Differences by sex in the prevalence of diabetes mellitus, impaired fasting glycaemia and impaired glucose tolerance in sub-Saharan Africa: a systematic review and meta-analysis

Targeting the Epigenetic Marks in Type 2 Diabetes Mellitus: Will Epigenetic Therapy Be a Valuable Adjunct to Pharmacotherapy?

Although genetic, environmental, and lifestyle factors largely contribute to type 2 diabetes mellitus (T2DM) risk, the role of epigenetics in its pathogenesis is now well established. The epigenetic mechanisms in T2DM mainly consist of DNA methylation, histone modifications and regulation by noncoding RNAs (ncRNAs). For instance, DNA methylation at CpG islands in the promoter regions of specific genes encoding insulin signaling and glucose metabolism suppresses these genes. Modulating the enzyme mediators of these epigenetic marks aims to restore standard gene expression patterns and improve glycemic control. In targeting these epigenetic marks, using epigenetic drugs such as DNA methyltransferase (DNAMT), histone deacetylase (HDAC) and histone acetyltransferase (HAT) inhibitors has led to variable success in humans and experimental murine models. Specifically, the United States' Food and Drug Administration (US FDA) has approved DNAMT inhibitors like 5-azacytidine and 5-aza-2'-deoxycytidine for use in diabetic retinopathy: a T2DM microvascular complication. These DNAMT inhibitors block the genes for methylation of mitochondrial superoxide dismutase 2 (SOD2) and matrix metallopeptidase 9 (MMP-9): the epigenetic marks in diabetic retinopathy. Traditional pharmacotherapy with metformin also have epigenetic effects in T2DM and positively alter disease outcomes when combined with epigenetic drugs like DNAMT and HDAC inhibitors, raising the prospect of using epigenetic therapy as a valuable adjunct to pharmacotherapy. However, introducing small interfering RNAs (siRNAs) in cells to silence specific target genes remains in the exploratory phase. Future research should focus on regulating gene expression in T2DM using long noncoding RNA (lncRNA) molecules, another type of ncRNA. This review discusses the epigenetics of T2DM and that of its macro- and microvascular complications, and the potential benefits of combining epigenetic therapy with pharmacotherapy for optimal results.

Distribution of the ACE Gene Polymorphisms in Type 2 Diabetes Mellitus Patients, Their Associations with Nephropathy Biomarkers and Metabolic Indicators at a Tertiary Hospital in Uganda

Purpose

We aimed at determining the distribution of the ACE insertion/deletion gene polymorphisms among type 2 diabetic patients and their association with the nephropathy biomarkers and the metabolic indicators.

Patients and Methods

Data were collected from 237 adult type 2 diabetes mellitus patients receiving healthcare at the diabetic clinic of Mbarara Regional Referral Hospital. Peripheral blood genomic DNA was amplified using a conventional PCR technique and analyzed for the ACE homozygous forms of the insertion (II), deletion (DD) and heterozygous insertion deletion (ID) genotypes as well as their respective allele counts. Biomarkers of nephropathy were analyzed on a Beckman coulter AU480 chemistry analyzer using system compatible reagents.

Results

Majority of the participants were older persons (Median = 57, IQR = 49-64) and female 171 (72.2%). Most of them had the Deletion allele 198 (83.5%) and DD genotype 116 (48.9%). At multivariate logistic regression, the nephropathy biomarkers that is microalbuminuria, serum creatinine, urea, eGFR and electrolytes had no association with the ACE I/D alleles or genotypes (p > 0.05). On the other hand, selected metabolic indicators had a positive relationship. The insertion allele was associated with increasing glycated hemoglobin (OR = 1.082, p = 0.019) and decreasing serum glucose levels (OR = 0.891, p = 0.001). Deletion allele was associated with decreasing glycated hemoglobin (OR = 0.924, p = 0.047) and increasing serum glucose levels (OR = 1.208, p = 0.001). ACE II genotype was associated with decreasing serum glucose levels (OR = 0.873, p = 0.029). ACE DD genotype was associated with decreasing glycated hemoglobin (OR = 0.917, p = 0.010) and increasing serum glucose levels (OR = 1.132, p = 0.001). ACE ID genotype was associated with increasing glycated hemoglobin (OR = 1.077, p = 0.022), triglyceride levels (OR = 1.316, p = 0.031) and decreasing serum glucose levels (OR = 0.933, p = 0.038).

Conclusion

The presence or absence of the ACE I/D alleles and genotypes affects the ultimate increase or decrease in the serum glucose, glycated hemoglobin and triglyceride levels. Although there was no significant association between the biomarkers of nephropathy and the ACE I/D alleles or genotypes, the above implicated metabolic indicators should be included in healthcare guidelines used when attending to type 2 diabetic patients.

Prevalence of prediabetes and associated factors among community members in rural Isingiro district

BACKGROUND

In rural Uganda a significant number of persons afflicted with pre-diabetes are unaware of the condition. This is likely to lead to diabetic complications resulting in catastrophic health expendirure.The burden of prediabetes in rural Isingiro has not previously been determined. This study examined the prevalence of prediabetes and the associated factors among rural community members.

METHODS

We conducted a cross-sectional survey and enrolled 370 participants aged between 18 and 70 years in the Kabuyanda sub-county, rural Isingiro district in march 2021. Multistage sampling and systematic random sampling were conducted to select eligible households. Data was collected using a pretested WHO STEP-wise protocol questionnaire. The primary outcome was prediabetes (FBG = 6.1mmol/l to 6.9mmol/l), calculated as a proportion. Participants known to be diabetic or on medication were excluded. Chi-square tests and multivariate logistic regression model were performed for data analysis using STATA.

RESULTS

The prevalence of prediabetes was 9.19% (95% CI 6.23-12.14). Independent factors significantly associated with pre-diabetes were; advancing age [AOR = 5.7, 95% CI:1.03-32.30], moderate-intensity work [AOR = 2.6,95% CI:1.23-5.63], high level of consumption of a healthy diet [AOR = 5.7, 95% CI:1.67-19.05] and body mass index [AOR = 3.7, 95% CI:1.41-9.20].

CONCLUSION

Prediabetes is prevalent among adult community members in rural Isingiro, southwestern Uganda. Age and lifestyle factors predict prediabetes in this rural population, suggesting a need for targeted health promotion interventions.

Chronic Kidney Disease and Its Clinical Correlates in a Rural Community in Southwestern Nigeria

Chronic kidney disease (CKD) is a burgeoning problem globally, and more than a billion adults were affected as of 2016, with 1.2 million people dying from renal failure in 2017. To arrest the seemingly relentless progression of CKD to renal failure, there is a need to detect CKD early in the community. A community-based study was carried out to look at the prevalence and risk factors of CKD. Anthropometric and other clinical variables were measured. Blood samples were taken for determining creatinine, uric acid, urea, and lipids. CKD was defined as an estimated glomerular filtration rate of ≤60 mL/min/1.73 m2. Electrocardiograms and renal ultrasound scans were performed. In total, 201 people were recruited. Those with CKD had a male:female ratio of 1:3.9 and were older. The prevalence of autosomal-dominant polycystic kidney disease and CKD was 531.9 persons/100,000 population and 46.3%, respectively. Systolic blood pressure, pulse pressure, total cholesterol, triglycerides, high-density lipoprotein (HDL), uric acid, QTc interval, and electrocardiographic left ventricular hypertrophy were higher in those with CKD. Age, female sex, and HDL were independently associated with CKD. There was a steep rise in CKD at the community level. Increased awareness of CKD and prompt interventions are therefore imperative.

Estimating the changing burden of disease attributable to high fasting plasma glucose in South Africa for 2000, 2006 and 2012

Background. Worldwide, higher-than-optimal fasting plasma glucose (FPG) is among the leading modifiable risk factors associated with all- cause mortality and disability-adjusted life years (DALYs) due to the direct sequelae of diabetes and the increased risk for cardiovascular and chronic kidney disease. Objectives. To report deaths and DALYs of health outcomes attributable to high FPG by age and sex for South Africa (SA) for 2000, 2006 and 2012. Methods. Comparative risk assessment methodology was used to estimate the burden attributable to high FPG. A meta-regression analysis was performed using data from national and small-area studies to estimate the population distribution of FPG and diabetes prevalence. Attributable fractions were calculated for selected health outcomes and applied to local burden estimates from the second South African National Burden of Disease Study (SANBD2). Age-standardised rates were calculated using World Health Organization world standard population weights. Results. We estimated a 5% increase in mean FPG from 5.31 (95% confidence interval (CI) 5.18 - 5.43) mmol/L to 5.57 (95% CI 5.41 - 5.72) mmol/L and a 75% increase in diabetes prevalence from 7.3% (95% CI 6.7 - 8.3) to 12.8% (95% CI 11.9 - 14.0) between 2000 and 2012. The age-standardised attributable death rate increased from 153.7 (95% CI 126.9 - 192.7) per 100 000 population in 2000 to 203.5 (95% CI 172.2 - 240.8) per 100 000 population in 2012, i.e. a 32.4% increase. During the same period, age-standardised attributable DALY rates increased by 43.8%, from 3 000 (95% CI 2 564 - 3 602) per 100 000 population in 2000 to 4 312 (95% CI 3 798 - 4 916) per 100 000 population in 2012. In each year, females had similar attributable death rates to males but higher DALY rates. A notable exception was tuberculosis, with an age-standardised attributable death rate in males double that in females in 2000 (14.3 v. 7.0 per 100 000 population) and 2.2 times higher in 2012 (18.4 v. 8.5 per 100 000 population). Similarly, attributable DALY rates were higher in males, 1.7 times higher in 2000 (323 v. 186 per 100 000 population) and 1.6 times higher in 2012 (502 v. 321 per 100 000 population). Between 2000 and 2012, the age-standardised death rate for chronic kidney disease increased by 98.3% (from 11.7 to 23.1 per 100 000 population) and the DALY rate increased by 116.9% (from 266 to 578 per 100 000 population). Conclusion. High FPG is emerging as a public health crisis, with an attributable burden doubling between 2000 and 2012. The consequences are costly in terms of quality of life, ability to earn an income, and the economic and emotional burden on individuals and their families. Urgent action is needed to curb the increase and reduce the burden associated with this risk factor. National data on FPG distribution are scant, and efforts are warranted to ensure adequate monitoring of the effectiveness of the interventions.

