan Multi-State Medicaid Database. Diabetes was defined as having (a) ≥1 claims for an outpatient or inpatient diabetes diagnosis and ≥2 prescriptions for any anti-diabetes medications or (b) records of ≥2 claims for an outpatient or inpatient diabetes diagnosis that were at least 30 days apart. Annual prevalence of diabetes and 95% confidence intervals (CIs) were calculated. Age-, sex-, and race-stratified prevalence were also assessed. RESULTS The annual prevalence of T1DM increased from 1.29 to 2.34/1000 pediatric persons from 2002 to 2016. The prevalence of T2DM rose from 0.70 in 2002 to 2.76/1000 in 2011, but then dropped to 2.12/1000 pediatric persons in 2016 in the Medicaid population. Prevalence of both T1DM and T2DM increased with age. While the prevalence of T1DM was similar in both sexes, and was most prevalent in Whites, prevalence of T2DM was higher in girls and was most prevalent in Blacks. CONCLUSIONS While the annual prevalence of T1DM in pediatric persons enrolled in Medicaid increased continuously from 2002 to 2016, the annual prevalence of T2DM increased from 2002 to 2011, with a subsequent decrease in 2016, possibly because of the increase of relatively healthier participants with the expanded eligibility through the ACA between 2011 and 2016.
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Affiliation(s)
- Yong Chen
- Department of Pharmacoepidemiology, Merck & Co., Inc., Kenilworth, New Jersey.,Department of Patient & Health Impact, Pfizer Inc., Collegeville, Pennsylvania
| | - Tongtong Wang
- Department of Pharmacoepidemiology, Merck & Co., Inc., Kenilworth, New Jersey
| | - Xinyue Liu
- Department of Pharmacoepidemiology, Merck & Co., Inc., Kenilworth, New Jersey
| | - R Ravi Shankar
- Department of Clinical Research, Merck & Co., Inc., Kenilworth, New Jersey
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Wu H, Bragg F, Yang L, Du H, Guo Y, Jackson CA, Zhu S, Yu C, Luk AOY, Chan JCN, Gasevic D, Li L, Chen Z, Wild SH. Sex differences in the association between socioeconomic status and diabetes prevalence and incidence in China: cross-sectional and prospective studies of 0.5 million adults. Diabetologia 2019; 62:1420-1429. [PMID: 31152186 PMCID: PMC6647183 DOI: 10.1007/s00125-019-4896-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/10/2019] [Indexed: 12/21/2022]
Abstract
AIMS/HYPOTHESIS China has undergone rapid socioeconomic transition accompanied by lifestyle changes that are expected to have a profound impact on the health of its population. However, there is limited evidence from large nationwide studies about the relevance of socioeconomic status (SES) to risk of diabetes. We describe the associations of two key measures of SES with prevalent and incident diabetes in Chinese men and women. METHODS The China Kadoorie Biobank study included 0.5 million adults aged 30-79 years recruited from ten diverse areas in China during 2004-2008. SES was assessed using the highest educational level attained and annual household income. Prevalent diabetes was identified from self-report and plasma glucose measurements. Incident diabetes was identified from linkage to disease and death registries and national health insurance claim databases. We estimated adjusted ORs and HRs for prevalent and incident diabetes associated with SES using logistic and Cox regression models, respectively. RESULTS At baseline, 30,066 (5.9%) participants had previously diagnosed (3.1%) or screen-detected (2.8%) diabetes among 510,219 participants included for cross-sectional analyses. There were 480,153 people without prevalent diabetes at baseline, of whom 9544 (2.0%) had new-onset diabetes during follow-up (median 7 years). Adjusted ORs (95% CIs) for prevalent diabetes, comparing highest vs lowest educational level, were 1.21 (1.09, 1.35) in men and 0.69 (0.63, 0.76) in women; for incident diabetes, the corresponding HRs were 1.27 (1.07, 1.51) and 0.80 (0.67, 0.95), respectively. For household income, the adjusted ORs for prevalent diabetes, comparing highest vs lowest categories, were 1.45 (1.34, 1.56) in men and 1.26 (1.19, 1.34) in women; for incident diabetes, the HRs were 1.36 (1.19, 1.55) and 1.06 (0.95, 1.17), respectively. CONCLUSIONS/INTERPRETATION Among Chinese adults, the associations between education and diabetes prevalence and incidence differed qualitatively between men and women, whereas higher household income was positively associated with diabetes prevalence and incidence in both sexes, with a stronger relationship in men than in women.
