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El Chaar M, King K, Al-Mardini A, Galvez A, Claros L, Stoltzfus J. Thirty-Day Outcomes of Bariatric Surgery in Adolescents: a First Look at the MBSAQIP Database. Obes Surg 2020; 31:194-199. [PMID: 32712784 PMCID: PMC7382644 DOI: 10.1007/s11695-020-04866-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Bariatric surgery is the only effective treatment of severe obesity. The number of adolescents undergoing bariatric surgery is increasing. However, bariatric surgery in adolescents is controversial. OBJECTIVE The purpose of this study is to evaluate the outcomes of bariatric surgery in adolescents based on the MBSAQIP database (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project). METHODS We analyzed the 2015-2017 MBSAQIP database; patients ≤ 19 years of age were included in our analysis. Primary outcomes were 30-day serious adverse events (SAEs), organ space infection (OSI), re-intervention, and re-operation rates. Secondary outcomes included operation length, hospital stay, and re-admission rates. We conducted separate Mann-Whitney rank sums tests, chi-square, or Fisher's exact tests as appropriate, with p < .05 denoting statistical significance. RESULTS A total of 1983 adolescent patients were included in our analysis. The average age and BMI were 18.1 and 47.5, respectively. Of adolescent patients, 21.7% underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) and 78.3% underwent laparoscopic sleeve gastrectomy (LSG). The 30-day SAE and readmission rates were significantly lower for LSG compared with LRYGB (2.9% and 2.6% vs 6.5% and 5.6%, respectively; p < 0.05). The 30-day reoperation rate was also lower for LSG compared with LRYGB albeit not significant (1.1% and vs 2.3%; p = 0.05). The 30-day intervention rate for LSG was significantly lower, however, compared with LRYGB (1.2% vs 3%; p < 0.05). Compared with adult patients, > 19 years old (n = 353,726), we found no difference in our outcomes. However, adolescents had significantly shorter operation length. CONCLUSION In adolescents, LSG had fewer SAE, re-intervention, and readmission rates compared with LRYGB. There was no difference in outcomes between adolescents and adults.
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Affiliation(s)
- Maher El Chaar
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA.,Temple Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Keith King
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA. .,St Luke's University Health Network, 240 Cetronia Road, Suite 205 North, Allentown, PA, 18104, USA.
| | - Amin Al-Mardini
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA
| | - Alvaro Galvez
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA.,St Luke's University Health Network, 240 Cetronia Road, Suite 205 North, Allentown, PA, 18104, USA
| | - Leonardo Claros
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA.,Temple Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Jill Stoltzfus
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA.,Temple Lewis Katz School of Medicine, Philadelphia, PA, USA
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Brown EC, Buchan DS, Madi SA, Gordon BN, Drignei D. Grip Strength Cut Points for Diabetes Risk Among Apparently Healthy U.S. Adults. Am J Prev Med 2020; 58:757-765. [PMID: 32273132 DOI: 10.1016/j.amepre.2020.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Early detection screening tools are needed to aid in preventing vascular complications associated with type 2 diabetes. As low muscular strength is linked to increased diabetes risk, the purpose of this study is to establish muscular strength cut points for determining diabetes risk using a large, nationally representative U.S. METHODS Using the 2011-2012 and 2013-2014 National Health and Nutrition Examination Survey data, 5,108 participants aged 20-80 years (68.6% aged 20-50 years; young male participants, n=1,813, mean age=33.43 years; young female participants, n=1,692, mean age=33.39 years; older male participants, n=813, mean age=59.92 years; older female participants, n=790, mean age=60.45 years) and free of common diabetes comorbidities were included. Muscular strength was assessed using a handgrip dynamometer and normalized by adjusting for body weight. A logistic regression for survey data controlling for covariates was used to determine normalized grip strength cut points. Diabetes risk was determined using American Diabetes Association diagnostic criteria. Analyses were conducted in the summer of 2019. RESULTS Normalized grip strength significantly predicted diabetes (p=0.0332), and the cut points for detecting diabetes risk included 0.78 (young male participants), 0.57 (young female participants), 0.68 (older male participants), and 0.49 (older female participants). The risk percentages for diabetes and estimated rates reported for all subgroups were comparable, and the risk percentages included 6.84 (95% CI=5.32, 8.36; younger male participants), 7.49 (95% CI=5.87, 9.10; younger female participants), 5.76 (95% CI=2.34, 9.19, older male participants), and 4.27 (95% CI=2.44, 6.10; older female participants). CONCLUSIONS Normalized grip strength using the cut points proposed in this paper may be a useful screening tool for diabetes risk in apparently healthy, normotensive adults.
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Affiliation(s)
- Elise C Brown
- Department of Public and Environmental Wellness, Oakland University, Rochester, Michigan.
| | - Duncan S Buchan
- Division of Sport and Exercise, Institute for Clinical Exercise and Health Sciences, University of the West of Scotland, Lanarkshire, Scotland
| | - Samar A Madi
- Department of Mathematics and Statistics, Oakland University, Rochester, Michigan
| | - Breanne N Gordon
- Department of Interdisciplinary Health Sciences, Oakland University, Rochester, Michigan
| | - Dorin Drignei
- Department of Mathematics and Statistics, Oakland University, Rochester, Michigan
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Liu S, Gao Y, Shen Y, Zhang M, Li J, Sun P. Application of three statistical models for predicting the risk of diabetes. BMC Endocr Disord 2019; 19:126. [PMID: 31771577 PMCID: PMC6878628 DOI: 10.1186/s12902-019-0456-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 11/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND At present, the proportion of undiagnosed diabetes in Chinese adults is as high as 15.5%. People with diabetes who are not treated and controlled in time may have various complications, such as cardiovascular and cerebrovascular diseases and diabetic foot disorders, which not only seriously affect the quality of life of people with diabetes but also impose a heavy burden on families and society. Therefore, prevention and control of type 2 diabetes is of great significance. METHODS We constructed a logistic regression model, a neural network model and a decision tree model to analyse the risk factors for type 2 diabetes and then compared the prediction accuracy of the different models by calculating the area under the relative operating characteristic (ROC) curve and back-inputting the data into the model. RESULTS The prevalence of type 2 diabetes in 4177 subjects who were not diagnosed with type 2 diabetes was 9.31%. The most influential factors associated with type 2 diabetes were triglyceride (TG) ≥ 1.17 mmol/L (odds ratio (OR) =2.233), age ≥ 70 years (OR = 1.734), hypertension (OR = 1.703), alcohol consumption (OR = 1.674), and total cholesterol≥5.2 mmol/L (TC) (OR = 1.463). The prediction accuracies of the three prediction models were 90.8, 91.2, and 90.7%, respectively, and the areas under curve (AUCs) were 0.711, 0.780, and 0.698, respectively. The differences in the AUCs after back propagation (BP) of the neural network model, logistic regression model and decision tree model were statistically significant (P < 0.05). CONCLUSION BP neural networks have a higher predictive power for identifying the associated risk factors of type 2 diabetes than the other two models, but it is necessary to select a suitable model for specific situations.
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Affiliation(s)
- Siyu Liu
- Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021 China
| | - Yue Gao
- Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021 China
| | - Yuhang Shen
- Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021 China
| | - Min Zhang
- Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021 China
| | - Jingjing Li
- Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021 China
| | - Pinghui Sun
- Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021 China
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Sathiyamoorthi S, Anand DP, Muthunarayanan L. Is Master Health Checkup the Answer to Tackle the Rising Non-Communicable Disease Burden in India? - A Cross-Sectional Study. J Lifestyle Med 2019; 9:111-118. [PMID: 31828029 PMCID: PMC6894444 DOI: 10.15280/jlm.2019.9.2.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/08/2019] [Indexed: 02/06/2023] Open
Abstract
Background Master Health Checkup (MHC) is a battery of tests done to detect and identify Non Communicable Diseases (NCDs) early. But it should also be noted that some tests in MHC have no known benefits for otherwise healthy adults. This study was conducted to evaluate the usefulness of MHC in a hospital based setting. Methods A cross-sectional study was conducted among 337 subjects aged 18 years and above who attended the MHC Clinic during the study period. They were subjected to interview and various biochemical investigations to estimate the number of newly diagnosed, clinically relevant abnormalities among apparently normal adults using standard guidelines. Categorical data summarized as frequencies with percentages. Chi-square test was used to compare proportions. Results Among the 337 participants, 244 were apparently normal with a gender distribution as 109 (44.7%) males and 135 (55.3%) females. The study was able to newly detect 12.3% with Type 2 diabetes, 37.7% in pre-diabetic stage, 54.1% with anaemia, 42.2% with dyslipidemia, 11.5% with hypothyroidism, 27% with liver disorders and 6.5% with renal disorders, about which the participants were unaware of. Females also had statistically significant association with dyslipidaemia and hypothyroidism compared to males with a p-value of 0.004, 0.026 respectively. Apparently normal participants aged > 35 years had strong statistical association with diabetic status and dyslipidemia compared to those aged between 18 – 35 years (p-value 0.001). Conclusion Based on the results from the study it is evident that a significant number of NCDs were newly identified by Master Health checkup (MHC).
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Affiliation(s)
- Sathiyanarayanan Sathiyamoorthi
- Department of Community & Family Medicine, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Vijayawada, Andhra Pradesh, India
| | - Dharshana Prem Anand
- Department of Community Medicine, SRM Medical College & Research Centre, SRM IST, Chennai, India
| | - Logaraj Muthunarayanan
- Department of Community Medicine, SRM Medical College & Research Centre, SRM IST, Chennai, India
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Xiong XL, Zhang RX, Bi Y, Zhou WH, Yu Y, Zhu DL. Machine Learning Models in Type 2 Diabetes Risk Prediction: Results from a Cross-sectional Retrospective Study in Chinese Adults. Curr Med Sci 2019; 39:582-588. [PMID: 31346994 DOI: 10.1007/s11596-019-2077-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 06/10/2019] [Indexed: 02/08/2023]
Abstract
Type 2 diabetes mellitus (T2DM) has become a prevalent health problem in China, especially in urban areas. Early prevention strategies are needed to reduce the associated mortality and morbidity. We applied the combination of rules and different machine learning techniques to assess the risk of development of T2DM in an urban Chinese adult population. A retrospective analysis was performed on 8000 people with non-diabetes and 3845 people with T2DM in Nanjing. Multilayer Perceptron (MLP), AdaBoost (AD), Trees Random Forest (TRF), Support Vector Machine (SVM), and Gradient Tree Boosting (GTB) machine learning techniques with 10 cross validation methods were used with the proposed model for the prediction of the risk of development of T2DM. The performance of these models was evaluated with accuracy, precision, sensitivity, specificity, and area under receiver operating characteristic (ROC) curve (AUC). After comparison, the prediction accuracy of the different five machine models was 0.87, 0.86, 0.86, 0.86 and 0.86 respectively. The combination model using the same voting weight of each component was built on T2DM, which was performed better than individual models. The findings indicate that, combining machine learning models could provide an accurate assessment model for T2DM risk prediction.
