Prevalence and Incidence Rate of Diabetes, Pre-diabetes, Uncontrolled Diabetes, and Their Predictors in the Adult Population in Southeastern Iran: Findings From KERCADR Study

Nutritional intake of micronutrient and macronutrient and type 2 diabetes: machine learning schemes

BACKGROUND

Diabetes mellitus, an endocrine system disease, is a common disease involving many patients worldwide. Many studies are performed to evaluate the correlation between micronutrients/macronutrients on diabetes but few of them have a high statistical population and a long follow-up period. We aimed to investigate the relationship between intake of macro/micronutrients and the incidence of type 2 diabetes (T2D) using logistic regression (LR) and a decision tree (DT) algorithm for machine learning.

METHOD

Our research explores supervised machine learning models to identify T2D patients using the Mashhad Cohort Study dataset. The study population comprised 9704 individuals aged 35-65 years were enrolled regarding their T2D status, and those with T2D history. 15% of individuals are diabetic and 85% of them are non-diabetic. For ten years (until 2020), the participants in the study were monitored to determine the incidence of T2D. LR is a statistical model applied in dichotomous response variable modeling. All data were analyzed by SPSS (Version 22) and SAS JMP software.

RESULT

Nutritional intake in the T2D group showed that potassium, calcium, magnesium, zinc, iodine, carotene, vitamin D, tryptophan, and vitamin B12 had an inverse correlation with the incidence of diabetes (p < 0.05). While phosphate, iron, and chloride had a positive relationship with the risk of T2D (p < 0.05). Also, the T2D group significantly had higher carbohydrate and protein intake (p-value < 0.05).

CONCLUSION

Machine learning models can identify T2D risk using questionnaires and blood samples. These have implications for electronic health records that can be explored further.

Predicting preventive self-care behaviours among type 2 diabetes based on the health belief model in Bandar Abbas city: a cross-sectional study

OBJECTIVES

It is essential to manage type 2 diabetes mellitus (T2DM) through self-care behaviours and to ascertain the predictors of correct health training for the control of diabetes. The aim of this study was to determine the predictive role of the constructs of the health belief model in encouraging T2DM to adopt self-care behaviours in Bandar Abbas city.

DESIGN

This cross-sectional study was conducted in 2022 in Bandar Abbas.

PARTICIPANTS

Participants were 246 patients with T2DM referring to six comprehensive healthcare centres in Bandar Abbas city. They were enrolled using the accessible sampling method and were requested to complete a questionnaire.

RESULTS

The results of the present study indicated that the health belief model could explain 50.73% of the variance in patients with T2DM's self-care behaviours. Among the constructs of the health belief model, the constructs of self-efficacy (52.4%), perceived barriers (38.8%) and perceived susceptibility (34.9%) best predicted the adherence of patients to self-care behaviours, suggesting that these constructs can be considered to improve self-care behaviours in patients with T2DM.

CONCLUSIONS

According to the results of this study, the health belief model can be a suitable and effective tool for predicting self-care behaviours in patients with T2DM. There was a statistically significant correlation was found between self-care behaviours and all the constructs except perceived barriers. Considering the positive effects of the health belief model in improving the self-care of patients with type 2 diabetes, it is suggested to use this model in planning interventions to improve self-care in other diseases affected by lifestyle-based behaviour.

Referral for Diabetes Self-Management Education and Support in Adult Primary Care: An Integrative Review

AIMS

The purpose of this integrative review was to identify effective diabetes self-management education and support for increasing adult primary care referrals, participation rates and improving health outcomes for persons with diabetes.

DESIGN

Integrative review.

METHODS

A systematic literature search of PubMed/MEDLINE, Embase and CINAHL was performed by applying the PRISMA guidelines. Following Whittemore and Knafl's method, 11 papers were included for review.

RESULTS

Integration of diabetes self-management education and support in primary care clinics and a multifaceted approach resulted in improved referral and participation rates, ameliorated glycated haemoglobin A1C and boosted patient, provider and staff satisfaction.

CONCLUSION

Patient-centred multifaceted interventions can boost current diabetes self-management education referrals and participation rates and enhance health outcomes for persons with diabetes. Nurses in their role as primary care providers, diabetes educators and clinic staff are well-positioned to undertake this intervention. Further investigation is needed to explore the impact of these interventions among individuals with type 1 diabetes, gestational diabetes and those living across various global regions.

IMPLICATIONS FOR PATIENT CARE

Along with other healthcare providers, nurses are qualified to advocate for, and lead programmes that increase referrals for persons with diabetes to improve health outcomes. Additionally, as primary care providers, nurse practitioners are well placed to positively impact the outcomes of individuals with diabetes by referring them to diabetes self-management education. Nurses, as diabetes educators, are well positioned to implement diabetes self-management education which can improve patient outcomes.