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Affiliation(s)
- Hongjiang Wu
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Fiona Bragg
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Huaidong Du
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Caroline A Jackson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Shankuan Zhu
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Danijela Gasevic
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Liming Li
- Chinese Academy of Medical Sciences, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhengming Chen
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
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Allister-Price C, Craig CM, Spielman D, Cushman SS, McLaughlin TL. Metabolic markers, regional adiposity, and adipose cell size: relationship to insulin resistance in African-American as compared with Caucasian women. Int J Obes (Lond) 2019; 43:1164-1173. [PMID: 30127463 PMCID: PMC6382609 DOI: 10.1038/s41366-018-0191-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/22/2018] [Accepted: 07/22/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND/OBJECTIVES African-American women have the greatest prevalence of obesity in the United States, and higher rates of type 2 diabetes than Caucasian women, yet paradoxically lower plasma triglycerides (TG), visceral fat and intrahepatic fat, and higher high-density lipoprotein (HDL)-cholesterol. Visceral fat has not been evaluated against insulin resistance in African-American women, and TG/HDL-cholesterol has been criticized as a poor biomarker for insulin resistance in mixed-sex African-American populations. Adipocyte hypertrophy, reflecting adipocyte dysfunction, predicts insulin resistance in Caucasians, but has not been studied in African-Americans. Our goal was to assess whether traditional correlates of insulin resistance, measures of adiposity and adipocyte characteristics similarly predict peripheral insulin resistance in African-American and Caucasian women. SUBJECTS/METHODS Thirty-four healthy African-American (n = 17) and Caucasian (n = 17) women, matched for age (mean = 53.0 yrs) and body mass index (BMI) (mean = 30 kg/m2), underwent a steady-state plasma glucose test to measure insulin sensitivity; computed tomography (fat distribution); and a periumbilical scalpel biopsy (adipocyte characterization). By-race analyzes utilized analysis of covariance; linear regressions evaluated relationships between metabolic/adipose variables. All analyses adjusted for BMI and menopausal status. RESULTS Insulin sensitivity did not differ between groups (p = 0.65). Neither BMI, nor %body fat or thigh fat predicted insulin resistance in African-American women. Fasting TG (p = 0.046), HDL-cholesterol (p = 0.0006) and TG/HDL-cholesterol ratio (p = 0.009) strongly predicted insulin resistance in African-American women. Despite being lower in African-American women, hepatic fat and visceral adipose tissue (VAT) correlated with insulin resistance in both groups, as did fasting glucose, VAT/SAT (subcutaneous adipose tissue) ratio, and %SAT (inverse). CONCLUSIONS Total adiposity measures and adipocyte hypertrophy did not predict insulin resistance in African-American women, but did in Caucasian women. Plasma TG and HDL-cholesterol were significant predictors of insulin resistance in African-American women. Our findings demonstrate the need to identify race and sex-specific biomarkers for metabolic risk profiling.
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Affiliation(s)
- Candice Allister-Price
- Department of Molecular Biology, School of Veterinary Medicine, University of California, Davis, CA, USA.