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Affiliation(s)
- Xiao-Lu Xiong
- Department of Endocrinology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China
| | - Rong-Xin Zhang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, 211166, China
| | - Yan Bi
- Department of Endocrinology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China
| | - Wei-Hong Zhou
- Department of Endocrinology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China.
| | - Yun Yu
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, 211166, China.
| | - Da-Long Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China.
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Evron JM, Herman WH, McEwen LN. Changes in Screening Practices for Prediabetes and Diabetes Since the Recommendation for Hemoglobin A 1c Testing. Diabetes Care 2019; 42:576-584. [PMID: 30728220 PMCID: PMC7373494 DOI: 10.2337/dc17-1726] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/13/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Screening involves the presumptive identification of asymptomatic individuals at increased risk for unrecognized disease. We examined changes in screening practices for prediabetes and diabetes since January 2010, when HbA1c was first recommended as an option for screening and diagnosis. RESEARCH DESIGN AND METHODS We studied members without diabetes of an HMO ≥45 years of age continuously enrolled for ≥3 years and assigned to primary care clinicians affiliated with a large academic health system. We defined screening as the first oral glucose tolerance test, HbA1c, or glucose test performed between 2010 and 2014. RESULTS Of 12,772 eligible patients, 9,941 (78%) were screened at least once over 3 years. HbA1c was the initial screening test 14% of the time and glucose 86% of the time. Of those screened with HbA1c, 63% had abnormal results defined as HbA1c ≥5.7% (≥39 mmol/mol). Of those tested with glucose, 30% had abnormal results defined as glucose ≥100 mg/dL, and 5% had abnormal results defined as glucose ≥126 mg/dL. Patients with abnormal HbA1c levels and those with glucose levels ≥126 mg/dL were equally likely to be scheduled for follow-up appointments (41% vs. 39%), but those with abnormal HbA1c levels were more likely to be diagnosed with prediabetes or diabetes (36% vs. 26%). CONCLUSIONS As we observed in 2004, rates of screening are high. HbA1c is still used less frequently than glucose for screening but is more likely to result in a clinical diagnosis. Evidence to support guidelines to define the role of random glucose screening, including definition of appropriate cut points and follow-up, is needed.
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Affiliation(s)
- Joshua M Evron
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - William H Herman
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI.,Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Laura N McEwen
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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7
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Roebroek YGM, Paulus GF, van Mil EGAH, Vreugdenhil ACE, Winkens B, Nederkoorn C, Stehouwer CDA, Greve JWM, Bouvy ND, van Heurn LWE. Bariatric surgery in adolescents: a prospective randomized controlled trial comparing laparoscopic gastric banding to combined lifestyle interventions in adolescents with severe obesity (BASIC trial). BMC Pediatr 2019; 19:34. [PMID: 30691442 PMCID: PMC6350363 DOI: 10.1186/s12887-019-1395-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 01/04/2019] [Indexed: 01/22/2023] Open
Abstract
Background Obesity in children and adolescents is an increasing problem associated with multiple co-morbidities including metabolic and endocrine changes, cardiovascular abnormalities, and impaired quality of life. Combined lifestyle interventions are the current standard treatment for severe obesity in children. However, the medium- and long-term results of these interventions are relatively poor. Bariatric surgery shows substantial weight loss and health improvement in adults and retrospective studies in adolescents show similar outcomes. However, well-designed prospective studies in this young age group are rare. Our objectives are to determine whether combining surgery with lifestyle interventions in severely obese adolescents leads to a significant additional weight reduction compared to lifestyle interventions solely, and to assess its effect on obesity-associated co-morbidities in a prospective randomized controlled setting. Methods Patients aged 14–16 years with sex- and age-adjusted BMI > 40 kg/m2 (or > 35 kg/m2 with comorbidity) and failure to achieve weight reduction > 5% during at least one year of combined lifestyle interventions are included in this trial. Randomization determines whether laparoscopic adjustable gastric banding will be added to combined lifestyle intervention throughout the trial period. Sixty children will be included in this trial. Follow-up visits are planned at 6 months, 1,2 and 3 years. Primary endpoints are percentage of total weight loss, and change of BMI. Secondary endpoints include body composition, pubertal development, metabolic and endocrine changes, inflammatory status, cardiovascular abnormalities, non-alcoholic steatohepatitis, quality of life and changes in behaviour. Discussion This randomized controlled trial is designed to provide important information about the safety and efficacy of laparoscopic adjustable gastric banding treatment in severely obese adolescents with unsuccessful combined lifestyle interventions. The reversibility of this surgical procedure forms a strong argument to decide for gastric banding over other surgical procedures, since bariatric surgery in adolescents is still in its infancy. Trial registration The BASIC trial is registered in the register of ClinicalTrials.gov since July 2010, Identifier: NCT01172899 Electronic supplementary material The online version of this article (10.1186/s12887-019-1395-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Y G M Roebroek
- Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, NL-6202, AZ, Maastricht, The Netherlands. .,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - G F Paulus
- Department of General Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - E G A H van Mil
- Department of Paediatrics, Jeroen Bosch Medical Centre, 's Hertogenbosch, The Netherlands
| | - A C E Vreugdenhil
- Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - B Winkens
- Department of Methodolgy and Statistics and CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - C Nederkoorn
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - C D A Stehouwer
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - J W M Greve
- Department of General Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - N D Bouvy
- Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, NL-6202, AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - L W E van Heurn
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam Medical Centre/ VU University Medical Centre, Amsterdam, The Netherlands
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Papaefstathiou E, Moysidis K, Sarafis P, Ioannidis E, Hatzimouratidis K. The impact of Diabetes Mellitus on Lower urinary tract symptoms (LUTS) in both male and female patients. Diabetes Metab Syndr 2019; 13:454-457. [PMID: 30641743 DOI: 10.1016/j.dsx.2018.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/02/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Contemporary studies examine the connection of Diabetes Mellitus (DM) with Lower urinary tract symptoms (LUTS), alone or associated with other factors of the metabolic syndrome. However, little research has occurred concerning patients with diabetes of both genders and sexes without other diseases of the lower urinary tract. The aim of this study is to examine the relationship between DM and LUTS. METHODS The study enrolled 110 patients with DM and 134 healthy individuals. The IPSS questionnaire was used for the evaluation of symptoms from lower urinary tract. Data was analyzed with univariate and multivariate logistic regression using SPSS v.24. RESULTS Analysis with moderate/severe LUTS as dependent variable and plausible confounding factors (age group, BMI, hypertension, dyslipidemia, years with DM and reported HbA1c) as covariates revealed that only HbA1c levels correlated independently with the presence of moderate/severe LUTS (p = 0,024, OR:2,729, CI:1,144-6,509) in diabetic women, while there was no statistically significant difference between male groups. HbA1c levels' correlation with IPSS-voiding and IPSS- storage score was not statistically significant. Quality of life is also affected in women with diabetes mellitus (p: 0,02). CONCLUSION Only an increase in HbA1c was independently connected with a deterioration of LUTS in the female group.
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Affiliation(s)
| | | | - Pavlos Sarafis
- Department of Nursing, Cyprus University of Technology, Greece.
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Sop J, Gustafson M, Rorrer C, Tager A, Annie FH. Undiagnosed Diabetes in Patients Admitted to a Clinical Decision Unit from the Emergency Department: A Retrospective Review. Cureus 2018; 10:e3390. [PMID: 30533325 PMCID: PMC6279010 DOI: 10.7759/cureus.3390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/01/2018] [Indexed: 12/02/2022] Open
Abstract
Objectives Diabetes is a debilitating disease that affects the way the body uses or produces insulin. Research evaluating the usefulness in screening patients admitted to a clinical decision unit (CDU) from the emergency department (ED) has been limited. Methods A retrospective chart review of patients admitted to a CDU from the ED was performed. Patients included were > 18-year-old who were observed in the CDU, had blood glucose drawn greater than eight hours after admission, and who had not been previously diagnosed with diabetes. Age, sex, and fasting glucose level were collected. The analysis was done to evaluate the percentage of patients undiagnosed and at risk for diabetes mellitus by assessing fasting blood glucose the morning after admission. Results Study revealed that 27.8% of the patients analyzed in this study had fasting blood glucose levels meeting or exceeding the diagnostic threshold of 126 mg/dL and could potentially have undiagnosed diabetes. Conclusion Screening patients admitted to a CDU from the emergency department identified that 27.8% had fasting plasma glucose levels ≥ 126 mg/dL. Consideration should be made to obtain a fasting blood glucose level in those without a previous diagnosis of diabetes who are observed overnight in a CDU.
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Affiliation(s)
- Jessica Sop
- Emergency Medicine, Charleston Area Medical Center, Charleston, USA
| | - Mark Gustafson
- Emergency Medicine, Charleston Area Medical Center, Charleston, USA
| | - Clyde Rorrer
- Emergency Medicine, Charleston Area Medical Center, Charleston , USA
| | - Alfred Tager
- Emergency Medicine, Charleston Area Medical Center, Charleston, USA
| | - Frank H Annie
- Cardiology, Charleston Area Medical Center, Charleston, USA
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The Global Spine Care Initiative: public health and prevention interventions for common spine disorders in low- and middle-income communities. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:838-850. [DOI: 10.1007/s00586-018-5635-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/13/2018] [Indexed: 12/11/2022]
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Risøy AJ, Kjome RLS, Sandberg S, Sølvik UØ. Risk assessment and HbA1c measurement in Norwegian community pharmacies to identify people with undiagnosed type 2 diabetes - A feasibility study. PLoS One 2018; 13:e0191316. [PMID: 29474501 PMCID: PMC5825028 DOI: 10.1371/journal.pone.0191316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/03/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Determine the feasibility of using a diabetes risk assessment tool followed by HbA1c-measurement in a community-pharmacy setting in Norway. METHODS In this longitudinal study two pharmacists in each of three community pharmacies were trained to perform risk assessments, HbA1c-measurements and counselling. Pharmacy customers who were > 18 years old and could understand and speak Norwegian or English were recruited in the pharmacies during a two-months-period. Information about the service was presented in local newspapers, social media, leaflets and posters at the pharmacy. Customers wishing to participate contacted the pharmacy staff. Participants completed a validated diabetes risk test and a background questionnaire including a validated instrument for self-rated health. A HbA1c measurement was performed for individuals with a moderate to high risk of developing diabetes. If HbA1c ≥ 6.5% they were recommended to visit their general practitioner for follow-up. The pharmacies performed internal and external quality control of the HbA1c instrument. RESULTS Of the 211 included participants 97 (46%) were > 50 years old. HbA1c was measured for the 47 participants (22%) with high risk. Thirty-two (15%) had HbA1c values < 5.7%, twelve (5.4%) had values between 5.7%-6.4%, and three (1.4%) had an HbA1c ≥ 6.5%. Two participants with HbA1 ≥ 6.5% were diagnosed with diabetes by their general practitioner. The third was lost to follow-up. Results from internal and external quality control for HbA1c were within set limits. CONCLUSION The pharmacists were able to perform the risk assessment and measurement of HbA1c, and pharmacy customers were willing to participate. The HbA1c measurements fulfilled the requirements for analytical quality. Thus, it is feasible to implement this service in community pharmacies in Norway. In a large-scale study the inclusion criteria should be increased to 45 years in accordance with the population the risk test has been validated for.