A retrospective database study of the demographic features and glycemic control of patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo

BACKGROUND

The Kin-Antwerp project aimed at improving the quality of care provided to patients with diabetes in Kinshasa, the Democratic Republic of the Congo in Central Africa, including the digitalisation of routine clinical data to improve patients' follow-up. We aim to analyse the data of a study population of Kin-Antwerp to characterise their demographic features, assess their achievement of glycemic target over time, and identify groups requiring prioritised attention.

METHODS

We performed a secondary database analysis of routinely collected information from primary care patients with type 2 diabetes followed from 1991 to 2019. Data included demographics (age, sex), anthropometrics (weight, height), clinical parameters (blood pressure, plasma glucose), and anti-diabetic treatments. Achievement of glycemic target, defined as fasting plasma glucose < 126 mg/dL, over time was assessed using a multilevel mixed-effects logistic regression model.

RESULTS

Our study population of patients with type 2 diabetes (N = 8976) comprised a higher proportion of women (67%) and patients between 40 and 65 years old (70.4%). At the first follow-up, most patients were on treatment with insulin (56.5%) and had glycemic levels under the target (79.9%). Women presented more often with obesity (27.4%) and high systolic blood pressure (41.8%) than men (8.6% and 37.0%, respectively). Patients had a median follow-up of 1.8 (interquartile range: 0.5-3.4) years. Overall, the odds of achieving glycemic target increased by 18.4% (odds ratio: 1.184, 95% CI: 1.130 to 1.239; p < 0.001) per year of follow-up. Stratified analyses suggested that the odds of achieving glycemic control over time increased among older patients (> 40 years), but not among younger patients (< 40 years).

CONCLUSION

In our study population, an overall poor glycemic control was observed albeit with a modest improvement in the achievement of glycemic target throughout patients' follow-up. Younger patients may benefit from prioritised attention to achieve glycemic targets. Based on the information provided by the database, continue monitoring and improvement of the project Kin-Antwerp is recommended. Introducing further efforts to improve type 2 diabetes management should include robust glycemia-monitoring tools and haemoglobin A1c, as well as further outlining self-management strategies.

Socioeconomic Inequalities in the Prevalence of Diabetes in Argentina: A Repeated Cross-Sectional Study in Urban Women and Men

This study measured the socioeconomic inequalities in the prevalence of diabetes between 2005 and 2018 in an urban Argentinian population. Data were obtained from the repeated cross-sectional surveys “National Survey of Risk Factors” (ENFR is its acronym in Spanish). From 2005 to 2018, four rounds of ENFR were administered to men and women over 18 years of age. Concentration curves (CC) and the Erreygers concentration index (ECI) were used to describe the socioeconomic inequalities in diabetes’ prevalence. A decomposition analysis was performed to determine the contribution of each variable to inequality in diabetes’ prevalence. Data from 41,219 (2005), 34,583 (2009), 32,232 (2013), and 29,094 (2018) individuals were analyzed. Women reported a greater prevalence of diabetes compared with men for all the years included. According to the CC and ECI, we found no evidence of inequality in men throughout all study years. For women, throughout all years, the CCs were above the line of equity, and the ECIs during all the years were negative and different from zero (p < 0.01). For women, we found no evidence of a reduction in inequalities between 2005 and 2018 (p = 0.475). The socioeconomic inequality for women was largely driven by public insurance, primary and secondary education, and employment. Diabetes’ prevalence was not associated with socioeconomic status in men, while the prevalence of diabetes in women was more concentrated among poorer women. During the 13 years, there was no evidence of a reduction of inequality in women, noting that interventions must prioritize and should focus on the main contribution of inequalities, such as education and employment.

Trajectories of energy intake distribution and subsequent risk of hyperglycemia among Chinese adults: findings from the China Health and Nutrition Survey (1997-2018)

AIMS

Few studies have examined the secular trend of the energy intake distribution, and its effect on future risk of hyperglycemia. This study aims to describe trajectories of energy intake distribution over 12 years and relate them to subsequent risk of hyperglycemia over 9 years of follow-up.

METHODS

Our study used ten waves of data from the CHNS survey, a population-based longitudinal survey in China, ongoing since 1989. We examined a cohort of adult participants who were free from diabetes but had at least three waves of dietary data from 1997 to 2009. We assessed energy intake using three consecutive 24 h recalls. We used these data to identify trajectory groups of energy intake distribution by multi-trajectory model based on energy intake proportions of breakfast, lunch, and dinner. We followed up participants for hyperglycemia, diabetes, and impaired fasting glucose for 9 years from 2009 to 2018. Outcomes were ascertained with fasting glucose, serum HbA1c, and self-report of diabetes and/or glucose-lowering medication. We estimated relative risk (RR) for hyperglycemia, diabetes, and impaired fasting glucose by identified trajectory groups using multilevel mixed-effects modified Poisson regression with robust (sandwich) estimation of variance. Gender difference was additionally examined.

RESULTS

A total of 4417 participants were included. Four trajectory groups were identified, characterized and labeled by "Energy evenly distributed with steady trend group" (Group 1), "Dinner and lunch energy dominant with relatively steady trend group" (Group 2), "Dinner energy dominant with increasing trend and breakfast energy with declining trend group" (Group 3), and "breakfast and dinner energy dominant with increasing trend group" (Group 4). During 48,091 person-years, 1053 cases of incident hyperglycemia occurred, 537 cases of incident diabetes occurred, and 516 cases of impaired fasting glucose occurred. Compared with Group 1, Group 3 was associated with higher subsequent risk of incident hyperglycemia in 9 years of follow-up (RR = 1.28, 95% CI = 1.02, 1.61). No association was found for incident diabetes and impaired fasting glucose. Among males, Group 3 was associated with higher risk of incident hyperglycemia in 9 years of follow-up (RR = 1.44, 95% CI = 1.07, 1.94). No relationship was found in females.

CONCLUSIONS

Energy intake distribution characterized by over 40% of energy intake from dinner with a rising trend over years was associated with higher long-term risk of hyperglycemia in Chinese adults.

Absence of a sexual dimorphism in postprandial glucose metabolism after administration of a balanced mixed meal in healthy young volunteers

BACKGROUND/OBJECTIVES

A different ability to regulate glucose homeostasis between men and women may contribute to their difference in diabetes prevalence and in its predisposing conditions. Data on this issue are controversial because of heterogeneous protocols and insufficient control of confounders affecting glucose metabolism like age, body composition, and physical activity level. To clarify this issue, we compared among sexes the postprandial glucose metabolism after the administration of a balanced mixed meal normalized to daily energy expenditure.

SUBJECTS/METHODS

Thirty-six healthy young volunteers (18 men and 18 women; age, 23.9 ± 2.8 years; BMI, 21.9 ± 1.7 kg/m²) were recruited for the experiment. After overnight fast, subjects consumed a mixed meal providing 40% of daily energy expenditure (60% carbohydrates, 25% lipids, 15% proteins) estimated multiplying resting energy expenditure, obtained by Harris & Benedict equation, for the corresponding physical activity level. Blood was sampled at 0, 10, 20, 30, 45, 60, 90, 120, and 180 min and serum concentrations of glucose, insulin, and C-peptide were measured.

RESULTS

Fasting serum glucose concentrations were lower in women than in men, while fasting insulin and C-peptide concentrations did not differ between sexes. Linear mixed models did not show any significant effect of sex and sex # time interaction on postprandial serum glucose, insulin, and C-peptide concentrations. The comparison of areas under the curve between the sexes revealed similar glycemic, insulinemic, and C-peptide postprandial responses between men and women.

CONCLUSIONS

Our results do not support the hypothesis of a sexual dimorphism in the regulation of carbohydrate metabolism in young when a mixed meal normalized on individual daily energy expenditure is ingested.

Prevalence and predictors of glucose metabolism disorders among People Living with HIV on combination antiretroviral therapy

Objective

We investigated prevalence and predictors of glucose metabolism disorders (GMDs) among People Living with HIV (PLWH) on efavirenz- and atazanavir/ritonavir-based combination antiretroviral therapy (cART).

Methods

This cross-sectional study involved adult PLWH on efavirenz- (n = 240) and atazanavir/ritonavir-based (n = 111) cART. The prevalence of GMDs was determined by fasting serum glucose, insulin, and homeostasis model assessment. A logistic regression model was used to determine predictors.