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Colleen M Craig
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Dan Spielman
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Samuel S Cushman
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Tracey L McLaughlin
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Hamilton M, Tomlinson G, Chu L, Robles P, Matte A, Burns S, Thomas C, Lamontagne F, Adhikari NKJ, Ferguson N, Friedrich JO, Rudkowski JC, Skrobik Y, Meggison H, Cameron J, Herridge M. Determinants of Depressive Symptoms at 1 Year Following ICU Discharge in Survivors of ≥ 7 Days of Mechanical Ventilation: Results From the RECOVER Program, a Secondary Analysis of a Prospective Multicenter Cohort Study. Chest 2019; 156:466-476. [PMID: 31102611 DOI: 10.1016/j.chest.2019.04.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/22/2019] [Accepted: 04/17/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Moderate to severe depressive symptoms occur in up to one-third of patients at 1 year following ICU discharge, negatively affecting patient outcomes. This study evaluated patient and caregiver factors associated with the development of these symptoms. METHODS This study used the Rehabilitation and Recovery in Patients after Critical Illness and Their Family Caregivers (RECOVER) Program (Phase 1) cohort of 391 patients from 10 medical/surgical university-affiliated ICUs across Canada. We determined the association between patient depressive symptoms (captured by using the Beck Depression Inventory II [BDI-II]), patient characteristics (age, sex, socioeconomic status, Charlson score, and ICU length of stay [LOS]), functional independence measure (FIM) motor subscale score, and caregiver characteristics (Caregiver Assistance Scale and Center for Epidemiologic Studies-Depression Scale) by using linear mixed models at time points 3, 6, and 12 months. RESULTS BDI-II data were available for 246 patients. Median age at ICU admission was 56 years (interquartile range, 45-65 years), 143 (58%) were male, and median ICU LOS was 19 days (interquartile range, 13-32 days). During the 12-month follow-up, 67 of 246 (27.2%) patients had a BDI-II score ≥ 20, indicating moderate to severe depressive symptoms. Mixed models showed worse depressive symptoms in patients with lower FIM motor subscale scores (1.1 BDI-II points per 10 FIM points), lower income status (by 3.7 BDI-II points; P = .007), and incomplete secondary education (by 3.8 BDI-II points; P = .009); a curvilinear relation with age (P = .001) was also reported, with highest BDI-II at ages 45 to 50 years. No associations were found between patient BDI-II and comorbidities (P = .92), sex (P = .25), ICU LOS (P = .51), or caregiver variables (Caregiver Assistance Scale [P = .28] and Center for Epidemiologic Studies Depression Scale [P = .74]). CONCLUSIONS Increased functional dependence, lower income, and lower education are associated with increased severity of post-ICU depressive symptoms, whereas age has a curvilinear relation with symptom severity. Knowledge of risk factors may inform surveillance and targeted mental health follow-up. Early mobilization and rehabilitation aiming to improve function may serve to modify mood disorders.
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Affiliation(s)
- Mika Hamilton
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
| | - George Tomlinson
- Department of Medicine, University Health Network and Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Leslie Chu
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Priscila Robles
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Andrea Matte
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Stacey Burns
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Claire Thomas
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Francois Lamontagne
- Centre de recherché du CHU de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Neill K J Adhikari
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Niall Ferguson
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jan O Friedrich
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Departments of Medicine and Critical Care Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Jill C Rudkowski
- Departments of General Internal Medicine and Critical Care, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | - Yoanna Skrobik
- Department of Medicine, Division of Critical Care, Maisonneuve Rosemont Hospital, University of Montreal, Montreal, QC, Canada
| | - Hilary Meggison
- Department of Critical Care, University of Ottawa, Ottawa, ON, Canada
| | - Jill Cameron
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto Rehabilitation Institute, University of Toronto, Toronto, ON, Canada
| | - Margaret Herridge
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada
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Ares Blanco J, Valdés Hernández S, Botas P, Rodríguez-Rodero S, Morales Sánchez P, Díaz Naya L, Menéndez-Torre E, Delgado E. [Gender differences in the mortality of people with type 2 diabetes: Asturias Study 2018]. GACETA SANITARIA 2019; 34:442-448. [PMID: 31029461 DOI: 10.1016/j.gaceta.2019.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To investigate the influence of gender on mortality according to the presence or absence of type 2 diabetes mellitus (DM2) and other cardiovascular risk factors in the Asturias Study cohort. METHOD The Asturias Study (started in 1998) is an observational, prospective cohort study of a representative sample of a population of Asturias aged 30-75 years. The population was divided into groups according to the presence or absence of DM2 and according to gender to assess control of cardiovascular risk factors. In addition, aware of the vital status of the cohort 18 years after the beginning of the study, we analyzed differences in causes of mortality according to the previous categories. RESULTS In 1998, 1034 people started the study, 561 women (54.25%) and 473 men (45.75%). Of these, 131 (12.66%) had diabetes (75 men and 56 women). The women with T2D presented a hazard ratio (HR) for total mortality of 1.64 (95% confidence interval [95%CI]: .97-2.77), which was 1.63 (95%CI: 1.07-2.50) for the men and, for cardiovascular mortality, 3.06 (95%CI: 1.44-6.47) for the females, versus 1.49 (95%CI: 0.64-3.46) for the males. The mortality rate for people with T2D of both sexes was higher than for people without T2D. CONCLUSIONS Women with T2D have a risk more than three times higher than women without diabetes of dying from cardiovascular causes. We should implement treatment strategies in women with this condition.