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Affiliation(s)
- Aslaug Johanne Risøy
- Department of Global Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Centre for pharmacy, Faculty of Medicine, University of Bergen, Bergen, Norway
- * E-mail:
| | - Reidun Lisbet Skeide Kjome
- Department of Global Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Centre for pharmacy, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Sverre Sandberg
- Department of Global Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Norwegian Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Una Ørvim Sølvik
- Department of Global Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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Jørgensen P, Langhammer A, Krokstad S, Forsmo S. Mortality in persons with undetected and diagnosed hypertension, type 2 diabetes, and hypothyroidism, compared with persons without corresponding disease - a prospective cohort study; The HUNT Study, Norway. BMC FAMILY PRACTICE 2017; 18:98. [PMID: 29212453 PMCID: PMC5719734 DOI: 10.1186/s12875-017-0672-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/28/2017] [Indexed: 12/24/2022]
Abstract
Background Suggested strategies in reducing the impact of non-communicable diseases (NCD) are early diagnosing and screening. We have limited proof of benefit of population screening for NCD. Increased mortality in persons with diagnosed NCD has been shown for decades. However, mortality in undetected NCD has barely been studied. This paper explores whether all-cause mortality differed between persons with diagnosed hypothyroidism, type 2 diabetes (T2DM), and hypertension, compared with persons with undetected-, and with persons without the corresponding disease. Methods A prospective cohort study of the general population in Nord-Trøndelag, Norway. Persons ≥20 years at baseline 1995–97 were followed until death or June 15, 2016. Cox proportional hazards models were used to compute age and multiple adjusted hazard ratios (HR) with 95% confidence intervals (CI) for the association between disease status and all-cause mortality. The number of participants in the hypothyroidism study was 31,960, in the T2DM study 37,957, and in the hypertension study 63,371. Results Mortality was increased in persons with diagnosed type 2 diabetes and hypertension, compared to persons without corresponding disease; HR 1.69 (95% CI 1.55–1.84) and HR 1.23 (95% CI 1.09–1.39), respectively. Among persons with undetected T2DM, the HR was 1.21 (95% CI 1.08–1.37), whilst among undetected hypothyroidism and hypertension, mortality was not increased compared with persons without the diseases. Further, the association with mortality was stronger in persons with long duration of T2DM (HR 1.96 (95% CI 1.57–2.44)) and hypertension (HR 1.32 (95% CI 1.17–1.49)), compared with persons with short duration (HR 1.29 (1.09–1.53) and HR 1.16 (1.03-1-30) respectively). Conclusions Mortality was increased in persons with diagnosed T2DM and hypertension, and in undetected T2DM, compared with persons without the diseases. The strength of the association with mortality in undetected T2DM was however lower compared with persons with diagnosed T2DM, and mortality was not increased in persons with undetected hypothyroidism and hypertension, compared with persons without the diseases. Thus, future research needs to test more thoroughly if early diagnosing of these diseases, such as general population screening, is beneficial for health.
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Affiliation(s)
- Pål Jørgensen
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, 7600, Levanger, Norway
| | - Siri Forsmo
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway
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Tsai SA, Xiao L, Lv N, Liu Y, Ma J. Association of the Cardiometabolic Staging System with Individual Engagement and Quality of Life in the US Adult Population. Obesity (Silver Spring) 2017; 25:1540-1548. [PMID: 28712159 DOI: 10.1002/oby.21907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/05/2017] [Accepted: 05/30/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to examine the relationships of Cardiometabolic Disease Staging (CMDS), a validated five-stage system for assessing risk for diabetes, cardiovascular mortality, and all-cause mortality, with measures of individual engagement and health-related quality of life (HRQOL) in the US adult population. METHODS Data from the 2011-2014 National Health and Nutrition Examination Survey were used to derive the CMDS stages, five participant engagement measures, and four HRQOL measures among adult participants ≥ 40 years of age. Analyses accounted for the complex sampling design and sample weights. RESULTS Higher CMDS was associated with greater participant awareness of cardiometabolic risk, but after adjusting for covariates, only Stage 4 remained significant (odds ratio: 5.08; 95% CI: 3.25, 7.94). Higher CMDS was associated with receiving recommendations to engage in a healthy lifestyle, not meeting 2008 physical activity guidelines, and fewer leisure time moderate activities after controlling for covariates. For HRQOL measures, Stage 4 was associated with a higher likelihood of perceiving health as fair or poor (odds ratio: 4.85; 95% CI: 2.42, 9.73). CONCLUSIONS Higher CMDS was associated with greater individual awareness of risk, less leisure time physical activity, and worse self-rated health. CMDS is a clinically practical method for identifying individuals for targeted preventive strategies.
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Affiliation(s)
- Sandra A Tsai
- Stanford University Medical School, Palo Alto, California, USA
| | - Lan Xiao
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - Nan Lv
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - Ying Liu
- Department of Finance, University of Oregon, Eugene, Oregon, USA
| | - Jun Ma
- Department of Health Policy and Administration, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
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Shankalala P, Jacobs C, Bosomprah S, Vinikoor M, Katayamoyo P, Michelo C. Risk factors for impaired fasting glucose or diabetes among HIV infected patients on ART in the Copperbelt Province of Zambia. J Diabetes Metab Disord 2017; 16:29. [PMID: 28725640 PMCID: PMC5513349 DOI: 10.1186/s40200-017-0310-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/03/2017] [Indexed: 12/03/2022]
Abstract
BACKGROUND Africa has a high prevalence of both Human Immunodeficiency Virus and Non Communicable Diseases (NCDs) but in Zambia there are few data on co-morbid NCDs like Diabetes Mellitus (DM) among HIV-infected individuals. We aimed to identify risk factors for impaired fasting glucose or diabetes among HIV-infected Zambians on long-term Combined Antiretroviral Treatment (cART). METHODS This was a cross sectional study of adult HIV patients in five health facilities of Copperbelt Province in Zambia. HIV/AIDS patients aged 18 years and above, enrolled in care at those health facilities and had been on cART for more than 2 years were included. All patients known to have Diabetes mellitus were excluded from the study. Participants underwent assessment of random blood sugar levels at enrolment and returned the following morning for fasting glucose measured by glucometers. The primary outcome was proportion with impaired fasting glucose or DM. Multivariable logistic regression was used to examine if demographics, time on ART, type of ART regimen, body mass index and baseline CD4 count were predictors of impaired fasting glucose. RESULTS Overall (n = 270) there were 186 females (69%) and 84 males (31%). The prevalence of impaired fasting blood sugar or diabetes after 8 h of fasting was 15% (95%CI: 11.1, 20.0). Ten percent (26/270) had impaired fasting glucose and 5 % (14/270) had diabetes. Impaired fasting glucose was higher in males than females [AOR = 3.26, (95% CI: 1.15-9.25; p-value = 0.03)]; as well as among patients on second line treatment than those on first line [AOR = 3.87 (95% CI 1.16-12.9); p-value = 0.03]. In contrast those with less likelihood of impaired fasting glucose included patients with a normal BMI (18.5-24.9) than overweight or obese patients [AOR = 0.09 (95% CI 0.03-0.31; p-value < 0.001)]; and participants who had less than 4 diabetes symptoms than those with more than 4 diabetes symptoms [AOR = 0.04 (95% CI 0.02-0.12); p-value < 0.001]. CONCLUSION We have found high levels of impaired fasting glucose or diabetes among ART patients compared to what is reported in the general population suggesting missed care and support opportunities associated with metabolic imbalance management. There is thus a need to re-package HIV programming to include integration of diabetes screening as part of the overall care and support strategy.
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Affiliation(s)
- Perfect Shankalala
- School of Public Health, Department of Epidemiology and Biostatiscs, University of Zambia, P.O Box 5110, Lusaka, Zambia
| | - Choolwe Jacobs
- School of Public Health, Department of Epidemiology and Biostatiscs, University of Zambia, P.O Box 5110, Lusaka, Zambia
| | - Samuel Bosomprah
- Centre for Infectious Diseases Research in Zambia, 5032 Great North Road, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Michael Vinikoor
- Centre for Infectious Diseases Research in Zambia, 5032 Great North Road, Lusaka, Zambia
- Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Patrick Katayamoyo
- Family Health International (fhi360), Plot 2374, Farmers Village, ZNFU Complex, Showground’s Area, TiyendePamodzi Road, Off Nangwenya Road, P.O. Box 320303, Lusaka, Zambia
| | - Charles Michelo
- School of Public Health, Department of Epidemiology and Biostatiscs, University of Zambia, P.O Box 5110, Lusaka, Zambia
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Glurich I, Nycz G, Acharya A. Status Update on Translation of Integrated Primary Dental-Medical Care Delivery for Management of Diabetic Patients. Clin Med Res 2017; 15:21-32. [PMID: 28373288 PMCID: PMC5572842 DOI: 10.3121/cmr.2017.1348] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/02/2017] [Accepted: 03/24/2017] [Indexed: 02/08/2023]
Abstract
Escalating prevalence of both diabetes and periodontal disease, two diseases associated with bi-directional exacerbation, has been reported. Periodontal disease represents a modifiable risk factor that may reduce diabetes onset or progression, and integrated models of cross-disciplinary care are needed to establish and manage glycemic control in affected patients. An ad-hoc environmental scan of current literature and media sought to characterize factors impacting status of integrated care models based on review of the existing evidence base in literature and media surrounding: (1) current cross-disciplinary practice patterns, (2) epidemiological updates, (3) status on risk assessment and screening for dysglycemia in the dental setting, (4) status on implementation of quality metrics for oral health, (5) care model pilots, and (6) public health perspectives. The survey revealed: escalating prevalence of diabetes and periodontitis globally; greater emphasis on oral health assessment for diabetic patients in recent medical clinical practice guidelines; high knowledgeability surrounding oral-systemic impacts on diabetes and growing receptivity to medical-dental integration among medical and dental providers; increasing numbers of programs/studies reporting on positive impact of emerging integrated dental-medical care models on diabetic patient healthcare access and health outcomes; a growing evidence base for clinically significant rates of undiagnosed dysglycemia among dental patients reported by point-of-care pilot studies; no current recommendation for population-based screening for dysglycemia in dental settings pending a stronger evidence base; improved definition of true periodontitis prevalence in (pre)/diabetics; emerging recognition of the need for oral health quality indicators and tracking; evidence of persistence in dental access disparity; updated status on barriers to integration. The potential benefit of creating clinically-applicable integrated care models to support holistic management of an escalating diabetic population by targeting modifiable risk factors including periodontitis is being recognized by the health industry. Cross-disciplinary efforts supported by high quality research are needed to mitigate previously- and newly-defined barriers of care integration and expedite development and implementation of integrated care models in various practice settings. Implementation of quality monitoring in the dental setting will support definition of the impact and efficacy of interventional clinical care models on patient outcomes.