Results

The overall prevalence of GMDs for all regimens was 27.6% (97/351) [95% CI 23.0–32.6%] s, with 31.1% (75/240) [95% CI 25.4–37.5%] for efavirenz-based and 19.8% (22/111) [95% CI 12.9–28.5%)] for atazanavir/ritonavir-based cART group. The prevalence of impaired fasting glycemia was significantly higher (p = 0.026) in the efavirenz- [(15.4%) (37/240); 95%CI (11.1–20.6%)] than atazanavir/ritonavir-based [(7.2%) (8/111), (95%CI (3.2–13.7%)] cART. However, no significant difference was observed in the prevalence of diabetes mellitus and insulin resistance between the two regimens. Age ≥46 years old and specific type of ARV contained in cART, such as TDF, were independent predictors of GMD in both groups. Whereas the male gender and BMI category were predictors of GMDs among EFV-based cART group, AZT- and ABC- containing regimens and triglyceride levels were predictors in the ATV/r-based group.

Conclusions

GMDs were highly prevalent among adults on EFV- than ATV/r-based cARTs. Age ≥46 years and TDF-containing cARTs are common predictors in both regimens. Close monitoring for impaired fasting glucose during long-term EFV-based cART is recommended for early diagnosis of type-2 diabetes and management.

Glycated Haemogloin, Fasting Plasma Glucose, Plasminogen Activator Inhibitor Type-1, and Soluble Thrombomodulin Levels in Patients with Type 2 Diabetes Mellitus

Diabetes mellitus has become increasingly prevalent over the years. The chronic hyperglycaemia of diabetes is associated with long-term damage, dysfunctions, and failure of different organs suggesting that the most effective tool to prevent complications is the effective control of hyperglycaemia itself. The study is set to determine the effect of glycemic control on plasminogen activator inhibitor type 1 (PAI-1), soluble thrombomodulin (STM) alongside fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) among type 2 diabetic subjects. One hundred diabetic subjects accessing care at the University of Calabar Teaching Hospital Calabar and 100 non -diabetics that served as controls were enrolled. Blood samples from participants were analyzed for FPG, HbA1c, PAI-1 and STM by standard methods. The result shows 74% of the diabetic to be females. Half of the diabetics were managed on only oral anti-diabetic drugs while the remaining half were either on insulin injection or a combination of oral and insulin injection.  Poor glycemic control was observed in 56% of the studied subjects. The mean age of 54.69 ± 9.94 years for the diabetics was comparable to the age-matched controls (p=.097). Diabetics showed significantly higher FPG, HbA1c, PAI-1and STM (P=0.001) compared to control values. Correlations between STM, PAI 1 and glycated hemoglobin (figures 2 p=0.001, p =0.001) and STM, PAI-1 and FPG revealed significantly robust association (p=0.001, p=0.001).  The study concludes that there is poor glycemic control among the treated diabetic subjects with PAI-1 and STM showing a very strong positive correlation with HbA1c than FPG.

Signaling defects associated with insulin resistance in nondiabetic and diabetic individuals and modification by sex

Insulin resistance is present in one-quarter of the general population, predisposing these people to a wide range of diseases. Our aim was to identify cell-intrinsic determinants of insulin resistance in this population using induced pluripotent stem cell-derived (iPSC-derived) myoblasts (iMyos). We found that these cells exhibited a large network of altered protein phosphorylation in vitro. Integrating these data with data from type 2 diabetic iMyos revealed critical sites of conserved altered phosphorylation in IRS-1, AKT, mTOR, and TBC1D1 in addition to changes in protein phosphorylation involved in Rho/Rac signaling, chromatin organization, and RNA processing. There were also striking differences in the phosphoproteome in cells from men versus women. These sex-specific and insulin-resistance defects were linked to functional differences in downstream actions. Thus, there are cell-autonomous signaling alterations associated with insulin resistance within the general population and important differences between men and women, many of which also occur in diabetes, that contribute to differences in physiology and disease.

Prevalence and Socioeconomic Factors of Diabetes and High Blood Pressure Among Women in Kenya: A Cross-Sectional Study

Background

The emerging burden of high blood pressure (HBP) and diabetes in sub-Saharan Africa will create new challenges to health systems in African countries. There is a scarcity of studies that have reported associations of diabetes and HBP with socioeconomic factors on women within the population. We assessed the prevalence and socioeconomic factors of diabetes and high blood pressure among women in Kenya.

Methods

We analysed cross-sectional data from the 2014 Kenya Demographic and Health Survey. Subjects were women aged 15–49 years. Self-reported status of HBP and diabetes was used to measure the prevalences. The association between educational and wealth index with HBP and diabetes was assessed by multivariable binary logistic regression.

Results

The prevalences of self-reported HBP and diabetes were 9.4% and 1.3%, respectively. Women with secondary [aOR = 1.53; 95% CI = 1.15–2.02] and primary [aOR = 1.48; 95% CI = 1.15–1.92] levels of education were more likely to report having HBP, compared to those with no formal education. However, there was no significant association between educational level and self-reported diabetes. In terms of wealth quintile, we found that women with higher wealth quintile were more likely to report having HBP and diabetes compared to those with poorest wealth quintile. Specifically, the highest odds of self-reported HBP was found among women with richest wealth quintile compared to those with poorest wealth quintile [aOR = 2.22; 95% CI = 1.71–2.88]. Also, women with poorer wealth quintile were more likely to have self-reported diabetes compared to those with poorest wealth quintile [aOR = 1.89; 95% CI = 1.08–2.38].

Conclusion

The prevalence of HBP and diabetes was low among women in Kenya. Household wealth status was associated with HBP and diabetes. No causation can be inferred from the data; hence, longitudinal studies focusing on health-related behaviour associated with NCDs are recommended. Proper dissemination of health information regarding the risk factors for HBP and diabetes may prove to be beneficial for NCD prevention programmes.

Prevalence and co-existence of cardiometabolic risk factors and associations with nutrition-related and socioeconomic indicators in a national sample of Gambian women

Cardiovascular diseases (CVD) are on the rise in Sub-Saharan Africa, and a large proportion of the adult population is thought to suffer from at least one cardiometabolic risk factor. This study assessed cardiometabolic risk factors and the contribution of nutrition-related indicators in Gambian women. The prevalence and co-existence of diabetes (elevated glycated hemoglobin (HbA1c ≥ 6.5%) or prediabetes (HbA1c ≥ 5.7% to < 6.5%), hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg), obesity (body mass index (BMI) ≥ 30.0) and inflammation (C-reactive protein (CRP) > 3 mg/L or alpha-1-acid glycoprotein (AGP) > 1 g/L) and the contribution of nutrition related and socioeconomic indicators were measured in non-pregnant women 15-49 years of age in the Gambia using data from a nationally representative cross-sectional stratified survey. Nationally, 54.5% (95% CI: 47.4, 61.4) of 1407 women had elevated HbA1c. Of these, 14.9% were diabetic and 85.1% were prediabetic. Moreover, 20.8% (95% CI 17.8, 20.0) of 1685 women had hypertension, 11.1% (95% CI 9.0, 13.7) of 1651 were obese and 17.2% (95% CI 5.1, 19.6) of 1401 had inflammation. At least one of the aforementioned cardiometabolic risk factor was present in 68.3% (95% CI 63.0, 73.1) of women. Obesity increased the risk of hypertension (aRR 1.84; 95% CI 1.40, 2.41), diabetes (aRR 1.91; 95% CI 1.29, 2.84), elevated HbA1c (aRR 1.31; 95% CI 1.14, 1.51) and inflammation (aRR 3.47; 95% CI 2.61, 4.61). Inflammation increased the risk of hypertension (aRR 1.42; 95% CI 1.14, 1.78). Aging increased the risk of hypertension, obesity and inflammation. Further, inadequate sanitation increased the risk for diabetes (aRR 1.65; 95% CI 1.17, 2.34) and iron deficiency increased the risk of elevated HbA1c (aRR 1.21; 95% CI 1.09, 1.33). The high prevalence of cardiometabolic risk factors and their co-existence in Gambian women is concerning. Although controlling obesity seems to be key, multifaceted strategies to tackle the risk factors separately are warranted to reduce the prevalence or minimize the risk of CVD.

Rates and risk factors for amputation in people with diabetes in Japan: a historical cohort study using a nationwide claims database

Background

The prevalence of diabetes is rising, and diabetes develops at a younger age in East Asia. Although lower limb amputation negatively affects quality of life and increases the risk of cardiovascular events, little is known about the rates and predictors of amputation among persons with diabetes from young adults to those in the “young-old” category (50–72 y).

Methods

We analyzed data from a nationwide claims database in Japan accumulated from 2008 to 2016 involving 17,288 people with diabetes aged 18–72 y (mean age 50.2 y, HbA1c 7.2%). Amputation occurrence was determined according to information from the claims database. Cox regression model identified variables related to lower limb amputation.

Results

The mean follow-up time was 5.3 years, during which time 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age (hazard ratio [HR] 1.09 [95% confidence intervals] 1.02–1.16, p = 0.01) and HbA1c (HR 1.46 [1.17–1.81], p < 0.01) were independently associated with amputations. Compared with those aged < 60 years with HbA1c < 8.0%, the HR for amputation was 27.81 (6.54–118.23) in those aged ≥60 years and HbA1c ≥8.0%.