IMPACT

Improved referral of persons with diabetes to diabetes self-management education and increased participation have the propensity to contribute to the achievement of positive health outcomes for individuals living with Type 2 Diabetes.

PATIENT OR PUBLIC CONTRIBUTION

There is no patient or public contribution for this review.

Effect of empagliflozin on weight in patients with prediabetes and diabetes

The impact of blood glucose-lowering medications on weight has always been a topic of interest in the treatment of diabetic patients. This study investigates the effect of empagliflozin on weight in patients with prediabetes and type 2 diabetes. This quasi-experimental study was performed on patients with prediabetes or type 2 diabetes with an HbA1c level up to 1% higher than the treatment target, and not using other blood glucose-lowering medications. Patients received 10 milligrams of Empagliflozin once daily for three months, and weight, BMI, waist circumference, and blood pressure were evaluated monthly. Forty-three patients (21 women and 22 men) enrolled. The average weight of patients decreased by 2.96 ± 1.96 kg (3.8%) (P < 0.001). BMI decreased by -1.10 ± 0.71 Kg/m2 (3.72%) (P < 0.001). The waist circumference of patients decreased by -3.23 ± 3.69 centimeters (P < 0.001). FPG decreased from 114.86 to 109.48 mg/dL (P < 0.001), and HbA1c decreased from 6.52% to 6.38% (P < 0.001). The weight change was more significant in men than women (-3.59 ± 1.74 vs. -2.30. ± 1.99), (P = 0.029). Weight reduction was greater in patients with GFR higher than 90 compared to GFR lower than 90 (-3.34. ± 2.00 vs. -2.16 ± 1.67) (P = 0.063). Also, no significant difference was observed in the weight, BMI, and waist circumference changes between different BMI groups (less than 25, 25 to 30, 30 to 35, and higher than 35). The trend of weight and BMI changes during the three-month empagliflozin treatment period was significant (P < 0.001) and didn't reach a plateau level after three months. The change in waist circumference was also significant, reaching a plateau level after one month (P < 0.001). There was no significant change in blood pressure. In conclusion the weight, BMI, and waist circumference of patients decreased following the administration of empagliflozin. Weight reduction was more pronounced in males than females and in patients with a GFR above 90 than those with a GFR below 90. Trial registration: This study was approved by the Research Deputy of Kerman University of Medical Sciences with tracking number 401,000,516, IRCT code: IRCT20090317001774N10, and ethical code: IR.KMU.AH.REC.1402.065 was approved by Research Ethics Committee of Afzalipour Hospital- Kerman University of Medical Sciences.

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

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

The prevalence of metabolically healthy obesity and its transition into the unhealthy state: A 5-year follow-up study

People with metabolically healthy obesity (MHO) are at risk of developing cardiometabolic diseases. We investigated the prevalence of MHO and factors influencing its transition into a metabolically unhealthy state (MUS). This study was conducted as part of the Kerman Coronary Artery Disease Risk Factor Study (KERCADRS). From 2014 to 2018, 9997 people were evaluated. The obesity and metabolic status of the MHO participants were re-examined after 5 years of their initial participation in the study. Out of 347 MHO, 238 individuals were accessed at follow-up. Twenty-nine (12.2%) had metabolic unhealthy normal weight (MUNW), 169 (71.0%) had metabolic unhealthy obesity (MUO), and the others had healthy metabolic state. Among age, total cholesterol, diastolic blood pressure and triglyceride (TG) variables, the baseline serum TG level was associated with a significant increase in the risk of developing MUS during 5 years (p <.05). The TG level optimal cut-off point for predicting the development into MUS was 107 mg/dL with 62.1% sensitivity and 77.5% specificity (AUC = 0.734, p <.001). A high percentage of MHO people transit into MUS during 5 years. A TG level higher than 107 mg/dL can help to identify people at a higher risk of developing into MUS.

Socioeconomic inequalities in the prevalence, non-awareness, non-treatment, and non-control of diabetes among South Korean adults in 2021

The purpose of this study was to investigate socioeconomic inequalities in diabetes prevalence, non-awareness, non-treatment, and non-control among South Korean adults in 2021. This cross-sectional study used data from the 2021 Korean National Health and Nutrition Examination Survey. Relative concentration indices (RCIs) and relative concentration curves stratified by sex and age were used to investigate socioeconomic inequalities in the prevalence, non-awareness, non-treatment, and non-control of diabetes. The prevalence, non-awareness, lack of treatment, and non-control rates in adults aged 30 years and older in 2021 were 15.9%, 29.5%, 33.3%, and 76.1%, respectively. Diabetes was more prevalent in participants under the age of 65 years than those aged 65 years and older for both men (RCI: -0.081, RCI: -0.158, respectively) and women (RCI: -0.203, RCI: -0.292, respectively). The larger the absolute value of the RCI in non-awareness and non-treatment of diabetes in women, the greater the level of socioeconomic inequalities (RCI: 0.182, RCI: 0.154). Socioeconomic inequalities existed in the prevalence of diabetes among both men and women aged under 65 years. In women, socioeconomic inequalities of non-awareness and non-treatment of diabetes were greater than those in men. Thus, preventive care and monitoring are required, particularly among women and individuals under the age of 65 years.