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Affiliation(s)
- Jessica Ares Blanco
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, España; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España.
| | - Sergio Valdés Hernández
- Instituto de Investigación Biomédica de Málaga, Málaga, España; Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario, Málaga, España; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), España
| | - Patricia Botas
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España; Sección de Endocrinología y Nutrición, Hospital San Agustín, Avilés, Asturias, España
| | - Sandra Rodríguez-Rodero
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, España; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España; Departamento de Medicina, Universidad de Oviedo, Oviedo, España
| | - Paula Morales Sánchez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, España; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España; Departamento de Medicina, Universidad de Oviedo, Oviedo, España
| | - Lucía Díaz Naya
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España; Sección de Endocrinología y Nutrición, Hospital de Cabueñes, Gijón, Asturias, España
| | - Edelmiro Menéndez-Torre
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, España; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
| | - Elías Delgado
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, España; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España; Departamento de Medicina, Universidad de Oviedo, Oviedo, España
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Siddiqi L, VanAarsen K, Iansavichene A, Yan J. Risk Factors for Adverse Outcomes in Adult and Pediatric Patients With Hyperglycemia Presenting to the Emergency Department: A Systematic Review. Can J Diabetes 2019; 43:361-369.e2. [PMID: 30846250 DOI: 10.1016/j.jcjd.2018.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 12/29/2022]
Abstract
Hyperglycemia is a significant cause of morbidity and mortality, often resulting in adverse outcomes. This review aimed to identify predictors of adverse outcomes, such as repeated hospital visits, hospitalization or death, in patients presenting to the emergency department (ED) with hyperglycemia. Electronic searches of Medline and EMBASE were conducted for studies in English of patients presenting to the ED with hyperglycemia. Both adult and pediatric populations were included, with and without diabetes. Two reviewers independently screened all titles and abstracts for relevance. If consensus was not reached, full-length manuscripts were reviewed. For discrepancies, a third reviewer was consulted. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Study- and patient-specific data were extracted and presented descriptively. Eight observational studies were reviewed; they included a total of 96,970 patients. Predictors of adverse outcomes included age, lowest income quintile, urban dwellers, presence of comorbidities, coexisting hyperlactatemia, having a family physician, elevated serum creatinine level, diabetes managed with insulin, sentinel visit for hyperglycemia in the past month, and high blood glucose level measured in the ED. Conflicting evidence was found for whether known history of diabetes was associated with risk. Factors associated with favourable outcomes included systolic blood pressure of 90 to 150 mmHg and tachycardia. This systematic review found 12 factors associated with adverse outcomes, and 2 factors associated with more favourable outcomes in patients presenting to the ED with hyperglycemia. These factors should be considered for easier identification of patients at higher risk for adverse outcomes to guide management and follow up.