Conclusions

Age and HbA1c were associated with amputations among diabetic individuals, and the rates of amputation were significantly greater in those ≥60 years old and with HbA1c ≥8.0%.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13047-021-00474-8.

Diabetes mellitus hospitalization and mortality rate according to a national database in Brazil: a longitudinal study

Background

Diabetes mellitus (DM) is an important public health problem worldwide. In addition to the impairment in functionality, the large number of complications which lead to hospitalizations results in high treatment costs. The aim of this study was to analyze the incidence of hospitalizations, mortality rate and hospital costs, as well as to observe the temporal trend of hospitalizations and length of hospital stay due to DM between 2008 and 2019 in Brazil.

Methods

This is a longitudinal descriptive study in which all data regarding hospital admissions registered in the Brazilian system of Hospital Information of “Sistema Único de Saúde” (SIH/SUS; http://datasus.saude.gov.br) due to DM (ICD-10) were included. Comparisons among the groups were performed by an unpaired Student’s t-test, two-way ANOVA with a Tukey post hoc test (p < 0.05).

Results

An increased hospitalization of 1.83% due to DM was observed between 2008 and 2019 in Brazil. The Southeastern region had the highest incidence (34.6%) and mortality rate when compared to the other regions (p < 0.05). We also found that females were more likely to be hospitalized in comparison to males, without a statistically significant difference. Finally, a progressive increase of hospitalizations and mortality rate were observed according to age groups, as well as increased spending due to DM hospitalizations over the years.

Conclusion

Hospitalizations due to DM in Brazil showed an expressive increase over the last 12 years, and there is a need for primary healthcare interventions to help reduce this situation.

Socio-demographic and clinical characteristics of diabetes mellitus in rural Rwanda: time to contextualize the interventions? A cross-sectional study

BACKGROUND

Existing prevention and treatment strategies target the classic types of diabetes yet this approach might not always be appropriate in some settings where atypical phenotypes exist. This study aims to assess the socio-demographic and clinical characteristics of people with diabetes in rural Rwanda compared to those of urban dwellers.

METHODS

A cross-sectional, clinic-based study was conducted in which individuals with diabetes mellitus were consecutively recruited from April 2015 to April 2016. Demographic and clinical data were collected from patient interviews, medical files and physical examinations. Chi-square tests and T-tests were used to compare proportions and means between rural and urban residents.

RESULTS

A total of 472 participants were recruited (mean age 40.2 ± 19.1 years), including 295 women and 315 rural residents. Compared to urban residents, rural residents had lower levels of education, were more likely to be employed in low-income work and to have limited access to running water and electricity. Diabetes was diagnosed at a younger age in rural residents (mean ± SD 32 ± 18 vs 41 ± 17 years; p < 0.001). Physical inactivity, family history of diabetes and obesity were significantly less prevalent in rural than in urban individuals (44% vs 66, 14.9% vs 28.7 and 27.6% vs 54.1%, respectively; p < 0.001). The frequency of fruit and vegetable consumption was lower in rural than in urban participants. High waist circumference was more prevalent in urban than in rural women and men (75.3% vs 45.5 and 30% vs 6%, respectively; p < 0.001). History of childhood under-nutrition was more frequent in rural than in urban individuals (22.5% vs 6.4%; p < 0.001).

CONCLUSIONS

Characteristics of people with diabetes in rural Rwanda appear to differ from those of individuals with diabetes in urban settings, suggesting that sub-types of diabetes exist in Rwanda. Generic guidelines for diabetes prevention and management may not be appropriate in different populations.

Factors Associated With Prediabetes and Diabetes Among Public Employees in Northern Ethiopia

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.

Factors influencing self-management in relation to type 2 diabetes in Africa: A qualitative systematic review

AIM

Effective control of type 2 diabetes is predicated upon the ability of a person with diabetes to adhere to self-management activities. In order to develop and implement services that are locally relevant and culturally acceptable, it is critical to understand people's experiences of living with the disease. We synthesized qualitative research evidence describing the views and experiences of persons with type 2 diabetes in Africa regarding diabetes self-management.

METHODS

Five data bases (MEDLINE, EMBASE, PsychINFO, SCOPUS and CINAHL) were searched for qualitative studies published between the year 2000 and December 2019. After study selection, the included papers were critically appraised using an established tool. The data were extracted, and findings were coded and analysed to identify descriptive and analytical themes using a thematic synthesis approach. This review was registered in the international prospective register of systematic reviews (PROSPERO) with registration number CRD42018102255.

RESULTS

Sixteen studies were included in this review, representing a total of 426 participants across seven countries. Synthesis of findings produced six analytical themes. The diagnosis of diabetes triggered a range of emotions and revealed culturally specific understandings of the condition that negatively affected self-management practices. People with diabetes seeking health care at hospitals encountered several challenges including long waiting times and costly diabetes treatment. Family support and a state of acceptance of the condition were identified as facilitators to diabetes self-management.

CONCLUSION

Effective self-management of type 2 diabetes is a challenge for most persons with diabetes in Africa. There is an urgent need for culturally appropriate education strategies and restructuring of the health system to facilitate self-management of diabetes.

Users of rehabilitation services in 14 countries and territories affected by conflict, 1988-2018

OBJECTIVE

To analyse the demographic and clinical characteristics of people attending physical rehabilitation centres run or supported by the International Committee of the Red Cross in countries and territories affected by conflict.

METHODS

Of 150 such rehabilitation centres worldwide, 38 use an electronic patient management system. We invited all 38 centres to participate. We extracted de-identified data from 1988 to 2018 and categorized them by sex, age, country or territory and reason for using rehabilitation services.

FINDINGS

Thirty-one of the 38 rehabilitation centres in 14 countries and territories participated. We included data for 287 274 individuals. Of people using rehabilitation services, 61.6% (176 949/287 274) were in Afghanistan, followed by 15.7% (44 959/287 274) in Cambodia. Seven places had over 9000 service users each (Afghanistan, Cambodia, Gaza Strip, Iraq, Myanmar, Somalia and Sudan). Overall, 72.6% (208 515/287 274) of service users were male. In eight countries, more than half of the users were of working age (18-59 years). Amputation was the most common reason for using rehabilitation services; 33.3% (95 574/287 274) of users were people with amputations, followed by 13.7% (39 446/287 274) with cerebral palsy. The male predominance was greater in the population aged 18-34 years (83.1%; 71 441/85 997) and in people with amputations (88.6%; 84 717/95 574) but was evident across all places, age groups and health conditions.

CONCLUSION

The considerably lower attendance of females at the rehabilitation centres highlights the need to understand the factors that affect the accessibility and acceptability of rehabilitation for women and girls in conflict settings.

Prevalence of Diabetes Mellitus and Its Associated Factors in Bangladesh: Application of Two-level Logistic Regression Model

This study intends to explore the prevalence of diabetes mellitus (DM) and its associated factors in Bangladesh. The necessary information was extracted from Bangladesh Demographic and Health Survey (BDHS) 2011. In bivariate analysis, Chi-square test was performed to assess the association between selected covariates and diabetes status. A two-level logistic regression model with a random intercept at each of the individual and regional level was considered to identify the risk factors of DM. A total of 7,535 individuals were included in this study. From the univariate analysis, the prevalence of DM was found to be 33.3% in 50-54 age group for instance. In bivariate setup, all the selected covariates except sex of the participants were found significant for DM (p < 0.05). According to the two-level logistic regression model, the chance of occurring DM increases as age of the participants' increases. It was observed that female participants were more likely to have DM. The occurrence of DM was 62% higher for higher educated participants, 42% higher for the individuals who came from rich family and 63% higher for the individuals having hypertension. The chance of developing diabetes among overweighed people was almost double. However, the individuals engaged in physical work had less chance to have DM. This study calls for greater attention of government and other concerned entities to come up with appropriate policy interventions to lower the risk of DM.

Assessment of diabetes and prediabetes prevalence and predictors by HbA1c in a population from sub-Saharan Africa with a high proportion of anemia: a prospective cross-sectional study

INTRODUCTION

Epidemiological data about diabetes mellitus (DM) for sub-Saharan Africa (SSA) are scarce and the utility of glycated hemoglobin (HbA1c) to diagnose DM is uncertain in African populations with a high proportion of anemia.

RESEARCH DESIGN AND METHODS

In a cross-sectional study, age-adjusted prevalence rates and predictors for DM and pre-DM were prospectively assessed by HbA1c in a semirural walk-in population of Tanzania (n=992). Predictors for DM were calculated by logistic regression. Correlations between HbA1c, hemoglobin, and blood glucose levels were done by Pearson's correlation.

RESULTS

Overall, DM and pre-DM prevalence rates were 6.8% (95% CI 5.3 to 8.5) and 25% (95% CI 22.8 to 28.3), respectively. There was an increase in DM prevalence in patients 50-59 (14.9%; 95% CI 9.1 to 22.5), ≥60 years old (18.5%; 95% CI 12.2 to 26.2) and in patients with overweight (9.3%; 95% CI 5.9 to 13.7), obesity (10.9%; 95% CI 6.9 to 16) compared with patients 18-29 years old (2.2%; 95% CI 0.9 to 4.4) (p<0.001) and to normal-weight patients (3.6%; 95% CI 2.1 to 5.6) (p<0.01), respectively. Age (OR 1.08, 95% CI 1.05 to 1.12; p<0.001), body mass index (BMI) (OR 1.10, 95% CI 1.04 to 1.16; p<0.001), and acute infection (OR 3.46, 95% CI 1.02 to 10.8; p=0.038) were predictors for DM. Comparing patients with a BMI of 20 kg/m² and a BMI of 35 kg/m², the relative risk for DM increases in average by 2.12-fold (range 1.91-2.24) across the age groups. Comparing patients 20 years old with patients 70 years old, the relative risk for DM increases in average 9.7-fold (range 8.9-10.4) across the BMI groups. Overall, 333 patients (36%) suffered from anemia. Pearson's correlation coefficients (r) between HbA1c and hemoglobin was -0.009 (p=0.779), and between HbA1c and fasting blood glucose and random blood glucose, it was 0.775 and 0.622, respectively (p<0.001).