Which antidiabetic drugs do patients of T2DM prefer in India and why? A discrete choice experiment

Background

Uncontrolled diabetes persists despite guideline-based treatment, partly attributed to inadequate patient involvement. This research addresses shared decision-making by eliciting patient preferences in Type 2 Diabetes Mellitus (T2DM) treatment based on certain key attributes and explores their correlation with socio-demographic-clinical profiles.

Methods

A discrete choice experiment (DCE) was conducted among T2DM outpatients in an Indian tertiary care center. A choice card was developed using the contextual choice framework, having six second-line antidiabetic drugs (ADs) from different classes incorporating seven attributes. Face-to-face interviews were conducted with patients, and elicited preferences were analyzed using descriptive statistics, Chi-square analysis, and multinomial logistic regression.

Results

Out of the 87 evaluated participant choices, the most preferred drug was Glimepiride (51.7%), followed by Dapagliflozin (22.9%) and Teneligliptin (17.2%). Overall, the most important attributes were the effect on weight (29%), followed by route of administration (24%), and additional benefits offered by the drug (18%). Significant associations were found between participants' drug preferences and their age (P = 0.002), socioeconomic status (P = 0.04), occupation (P = 0.004), and monthly income (P = 0.03). Age was not a significant predictor of drug choice for any of the drugs. Multinomial logistic regression showed that the overall model was statistically significant (P = 0.025), and it correctly predicted drug choice for 58.6% of the participants.

Conclusion

Glimepiride was the most preferred option overall while the effect on weight was the most important attribute for patients in determining their preference. The study highlighted the importance of shared decisions and can guide practitioners in considering patient preferences when prescribing antidiabetic drugs.

Patterns of diabetes mellitus by age, sex, and province among Iranian Hajj pilgrims and health care delivery during 2012-2022: A retrospective study of 469,581 participants

OBJECTIVE

Hajj is among the oldest pilgrimages in the world, there is a limited study that evaluates the epidemiological pattern of Diabetes Mellitus [1] and the medical care required and provided to pilgrims. The present study assessed the prevalence and pattern of DM in Iranian pilgrims from 2012-22.

METHOD

All demographic information, risk factors, and the prevalence of DM were extracted from the database and medical records of the Hajj Pilgrimage Medical Centre, Iranian Red Crescent Society through file reading. Also, to investigate the effect of the risk factors considered in the study, the multiple logistic regression model was used.

RESULTS

The present study included data from 469,581 Hajj pilgrims. Most pilgrims were in the age group of 45 to 70 years (73.25%). The prevalence of diabetes in patients over 70 years old was the highest (16.73%). The prevalence of DM was estimated at 14.64% in women and 12.51% in men. The lowest DM prevalence was in Lorestan (7.81%), North Khorasan (9.07%), Sistan and Baluchistan (9.29%), and Hamedan (9.41), respectively. The highest prevalence rate was in Khuzestan (20.12%), Yazd (19.14), and Mazandaran (17.55), respectively. Our analysis reveals that, for instance, with each yearly increase in the age of the pilgrims (assuming other variables remain constant), the odds of having DM increase by 0.04. For the gender, the odds of having DM among women is 0.33 higher than among men, when the other variable is constant.

CONCLUSIONS

The study results show a significant difference in the prevalence of diabetes in age, gender, and distribution in different provinces. Therefore, appropriate screening, diagnosis, and management by primary care physicians are necessary to prevent adverse health outcomes and reduce the economic burden of mortality and morbidity.

The incidence of diabetes mellitus and its determining factors in a Kurdish population: insights from a cohort study in western Iran

Diabetes mellitus (DM) is among the most widespread non-communicable diseases and poses a substantial global health challenge. The aim of this study was to examine the incidence of DM and its nutritional, anthropometric, laboratory, demographic, and behavioral determinants, as well as comorbidities, within a Kurdish population residing in western Iran. This research was conducted in the Ravansar Non-Communicable Disease (RaNCD) cohort study, followed 9170 participants aged 35-65 years, for an average ± SD of 7.11 ± 1.26 years, from 2015 until 2023. A hierarchical Cox regression model was used to estimates the adjusted hazard ratios (HRs). The incidence of DM was 4.45 (95% CI 3.96, 4.99) per 1000 person-years. We found several significant predictors for DM incidence, including prediabetes, comorbidity, urban residence, total antioxidant capacity (TAC), and the interaction between gender and body mass index (BMI). Prediabetes emerged as the strongest predictor of DM incidence, with a hazard ratio of 10.13 (CI 7.84, 13.09). Additionally, having two diseases (HR = 2.18; 95% CI 1.44, 3.29) or three and more diseases (HR = 3.17; 95% CI 2.06, 4.90) increased the risk of developing DM. Also, the hazard ratios for the effects of gender on DM incidence in the normal, overweight, and obese BMI groups were 0.24, 0.81, and 1.01, respectively. The presence of prediabetes and obesity serve as the crucial indicators for the onset of DM, emphasizing the pressing need for interventions to prevent DM in these circumstances. Furthermore, there are notable disparities between urban and rural populations in this study, warranting further investigations to ascertain the underlying causes of such variations.