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Affiliation(s)
- Lubna Siddiqi
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Kristine VanAarsen
- London Health Sciences Centre, Division of Emergency Medicine, London, Ontario, Canada
| | | | - Justin Yan
- Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; St. Joseph's Healthcare London, London, Ontario, Canada
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Simmons M, Bishu KG, Williams JS, Walker RJ, Dawson AZ, Egede LE. Racial and Ethnic Differences in Out-of-Pocket Expenses among Adults with Diabetes. J Natl Med Assoc 2019; 111:28-36. [PMID: 30129486 PMCID: PMC7995684 DOI: 10.1016/j.jnma.2018.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 04/17/2018] [Accepted: 04/25/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Racial and ethnic minority groups have a higher prevalence of diabetes, increased risk for adverse complications, and worse health outcomes compared to Non-Hispanic Whites. Evidence suggests they also have higher healthcare expenses associated with diabetes care. Therefore, the objective of this study was to assess racial and ethnic differences in out-of-pocket (OOP) costs among a nationally representative sample of adults with diabetes. METHODS Cross-sectional study of 17,702 adults (aged ≥18 years) with diabetes from years 2002-2011 in the Medical Expenditure Panel Survey Household Component. The outcome was OOP expenditures, and the primary predictor was race/ethnicity. Descriptive statistics summarized the sample population. Unadjusted mean values were computed to compare OOP expenses over time. A two-part model was used to estimate adjusted incremental OOP expenses. RESULTS For the overall sample, OOP expenditures decreased significantly over time. In addition, compared to NHWs, racial and ethnic minority groups had significantly lower OOP costs per year when adjusted for sociodemographic characteristics, comorbid conditions, and time. NHBs paid $481 less than NHWs; Hispanics paid $591 less than NHWs; and individuals in the 'Other' racial/ethnic category paid nearly $645 less compared to NHWs (p < 0.001). CONCLUSIONS Racial/ethnic minority patients with diabetes had significantly less OOP expenses compared to NHWs, possibly due to differences in healthcare utilization. OOP expenses decreased significantly over time for all racial and ethnic groups. Additional research is needed to understand the factors associated with differences in OOP expenditures among racial groups.
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Affiliation(s)
- Makiera Simmons
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kinfe G Bishu
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Joni S Williams
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Room H3165, Milwaukee, WI 53226, USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Room H3165, Milwaukee, WI 53226, USA
| | - Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Room H3165, Milwaukee, WI 53226, USA
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Room H3165, Milwaukee, WI 53226, USA.
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Biswas P, Chakraborty AK, Mukherjee A, Pal B, Maji D, De M. Elevated Vascular Endothelial Growth Factor Level in Association with Mean Platelet Volume Are Emerging Risk Factors for Vascular Complications in T2DM Patients. Health (London) 2019. [DOI: 10.4236/health.2019.1111116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Nagamine Y, Kondo N, Yokobayashi K, Ota A, Miyaguni Y, Sasaki Y, Tani Y, Kondo K. Socioeconomic Disparity in the Prevalence of Objectively Evaluated Diabetes Among Older Japanese Adults: JAGES Cross-Sectional Data in 2010. J Epidemiol 2018; 29:295-301. [PMID: 30449769 PMCID: PMC6614078 DOI: 10.2188/jea.je20170206] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Studies on sex-specific socioeconomic gradients in objectively evaluated diabetes among older adults are scarce. Methods We used cross-sectional data of 9,893 adults aged 65 years and older in Aichi Prefecture without long-term care insurance from the Japan Gerontological Evaluation Study (JAGES) in 2010 (Response rate: 66.3%). We collected demographic, socioeconomic (income, years of education, and longest occupation) and behavioral information using a mail-in self-reported survey. Blood samples for the objectively evaluated diabetes and self-reported medical history were collected at annual municipal health checkups. Poisson regression analysis stratified by sex with multiple imputations was conducted to calculate prevalence ratio and 95% confidence interval. Results A clear income gradient in diabetes prevalence was observed among women, from 11.7% in the lowest income quartile (Q1) to 7.8% in the highest (Q4). Among men, the findings were 17.6% in Q1 to 15.1% in Q4. The prevalence ratios for diabetes with incomes Q1 to Q4 were 1.43 (95% confidence interval [CI], 1.07–1.90) for women and 1.16 (95% CI, 0.90–1.50) for men after adjusting for age and other socioeconomic factors. Even after adjusting for marital status, body mass index, other metabolic risk factors, and lifestyle factors, the income-based gradient remained among women. Education and occupation were not significantly associated with diabetes in the study population. Conclusions Only women showed an income-based gradient in diabetes. Monitoring income gradient in diabetes is important in public health actions, even in older populations. Future longitudinal and intervention studies should evaluate the causal link of income to diabetes onset, determine the mechanisms of the potential sex differences in the income/diabetes association, and identify ways to mitigate the income-based inequality.