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Affiliation(s)
- Ingrid Glurich
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Gregory Nycz
- Family Health Center of Marshfield, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - Amit Acharya
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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One-Year Outcomes of Diabetes Self-Management Training Among Medicare Beneficiaries Newly Diagnosed With Diabetes. Med Care 2017; 55:391-397. [DOI: 10.1097/mlr.0000000000000653] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lau CJ, Pisinger C, Husemoen LLN, Jacobsen RK, Linneberg A, Jørgensen T, Glümer C. Effect of general health screening and lifestyle counselling on incidence of diabetes in general population: Inter99 randomised trial. Prev Med 2016; 91:172-179. [PMID: 27514243 DOI: 10.1016/j.ypmed.2016.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/05/2016] [Accepted: 08/07/2016] [Indexed: 01/19/2023]
Abstract
UNLABELLED We aimed to examine the effect of a large population-based multifactorial screening and lifestyle intervention programme on 10-year incidence of diabetes. In a randomised trial of the general Danish population initiated in 1999-2001 59,616 men and women aged 30-60years were assigned to a five year screening and lifestyle counselling programme (n=11,629) or control group (n=47,987) and followed for ten years in nationwide registers. Intention to treat was applied and risk of diabetes was modeled by Cox regression and expressed as hazard ratios (HRs). We found that 1692 individuals had diabetes at baseline. Among 57,924 individuals without diabetes at baseline, 1267 emigrated, 2593 died and 3369 (Intervention group=684, Control group=2685) developed diabetes. We saw no significant difference in diabetes incidence between the groups after 10-year follow-up (Grey's test: p=0.22). In the first year of follow-up, incidence of diabetes was significantly higher in the intervention group than the control group (HR=1.68, 95%CI 1.29 to 2.29). We observed no difference in incidence of diabetes between the groups in the follow-up intervals from 1 to 6years or after 6-10years (HR=0.94, 0.83 to 1.06; HR=1.03, 0.91 to 1.17). Inviting the general population to participate in a repeated screening and lifestyle counselling programme over five years did not result in lower incidence of diabetes after 10years of follow-up. As expected, significantly more individuals were diagnosed with diabetes in the intervention group during the first year, but this was not followed by a decrease in the following years. TRIALS REGISTRATION Clinical trials NCT00289237.
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Affiliation(s)
- Cathrine J Lau
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600 Glostrup, Denmark.
| | - Charlotta Pisinger
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600 Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Lise Lotte N Husemoen
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600 Glostrup, Denmark
| | - Rikke Kart Jacobsen
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600 Glostrup, Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600 Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600 Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; Faculty of Medicine, Aalborg University, 9229 Aalborg East, Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600 Glostrup, Denmark; Faculty of Medicine, Aalborg University, 9229 Aalborg East, Denmark
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Association of Aortic Compliance and Brachial Endothelial Function with Cerebral Small Vessel Disease in Type 2 Diabetes Mellitus Patients: Assessment with High-Resolution MRI. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1609317. [PMID: 27525261 PMCID: PMC4971295 DOI: 10.1155/2016/1609317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/26/2016] [Indexed: 12/21/2022]
Abstract
Objective. To assess the possible association of aortic compliance and brachial endothelial function with cerebral small vessel disease in type 2 diabetes mellitus (DM2) patients by using 3.0 T high-resolution magnetic resonance imaging. Methods. Sixty-two clinically confirmed DM2 patients (25 women and 37 men; mean age: 56.8 ± 7.5 years) were prospectively enrolled for noninvasive MR examinations of the aorta, brachial artery, and brain. Aortic arch pulse wave velocity (PWV), flow-mediated dilation (FMD) of brachial artery, lacunar brain infarcts, and periventricular and deep white matter hyperintensities (WMHs) were assessed. Pearson and Spearman correlation analysis were performed to analyze the association between PWV and FMD with clinical data and biochemical test results. Univariable logistic regression analyses were used to analyze the association between PWV and FMD with cerebral small vessel disease. Multiple logistic regression analyses were used to find out the independent predictive factors of cerebral small vessel disease. Results. Mean PWV was 6.73 ± 2.00 m/s and FMD was 16.67 ± 9.11%. After adjustment for compounding factors, PWV was found significantly associated with lacunar brain infarcts (OR = 2.00; 95% CI: 1.14–3.2; P < 0.05) and FMD was significantly associated with periventricular WMHs (OR = 0.82; 95% CI: 0.71–0.95; P < 0.05). Conclusions. Quantitative evaluation of aortic compliance and endothelial function by using high-resolution MRI may be potentially useful to stratify DM2 patients with risk of cerebral small vessel disease.
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Blackford K, Jancey J, Lee AH, James A, Howat P, Waddell T. Effects of a home-based intervention on diet and physical activity behaviours for rural adults with or at risk of metabolic syndrome: a randomised controlled trial. Int J Behav Nutr Phys Act 2016; 13:13. [PMID: 26830197 PMCID: PMC4736250 DOI: 10.1186/s12966-016-0337-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/26/2016] [Indexed: 11/29/2022] Open
Abstract
Background This study aimed to determine whether a home-based 6-month lifestyle intervention program complemented by motivational interviewing could improve diet and physical activity behaviours in 50–69 year olds with or at risk of metabolic syndrome, residing in a disadvantaged rural Western Australian community. Methods Participants from the City of Albany and surrounding towns (n = 401) were recruited into a 6 month randomised controlled trial. They were screened for metabolic syndrome and randomly allocated to intervention (n = 201) or control group (n = 200). Baseline and post-test data collection for both groups included a self-report questionnaire which incorporated the Fat and Fibre Barometer and the International Physical Activity Questionnaire Short Form. The intervention group received the program materials at baseline and the control group was waitlisted. Generalised estimating equation models assessed repeated outcome measures over time. Results A total of 151 (75.1 %) intervention and 159 (79.5 %) control group participants completed post-test and were included in the analysis. After controlling for confounders, the intervention group achieved a marginally significant increase in their metabolic equivalent (MET) minutes of moderate intensity physical activity per week (p = 0.049), and significantly improved fibre intake (p < 0.001), fat intake (p = 0.003), and vegetable serves per day (p = 0.002) from baseline to post-test relative to the control group. Conclusion A home-based, low-cost intervention with motivational support can effectively improve the physical activity and dietary behaviours of adults aged 50–69 years with or at risk of metabolic syndrome residing in a disadvantaged rural area. Trial registration Anzctr.org.au Identifier: ACTRN12614000512628
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Affiliation(s)
- Krysten Blackford
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, Perth, WA, Australia. .,School of Public Health, Curtin University, Perth, WA, Australia.
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, Perth, WA, Australia. .,School of Public Health, Curtin University, Perth, WA, Australia.
| | - Andy H Lee
- School of Public Health, Curtin University, Perth, WA, Australia.
| | - Anthony James
- School of Public Health, Curtin University, Perth, WA, Australia.
| | - Peter Howat
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, Perth, WA, Australia. .,School of Public Health, Curtin University, Perth, WA, Australia.
| | - Tracy Waddell
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, Perth, WA, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
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Bhowmik B, Akhter A, Ali L, Ahmed T, Pathan F, Mahtab H, Khan AKA, Hussain A. Simple risk score to detect rural Asian Indian (Bangladeshi) adults at high risk for type 2 diabetes. J Diabetes Investig 2015; 6:670-7. [PMID: 26543541 PMCID: PMC4627544 DOI: 10.1111/jdi.12344] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 01/27/2015] [Accepted: 02/22/2015] [Indexed: 01/29/2023] Open
Abstract
AIMS/INTRODUCTION To develop and evaluate a simple, non-invasive, diabetes risk score for detecting individuals at high risk for type 2 diabetes in rural Bangladesh. MATERIALS AND METHODS Data from 2,293 randomly selected individuals aged ≥20 years from a cross-sectional study in a rural community of Bangladesh (2009 Chandra Rural Study) was used for model development. The validity of the model was assessed in another rural cross-sectional study (2009 Thakurgaon Rural Study). The logistic regression model used included age, sex, body mass index, waist-to-hip ratio and hypertension status to predict individuals who were at high risk for type 2 diabetes. RESULTS On applying the developed model to both cohorts, the area under the receiver operating characteristic curve was 0.70 (95% confidence interval 0.68-0.72) for the Chandra cohort and 0.71 (95% confidence interval 0.68-0.74) for the Thakurgaon cohort. The risk score of >9 was shown to have the optimal cut-point to detect diabetes. This score had a sensitivity of 62.4 and 75.7%, and specificity of 67.4 and 61.6% in the two cohorts, respectively. This risk score was shown to have improved sensitivity and specificity to detect type 2 diabetes cases compared with the Thai, Indian, Omani, UK, Dutch, Portuguese and Pakistani diabetes risk scores. CONCLUSIONS This simple, non-invasive risk score can be used to detect individuals at high risk for type 2 diabetes in rural Bangladesh. Subjects with a score of 9 or above (out of 15) should undergo an oral glucose tolerance test for definitive diagnosis of diabetes.
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Affiliation(s)
| | - Afroza Akhter
- Department of Epidemiology & Biostatistics, Bangladesh Institute of Health Sciences (BIHS)Mirpur, Bangladesh
| | - Liaquat Ali
- Department of Biochemistry & Cell Biology, BUHSMirpur, Bangladesh
| | - Tofail Ahmed
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM)Dhaka, Bangladesh
| | - Faruque Pathan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM)Dhaka, Bangladesh
| | - Hajera Mahtab
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM)Dhaka, Bangladesh
| | - Abul Kalam Azad Khan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM)Dhaka, Bangladesh
| | - Akhtar Hussain
- Department of International Health, University of OsloOslo, Norway
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Systematic Review and Meta-Analysis of Response Rates and Diagnostic Yield of Screening for Type 2 Diabetes and Those at High Risk of Diabetes. PLoS One 2015; 10:e0135702. [PMID: 26325182 PMCID: PMC4556656 DOI: 10.1371/journal.pone.0135702] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 07/25/2015] [Indexed: 12/16/2022] Open
Abstract
Background Screening for type 2 diabetes (T2DM) and individuals at risk of diabetes has been advocated, yet information on the response rate and diagnostic yield of different screening strategies are lacking. Methods Studies (from 1998 to March/2015) were identified through Medline, Embase and the Cochrane library and included if they used oral glucose tolerance test (OGTT) and WHO-1998 diagnostic criteria for screening in a community setting. Studies were one-step strategy if participants were invited directly for OGTT and two, three/four step if participants were screened at one or more levels prior to invitation to OGTT. The response rate and diagnostic yield were pooled using Bayesian random-effect meta-analyses. Findings 47 studies (422754 participants); 29 one-step, 11 two-step and seven three/four-step were identified. Pooled response rate (95% Credible Interval) for invitation to OGTT was 65.5% (53.7, 75.6), 63.1% (44.0, 76.8), and 85.4% (76.4, 93.3) in one, two and three/four-step studies respectively. T2DM yield was 6.6% (5.3, 7.8), 13.1% (4.3, 30.9) and 27.9% (8.6, 66.3) for one, two and three/four-step strategies respectively. The number needed to invite to the OGTT to detect one case of T2DM was 15, 7.6 and 3.6 in one, two, and three/four-step strategies. In two step strategies, there was no difference between the response or yield rates whether the first step was blood test or risk-score. There was evidence of substantial heterogeneity in rates across study populations but this was not explained by the method of invitation, study location (rural versus urban) and developmental index of the country in which the study was performed. Conclusions Irrespective of the invitation method, developmental status of the countries and or rural/urban location, using a multi-step strategy increases the initial response rate to the invitation to screening for diabetes and reduces the number needed to have the final diagnostic test (OGTT in this study) for a definite diagnosis.