IcoSema: unveiling the future of diabetes management from a clinical pharmacology perspective

IcoSema, a groundbreaking approach to diabetes management, combines insulin icodec and semaglutide to offer a transformative treatment option. Insulin icodec delivers consistent glucose-lowering effects with once-weekly dosing, while semaglutide, a GLP-1 agonist, stimulates insulin secretion and aids in weight loss. This comprehensive article evaluates the potential of IcoSema from a clinical pharmacology perspective, examining the pharmacokinetics, efficacy, safety, compliance and cost-effectiveness of its individual components, as well as considering comparable combination therapies like iGlarLixi and IDegLira. By analysing these crucial factors, the article aims to determine the potential of IcoSema in the field of diabetes management. The combination of insulin icodec and semaglutide has the potential to provide improved glycaemic control, weight management, and simplified treatment regimens, addressing common challenges faced in diabetes management. Safety, compliance and cost considerations are important aspects of evaluating this combination therapy. Ongoing trials investigating IcoSema are expected to provide valuable insights into its efficacy, safety and comparative effectiveness. By addressing concerns such as potential side effects, individual patient response and drug interactions, healthcare providers can optimize treatment outcomes and enhance the management of type 2 diabetes.

Stroke Characteristics in the Elderly: A Hospital-Based Study in Cameroon

INTRODUCTION

Advanced age is an important nonmodifiable risk factor for stroke. Little data are available on stroke in older people in sub-Saharan Africa. This study aimed to determine the clinical features of stroke and identify the predictive factors for poor outcomes in this age group.

METHODS

A 4-month retrospective study was conducted using the Stroke Registry of Douala General Hospital. The main outcomes were mortality, poor functional recovery at 3 months (modified Rankin Scale score ≥3), and recurrence at 1 year. Factors associated with poor outcomes were determined using binary logistic regression. Survival was estimated using the Kaplan-Meier method. The significance threshold was set at p < 0.05.

RESULTS

Elderly patients represented 38.6% of all stroke cases (n = 1,260). Male represented 48.6% of the old patients. The incidence of hypertension, diabetes, previous stroke, and cardiopathies was significantly higher in older patients (p < 0.05). Ischemic stroke accounted for 73.1% of stroke types. Cardiopathies, GCS 8-12, GCS <8, hemorrhagic stroke, NIHSS >14, and Barthel index at 1 month were independently associated with mortality. Being divorced, a modified Rankin scale score ≥3 at 1 month, and a Barthel index ≤60 at 1 month were independently associated with poor functional recovery at 3 months. Old patients represented 50% of recurrent stroke cases. Age >90 years (p < 0.001) and NIHSS <5 were independently associated to recurrence at 1 year.

CONCLUSION

Approximately two out of five stroke cases were old. Cardiopathies, hemorrhagic stroke, and data related to stroke severity contribute to poor outcomes. A management approach that considers the particularities of this age group could contribute to improving the outcomes of these patients.

Prevalence of Complementary and Alternative Medicine Use and Its Associated Factors among Iranian Diabetic Patients: A Cross-Sectional Study

Objective

This cross-sectional study aimed to assess the prevalence of complementary and alternative medicine (CAM) use and its associated factors among diabetic patients in Fasa, a city in southern Iran.

Methods

Data were collected from diabetic patients who visited the endocrinology clinics at Fasa University of Medical Sciences. A structured questionnaire was administered to gather information on CAM use, including the types of CAM modalities used, and reasons for use. The patient's demographic and clinical characteristics, such as age, gender, duration of diabetes, glycosylated hemoglobin (HbA1c) levels, and quality of life (QoL) were also recorded. Descriptive statistics were used to determine the prevalence of CAM use, while logistic regression analysis was employed to identify factors associated with CAM use.

Results

A total of 376 diabetic patients participated in the study, with more than 89% reporting CAM use within the past year. Herbal preparations were the most commonly used type of CAM, with a prevalence rate of 99.4%. Factors associated with CAM use included patients' psychological health, attitude towards the safety of CAM, belief in the synergistic effects of combining routine medications with CAM, and previous positive experiences with CAM.