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Affiliation(s)
- Yuiko Nagamine
- Department of Public Health, Graduate School of Medicine, Chiba University
| | - Naoki Kondo
- Department of Health Education and Health Sociology, School of Public Health, the University of Tokyo
| | | | - Asami Ota
- Division of Health and Nutrition, University of Niigata Prefecture
| | - Yasuhiro Miyaguni
- Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology
| | - Yuri Sasaki
- Department of International Health and Collaboration, National Institute of Public Health
| | - Yukako Tani
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU).,Research Fellow of Japan Society for the Promotion of Science
| | - Katsunori Kondo
- Department of Public Health, Graduate School of Medicine, Chiba University.,Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology.,Center for Well-being and Society, Nihon Fukushi University
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Biological and socioeconomic determinants of prediabetes in youth: an analysis using 2007 to 2011 Canadian Health Measures Surveys. Pediatr Res 2018; 84:248-253. [PMID: 29899385 DOI: 10.1038/s41390-018-0025-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/24/2018] [Accepted: 04/01/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To describe rates of prediabetes among youth in Canada and the associated social and biological characteristics. METHODS We analyzed the cross-sectional data from the first (2007-2009) and second (2009-2011) cycles of the Canadian Health Measures Survey (CHMS) for youth aged 6-19 years. Prediabetes was defined using the glycated hemoglobin (A1C) guidelines set out by the American Diabetes Association (ADA) and the Canadian Diabetes Association (CDA) of A1C ranges 5.7-6.4% (38.8-46.4 mmol/mol) and 6.0-6.4% (42.1-46.4 mmol/mol), respectively. RESULTS An elevated A1C was observed in 22.8% of our sample (n = 3449) based on the ADA definition and 5.2% of youth using the CDA definition. Independent predictors in a fully adjusted model for prediabetes were non-White (odds ratio (OR) 2.62: 95% Confidence intervals 2.05-3.35), obese (OR 1.53: 1.19-1.96), less physically active youth (0.97: 0.95-0.99), and parents with high school education or less (1.34: 1.02-1.74). Moreover, significant regional variations were noted with higher rates for all regions except Ontario. CONCLUSION Prediabetes is relatively common in Canada and associated with common biologic and socioeconomic factors. Importantly, regular physical activity was significantly associated with reduced odds of prediabetes. Targeted screening and continued emphasis on physical activity may help curb the increasing rates of prediabetes.
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Xu F, He J, Wang Z, Ware RS. The relationship between socio-economic status and diagnosed Type 2 diabetes is changing with economic growth in Nanjing, China. Diabet Med 2018; 35:567-575. [PMID: 29417617 DOI: 10.1111/dme.13597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2018] [Indexed: 11/30/2022]
Abstract
AIM In developed countries, the relationship between socio-economic status (SES) and Type 2 diabetes was positive several decades ago but is now negative. However, in developing societies such as China the relationship remains positive. It is likely that at some stage of economic development the SES-Type 2 diabetes association will become negative in developing communities. This study aimed to examine whether this inflexion is approaching in China. METHODS Two cross-sectional surveys were undertaken in Nanjing, China, in 2000 and 2011. The same sampling approach was used to randomly select participants. Diagnosed Type 2 diabetes was the outcome variable. SES was measured using monthly family average income and divided into thirds. Mixed-effects models were used to calculate the association between SES and Type 2 diabetes. RESULTS There were 19 861 (response rate, 90.1%) and 7824 (response rate, 82.8%) participants in 2000 and 2011, respectively. A 2.6-fold increase in Type 2 diabetes prevalence was observed from 3.0% (95% confidence interval 2.8%, 3.3%) in 2000 to 8.2% (7.7%, 8.8%) in 2011 (P < 0.01). After controlling for potential confounders, the odds ratios of having Type 2 diabetes decreased from 2.06 (95% CI 1.55, 2.73) and 1.83 (1.40, 2.37) in 2000 to 1.58 (1.23, 2.02) and 1.35 (1.06, 1.74) in 2011 for the higher and middle SES groups respectively, compared with those in the lower SES category. CONCLUSIONS The SES-Type 2 diabetes association remained positive in Nanjing, China, in 2011 but the disparity diminished significantly compared with 2000. These results can inform the delivery of appropriate interventions to people at risk of developing Type 2 diabetes.