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Chen GY, Li L, Dai F, Li XJ, Xu XX, Fan JG. Prevalence of and Risk Factors for Type 2 Diabetes Mellitus in Hyperlipidemia in China. Med Sci Monit 2015; 21:2476-84. [PMID: 26297334 PMCID: PMC4550046 DOI: 10.12659/msm.894246] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background We explored the prevalence of and risk factors for type 2 diabetes in the adult population of Shanghai (China) with and without dyslipidemia. Material/Methods We conducted a cross-sectional survey including 14 385 adults (aged 16 to 88 years) in Shanghai using a stratified, multistage cluster sampling approach. Results Type 2 diabetes and hyperlipidemia were found in 1456 (10.1%) and 4583 (31.9%) subjects, respectively. Type 2 diabetes was more common in males (11.4%) than in females (9.2%, P<0.01), in the elderly (> or =65 years, 22.5%) than in younger (<55 years, <10%, P<0.01) individuals, and in urban (12.8%) than in rural populations (5.2%, P<0.01). Diabetes incidence was higher among patients with hyperlipidemia than in controls (16.9% vs. 7.0%, P<0.01; OR=2.72, 95% CI 2.44–3.03). Compared with controls, the risk for diabetes in subjects with isolated hypertriglyceridemia, isolated hypercholesterolemia, and mixed hyperlipidemia increased 1.75-fold (95% CI 1.53–1.99), 1.53-fold (95% CI 1.17–2.01), and 2.93-fold (95% CI 2.37–3.63), respectively. The fasting plasma glucose (FPG) and 2h-postprandial plasma glucose (2h-PG) increased with age in both sexes. The age- and sex-adjusted FPG and 2h-PG levels in hyperlipidemia were significantly higher than in controls (P<0.01). Conclusions A high prevalence of type 2 diabetes in hyperlipidemia patients exists in Shanghai. Hyperlipidemia is associated with elevated blood glucose levels and therefore requires prompt intervention for prevention and treatment of diabetes in patients with dyslipidemia.
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Affiliation(s)
- Guang-Yu Chen
- Center for Fatty Liver Disease, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Lui Li
- Department of Chronic Disease, Shanghai Center for Disease Control and Prevention, Shanghai, China (mainland)
| | - Fei Dai
- School of Public Health, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Xing-Jian Li
- Department of Chronic Disease, Shanghai Center for Disease Control and Prevention, Shanghai, China (mainland)
| | - Xiao-Xin Xu
- Research Center for Clinical Epidemiology, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Jian-Gao Fan
- Center for Fatty Liver Disease, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
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Holt RIG. The prevention of diabetes and cardiovascular disease in people with schizophrenia. Acta Psychiatr Scand 2015; 132:86-96. [PMID: 25976975 DOI: 10.1111/acps.12443] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Primary prevention of diabetes and cardiovascular disease is an important priority for people with schizophrenia. This review aims to identify lifestyle and pharmacological interventions that reduce diabetes and cardiovascular disease in people with schizophrenia. METHOD PubMed and other electronic databases were searched to identify relevant articles. RESULTS Lifestyle interventions that focus on diet and physical activity reduce the incidence of diabetes. Similar programmes in people with schizophrenia have led to significant weight loss and may reasonably be expected to reduce diabetes in the long-term. Metformin may be considered when lifestyle change is not feasible or effective. Lifestyle interventions, particularly smoking cessation, are likely to be effective in reducing cardiovascular disease in people with schizophrenia. Although cardiovascular prevention trials with statins have not been performed in people with schizophrenia, similar reductions in cholesterol has been seen as in the general population and statins should be considered for those at high risk. Traditional cardiovascular risk prediction models perform well in identifying those at high cardiovascular risk, but bespoke prediction models using data from people with schizophrenia perform better. CONCLUSION Reducing diabetes and cardiovascular disease requires a coordinated and concerted effort from mental and physical health teams working across primary and secondary care.
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Affiliation(s)
- R I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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Gamble JM, Clarke A, Myers KJ, Agnew MD, Hatch K, Snow MM, Davis EM. Incretin-based medications for type 2 diabetes: an overview of reviews. Diabetes Obes Metab 2015; 17:649-58. [PMID: 25772666 DOI: 10.1111/dom.12465] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/16/2015] [Accepted: 03/10/2015] [Indexed: 01/23/2023]
Abstract
AIMS To summarize evidence from and assess the quality of published systematic reviews evaluating the safety, efficacy and effectiveness of incretin-based medications used in the treatment of type 2 diabetes. METHODS We identified systematic reviews of randomized controlled trials or observational studies published in any language that evaluated the safety and/or effectiveness of glucagon-like peptide-1 (GLP-1) receptor agonists or dipeptidyl-peptidase-4 (DPP-4) inhibitors. Data sources used include the Cochrane Library, PubMed, EMBASE, Web of Science, International Pharmaceutical Abstracts, table of contents of diabetes journals, and hand-searching of reference lists and clinical practice guidelines. The methodological quality of systematic reviews was independently assessed by two reviewers using the Assessment of Multiple Systematic Reviews (AMSTAR) checklist. Our study protocol was registered with PROSPERO (2013:CRD42013005149). The primary outcomes were pooled treatment effect estimates for glycaemic control, macrovascular and microvascular complications, and hypoglycaemic events. RESULTS We identified 467 unique citations of which 84 systematic reviews met our inclusion criteria. There were 51 reviews that evaluated GLP-1 receptor agonists and 64 reviews that evaluated DPP-4 inhibitors. The median (interquartile range) AMSTAR score was 6 (3) out of 11 for quantitative and 1 (1) for non-quantitative reviews. Among the 66 quantitative systematic reviews, there were a total of 718 pooled treatment effect estimates reported for our primary outcomes and 1012 reported pooled treatment effect estimates for secondary outcomes. CONCLUSIONS Clinicians and policy makers, when using the results of systematic reviews to inform decision-making with regard to round clinical care or healthcare policies for incretin-based medications, should consider the variability in quality of reviews.
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Affiliation(s)
- J-M Gamble
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - A Clarke
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - K J Myers
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - M D Agnew
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - K Hatch
- Allyn and Betty Taylor Library, Western University, London, Ontario, Canada
| | - M M Snow
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - E M Davis
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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Selph S, Dana T, Blazina I, Bougatsos C, Patel H, Chou R. Screening for type 2 diabetes mellitus: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2015; 162:765-76. [PMID: 25867111 DOI: 10.7326/m14-2221] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Screening for type 2 diabetes mellitus could lead to earlier identification and treatment of asymptomatic diabetes, impaired fasting glucose (IFG), or impaired glucose tolerance (IGT), potentially resulting in improved outcomes. PURPOSE To update the 2008 U.S. Preventive Services Task Force review on diabetes screening in adults. DATA SOURCES Cochrane databases and MEDLINE (2007 through October 2014) and relevant studies from previous Task Force reviews. STUDY SELECTION Randomized, controlled trials; controlled, observational studies; and systematic reviews. DATA EXTRACTION Data were abstracted by 1 investigator and checked by a second; 2 investigators independently assessed study quality. DATA SYNTHESIS In 2 trials, screening for diabetes was associated with no 10-year mortality benefit versus no screening (hazard ratio, 1.06 [95% CI, 0.90 to 1.25]). Sixteen trials consistently found that treatment of IFG or IGT was associated with delayed progression to diabetes. Most trials of treatment of IFG or IGT found no effects on all-cause or cardiovascular mortality, although lifestyle modification was associated with decreased risk for both outcomes after 23 years in 1 trial. For screen-detected diabetes, 1 trial found no effect of an intensive multifactorial intervention on risk for all-cause or cardiovascular mortality versus standard control. In diabetes that was not specifically screen-detected, 9 systematic reviews found that intensive glucose control did not reduce risk for all-cause or cardiovascular mortality and results for intensive blood pressure control were inconsistent. LIMITATION The review was restricted to English-language articles, and few studies were conducted in screen-detected populations. CONCLUSION Screening for diabetes did not improve mortality rates after 10 years of follow-up. More evidence is needed to determine the effectiveness of treatments for screen-detected diabetes. Treatment of IFG or IGT was associated with delayed progression to diabetes. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Shelley Selph
- From Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon
| | - Tracy Dana
- From Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon
| | - Ian Blazina
- From Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon
| | - Christina Bougatsos
- From Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon
| | - Hetal Patel
- From Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon
| | - Roger Chou
- From Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon
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Ureña-Bogarín EL, Martínez-Ramírez HR, Torres-Sánchez JR, Hernández-Herrera A, Cortés-Sanabria L, Cueto-Manzano AM. Prevalence of pre-diabetes in young Mexican adults in primary health care. Fam Pract 2015; 32:159-64. [PMID: 25199520 DOI: 10.1093/fampra/cmu047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pre-diabetes in young people is frequently unrecognized or not treated on time, with the consequent loss of opportunity for diabetes prevention. In Mexico, there is scarce information about the prevalence of pre-diabetes in young adults. OBJECTIVE To determine the prevalence and risk factors for pre-diabetes in young Mexican adults in primary health care. METHODS In a cross-sectional study, 288 subjects, aged 18-30 years, from a primary care unit were included. Pre-diabetes was diagnosed (according to the criteria of the American Diabetes Association) as impaired fasting glucose (8-12 hours fasting plasma glucose level: 100-125 mg/dl) or impaired glucose tolerance (140-199 mg/dl after a 2-hour oral glucose tolerance test). RESULTS Prevalence of pre-diabetes was 14.6% [95% confidence interval (CI): 10.7-19.2], whereas that of diabetes was 2.4% (95% CI: 1.0-4.9). A high proportion of patients had history of obesity, diabetes, hypertension and consumption of tobacco and alcohol. Pre-diabetic patients were older than normoglycaemics (pre-diabetic patients: 26±4 years versus normoglycaemic subjects: 24±3 years, P = 0.003) and had higher body mass index (BMI; pre-diabetic patients: 29.4±6.8 kg/m(2) versus normoglycaemic subjects: 26.8±5.8 kg/m(2); P = 0.009), particularly in the case of men (pre-diabetic men: 29.3±7.0 kg/m(2) versus normoglycaemic men: 26.4±5.1 kg/m(2); P = 0.03). Although waist circumference showed a trend to be higher among pre-diabetics, no significant differences were found according to gender (among males: pre-diabetics: 99.5±18.8 cm versus normoglycaemics: 93.3±14.4 cm, P = 0.09; among females: pre-diabetics: 91.5±13.8 cm versus normoglycaemics: 85.8±15.9 cm, P = 0.16). Only age and BMI were significantly associated with the presence of pre-diabetes. CONCLUSIONS Almost 15% of these young adults had pre-diabetes. Many modifiable and non-modifiable risk factors were present in these patients, but only age and a higher BMI were independent variables significantly associated with pre-diabetes. Timely interventions in primary health care are needed to prevent or delay the progression to diabetes.