Conclusion

The high prevalence of CAM use highlights the importance of considering it in diabetes management and the need for healthcare professionals' engagement in open discussions with patients about their CAM practices. Understanding the factors influencing CAM use can inform healthcare providers and policymakers in developing appropriate strategies for integrating CAM approaches into conventional diabetes care.

A retrospective cohort study of the impact of COVID-19 infection control measures on surgical site infections in an academic hospital setting

Previous studies show that both the frequency of surgeries and incidence of surgical site infections (SSIs) have been lower during the coronavirus disease 2019 (COVID-19) pandemic. This study's purpose is to analyse the possible association of the COVID-19 epidemic-related increased health measures, such as protective equipment and products, increased hand hygiene and restrictions imposed, on the incidence of SSIs in an academic medical centre. We designed a single-centre, retrospective cohort study and collected data on the frequency of surgeries and the incidence of SSIs, among patients who had surgeries pre- and post-COVID-19 pandemic. Besides the intervention and outcome variable, we sought information on patient gender, surgery type, body mass index (BMI), smoking, and type II diabetes mellitus. We used Wald 95% confidence interval (95% CI) and the p values of the odds ratio (OR) to report results. Of the N = 24 098 surgeries performed in this hospital, there were 269 patients who reported post-surgical SSIs in this hospital between March 2019 and March 2021. The OR of developing a post-surgical SSI was 0.40 (95% CI: 0.33-0.57, p < 0.05; adjusted for confounders 0.39 [95% CI: 0.30-0.52, p < 0.05]) among patients who had surgery under post-pandemic infection control measures, as compared to patients who had surgery under pre-pandemic usual care infection control measures. Our significant results conclude that an association may exist between the enhanced infection control measures used during the COVID-19 pandemic and lower incidence of SSIs we observed during this period.

Prevalence of major non-communicable diseases and their associated risk factors in Afghanistan: a systematic review and meta-analysis

Background

Non-communicable diseases (NCDs) are the leading cause of mortality worldwide, and increasingly so in low- and middle-income countries. Afghanistan is dealing with a double burden of diseases, yet there has been no evidence synthesis on the prevalence of major NCDs and their risk factors.

Objective

This study aims to provide a comprehensive synthesis of the existing data on the prevalence of major NCDs and the common related risk factors in Afghanistan.

Method

We systematically reviewed scientific articles from 2000 to 2022 that reported the prevalence of diabetes, chronic respiratory diseases (CRDs), cardiovascular diseases (CVDs) or cancer, and their risk factors in Afghanistan. Four online databases (PubMed, Web of Science, Cochrane and Google Scholar) and two local journals in Afghanistan (not indexed online) were systematically searched and screened. Two reviewers independently screened and appraised the quality of the articles. Data extraction and synthesis were performed using tabulated sheets.

Results

Among 51 eligible articles, 10 (19.6%) focused on cancer, 10 (19.6%) on diabetes, 4 (7.8%) on CVDs, 4 (7.8%) on CRDs and 23 (45.1%) on risk factors as the primary outcome. Few articles addressed major NCD prevalence; no evidence of CVDs, cancer was 0.15%, asthma ranged between 0.3% and 17.3%, and diabetes was 12%. Pooled prevalence of hypertension and overweight were 31% and 35%, respectively. Central obesity was twice as prevalent in females (76% versus 40%). Similarly, gender differences were observed in smoking and snuff use with prevalence rates of 14% and 25% among males and 2% and 3% among females, respectively. A total of 14% of the population engaged in vigorous activity. Pooled prevalence for physical inactivity, general obesity, fruit and vegetable consumption, dyslipidaemia and alcohol consumption couldn't be calculated due to the heterogeneity of articles.

Conclusion

Only little evidence is available on the prevalence of major NCDs in Afghanistan; however, the NCD risk factors are prevalent across the country. The quality of the available data, especially those of the local resources, is poor; therefore, further research should generate reliable evidence in order to inform policymakers on prioritizing interventions for controlling and managing NCDs.

Associations of glycosylated hemoglobin, pre-diabetes, and type 2 diabetes with incident lung cancer: A large prospective cohort study

BACKGROUND

The association of pre-diabetes and type 2 diabetes (T2D) with incident lung cancer is uncertain, and the incident risk across the glycemic spectrum is unclear. We aimed to explore the associations of glycosylated hemoglobin (HbA1c), pre-diabetes, and T2D with incident lung cancer in a large prospective cohort.

METHODS

Leveraging a total of 210,779 cancer-free adults recruited in the UK Biobank between 2006 and 2010. We performed multivariable Cox proportional hazards models and restricted cubic spline methods to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the associations of HbA1c, pre-diabetes, and T2D with incident lung cancer.