CONCLUSION

We observed a high prevalence of DM and pre-DM, mainly triggered by increasing age and BMI, and provide evidence that HbA1c is suitable to assess DM also in populations of SSA with high proportions of anemia.

TRIAL REGISTRATION NUMBER

NCT03458338.

Patterns of concomitant use of Ayurveda and conventional anti-diabetic formulations - Experiences at a tertiary care Ayurveda hospital, India

Background:

Majority of the population relies on traditional medicines for many of their health related problems. Particularly individuals with chronic illness like diabetes mellitus (DM) are more likely to simultaneously use herbal medicines. Many of such users believe that traditional medicines are natural and therefore safe, but this is a dangerous over simplification. Some herbal medicines may be associated with adverse effects, which include interactions with prescribed drugs. Information on such concomitant use of anti-diabetic drugs along with Ayurveda medicines is limited in Indian scenario.

Aims and objectives:

To survey the patterns of concomitant use of Ayurveda and conventional anti-diabetic drugs by diabetic patients attending an out-patient department of a tertiary care teaching hospital in New Delhi, India through a validated questionnaire.

Materials and methods:

This is a questionnaire-based survey, carried out after the approval of the Institutional Ethics Committee, subsequently registered at CTRI. A questionnaire to assess the pattern of concomitant use was developed; content was validated and pre-tested by a pilot study in 40 patients, further refined and used in the survey. The data was analyzed to evaluate the patterns of concomitant use of Ayurvedic and conventional anti-diabetic drugs.

Results:

About 95.9% of diabetic patients were taking herbo-mineral formulations concomitantly with conventional anti-diabetic drugs. Although 45.3% of diabetics were using Ayurveda interventions under the supervision of qualified AYUSH physicians, remaining involved in procuring the drugs over the counter (OTC) or from the local vendors. In majority of these instances, the use of Ayurveda formulations was not communicated with their physicians.

Conclusion:

The observations reveal that a majority of the diabetics (95.9%) were taking one or the other form of herbal preparations along with their conventional anti-diabetic drugs and about 44% among them were using these concomitantly. Thus, generating awareness on good practices of drug use seems to be essential.

Prevalence and characteristics of risk factors for non-communicable diseases in semi-urban communities

Purpose

The purpose of this research aimed to identify the risk factors for non-communicable diseases (NCDs) and determine their prevalence and characteristics in a semi-urban community in Thailand.

Design/methodology/approach

The survey was designed to determine the type and prevalence of risk factors for NCDs among populations in semi-urban areas in the Takianleurn subdistrict of Nakhonsawan, Thailand. A stratified random sampling design was used to select 352 subjects, aged over 15 years and living in this region. Data were collected by questionnaire and analyzed to show frequency, percentage, mean, standard deviation, chi-squared, prevalence rate and prevalence rate ratio with significance indicated by p-value < 0.05 and confidence interval 95 percent.

Research limitations/implications

The implications for the future study are as follows: (1) a comparative study between rural and urban or rural and semi-urban or urban and semi-urban should be studied to understand how risk factors cause NCDs and (2) Participatory action research should be introduced to assess the effectiveness of the decrease in NCDs risk factors management in the community.

Practical implications

(1) To scale up public health interventions measures to promote and prevent NCDs should be focused on behavioral risk factors of NCDs such as eating habits, physical activity, smoking and alcohol consumption. (2) Health promotion and disease prevention for decrease in NCDs should consist of reducing alcohol consumption and enhancing healthy eating habits and (3) To manage unmodified risk factors such as age, gender, educational level, etc. should be focused on surveillance and physical health examination yearly.

Findings

The results revealed a prevalence of NCDs of 14.8 percent. The main unmodifiable risk factors affecting NCD prevalence were gender, age, low level of education and poverty; behavioral risk factors included not eating enough fruit and vegetables, high alcohol consumption, a high-fat fast-food diet and smoking.

Originality/value

The prevention of NCDs requires more focus on changing the eating behavior of high-risk groups and providing easily accessible health care information and services. The entire family should be involved in the process of maintaining good health and disease prevention for all family members.

Urban-Rural Differences in the Trends of Type 1 and Type 2 Diabetes Among Adults Who Received Medical Treatment from Public Hospitals in Resource-Poor Community Tigray, Ethiopia

OBJECTIVE

This study carried out to describe urban-rural differences in the trend of type 1 and type 2 diabetes among adults who have received medical treatment from public hospitals over the last five years.

METHODS

The trends of adult diabetes assessed from September 1, 2013, to August 31, 2018, using hospital-based retrospective medical records of 299,806 adult patients in the adult medical outpatient and emergency units. Data were collected using a uniform data abstraction format. An extended Mantel-Haenszel chi-square test of the linear trend used to examine the trend over time.

RESULTS

Of the total 299,806 adult patients, 3056 (1.02% (95% CI: 0.98-1.06)) patients were confirmed diabetes patients. The overall trend in the proportion of diabetes had increased from 6.8 to 14.3 per 1000 adult patients. The trend of type 1 diabetes increased for both urban from 1.0 to 2.2 per 1000 adult urban residents and rural from 1.2 to 2.6 per 1000 adult rural residents, with statistically a significant increase (χ²= 9.1, P=0.002) and (χ²=17.8, P<0.001) for linear trend, respectively. The trend of type 2 diabetes increased for both urban from 6.9 to 14.0 per 1000 adult urban residents and rural from 4.0 to 9.5 per 1000 adult rural residents, with a statistically significant increase (χ²=68.4, P<0.001) and (χ²=74.2, P<0.001) for linear trend, respectively. The higher increase in the proportion of both type 1 and type 2 diabetes observed among women patients.

CONCLUSION

The trend in the proportion of type 1 and type 2 diabetes increasing for both urban and rural residents, with a higher increase observed among women. These findings highlight health-care professionals and policymakers to design effective public health policies to treat each type of disease.

Challenges And Factors Associated With Poor Glycemic Control Among Type 2 Diabetes Mellitus Patients At Nekemte Referral Hospital, Western Ethiopia

Background

Diabetes is increasing at an alarming rate throughout the world, and ~80% of diabetics live in developing countries. Similar to the rest of sub-Saharan African countries, Ethiopia is experiencing a significant burden of diabetes, with increased prevalence, complications, and mortality, as well as life threatening disabilities. Reasons for poor glycemic control among type 2 diabetes patients are complex and multivariable. Hence, this study aimed to identify challenges and factors associated with poor glycemic control among type 2 diabetes patients.

Method

A hospital-based cross-sectional study was conducted among type 2 diabetic patients attending the diabetic clinic of Nekemte Referral Hospital (NRH) from February 1 to April 30, 2018. Fasting blood glucose levels of the last three clinic visits were obtained and the mean fasting blood glucose measurement was used to determine the level of glycemic control. Analysis included both descriptive and inferential statistics with SPSS version 20.0. Predictor variable P<0.05 was considered statistically significant.

Results

Out of the total 228 included type 2 diabetes mellitus (DM) patients, 51.8% were males. The mean age of patients was 43±12.4 years and 154 (67.5%) were found to not be following their general dietary program correctly. Nearly one third, 73 (32%), of patients never attended diabetic education and 52 (22.8%) of the patients had greater than 10 years’ duration on treatment. The majority, 148 (64.9%), of patients had poor blood glucose control. Age 40–60 years (AOR=2.01, 95% CI=0.04–0.06, P=0.044), being illiterate (AOR=3.12, 95% CI=1.52–8.50, P=0.001), having informal education only (AOR=2.28, 95% CI=2.14–32.60, P=0.024), longer duration of diabetes treatment (>10 years) (AOR=3.94, 95% CI=1.51–27.83, P=0.012), inadequate physical exercise (AOR=3.19, 95% CI=1.05–19.84, P=0.019), and smoking (AOR=4.51, 95% CI=0.00–0.50, P=0.022) were independent predictors of poor glycemic control on multivariable logistic regression analysis.

Conclusion

Nearly two-thirds of patients had poorly controlled diabetes. Age, exercise, level of education, duration of the treatment, and smoking were significantly associated with poor glycemic control. Health facilities should provide continuous education, and barriers of glycemic control should be explored with further research.

Sex differences in the burden of type 2 diabetes and cardiovascular risk across the life course

By 2017 estimates, diabetes mellitus affects 425 million people globally; approximately 90-95% of these have type 2 diabetes. This narrative review highlights two domains of sex differences related to the burden of type 2 diabetes across the life span: sex differences in the prevalence and incidence of type 2 diabetes, and sex differences in the cardiovascular burden conferred by type 2 diabetes. In the presence of type 2 diabetes, the difference in the absolute rates of cardiovascular disease (CVD) between men and women lessens, albeit remaining higher in men. Large-scale observational studies suggest that type 2 diabetes confers 25-50% greater excess risk of incident CVD in women compared with men. Physiological and behavioural mechanisms that may underpin both the observed sex differences in the prevalence of type 2 diabetes and the associated cardiovascular burden are discussed in this review. Gender differences in social behavioural norms and disparities in provider-level treatment patterns are also highlighted, but not described in detail. We conclude by discussing research gaps in this area that are worthy of further investigation.