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Affiliation(s)
- Enrique L Ureña-Bogarín
- Medical Research Unit in Renal Disease, Specialities Hospital, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Héctor R Martínez-Ramírez
- Medical Research Unit in Renal Disease, Specialities Hospital, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - José R Torres-Sánchez
- Medical Research Unit in Renal Disease, Specialities Hospital, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Aurora Hernández-Herrera
- Medical Research Unit in Renal Disease, Specialities Hospital, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Laura Cortés-Sanabria
- Medical Research Unit in Renal Disease, Specialities Hospital, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Alfonso M Cueto-Manzano
- Medical Research Unit in Renal Disease, Specialities Hospital, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico.
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Value of lifestyle intervention to prevent diabetes and sequelae. Am J Prev Med 2015; 48:271-80. [PMID: 25498548 DOI: 10.1016/j.amepre.2014.10.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 09/09/2014] [Accepted: 10/03/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND The Community Preventive Services Task Force recommends combined diet and physical activity promotion programs for people at increased risk of type 2 diabetes, as evidence continues to show that intensive lifestyle interventions are effective for overweight individuals with prediabetes. PURPOSE To illustrate the potential clinical and economic benefits of treating prediabetes with lifestyle intervention to prevent or delay onset of type 2 diabetes and sequelae. METHODS This 2014 analysis used a Markov model to simulate disease onset, medical expenditures, economic outcomes, mortality, and quality of life for a nationally representative sample with prediabetes from the 2003-2010 National Health and Nutrition Examination Survey. Modeled scenarios used 10-year follow-up results from the lifestyle arm of the Diabetes Prevention Program and Outcomes Study versus simulated natural history of disease. RESULTS Over 10 years, estimated average cumulative gross economic benefits of treating patients who met diabetes screening criteria recommended by the ADA ($26,800) or USPSTF ($24,700) exceeded average benefits from treating the entire prediabetes population ($17,800). Estimated cumulative, gross medical savings for these three populations averaged $10,400, $11,200, and $6,300, respectively. Published estimates suggest that opportunistic screening for prediabetes is inexpensive, and lifestyle intervention similar to the Diabetes Prevention Program can be achieved for ≤$2,300 over 10 years. CONCLUSIONS Lifestyle intervention among people with prediabetes produces long-term societal benefits that exceed anticipated intervention costs, especially among prediabetes patients that meet the ADA and USPSTF screening guidelines.
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Kaya E, Sikka SC, Gur S. A comprehensive review of metabolic syndrome affecting erectile dysfunction. J Sex Med 2015; 12:856-75. [PMID: 25675988 DOI: 10.1111/jsm.12828] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Metabolic syndrome (MetS) is the most important public health issue threatening the health of men and women all over the world. Its current prevalence (i.e., approximately 30%) is continuously increasing. MetS by itself is considered a risk factor for erectile dysfunction (ED). AIM To focus on the definition epidemiology, pathogenesis, and possible mechanistic links between MetS and ED in order to provide guidelines for treating such individuals. METHODS The search strategies yielded total records screened from PubMed. MAIN OUTCOME MEASURES Regardless of the definition, MetS consists of insulin resistance, hypertension, dyslipidemia, and obesity. MetS is not an end disease but is a disorder of energy utilization and storage. RESULTS The prevalence of ED in patients with MetS is almost twice than in those without MetS, and about 40% of patients with ED have MetS. An important mechanism linking MetS and ED is hypogonadism. CONCLUSIONS Recognizing through ED, underlying conditions such as hypogonadism, diabetes and MetS might be a useful motivation for men to improve their health-related choices. The clinical management of MetS can be done by therapeutic interventions that include lifestyle modifications, hormone replacement alone or in combination with phosphodiesterase 5 inhibitors, and other pharmacological treatments.
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Affiliation(s)
- Ecem Kaya
- Departments of Biochemistry and Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
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Abstract
The prevalence of diabetes mellitus is twofold to threefold higher in people with severe mental illness (SMI) than in the general population, with diabetes mellitus affecting ∼12% of people receiving antipsychotics. The consequences of diabetes mellitus are more severe and frequent in people with SMI than in those without these conditions, with increased rates of microvascular and macrovascular complications, acute metabolic dysregulation and deaths related to diabetes mellitus. Multiple complex mechanisms underlie the association between diabetes mellitus and SMI; these mechanisms include genetic, environmental and disease-specific factors, and treatment-specific factors. Although antipsychotics are the mainstay of treatment in SMI, a causative link, albeit of uncertain magnitude, seems to exist between antipsychotics and diabetes mellitus. The principles of managing diabetes mellitus in people with SMI are similar to those for the general population and should follow currently established treatment algorithms. Lifestyle interventions are needed to reduce incident diabetes mellitus. In addition, improved uptake of opportunities to screen for this disease will reduce the high prevalence of undiagnosed diabetes mellitus. Currently, people with SMI receive poorer treatment for diabetes mellitus than the general population. Thus, health-care professionals in primary care, diabetes mellitus services and mental health teams have a responsibility to ensure that patients with SMI are not disadvantaged.
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Affiliation(s)
- Richard I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Alex J Mitchell
- Department of Cancer Studies and Molecular Medicine, Infirmary Close, University of Leicester, Leicester LE1 5WW, UK
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Kidney RSM, Peacock JM, Smith SA. Blood glucose screening rates among Minnesota adults with hypertension, Behavioral Risk Factor Surveillance System, 2011. Prev Chronic Dis 2014; 11:E207. [PMID: 25427315 PMCID: PMC4247121 DOI: 10.5888/pcd11.140204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Many US adults have multiple chronic conditions, and hypertension and diabetes are among the most common dyads. Diabetes and prediabetes prevalence are increasing, and both conditions negatively affect cardiovascular health. Early diagnosis and treatment of diabetes and prediabetes can benefit people with hypertension by preventing cardiovascular complications. Methods We analyzed 2011 Minnesota Behavioral Risk Factor Surveillance System data to describe the proportion of adults with hypertension screened for diabetes according to US Preventive Services Task Force Recommendations for blood glucose testing. Covariates associated with lower odds of recent screening among adults without diabetes were determined using weighted logistic regression. Results Of Minnesota adults with self-reported hypertension, 19.6% had a diagnosis of diabetes and 10.7% had a diagnosis of prediabetes. Nearly one-third of adults with hypertension without diabetes had not received blood glucose screening in the past 3 years. Factors associated with greater odds of not being screened in multivariable models included being aged 18 to 44 years (adjusted odds ratio [AOR], 1.77; 95% confidence interval [CI], 1.23–2.55); being nonobese, with stronger effects for normal body mass index; having no check-up in the past 2 years (AOR, 2.49; 95% CI, 1.49–4.17); having hypertension treated with medication (AOR, 2.01; 95% CI, 1.49–2.71); and completing less than a college degree (AOR, 1.45; 95% CI, 1.14–1.84). Excluding respondents with prediabetes or those not receiving a check-up did not change the results. Conclusions Failure to screen among providers and failure to understand the importance of screening among individuals with hypertension may mean missed opportunities for early detection, clinical management, and prevention of diabetes.
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Affiliation(s)
- Renée S M Kidney
- Minnesota Department of Health, Division of Health Promotion and Chronic Disease, Center for Health Promotion, Diabetes Unit, PO Box 64882, St Paul, MN 55164-5429. E-mail:
| | | | - Steven A Smith
- Mayo Clinic, Rochester, Minnesota. Dr Smith is also affiliated with the Mayo College of Medicine, Rochester, Minnesota
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Screening for type 2 diabetes in a high-risk population: effects of a negative screening test after 4 years follow-up. Ann Behav Med 2014; 47:102-10. [PMID: 23818042 DOI: 10.1007/s12160-013-9525-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND A negative diabetes screening test may unintentionally provide reassurance, resulting in reduced incentive to follow a healthy lifestyle. PURPOSE The purpose of this study is to assess negative test result effects on lifestyle and risk perception at 4 years follow-up. METHODS Risk perception and changes in smoking, physical activity, body mass index (BMI), and waist circumference were compared between 706 high-risk participants with a negative test result and 706 high-risk participants not offered screening (controls) in a randomized controlled trial of diabetes screening. RESULTS Negative-screened individuals experienced a small but significant increase in BMI and waist circumference, but there was no significant difference with controls. The negative-screened group had significantly higher perception of risk of developing diabetes (p = 0.009) than controls, but no differences were observed in perceived personal control, worry, and optimistic bias. CONCLUSION Screening negative for diabetes did not lead to overt long-term changes in lifestyle, despite a high perception of risk of developing diabetes. (ISRCTN75983009.).
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Li YQ, Sun CQ, Li LL, Wang L, Guo YR, You AG, Xi YL, Wang CJ. Resting heart rate as a marker for identifying the risk of undiagnosed type 2 diabetes mellitus: a cross-sectional survey. BMC Public Health 2014; 14:1052. [PMID: 25297916 PMCID: PMC4210587 DOI: 10.1186/1471-2458-14-1052] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 08/18/2014] [Indexed: 01/13/2023] Open
Abstract
Background Fast resting heart rate might increase the risk of developing type 2 diabetes mellitus (T2DM). However, it is unclear whether resting heart rate could be used to predict the risk of undiagnosed T2DM. Therefore, the purposes of this study were to examine the association between resting heart rate and undiagnosed T2DM, and evaluate the feasibility of using resting heart rate as a marker for identifying the risk of undiagnosed T2DM. Methods A cross-sectional survey was conducted. Resting heart rate and relevant covariates were collected and measured. Fasting blood samples were obtained to measure blood glucose using the modified hexokinase enzymatic method. Predictive performance was analyzed by Receiver Operating Characteristic (ROC) curve. Results This study included 16, 636 subjects from rural communities aged 35–78 years. Resting heart rate was significantly associated with undiagnosed T2DM in both genders. For resting heart rate categories of <60, 60–69, 70–79, and ≥80 beats/min, adjusted odds ratios for undiagnosed T2DM were 1.04, 2.32, 3.66 and 1.05, 1.57, 2.98 in male and female subjects, respectively. For male subjects, resting heart rate ≥70 beats/min could predict undiagnosed T2DM with 76.56% sensitivity and 48.64% specificity. For female subjects, the optimum cut-off point was ≥79 beats/min with 49.72% sensitivity and 67.53% specificity. The area under the ROC curve for predicting undiagnosed T2DM was 0.65 (95% CI: 0.64-0.66) and 0.61(95% CI: 0.60-0.62) in male and female subjects, respectively. Conclusions Fast resting heart rate is associated with an increased risk of undiagnosed T2DM in male and female subjects. However, resting heart rate as a marker has limited potential for screening those at high risk of undiagnosed T2DM in adults living in rural areas.