RESULTS

During a median follow-up of 11.06 years, 1738 incident lung cancer cases were ascertained. The incidence of lung cancer was 20% higher among people with diabetes (HR: 1.20, 95% CI: 1.02 to 1.42) and 38% higher among people with pre-diabetes (HR: 1.38, 95% CI: 1.15 to 1.65). After dividing people with diabetes by whether taking antidiabetic medications, the incidence was 28% higher among people with diabetes without medications (HR: 1.28, 95% CI: 1.02 to 1.61) and 15% higher among people with diabetes with medications (HR: 1.15, 95% CI: 0.93 to 1.41). The increased risk of incident lung cancer for each standard deviation (6.45 mmol/mol) increase in HbA1c was more pronounced across HbA1c values of 32-42 mmol/mol (HR: 1.37, 95% CI: 1.18 to 1.59). The risk was more pronounced among participants <60 years.

CONCLUSIONS

Pre-diabetes and T2D are associated with an increased incidence of lung cancer. The increased risk of incident lung cancer is more pronounced across HbA1c values of 32-42 mmol/mol, which are currently considered normal values.

Cognitive factors associated with hypertension and diabetes control among diagnosed and treated patients; findings from a community cohort in India

Uncontrolled hypertension and diabetes are a challenge for healthcare providers worldwide. The research documenting the underlying risk factors of uncontrolled chronic illnesses in community cohorts from India is negligible. The current cross-sectional household door-knock survey conducted among 759 participants aged 30 and above from a geographically well-defined area examines the cognitive risk factors associated with hypertension and diabetes control in the Indian population. The study used an assessment tool consisting of a socio-demographic questionnaire, items to measure cognitive factors, and onsite hypertension and diabetes measurements. Results suggested that among the participants, more than 36% had hypertension, 26% had diabetes, and of those with diagnosed diabetes and hypertension, more than 22% with hypertension and 48% with diabetes had uncontrolled conditions. Univariate analysis suggests that cognitive functioning was negatively associated with uncontrolled hypertension and psychological impairments of depression and anxiety were positively associated. The associations were not significant for uncontrolled diabetes. Only if treatments integrate psychological and cognitive interventions to ensure adherence to medical and lifestyle modifications will it achieve the WHO target of 80% control of detected conditions. The findings can inform the policies and programs to optimise government spending and modify the current chronic condition management practices.

Protamine as a barrier against the angiogenic effect of insulin: a possible role of apelin

Insulin is proved to have angiogenic ability thereby may worsen the diabetic retinopathy (DR) progression. Insulin also triggers the expression of endogenous angiogenic peptide, apelin. Since protamine was introduced as an inhibitor of the apelin receptor, we hypothesized that use of protaminated insulin instead of non-protaminated insulin can decrease the negative role of insulin in progression of DR. Firstly, the incidence of DR was compared among three diabetic patient groups: an oral medication, non-protaminated insulin, and protaminated insulin (PIns). Proliferation and migration rate of HUVECs was measured after insulin, apelin, and protamine exposure. In clinical study, the chance of developing DR was 8.5 and 4.1 times higher in insulin group and PIns groups compared with oral group respectively. Insulin group had a chance of 9.5-folds of non-proliferative DR compared to oral group. However, the difference of non-proliferative DR between PIns and oral group wasn't significant. In-vitro tests showed that concomitant use of insulin and apelin increases viability and migratory potential of HUVECs. However, protamine could reverse this effect. Protamine present in some insulins might show a promising protective role against diabetic retinopathy. Thus, protaminated insulins may be preferable in the treatment of diabetes.

Implementation of pharmacist recommendations in patients with type 2 diabetes enrolled in an employer-sponsored health plan

BACKGROUND

The new, employee health plan (EHP) focused, population health initiative was established at Atrium Health Wake Forest Baptist in October 2020. The initiative's goals are to reduce health care costs and optimize patient care by providing patient-specific recommendations to help manage chronic disease states in the ambulatory care setting. This project's purpose is to quantify and categorize pharmacist recommendations implemented and not implemented.

OBJECTIVE

Describe the implementation of pharmacist recommendations in a new, population health program.

METHODS

Eligible patients: >18 years of age, diagnosed with type 2 diabetes, baseline HbA1c > 8%, and enrolled in the EHP. Patients were identified retrospectively through an electronic health record report. The primary endpoint assessed the proportion of pharmacist recommendations implemented. Interventions implemented and not implemented were categorized and reviewed for timely optimization of patient care and quality improvement.

RESULTS

Overall, 55.7% of pharmacist recommendations were implemented. The most common reason recommendations were not implemented was that they were not addressed by the provider. The most common pharmacist recommendation was a drug therapy addition. Recommendations were implemented in a median time of 44 days.