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Affiliation(s)
- F Xu
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - J He
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Z Wang
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - R S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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Buscemi J, Pugach O, Springfield S, Jang J, Tussing-Humphreys L, Schiffer L, Stolley MR, Fitzgibbon ML. Associations between fiber intake and Body Mass Index (BMI) among African-American women participating in a randomized weight loss and maintenance trial. Eat Behav 2018; 29:48-53. [PMID: 29510372 PMCID: PMC6637407 DOI: 10.1016/j.eatbeh.2018.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 01/31/2018] [Accepted: 02/15/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION African-American women are at increased risk for obesity, and therefore it is important to identify dietary factors that have the potential to prevent weight gain within this population. The purpose of the current study was to examine associations between daily fiber intake and Body Mass Index (BMI) over the course of an 18-month weight loss intervention for African-American women. METHODS Anthropometric measures and the Block Food Frequency Questionnaire were administered at baseline, 6-month, and 18-month follow-up between 2008 and 2010. A mixed-effects linear regression model with random intercept and time slope was used to model associations between fiber consumption and BMI controlling for time trend. RESULTS Associations between fiber consumption and BMI were significantly different over time (β̂Fiber∗Time=-0.07,p-value=0.003). There was no association between fiber intake and BMI at baseline; however, there was a significant inverse relation between fiber consumption and BMI at 6 months, and the association was even stronger at 18 months. CONCLUSIONS Results from this study suggest that dietary fiber consumption may be particularly important within weight loss interventions tailored for African-American women.
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Affiliation(s)
- Joanna Buscemi
- DePaul University, 2219 N Kenmore Ave, Chicago, IL 60614, United States.
| | - Oksana Pugach
- University of Illinois at Chicago, College of Medicine, Institute for Health Research and Policy, 486 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608
| | - Sparkle Springfield
- Stanford University, School of Medicine, Stanford Prevention Research Center, 1215 Welch Rd., Palo Alto, CA 94304, United States
| | - Jiyeong Jang
- University of Illinois at Chicago, College of Medicine, Institute for Health Research and Policy, 486 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608
| | - Lisa Tussing-Humphreys
- University of Illinois at Chicago, College of Medicine, Institute for Health Research and Policy, 486 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608
| | - Linda Schiffer
- University of Illinois at Chicago, College of Medicine, Institute for Health Research and Policy, 486 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608
| | - Melinda R. Stolley
- Medical College of Wisconsin, Department of Medicine, 8701 Watertown Plank Rd., Milwaukee, WI 53226, United States
| | - Marian L. Fitzgibbon
- University of Illinois at Chicago, College of Medicine, Institute for Health Research and Policy, 486 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608
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Horner EM, Strombotne K, Huang A, Lapham S. Investigating the Early Life Determinants of Type-II Diabetes Using a Project Talent-Medicare Linked Data-set. SSM Popul Health 2018; 4:189-196. [PMID: 29854904 PMCID: PMC5976829 DOI: 10.1016/j.ssmph.2018.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/25/2017] [Accepted: 01/23/2018] [Indexed: 12/23/2022] Open
Abstract
The increasing prevalence of Type II Diabetes (T2D) presents a serious health and financial public crisis. Our study examines the hypothesis that adolescents' perceptions of economic insecurity, along with absolute and relative socioeconomic status (SES), can contribute to T2D prevalence later in life. Project Talent (PT) Survey data, collected on high school students in 1960, have been linked to Medicare records from 2012, presenting a unique opportunity to examine measures gathered in adolescence and T2D prevalence later-in-life among a large, national, and diverse sample (n=88,849). Our results provide compelling evidence that real, perceived, and relative SES in adolescence have persistent impacts on later-in-life diabetes risk, even when controlling for possible confounders such as cognitive ability, conscientiousness, and early-adulthood educational attainment.