Sex-specific prevalence, inequality and associated predictors of hypertension, diabetes, and comorbidity among Bangladeshi adults: results from a nationwide cross-sectional demographic and health survey

OBJECTIVES

To determine the sex-specific prevalence, inequality and factors associated with healthcare utilisation for diabetes mellitus (DM), hypertension and comorbidity among the adult population of Bangladesh.

STUDY DESIGN

This study analysed cross-sectional nationwide Bangladesh Demographic and Health Survey data from 2011. Comorbidity was defined as the coexistence of both DM and hypertension. Several socioeconomic and demographic factors such as age, sex, education, geographic location, administrative division, employment status, education and wealth index were considered as major explanatory variables. Inequality in prevalence and healthcare utilisation was measured using the 'Lorenz curve'. Adjusted multiple logistic regression models were performed to observe the effects of different factors and reported as adjusted ORs (AORs) with 95% CIs. A p value of <0.05 was adopted as the level of statistical significance.

SETTING

The study was conducted in Bangladesh.

PARTICIPANTS

A total of 7521 adult participants with availability of biomarkers information were included.

RESULTS

The mean age of the study participants was 51.4 years (SD ±13.0). The prevalence of hypertension, diabetes and comorbidity were 29.7%, 11.0% and 4.5% respectively. Socioeconomic inequality was observed in the utilisation of healthcare services. A higher prevalence of hypertension and comorbidity was significantly associated with individuals aged >70 years (AOR 7.0, 95% CI 5.0 to 9.9; AOR 6.7, 95% CI 3.0 to 14.9). The risk of having hypertension, diabetes and comorbidity were significantly higher among more educated, unemployed as well as among individuals from Khulna division.

CONCLUSIONS

The study revealed a rising prevalence of hypertension, diabetes and comorbidity with inequality in service utilisation. A joint effort involving public, private and non-governmental organisations is necessary to ensure improved accessibility in service utilisation and to reduce the disease burden.

Anthropometric changes and risk of diabetes: are there sex differences? A longitudinal study of Alberta's Tomorrow Project

OBJECTIVES

To characterise the sex-specific difference in the association between anthropometric changes and risk of diabetes in the general population in Canada.

SETTING AND PARTICIPANTS

From 2000 to 2008, Alberta's Tomorrow Project (ATP) invited Alberta's residents aged 35-69 years to a prospective cohort study. A total of 19 655 diabetes-free ATP participants having anthropometrics measured at the baseline and follow-ups were included.

DESIGN AND OUTCOME MEASURES

A longitudinal study design was used to examine the association between anthropometric changes and risk of diabetes and the sex difference in this association. Changes in weight, body mass index (BMI), waist circumference (WC) and waist-hip-ratio (WHR) were calculated as the difference between baseline and follow-up measures. Diabetes cases were identified using the Canadian National Diabetes Surveillance System algorithm with administrative healthcare data (2000-2015) linked to the ATP cohort. The sex-specific association between anthropometric changes and incidence of diabetes were examined by multivariable Cox regression models.

RESULTS

Changes in weight, BMI, WC and WHR over time were positively associated with incidence of diabetes in both men and women. The sex difference in risk of diabetes associated with 1 standard deviation (SD) increase in anthropometrics was 0.07 (95% CI -0.02 to 0.14) for weight, 0.08 (95% CI -0.03 to 0.17) for BMI, 0.07 (95% CI -0.02 to 0.15) for WC and 0.09 (95% CI 0.03 to 0.13) for WHR. Similar results were found in sex difference in the associations with changes per 5% and changes per categories (5% loss, ±5%, 5% gain).

CONCLUSIONS

The positive association between anthropometric changes and risk of diabetes was generally stronger in men than in women. However, this sex-specific difference of approximately 10% of the total risk associated with anthropometric changes had limited significance. For population-based public health programmes aiming to control obesity and incidence of diabetes, it may not be necessary to set up sex-specific goals for anthropometric reduction.

Differential clusters of modifiable risk factors for impaired fasting glucose versus impaired glucose tolerance in adults 50 years of age and older

Background

The aim of this study was to identify modifiable risk factors associated with isolated impaired fasting glucose (IFG), isolate impaired glucose tolerance (IGT), or combined IFG-IGT in men and women aged 50 years and older.

Methods

Cross-sectional analyses were performed in 703 men and women aged between 50 and 80 years old from NHANES (2007-2008). Outcome variables: IFG and IGT (ADA 2003), estimated body composition, cardiometabolic profile, and socio-demographic, dietary, and lifestyle factors.

Results

First, 235 had normal glucose tolerance (men = 38.3%, women = 61.7%), 243 had IFG (men = 61.7%, women = 38.3%), 67 had IGT (men = 40.3%, women = 59.7%) and 158 had both conditions (men = 57.0%, women = 43.0%). The only common determinant of both IFG and IGT was triglyceride levels. High total fat mass index (FMI) and high total fat-free mass index (FFMI) were independently associated with IFG; while high C-reactive protein (CRP) levels were independently associated with IGT. Finally, combined IFG-IGT was associated with inadequate fiber intake, high FMI, FFMI, and CRP levels.

Conclusions

Middle-age and older individuals presented different modifiable risk factors depending on whether they had IFG or IGT. IFG was associated with deteriorated body composition and lipids, whereas IGT was associated with deteriorated lipids and inflammatory factors. IFG-IGT, on the other hand, was associated with a larger number of risk factors, including worsen body composition, cardiometabolic and dietary factors. To prevent the transition to type 2 diabetes, specific clinical interventions targeting these risk factors should be considered.

Prevalence of type 2 diabetes mellitus in women of childbearing age in Africa during 2000-2016: a systematic review and meta-analysis

OBJECTIVES

The aim of this research was to estimate the prevalence of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), in African women of childbearing age.

STUDY DESIGN

Systematic review and meta-analysis of relevant African studies published from January 2000 to December 2016.

DATA SOURCES

We searched several databases, including EMBASE, MEDLINE, CINAHL, grey literature and references of included studies.

SETTING

Studies carried out in African communities or any population-based studies were included.

PARTICIPANTS

We included studies, carried out in Africa, with non-pregnant women of childbearing age. Studies must have been published between the years 2000 and 2016.

OUTCOMES

The primary outcome was prevalent T2DM. The secondary outcomes were IFG and IGT.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data and, using the adapted Hoy risk of bias tool, independently assessed for risk of bias. We used random-effects meta-analysis models to pool prevalence estimates across studies. We used Cochran's Q statistic and the I² statistic to assess heterogeneity.

RESULTS

A total of 39 studies from 27 countries were included, totaling 52 075 participants, of which 3813 had T2DM. The pooled prevalence of T2DM was 7.2% (95% CI 5.6% to 8.9%) overall and increased with age. The pooled prevalence was 6.0% (95% CI 4.2% to 8.2%) for impaired fasting glycemia while the prevalence of IGT ranged from 0.9% to 37.0% in women aged 15-24 and 45-54 years, respectively. Substantial heterogeneity across studies was not explained by major studies characteristics such as period of publication, rural/urban setting or whether a study was nationally representative or not.

CONCLUSION

This review highlights the need for interventions to prevent and control diabetes in African women of childbearing age, in view of the significant prevalence of T2DM and prediabetes.

PROSPERO REGISTRATION NUMBER

CRD42015027635.

Neurological Alterations in Type 1 Diabetes Mellitus Among Adolescents

BACKGROUND:

Diabetes mellitus (DM) is a group of chronic disorders of metabolism characterised by high blood glucose levels. There is an increased prevalence of Type 1 DM in children and adolescents with its adverse complications especially microvascular ones (retinopathy, nephropathy and neuropathy) that might cause multiple organ damage.

AIM:

To study the relation between DM and neurological affection.

METHODS:

Fifty-nine children with type I DM, divided randomly into 2 groups, aged 8-18 years old of both sexes were enrolled in this cross-sectional study. All children were subjected to full history taking, physical, neurological and systemic examination.

RESULTS:

There was an affection of motor power in both upper limbs as well as lower limbs. Also, we found that there was an affection of the superficial peripheral sensation affecting both upper and lower limbs.

CONCLUSION:

Neurological assessment of children with diabetes mellitus type I should be a routine to early discover these manifestations which can have a deteriorating effect on the child’s health.

Association of demographic and socioeconomic characteristics with body mass index of outpatient diabetic adults attending a tertiary health facility in Enugu, Nigeria

BACKGROUND/OBJECTIVE

Recently, demographic and socioeconomic characteristics have been emphasized in dealing with chronic diseases of which Type 2 diabetes (T2D) is one. This present study was conducted to correlate the demographic and socioeconomic characteristics of out-patient type 2 diabetic adults with their body mass index (BMI).

METHODOLOGY

This cross-sectional study was conducted in the Out-patients Diabetic clinic of University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu Nigeria. A total of 370 subjects were purposively selected from the 2888 annual average attendances and examined with questionnaire and anthropometry. Information on their demographic and socioeconomic characteristics was correlated with their body mass index.