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Affiliation(s)
| | | | | | | | | | | | | | - Chong-jian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou 450001, Henan, PR China.
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Abstract
As diabetes develops, we currently waste the first ∼10 years of the natural history. If we found prediabetes and early diabetes when they first presented and treated them more effectively, we could prevent or delay the progression of hyperglycemia and the development of complications. Evidence for this comes from trials where lifestyle change and/or glucose-lowering medications decreased progression from prediabetes to diabetes. After withdrawal of these interventions, there was no "catch-up"-cumulative development of diabetes in the previously treated groups remained less than in control subjects. Moreover, achieving normal glucose levels even transiently during the trials was associated with a substantial reduction in subsequent development of diabetes. These findings indicate that we can change the natural history through routine screening to find prediabetes and early diabetes, combined with management aimed to keep glucose levels as close to normal as possible, without hypoglycemia. We should also test the hypothesis with a randomized controlled trial.
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Affiliation(s)
- Lawrence S Phillips
- Atlanta VA Medical Center, Decatur, GA Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - John B Buse
- Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Steven E Kahn
- VA Puget Sound Health Care System, Seattle, WA Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA
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New insight into improvement of cardiovascular outcomes with intensive glycemic control in patients with metabolic syndrome and type 2 diabetes mellitus included. Cell Biochem Biophys 2014; 71:9-15. [PMID: 25113641 DOI: 10.1007/s12013-014-0175-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The epidemiology of metabolic syndrome (MetS) is very concerning since this is a widespread chronic disease in adult and elderly population. Different epidemiological studies confirmed strong relationship between type 2 diabetes mellitus (DM2) inclusive MetS and the occurrence of microvascular and macrovascular complications in these patients. Therefore, we are discussing molecular mechanisms and pathways recently introduced and intensively researched. These molecules have been held responsible for direct and indirect correlative trends important in the assessment of potential benefit of intensive glycemic control. Novel substances may improve patient's outcome in recent future regarding cardiovascular complications though their acting mechanisms have not been completely elucidated. We are reviewing whether it would intensive glycemic control be a reasonable approach in patients with MetS when DM2 is included and which recommendations are currently widely applied. The aim was therefore to emphasize current need for further investigations in the field since the utility of intensive glycemic control in all DM/MetS patients as mean for reduction of cardiovascular complications still remains controversial.
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Analysis and improvement of organizational models for the management of patients with type 2 diabetes mellitus: a case study in north-east Italy. Qual Manag Health Care 2014; 23:99-118. [PMID: 24710186 DOI: 10.1097/qmh.0000000000000025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The study aimed to establish whether the organization for the management of type 2 diabetes mellitus at 9 diabetic units (DUs), in 5 neighboring local health authorities (LHAs), was able to (a) comply with the organizational model prescribed by specific regional standards; (b) ensure adequate clinical management of diabetic patients; (c) assess whether the relationship between primary care physicians (PCPs) and diabetologists (SDs) was instrumental to the needs of patients; (d) optimize specialist treatment at the DUs; (e) optimize drug management; and (f) check whether organizational changes led to variations in clinical results. METHODS This 6-stage study analyzed procedures, precoded actions, and recordable processes. Stage (1) Defining clinical and organizational endpoints; (2) Drafting flowcharts to describe the actions and work procedures implemented within each LHA; (3) Comparing the flowcharts with the data obtained from related literature; (4) Establishing a protocol shared with PCPs for the management and treatment of patients with type 2 diabetes; (5) Changing the procedures at the DUs; and (6) Evaluating the results. The data were assessed before and after establishing a shared protocol for SDs and PCPs (year 2009 vs 2011). RESULTS The study shows inconsistencies in the organization of work in the 5 LHAs; however, collaboration with PCPs has guaranteed: (a) unchanged hemoglobin A1C values before and after applying the protocol; (b) a percentage increase in the number of patients with type 2 diabetes who were identified thanks to these protocols; (c) an increase in the use of biguanides compared to the preprotocol period; and (d) no change in the number of patients hospitalized because of acute complications from type 2 diabetes mellitus. CONCLUSIONS This study confirms how adequate collaboration between SDs and PCPs keeps the risk of complications stable. Nevertheless, shared protocols and clearly defined roles are required.
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Adonis L, Basu D, Luiz J. Predictors of adherence to screening guidelines for chronic diseases of lifestyle, cancers, and HIV in a health-insured population in South Africa. Glob Health Action 2014; 7:23807. [PMID: 24647130 PMCID: PMC3957800 DOI: 10.3402/gha.v7.23807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 02/20/2014] [Accepted: 02/22/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adherence to screening guidelines has been widely accepted to reduce morbidity, mortality, and cost outcomes. The aim of this study was to identify predictors of adherence to screening guidelines for chronic diseases of lifestyle (CDL), cancers, and HIV in a health-insured population in South Africa, some of whom voluntarily opt into a wellness program that incentivizes screening. METHOD A cross-sectional study for the period 2007-2011 was conducted using a random sample of 170,471 health insurance members from a single insurer. Adherence to screening guidelines was calculated from medical claims data. RESULTS Adherence to screening guidelines ranged from 1.1% for colorectal cancer to 40.9% for cholesterol screening. Members of the wellness program were up to three times more likely to screen for diseases (odds ratio [OR] = 3.2 for HIV screening, confidence interval [CI] = 2.75-3.73). Plan type (full comprehensive plan) was most strongly associated with cholesterol screening (OR = 3.53, CI = 3.27-3.80), and most negatively associated (hospital-only core plan) with cervical cancer screening (OR = 0.44, CI = 0.28-0.70). Gender was a negative predictor for glucose screening (OR = 0.88, CI = 0.82-0.96). Provincial residence was most strongly associated with cervical cancer screening (OR = 1.89, CI = 0.65-5.54). CONCLUSION Adherence to screening recommendations was <50%. Plan type, gender, provincial residence, and belonging to an incentivized wellness program were associated with disproportionate utilization of screening services, even with equal payment access.
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Affiliation(s)
- Leegale Adonis
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Debashis Basu
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - John Luiz
- Graduate School of Business, University of Cape Town, Cape Town, South Africa
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Mani H, Khunti K, Levy M, Davies MJ. Diabetes advice for women with polycystic ovary syndrome: prevention, prevention, prevention. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/dmt.13.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Why we should screen for type 2 diabetes in high-risk patients. Am J Prev Med 2013; 44:S371-4. [PMID: 23498301 DOI: 10.1016/j.amepre.2012.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 10/12/2012] [Accepted: 12/07/2012] [Indexed: 11/21/2022]
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Wang C, Li L, Wang L, Ping Z, Flory MT, Wang G, Xi Y, Li W. Evaluating the risk of type 2 diabetes mellitus using artificial neural network: an effective classification approach. Diabetes Res Clin Pract 2013; 100:111-8. [PMID: 23453177 DOI: 10.1016/j.diabres.2013.01.023] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 10/15/2012] [Accepted: 01/23/2013] [Indexed: 01/22/2023]
Abstract
AIM To develop and evaluate an effective classification approach without biochemical parameters to identify those at high risk of T2DM in rural adults. METHODS A cross-sectional survey was conducted. Of 8640 subjects who met inclusion criteria, 75% (N1=6480) were randomly selected to provide training set for constructing artificial neural network (ANN) and multivariate logistic regression (MLR) models. The remaining 25% (N2=2160) were assigned to validation set for performance comparisons of the ANN and MLR models. Predictive performance of different models was analyzed by the receiver operating characteristic (ROC) curve using the validation set. RESULTS The prevalence rates of T2DM were 8.66% (n=561) and 9.21% (n=199) in training and validation sets, respectively. For ANN model, the sensitivity, specificity, positive and negative predictive value for identifying T2DM were 86.93%, 79.14%, 31.86%, and 98.18%, respectively, while MLR model were only 60.80%, 75.48%, 21.78%, and 94.52%, respectively. Area under the ROC curve (AUC) value for identifying T2DM when using the ANN model was 0.891, showing more accurate predictive performance than the MLR model (AUC=0.744) (P=0.0001). CONCLUSION The ANN model is an effective classification approach for identifying those at high risk of T2DM based on demographic, lifestyle and anthropometric data.
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Affiliation(s)
- Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
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Rouse MD, Shoukry CL. Elevated blood glucose levels in the emergency department: missed opportunities. J Emerg Nurs 2013; 40:311-6. [PMID: 23518220 DOI: 10.1016/j.jen.2013.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/29/2013] [Accepted: 02/03/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Prediabetes is an important public health issue. In 2011, 79 million Americans had prediabetes, and 7 million were undiagnosed. By 2025, the number of persons with prediabetes is projected to increase to 472 million globally. For many, the emergency department may be the only source of medical care or interaction with a health care provider. This makes the emergency department an ideal place to identify individuals with elevated random blood glucose levels, inform them of the elevation, and refer them for follow-up. METHODS This was a descriptive, correlational, cross-sectional study using retrospective data from 2 emergency departments in north San Diego County to determine the incidence of elevated blood glucose levels and the disposition of these individuals. Descriptive and correlational statistical analyses were completed with SPSS software (IBM, Armonk, NY). RESULTS Patients (N = 106) with random blood glucose levels of 150 mg/dL or greater, without a prior diagnosis of diabetes, were identified over a 9-day period. The mean glucose level was 181.53 mg/dL. Of the patients, 45 (42%) were discharged. Only 1 of these 45 patients (2.2%) was informed about the elevated blood glucose level and referred for follow-up. DISCUSSION Emergency nurses and providers care for patients with elevated blood glucose levels who may have undiagnosed prediabetes. The finding that only 1 patient with an elevated glucose level was informed and referred for follow-up indicates opportunities to address this population of patients who are being missed. Failing to inform and provide referral minimizes patients' abilities to make relevant lifestyle changes to help prevent or delay progression to type 2 diabetes.
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Klein Woolthuis EP, de Grauw WJC, van Keeken SM, Akkermans RP, van de Lisdonk EH, Metsemakers JFM, van Weel C. Vascular outcomes in patients with screen-detected or clinically diagnosed type 2 diabetes: Diabscreen study follow-up. Ann Fam Med 2013; 11:20-7. [PMID: 23319502 PMCID: PMC3596031 DOI: 10.1370/afm.1460] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Screening guidelines for type 2 diabetes recommend targeting high-risk individuals. Our objective was to assess whether diagnosis of type 2 diabetes based on opportunistic targeted screening results in lower vascular event rates compared with diagnosis on the basis of clinical signs or symptoms. METHODS In a prospective, nonrandomized, observational study, we enrolled patients aged 45 to 75 years from 10 family practices in the Netherlands with a new diagnosis of type 2 diabetes, detected either by (1) opportunistic targeted screening (n = 359) or (2) clinical signs or symptoms (n = 206). Patients in both groups received the same guideline-concordant diabetes care. The main group outcome measure was a composite of death from cardiovascular disease (CVD), nonfatal myocardial infarction, and nonfatal stroke. RESULTS Baseline vascular disease was more prevalent in the opportunistic targeted screening group, mainly ischemic heart disease (12.3% vs 3.9%, P = .001) and nephropathy (16.9% vs 7.1%, P = .002). After a mean follow-up of 7.7 years (SD = 2.4 years) and 7.1 years (SD = 2.7 years) for the opportunistic targeted screening and clinical diagnosis groups, respectively, composite primary event rates did not differ significantly between the 2 groups (9.5% vs 10.2%, P = .78; adjusted hazard ratio 0.67, 95% confidence interval, 0.36-1.25; P = .21). There were also no significant differences in the separate event rates of deaths from CVD, nonfatal myocardial infarction, and nonfatal strokes. CONCLUSIONS Opportunistic targeted screening for type 2 diabetes detected patients with higher CVD morbidity at baseline when compared with clinical diagnosis but showed similar CVD mortality and major CVD morbidity after 7.7 years. Opportunistic targeted screening and guided care appears to improve vascular outcomes in type 2 diabetes in primary care.