CONCLUSION

Over half of pharmacist recommendations were implemented. Provider communication and awareness was identified as a barrier for this new initiative. Increasing provider education and advertisement of pharmacist services should be considered to increase future implementation rates. The project identified a need for optimization of timely patient care by prioritizing patient charts prior to their next applicable provider visit.

The causal effect of family physician program on the prevalence, screening, awareness, treatment, and control of hypertension and diabetes mellitus in an Eastern Mediterranean Region: a causal difference-in-differences analysis

BACKGROUND

Hypertension (HTN) and diabetes mellitus (DM) as part of non-communicable diseases are among the most common causes of death worldwide, especially in the WHO's Eastern Mediterranean Region (EMR). The family physician program (FPP) proposed by WHO is a health strategy to provide primary health care and improve the community's awareness of non-communicable diseases. Since there was no clear focus on the causal effect of FPP on the prevalence, screening, and awareness of HTN and DM, the primary objective of this study is to determine the causal effect of FPP on these factors in Iran, which is an EMR country.

METHODS

We conducted a repeated cross-sectional design based on two independent surveys of 42,776 adult participants in 2011 and 2016, of which 2301 individuals were selected from two regions where the family physician program was implemented (FPP) and where it wasn't (non-FPP). We used an Inverse Probability Weighting difference-in-differences and Targeted Maximum Likelihood Estimation analysis to estimate the average treatment effects on treated (ATT) using R version 4.1.1.

RESULTS

The FPP implementation increased the screening (ATT = 36%, 95% CI: (27%, 45%), P-value < 0.001) and the control of hypertension (ATT = 26%, 95% CI: (1%, 52%), P-value = 0.03) based on 2017 ACC/AHA guidelines that these results were in keeping with JNC7. There was no causal effect in other indexes, such as prevalence, awareness, and treatment. The DM screening (ATT = 20%, 95% CI: (6%, 34%), P-value = 0.004) and awareness (ATT = 14%, 95% CI: (1%, 27%), P-value = 0.042) were significantly increased among FPP administered region. However, the treatment of HTN decreased (ATT = -32%, 95% CI: (-59%, -5%), P-value = 0.012).

CONCLUSION

This study has identified some limitations related to the FPP in managing HTN and DM, and presented solutions to solve them in two general categories. Thus, we recommend that the FPP be revised before the generalization of the program to other parts of Iran.

Demographic variables, anthropometric indices, sleep quality, Metabolic Equivalent Task (MET), and developing diabetes in the southwest of Iran

Propose

The present study has sought to investigate the prevalence of diabetes and its related risk factors, to examine the relationship between demographic variables, anthropometric indices, sleep quality, and Metabolic Equivalent Task (MET) with diabetes in Khuzestan province, southwest Iran.

Methods

The present study has a cross-sectional design (the baseline data of the Hoveyzeh cohort study as a sub-branch of the Persian Prospective Cohort Study). Comprehensive information from 10,009 adults (aged 35–70 years) was collected from May 2016 to August 2018 through a multi-part general questionnaire containing general characteristics, marital status, education, smoking, sleep quality, MET, and anthropometric indices. Data analysis was performed by SPSS software version 19.

Results

The mean age of the sample was 52.97 ± 8.99 years. 60.3% of the population were women and 67.7% were illiterate. Out of the 10,009 people surveyed, 1,733 stated that they have diabetes (17%). In 1,711 patients (17%) the amount of FBS was ≥126 mg/dl. There is a statistically significant relationship between diabetes and MET. More than 40% had BMI above 30. Anthropometric indices in diabetic and non-diabetic individuals were different. Also, there was a statistically significant difference between the mean duration of sleep and the use of sleeping pills in diabetic and non-diabetic groups (p &lt; 0.05). Based on logistic regression, marital status [OR = 1.69 (95% CI, 1.24, 2.30)], education level [OR = 1.49 (95% CI, 1.22, 1.83)], MET [OR = 2.30 (95% CI, 2.01, 2.63)], height [OR = 0.99 (95% CI, 0.98, 0.99)], weight [OR = 1.007 (95% CI, 1.006, 1.012)], wrist circumference [OR = 1.10 (95% CI, 1.06, 1.14)], waist circumference [OR = 1.03 (95% CI, 1.02, 1.03)], waist-to-hip ratio [OR = 3.41 (95% CI, 2.70, 4.29)], and BMI [OR = 2.55 (95% CI, 1.53, 4.25)], are good predictors for diabetes.

Conclusion

The results of this study showed that the prevalence of diabetes in Hoveyzeh city, Khuzestan, Iran, was almost high. and emphasize that preventive interventions should focus on risk factors, especially socioeconomic status, and anthropometric indicators along with lifestyle.