RESULT

The results indicated that there were more (59%) urban diabetics than rural (25.7%) diabetics, many (65.7%) were within the age range of 41-60years, more (64.9%) females than males (35.1%), mainly (86.2%) married and of Christian religion (94.1%) and Igbo ethnicity (95.9%). The majority (91.1%) were of a monogamous family type with 55.4% from average sized (4-6persons) families. More than 1/3 (34.1%) had tertiary education, mainly (43%) civil servants, and 45.1% earning above 137.21 US Dollar per month. Most (69%) of the diabetics were over-weight, a trend of both under-nutrition (1.1%), and over-nutrition (68.7%) with mean BMI value of 27.19 kg/m² was also observed. BMI had slight negative association with age, sex, and occupation and positive association with religion, ethnicity, marital status and level of education.

CONCLUSION

There is a weak negative association of age, sex and occupation with BMI.

Knowledge regarding medicines management of type 2 diabetes amongst patients attending a Community Health Centre in South Africa

Objective

The prevalence of type 2 diabetes mellitus (T2DM) is growing in Sub-Saharan countries including South Africa. This is a concern given its appreciable impact on morbidity, mortality and costs with the recent introduction of universal health care in South Africa. The purpose of the study was to assess the knowledge of patients with T2DM attending a typical community health centre (CHC) regarding the management of their disease including risk factors and prevention to guide future initiatives. Typically, patients with T2DM in South Africa are managed in ambulatory care including CHCs.

Method

A quantitative, descriptive study in a CHC. The sample included 217 adults with T2DM who have visited a physician as well as the pharmacy. Face-to-face patient exit interviews were conducted using a structured questionnaire.

Key findings

Females predominated (65%), with the majority of patients &gt;60 years (38.2%) and more than half from the Indian racial category. Most patients did not know how their medication controls their diabetes (79.3%) or did not know any of the side effects (83.9%) from their medication. Less than half of the patients knew how to take their medication, and more than a third of patients indicated that they were not practicing any form of self-care.

Conclusion

The results indicate that these T2DM patients lacked sufficient knowledge regarding the management of their disease. Healthcare managers should consider instigating programmes to improve patients’ knowledge about the management of their disease as part of general initiatives within South Africa to improve the management of patients with chronic diseases in the public sector.

Modifiable and emerging risk factors for type 2 diabetes in Africa: a systematic review and meta-analysis protocol

BACKGROUND

Type 2 diabetes mellitus (T2DM) remains a public health problem in low-income countries, including African countries. Risk factors of this disease in Africa are still unclear. This study will examine the modifiable and emerging risk factors associated with T2DM in Africa.

METHODOLOGY

The study will include a systematic review and meta-analysis of published and unpublished empirical studies, reporting quantitative data only. We will conduct a search on scientific databases (e.g. Global Health), general online search engines (e.g. Google Scholar) and key websites for grey literature using a combination of key countries/geographic terms, risk factors (e.g. overweight/obesity) and T2DM (including a manual search of the included reference lists). We will use the Comprehensive Meta-Analysis Software (CMA) version 2.0 for data management and analysis. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P).

DISCUSSION

The systematic review and meta-analysis will provide a robust and reliable evidence base for policy makers and future research. This may help with identifying and implementing more cost-effective diabetes prevention strategies and improved resource allocation.

SYSTEMATIC REVIEW REGISTRATION

This protocol has been registered with the PROSPERO international prospective register of systematic reviews. The reference number is CRD42016043027 .

Higher HbA1c and/or glucose levels alter the association patterns between glycated hemoglobin and fasting glucose levels

AIMS

To verify the correlations between HbA1c and fasting glucose levels.

METHODS

A cross-sectional study with 14,249 Chinese subjects. Objective was evaluated in pooled, age-stratified, HbA1c and fasting glucose-stratified populations.

RESULTS

In pooled populations, the Pearson correlation coefficients (PCCs) of males and females were 0.684 (P < 0.001) and 0.800 (P < 0.001), respectively. HbA1c and fasting glucose maintained significant correlations within the group with HbA1c < 6.5% and glucose <7.0 mmol/L and the group with HbA1c ≥ 6.5% and glucose ≥7.0 mmol/L in both males (PCC: 0.342, P < 0.001; and PCC: 0.765, P < 0.001, respectively) and females (PCC: 0.318, P < 0.001 and PCC: 0.788, P < 0.001, respectively). The slopes increased from the group with HbA1c < 6.5% and glucose <7.0 mmol/L to the group with HbA1c ≥ 6.5% and glucose ≥7.0 mmol/L in both males (0.26-0.44) and females (0.31-0.46). Linear regression analysis showed that fasting glucose and age were two common factors positively associated with HbA1C, and red blood cell count and red cell distribution width were two common factors negatively associated with HbA1c in both males and females with HbA1c < 6.5% and glucose <7.0 mmol/L. The correlations changed dramatically in the groups with HbA1c ≥ 6.5% and glucose <7.0 mmol/L and HbA1c < 6.5% and glucose ≥7.0 mmol/L.

CONCLUSIONS

High HbA1c and fasting glucose levels greatly altered the associations between HbA1c, glucose and age.

Glycated haemoglobin A1c (HbA1c) for detection of diabetes mellitus and impaired fasting glucose in Malawi: a diagnostic accuracy study

OBJECTIVES

To examine the accuracy of glycated haemoglobin A_1c (HbA_1c) in detecting type 2 diabetes and impaired fasting glucose among adults living in Malawi.

DESIGN

A diagnostic validation study of HbA_1c. Fasting plasma glucose (FPG) ≥7.0 mmol/L was the reference standard for type 2 diabetes, and FPG between 6.1 and 6.9 mmol/L as impaired fasting glucose.

PARTICIPANTS

3645 adults (of whom 63% were women) recruited from two demographic surveillance study sites in urban and rural Malawi. This analysis excluded those who had a previous diagnosis of diabetes or had history of taking diabetes medication.

RESULTS

HbA_1c demonstrated excellent validity to detect FPG-defined diabetes, with an area under the receiver operating characteristic (AUROC) curve of 0.92 (95% CI 0.90 to 0.94). At HbA_1c ≥6.5% (140 mg/dL), sensitivity was 78.7% and specificity was 94.0%. Subgroup AUROCs ranged from 0.86 for participants with anaemia to 0.94 for participants in urban Malawi. There were clinical and metabolic differences between participants with true diabetes versus false positives when HbA_1c was ≥6.5% (140 mg/dL).

CONCLUSIONS

The findings from this study provide justification to use HbA_1c to detect type 2 diabetes. As HbA_1c testing is substantially less burdensome to patients than either FPG testing or oral glucose tolerance testing, it represents a useful option for expanding access to diabetes care in sub-Saharan Africa.

Diabetes and abnormal glucose regulation in the adult population of Burkina Faso: prevalence and predictors

BACKGROUND

The prevalence of diabetes mellitus (DM) is reportedly growing fast in sub-Saharan Africa. There is however a scarcity of epidemiologic data on DM in Burkina Faso. We carried out a secondary analysis of the first survey conducted in Burkina Faso on a nationally representative sample following the World Health Organization (WHO) Stepwise approach to risk factors Surveillance (STEPS) for non-communicable diseases (NCDs) with the aims of identifying the prevalence of NCDs and the prevalence of common risk factors for NCDs. We report here on the prevalence of diabetes and overall abnormal glucose regulation (AGR) and their associated risk factors.

METHODS

In the primary study 4800 individuals were randomly sampled using a stratified multistage clusters sampling process. We used fasting capillary whole blood glucose level to define three glucose regulation statuses using WHO's cut-off levels: normal, diabetes and overall abnormal glucose regulation (impaired fasting glucose and diabetes). Appropriate statistical techniques for the analysis of survey data were used to identify the factors associated with diabetes and abnormal glucose regulation fitting a logistic regression model. Analyses were carried out using Stata Version 14 software.

RESULTS

The prevalence of DM and AGR were respectively 5.8% (95% CI: 5-6.7) and 9% (95% CI: 8-10.1). Significant risk factors for DM include age (OR = 1.9; P = 0.009 for the age group of 55-64), obesity (OR: 2.6; P = 0.001), former smoke (OR:2; P = 0.03), second-hand smoke (OR = 1.7; P = 0.006) and total cholesterol level (OR: 2.1; P = 0.024). The same predictors were also found significantly associated with AGR. In addition, having an history family diabetes was protective against AGR (OR = 0.5; P = 0.032).

CONCLUSION

Diabetes is no longer a rare disease in the adult active population of Burkina Faso. Its burden is significant in both rural and urban areas. Health policies that promote healthy life style are needed to give precedence to the prevention in a context of an under-resourced country.

Screening for Diabetes Mellitus among Tuberculosis Patients: Findings from a Study at a Tertiary Hospital in Lusaka, Zambia

BACKGROUND

Diabetes mellitus (DM) is known to be associated with active tuberculosis (TB). Zambia is a low-income sub-Saharan African country with a high TB burden and increasing numbers of newly diagnosed DM patients.

MATERIALS AND METHODS

This was an observational study conducted at the University Teaching Hospital in Lusaka, Zambia, from October 2014 to February 2016. Adult patients with active TB were screened for DM.