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Li S, Xu F, He J, Wang Z, Tse LA, Xiong Y, Chen D. Re-look at socioeconomic inequalities in stroke prevalence among urban Chinese: is the inflexion approaching? BMC Public Health 2018; 18:367. [PMID: 29554881 PMCID: PMC5859657 DOI: 10.1186/s12889-018-5279-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 03/08/2018] [Indexed: 11/17/2022] Open
Abstract
Background The present association between socioeconomic status (SES) and stroke is positive in developing communities, but it is negative in developed countries where a positive SES-stroke relationship was recorded several decades ago. We hypothesized that the SES-stroke relationship in developing societies mirrors the trajectory of the Western countries at some stage of economic development. This study aimed to examine whether this inflexion is approaching in China. Methods This study comprises of two cross-sectional surveys conducted in the same urban areas of Nanjing, China in 2000 (S2000) and 2011 (S2011) using the same selection criteria (i.e., aged≥35 years) and sampling approach. Physician-diagnosed stroke was the outcome event, while family average income (FAI) was the explanatory variable and tertiled in our anlaysis. Mixed-effects models were used to examine the FAI-stroke association. Results Overall, 19,861 (response rate = 90.1%) and 7824 (response rate = 82.8%) participants participated in the S2000 and S2011, respectively. The prevalence of stroke increased by 2.5-folds (95%CI = 2.2, 2.9) from 2000 (2.1%, 95%CI = 1.9%, 2.3%) to 2011 (5.1%, 95%CI = 4.6%, 5.6%) (p < 0.01). Compared with the lower FAI category, the positive association between stroke prevalence and the higher FAI group decreased from 1.99 (95%CI = 1.55, 2.56) in 2000 to 1.49 (95%CI = 1.09, 2.03) in 2011 after control for potential confounders. A similar pattern was also observed for the middle FAI group (1.60, 95% CI = 1.23, 2.08 in 2000 vs. 1.37, 95%CI = 1.01, 1.88 in 2011). Conclusions This study revealed that socioeconomic inequalities in stroke were diminishing in regional China during the recent 11-year period, although the SES-stroke association was still positive. Tailored intervention against stroke should currently target on SES-vulnerable people.
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Affiliation(s)
- Shenghua Li
- Department of Neurology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Fei Xu
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.,Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jing He
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhiyong Wang
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Lap Ah Tse
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yaqing Xiong
- Jiangsu Province Geriatric Hospital, 30, Luojia Road, Nanjing, 210024, China.
| | - Daowen Chen
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, 264, Guangzhou Road, Nanjing, 210029, China.
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Renn BN, Obetz V, Feliciano L. Comorbidity of depressive symptoms among primary care patients with diabetes in a federally qualified health center. J Health Psychol 2018; 25:1303-1309. [DOI: 10.1177/1359105318755260] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Depression is frequently comorbid with diabetes; however, less is known about this comorbidity in socially disadvantaged populations. This cross-sectional study examined depressive symptomatology among 424 patients with prediabetes or type 2 diabetes mellitus at a federally qualified health center. Prevalence of clinically significant depressive symptoms was assessed using the World Health Organization Five-Item Well-Being Index. The majority (67.7%) endorsed depressive symptoms, with greater prevalence among middle-aged adults (45–64 years) than younger or older counterparts. More women than men endorsed depressive symptoms. Findings suggest the need for routine depression screening in both prediabetes and type 2 diabetes mellitus, particularly among middle-aged and low-income individuals.
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Affiliation(s)
| | | | - Leilani Feliciano
- University of Colorado Colorado Springs, USA
- Peak Vista Community Health Centers, USA
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Abstract
All too often, palliative care services are not responsive to the needs of those who are doubly vulnerable, being that they are both in need of palliative care services and experiencing deficits in the social determinants of health that result in complex, intersecting health and social concerns. In this article, we argue for a reorientation of palliative care to explicitly integrate the premises of health equity. We articulate the philosophical, theoretical, and empirical scaffolding required for equity-informed palliative care and draw on a current study to illustrate such an approach to the care of people who experience structural vulnerabilities.
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