Prediction of type 2 diabetes mellitus using hematological factors based on machine learning approaches: a cohort study analysis

Type 2 Diabetes Mellitus (T2DM) is a significant public health problem globally. The diagnosis and management of diabetes are critical to reduce the diabetes complications including cardiovascular disease and cancer. This study was designed to assess the potential association between T2DM and routinely measured hematological parameters. This study was a subsample of 9000 adults aged 35-65 years recruited as part of Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort study. Machine learning techniques including logistic regression (LR), decision tree (DT) and bootstrap forest (BF) algorithms were applied to analyze data. All data analyses were performed using SPSS version 22 and SAS JMP Pro version 13 at a significant level of 0.05. Based on the performance indices, the BF model gave high accuracy, precision, specificity, and AUC. Previous studies suggested the positive relationship of triglyceride-glucose (TyG) index with T2DM, so we considered the association of TyG index with hematological factors. We found this association was aligned with their results regarding T2DM, except MCHC. The most effective factors in the BF model were age and WBC (white blood cell). The BF model represented a better performance to predict T2DM. Our model provides valuable information to predict T2DM like age and WBC.

Psychometric evaluation of the Persian version of the Heart Disease Fact Questionnaire (HDFQ) in people with diabetes in Iran

BACKGROUND AND AIMS

Public health and clinic-based educational strategies are desperately needed to stem the tide of death from heart disease among people with diabetes in low and middle-income countries. This study translated the Heart Disease Fact Questionnaire into Persian and evaluated its reliability and validity for use in Iran.

METHODS

Using rigorous translation methods, the 25-item scale was administered to Persian speakers with diabetes. The scale was evaluated for content validity, construct validity and reliability.

RESULTS

Participants were 268 patients with diabetes with mean age of 63.19 ± 16.61 years. The mean HDFQ score was 17.31 ± 5.11 (in the low range). Higher scores were associated with younger age, younger age of diabetes onset, higher education, higher employment position, family history of diabetes and hypertension, shorter diabetes duration, and adherence to home exercise regimens. Kuder-Richardson's reliability coefficient was good, i.e., 0.82. Confirmatory factor analysis showed that the factor loadings of all questions, except question number 25, were favorable, i.e., >0.3. Model fit indices were favorable: Chi-square statistic to degree of freedom ratio (χ²⁄df) = 1.82, Comparative fit index = 0.96, Tucker-Lewis Index = 0.96 and root mean square error = 0.06.

CONCLUSION

After removing item #25, the Persian heart disease fact questionnaire has good validity and reliability and can be used to inform and evaluate clinical and public health educational programs aimed at decreasing risk for heart disease among Persian speakers with diabetes.

High Prevalence of Prediabetes and Associated Risk Factors in Urban Areas of Pontianak, Indonesia: A Cross-Sectional Study

Uncontrolled prediabetes can develop into Type 2 Diabetes mellitus (T2DM). The incidence of T2DM among adults in Pontianak, Indonesia was reported remarkably high. Therefore, this study aimed to investigate the risk factors for prediabetes in adults living in urban areas of Pontianak, Indonesia. A cross-sectional study was conducted in 5 subdistricts of Pontianak. A total of 506 adults underwent screening to obtain subjects with fasting blood glucose (FBS) of ≤124 mg/dL and aged >30 years. Blood pressure and body mass index (BMI) were measured. Interview using a structured questionnaire were performed to obtain data on predictor variables (age, sex, education, income, health insurance, tobacco use, history of hypertension, gout, high cholesterol level, frequency of exercise per week, and diabetic education). The prevalence of prediabetes among subjects was significantly high (76.4%). Subjects were predominantly above 40 years, female, had low income, low education level, and had health insurance. About a third of the subjects had a history of hypertension, gout, and high cholesterol level, respectively. The exercise frequency was mostly less than 3 times/week, and the BMI was mainly classified as overweight and obese. The result of spearman's rho correlation showed that age (r = 0.146; p=0.022) and BMI (r = 0.130; p=0.041) significantly correlated with prediabetes incidence. Moreover, the chi-square analysis demonstrated that health insurance ownership (OR = 4.473; 95% CI 1.824-10.972; p ≤ 0.001), history of hypertension (OR = 3.096; 95% CI 1.542-6.218; p=0.001), and history of gout (OR = 2.419; 95% CI 1.148-5.099; p=0.018), were associated with prediabetes incidence. For all these significant risk predictors except BMI, the significant associations were found only among female subjects after specific sex analysis. Moreover, multivariate logistic regression showed that health insurance ownerships (OR = 5.956; 95% CI 2.256-15.661; p ≤ 0.001) and history of hypertension (OR = 3.257; 95% CI 1.451-7.311; p=0.004), and systolic blood pressure (OR = 2.141; 95% CI 1.092-4.196; p=0.027) were the risk factors for prediabetes. It is concluded that the prevalence of prediabetes is probably high especially among urban people in Pontianak, Indonesia. Health insurance ownership and hypertension may have an important role in prediabetes management. The risk factors might be different between male and female.