RESULTS

A total of 127 individuals were enrolled in the study. Six patients (5%) were found to have diabetes. Of these, three had a prior diagnosis of diabetes and were on medication while three were newly diagnosed. Low education level was significantly associated with DM (p=0.001; 95% CI 0.001-0.148).

CONCLUSION

The prevalence of DM among individuals with smear positive TB in our study population was similar to that of the general population in Zambia.

Prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolaemia among adults in Dande municipality, Angola

Objectives

To estimate the prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolaemia in an Angolan population aged 15 to 64 years and to determine relationships with sociodemographic, behavioural and anthropometric characteristics.

Methods

A total of 2 354 individuals were assessed for behavioural, sociodemographic and physical characteristics in a cross–sectional, community–based survey. Post–stratification survey weights were applied to obtain prevalence levels. Adjusted odds ratios for each variable related to the conditions were calculated using logistic regression models.

Results

Overall, the prevalence of hypertension was 18.0%, diabetes 9.2% and hypercholesterolaemia 4.0%. Among hypertensive individuals, the awareness rate was 48.5%; 15.8% were on treatment and 9.1% had their blood pressure controlled. Only 10.8% were aware they had diabetes, 4.5% were on treatment and 2.7% were controlled. The awareness level for hypercholesterolaemia was 4.2%, with 1.4% individuals on treatment and 1.4% controlled.

Conclusions

The prevalence levels of hypertension and diabetes, which were higher than previous findings for the region, together with the observed low rates of awareness, treatment and control of all conditions studied, constitute an additional challenge to the regional health structures, which must rapidly adapt to the epidemiological shift occurring in this population.

A Clinical Mentorship and Quality Improvement Program to Support Health Center Nurses Manage Type 2 Diabetes in Rural Rwanda

INTRODUCTION

The prevalence of diabetes mellitus is rapidly rising in SSA. Interventions are needed to support the decentralization of services to improve and expand access to care. We describe a clinical mentorship and quality improvement program that connected nurse mentors with nurse mentees to support the decentralization of type 2 diabetes care in rural Rwanda.

METHODS

This is a descriptive study. Routinely collected data from patients with type 2 diabetes cared for at rural health center NCD clinics between January 1, 2013 and December 31, 2015, were extracted from EMR system. Data collected as part of the clinical mentorship program were extracted from an electronic database. Summary statistics are reported.

RESULTS

The patient population reflects the rural settings, with low rates of traditional NCD risk factors: 5.6% of patients were current smokers, 11.0% were current consumers of alcohol, and 11.9% were obese. Of 263 observed nurse mentee-patient encounters, mentor and mentee agreed on diagnosis 94.4% of the time. Similarly, agreement levels were high for medication, laboratory exam, and follow-up plans, at 86.3%, 87.1%, and 92.4%, respectively.

CONCLUSION

Nurses that receive mentorship can adhere to a type 2 diabetes treatment protocol in rural Rwanda primary health care settings.

Prevalence of non-communicable disease risk factors among poor shantytown residents in Dhaka, Bangladesh: a community-based cross-sectional survey

OBJECTIVES

This study aims to describe the prevalence of non-communicable disease (NCD) risk factors among the urban poor in Bangladesh.

DESIGN

We conducted a community-based cross-sectional epidemiological study.

SETTING

The study was conducted in a shantytown in the city of Dhaka. There were 8604 households with 34 170 residents in the community. Those households were categorised into two wealth strata based on the housing structure.

PARTICIPANTS

The study targeted residents aged 18-64 years. A total of 2986 eligible households with one eligible individual were selected by simple random sampling stratified by household wealth status. A total of 2551 residents completed the questionnaire survey, and 2009 participated in the subsequent physical and biochemical measurements.

OUTCOME MEASURES

A modified WHO survey instrument was used for assessing behavioural risk factors and physical and biochemical measurements, including glycated haemoglobin (HbA1c). The prevalence of NCD risk factors, such as tobacco use, fruit and vegetable intake, overweight/obesity, hypertension, diabetes (HbA1c ≥6.5%) and dyslipidaemia, was described according to household wealth status and gender differences.

RESULTS

The prevalence of current tobacco use was 60.4% in men and 23.5% in women. Most of them (90.8%) consumed more than 1 serving of fruits and vegetables per day; however, only 2.1% consumed more than 5 servings. Overweight/obesity was more common in women (39.2%) than in men (18.9%), while underweight was more common in men (21.0%) than in women (7.1%). The prevalence of hypertension was 18.6% in men and 20.7% in women. The prevalence of diabetes was 15.6% in men and 22.5% in women, which was much higher than the estimated national prevalence (7%). The prevalence of raised total cholesterol (≥190 mg/dL) was 25.7% in men and 34.0% in women.

CONCLUSION

The study identified that tobacco use, both overweight and underweight, diabetes, hypertension and dyslipidaemia were prevalent among the urban poor in Bangladesh.

Risk factors of diabetes mellitus amongst the executives of an industrial area of North East India: A community based cross sectional study

AIM

To assess risk factors of diabetes mellitus amongst the executives of an industrial area of North East India.

MATERIAL AND METHOD

Executive the aged 20 to 60 years were selected by simple random sampling in a community based cross-sectional study. The sample size was 340. Data was collected by a predesigned pretested proforma to know about different risk factors. Fasting capillary blood glucose and 2h capillary blood glucose were taken to assess diabetes mellitus.

RESULTS AND OBSERVATION

30.7% of the male and 18.4% of the female participants had family history of DM. 29.3% of the male and 39.5% of the female had family history of hypertension. 24.7%, 0.6% and 2.9% smoked regularly, occasionally and in the past respectively. 2.9% subjects consumed chewed tobacco regularly, 0.3% consumed occasionally and 1.6% consumed tobacco in the past. 44.5%, 10.7%, 2.3% of the study subjects took alcohol regularly, occasionally, in the past respectively. 44.5%, 47.4% and 8.1% of the participants were involved in sedentary work, active work and heavy work respectively. Prevalence of diabetes mellitus was significantly associated with advancement of age, family history of diabetes mellitus, family history of hypertension and sedentary life style. No significant association of diabetes mellitus with gender, tobacco consumption and alcohol intake.

CONCLUSION

A package for the early diagnosis and management of diabetes may be initiated to bring down the morbidity and mortality in industrial population.

The prevalence of type 2 diabetes in urban Bo, Sierra Leone, and in the 16 countries of the West Africa region

BACKGROUND

The goal of this study was to measure the prevalence of diabetes among adults in urban Bo, Sierra Leone, and to compare the new results to the diabetes prevalence rates reported from studies across West Africa.

METHODS

A total of 694 outpatients ages 18 and older at Bo Government Hospital were tested for diabetes between January 2012 and December 2014. Diabetes was defined as a fasting blood sugar level of ≥126 mg/dL (≥7.0 mmol/L).

RESULTS

The overall prevalence of diabetes was 6.2% (43/694). Diabetes prevalence increased from 0.8% (2/256) among patients ages 18 to 29 years to 3.9% (8/204) among patients ages 30 to 39, 8.4% (11/131) among patients ages 40 to 49, 19.0% (12/63) among patients ages 50 to 59, and 25.0% (10/40) among patients ages 60 and older. The prevalence of diabetes was 5.2% among females and 7.4% among males. After adjusting the study population to the age and sex distribution of the national population, the standardized prevalence of diabetes was 7.0%. The only previously published study of diabetes in Sierra Leone found a much lower 2.4% prevalence rate in 1997. A comprehensive literature search identified studies from across West Africa (including Benin, Burkina Faso, Cabo Verde, Côte d'Ivoire, the Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, and Togo) that illustrate an increasing rate of diabetes and impaired glucose tolerance in the region.

CONCLUSIONS

It is important for hospitals and clinics across West Africa to increase their ability to diagnose, monitor, and treat type 2 diabetes in urban and rural areas.

Interaction of iron status with single nucleotide polymorphisms on incidence of type 2 diabetes

The objective of this study is to find single nucleotide polymorphisms (SNPs) associated with a risk of Type 2 diabetes (T2D) in Korean adults and to investigate the longitudinal association between these SNPs and T2D and the interaction effects of iron intake and average hemoglobin level. Data from the KoGES_Ansan and Ansung Study were used. Gene-iron interaction analysis was conducted using a two-step approach. To select candidate SNPs associated with T2D, a total of 7,935 adults at baseline were included in genome-wide association analysis (step one). After excluding T2D prevalent cases, prospective analyses were conducted with 7,024 adults aged 40–69 (step two). The association of selected SNPs and iron status with T2D and their interaction were determined using a Cox proportional hazard model. A total of 3 SNPs [rs9465871 (CDKAL1), rs10761745 (JMJD1C), and rs163177 (KCNQ1)] were selected as candidate SNPs related to T2D. Among them, rs10761745 (JMJD1C) and rs163177 (KCNQ1) were prospectively associated with T2D. High iron intake was also prospectively associated with the risk of T2D after adjusting for covariates. Average hemoglobin level was positively associated with T2D after adjusting for covariates in women. We also found significant interaction effects between rs10761745 (JMJD1C) and average hemoglobin levels on the risk of T2D among women with normal inflammation and without anemia at baseline. In conclusion, KCNQ1 and JMJD1C may prospectively contribute to the risk of T2D incidence among adults over the age of 40 and JMJD1C, but CDKAL1 may not, and iron status may interactively contribute to T2D incidence in women.