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Affiliation(s)
- Erwin P Klein Woolthuis
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, The Netherlands.
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Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ 2012; 345:e7191. [PMID: 23169868 PMCID: PMC3502745 DOI: 10.1136/bmj.e7191] [Citation(s) in RCA: 201] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2012] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To quantify the benefits and harms of general health checks in adults with an emphasis on patient-relevant outcomes such as morbidity and mortality rather than on surrogate outcomes. DESIGN Cochrane systematic review and meta-analysis of randomised trials. For mortality, we analysed the results with random effects meta-analysis, and for other outcomes we did a qualitative synthesis as meta-analysis was not feasible. DATA SOURCES Medline, EMBASE, Healthstar, Cochrane Library, Cochrane Central Register of Controlled Trials, CINAHL, EPOC register, ClinicalTrials.gov, and WHO ICTRP, supplemented by manual searches of reference lists of included studies, citation tracking (Web of Knowledge), and contacts with trialists. SELECTION CRITERIA Randomised trials comparing health checks with no health checks in adult populations unselected for disease or risk factors. Health checks defined as screening general populations for more than one disease or risk factor in more than one organ system. We did not include geriatric trials. DATA EXTRACTION Two observers independently assessed eligibility, extracted data, and assessed the risk of bias. We contacted authors for additional outcomes or trial details when necessary. RESULTS We identified 16 trials, 14 of which had available outcome data (182,880 participants). Nine trials provided data on total mortality (11,940 deaths), and they gave a risk ratio of 0.99 (95% confidence interval 0.95 to 1.03). Eight trials provided data on cardiovascular mortality (4567 deaths), risk ratio 1.03 (0.91 to 1.17), and eight on cancer mortality (3663 deaths), risk ratio 1.01 (0.92 to 1.12). Subgroup and sensitivity analyses did not alter these findings. We did not find beneficial effects of general health checks on morbidity, hospitalisation, disability, worry, additional physician visits, or absence from work, but not all trials reported on these outcomes. One trial found that health checks led to a 20% increase in the total number of new diagnoses per participant over six years compared with the control group and an increased number of people with self reported chronic conditions, and one trial found an increased prevalence of hypertension and hypercholesterolaemia. Two out of four trials found an increased use of antihypertensives. Two out of four trials found small beneficial effects on self reported health, which could be due to bias. CONCLUSIONS General health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes, although they increased the number of new diagnoses. Important harmful outcomes were often not studied or reported. SYSTEMATIC REVIEW REGISTRATION Cochrane Library, doi:10.1002/14651858.CD009009.
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Affiliation(s)
- Lasse T Krogsbøll
- Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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Affiliation(s)
- Michael M Engelgau
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Hansbauer B, Enthaler N, Mahlknecht A, Sönnichsen A. [Preventive screening in general practice. What examined and how reliable is it?]. MMW Fortschr Med 2012; 154 Spec No 3:46-50. [PMID: 23724719 DOI: 10.1007/s15006-012-1295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Thorp ML, Smith DH, Johnson ES, Weiss JW, Vupputuri S, Petrik AF, Yang XH. Should measuring haemoglobin among chronic kidney disease patients be a performance measure? J Evid Based Med 2012; 5:194-204. [PMID: 23557499 DOI: 10.1111/jebm.12005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We attempted to: (1) to assess whether or not adequate evidence exists to advocate the measurement of anaemia in chronic kidney disease as a performance measure; and (2) to determine what the appropriate benchmarks might be for health systems seeking to implement this performance measure. DESIGN Our study was conducted in two phases: (1) we used the United States Preventive Service Task Force chain of evidence methodology to determine six key questions that were subsequently reviewed to determine if adequate evidence existed to recommend haemoglobin testing among patients with chronic kidney disease; and (2) in order to establish a benchmark for a potential performance measure we measured the number of patients who had a test for anaemia during the preceding year and during the preceding three years. We established these benchmarks using chronic kidney disease defined both by estimated glomerular filtration rate and ICD-9 codes. SETTING Benchmarking was undertaken at Kaiser Permanente Northwest, which serves the Portland, Oregon and Vancouver, Washington metropolitan area, and Kaiser Permanente Georgia, which serves the Atlanta metropolitan area. PARTICIPANTS Patients with chronic kidney disease identified by either estimated glomerular filtration rate or ICD-9 code. MAIN OUTCOMES MEASUREMENT: Serum haemoglobin INTERVENTION This was an observational study. RESULTS Our review of the evidence found no direct evidence that testing for anaemia among patients with chronic kidney disease improved patient morbidity or mortality. The ideal test for anaemia was serum haemoglobin. We found that available treatments of anaemia improve fatigue, but may increase mortality and stoke. We also found that an overwhelming majority of patients with chronic kidney disease defined by either estimated glomerular filtration rate or ICD-9 codes, over one or three years had had a haemoglobin measurement. CONCLUSION There is currently inadequate evidence to recommend haemoglobin measurement among patients with chronic kidney disease as a performance measure. In addition, most patients with chronic kidney disease have already had haemoglobin measurement, minimizing the potential benefit of a performance measure.
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Affiliation(s)
- Micah L Thorp
- Department of Nephrology, Kaiser Permanente Northwest, Portland, OR 97215, USA.
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Echouffo-Tcheugui JB, Mayige M, Ogbera AO, Sobngwi E, Kengne AP. Screening for hyperglycemia in the developing world: rationale, challenges and opportunities. Diabetes Res Clin Pract 2012; 98:199-208. [PMID: 22975016 DOI: 10.1016/j.diabres.2012.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/17/2012] [Accepted: 08/09/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND The prevalence of diabetes and prediabetes are increasingly high in developing countries, where detection rates remain very low. This manuscript discusses the rationale, challenges and opportunities for early detection of diabetes and prediabetes in developing countries. METHODS PubMed was searched up to March 2012 for studies addressing screening for hyperglycemia in developing countries. Relevant studies were summarized through key questions derived from the Wilson and Junger criteria. RESULTS In developing countries, diabetes predominantly affects working-age persons, has high rates of complications and devastating economic impacts. These countries are ill-equipped to handle advanced stages of the disease. There are acceptable and relatively simple tools that can aid screening in these countries. Interventions shown to be cost-effective in preventing diabetes and its complications in developed countries can be used in screen-detected people of developing countries. However, effective implementation of these interventions remains a challenge, and the costs and benefits of diabetes screening in these settings are less well-known. Implementing screening policies in developing countries will require health systems strengthening, through creative funding and staff training. CONCLUSIONS For many compelling reasons, screening for hyperglycemia preferably targeted, should be a policy priority in developing countries. This will help reorient health systems toward cost-saving prevention.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev 2012; 10:CD009009. [PMID: 23076952 DOI: 10.1002/14651858.cd009009.pub2] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND General health checks are common elements of health care in some countries. These aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used screening tests offered in general health checks have been incompletely studied. Also, screening leads to increased use of diagnostic and therapeutic interventions, which can be harmful as well as beneficial. It is, therefore, important to assess whether general health checks do more good than harm. OBJECTIVES We aimed to quantify the benefits and harms of general health checks with an emphasis on patient-relevant outcomes such as morbidity and mortality rather than on surrogate outcomes such as blood pressure and serum cholesterol levels. SEARCH METHODS We searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, MEDLINE, EMBASE, Healthstar, CINAHL, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) to July 2012. Two authors screened titles and abstracts, assessed papers for eligibility and read reference lists. One author used citation tracking (Web of Knowledge) and asked trialists about additional studies. SELECTION CRITERIA We included randomised trials comparing health checks with no health checks in adults unselected for disease or risk factors. We did not include geriatric trials. We defined health checks as screening general populations for more than one disease or risk factor in more than one organ system. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed the risk of bias in the trials. We contacted authors for additional outcomes or trial details when necessary. For mortality outcomes we analysed the results with random-effects model meta-analysis, and for other outcomes we did a qualitative synthesis as meta-analysis was not feasible. MAIN RESULTS We included 16 trials, 14 of which had available outcome data (182,880 participants). Nine trials provided data on total mortality (155,899 participants, 11,940 deaths), median follow-up time nine years, giving a risk ratio of 0.99 (95% confidence interval (CI) 0.95 to 1.03). Eight trials provided data on cardiovascular mortality (152,435 participants, 4567 deaths), risk ratio 1.03 (95% CI 0.91 to 1.17) and eight trials on cancer mortality (139,290 participants, 3663 deaths), risk ratio 1.01 (95% CI 0.92 to 1.12). Subgroup and sensitivity analyses did not alter these findings.We did not find an effect on clinical events or other measures of morbidity but one trial found an increased occurrence of hypertension and hypercholesterolaemia with screening and one trial found an increased occurence of self-reported chronic disease. One trial found a 20% increase in the total number of new diagnoses per participant over six years compared to the control group. No trials compared the total number of prescriptions, but two out of four trials found an increased number of people using antihypertensive drugs. Two out of four trials found small beneficial effects on self-reported health, but this could be due to reporting bias as the trials were not blinded. We did not find an effect on admission to hospital, disability, worry, additional visits to the physician, or absence from work, but most of these outcomes were poorly studied. We did not find useful results on the number of referrals to specialists, the number of follow-up tests after positive screening results, or the amount of surgery. AUTHORS' CONCLUSIONS General health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes, although the number of new diagnoses was increased. Important harmful outcomes, such as the number of follow-up diagnostic procedures or short term psychological effects, were often not studied or reported and many trials had methodological problems. With the large number of participants and deaths included, the long follow-up periods used, and considering that cardiovascular and cancer mortality were not reduced, general health checks are unlikely to be beneficial.
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Affiliation(s)
- Canadian Task Force on Preventive Health Care
- From the Department of Family Medicine (Pottie, Lewin), University of Ottawa, Ottawa, Ont.; the Public Health Agency of Canada (Jaramillo, Dunfield), Ottawa, Ont.; the Department of Family Medicine (Dickinson), University of Calgary Medical Centre, Calgary, Alta.; the Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; the Department of Family Relations and Applied Nutrition (Brauer), University of Guelph, Guelph, Ont.; the Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; the Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; and the Division of Nephrology (Tonelli), Department of Medicine, University of Alberta, Edmonton, Alta
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