ORal anticoaGulants in diAbetic and Nondiabetic patients with nOn-valvular atrial fibrillatioN (ORGANON).

BACKGROUND: Diabetes represents a pro-thrombotic condition. OBJECTIVES: The primary objective was to evaluate the effects of Vitamin K Antagonist (VKA) compared to direct oral anticoagulants (DOACs) in diabetic and nondiabetic patients with non-valvular atrial fibrillation, newly diagnosed. The secondary objective was to evaluate the effects on the risk of bleeding. METHODS: We enrolled 300 patients with newly diagnosed atrial fibrillation. One hundred and sixteen patients were taking warfarin, 31 acenocumarol, 22 dabigatran, 80 rivaroxaban, 34 apixaban, and 17 edoxaban. We evaluated: anthropometric parameters, glycated hemoglobin (HbA1c), fasting and post-prandial glucose (FPG, and PPG), lipid profile, Lp(a), small and dense low-density lipoprotein (SD-LDL), oxidized LDL (Ox-LDL), I-troponin (I-Tn), creatinine, transaminases, iron, red blood cells (RBC); hemoglobin (Hb), platelets (PLT), fibrinogen, D-dimer, anti-thrombin III, C-reactive protein (Hs-CRP), Metalloproteinases-2 (MMP-2), Metalloproteinases-9 (MMP-9), and incidence of bleeding. RESULTS: We did not record any differences among nondiabetic patients between VKA and DOACs. However, when we considered diabetic patients, we found a slight, but significant improvement of triglycerides and SD-LDL. As regards incidence of bleeding, minor bleeding was more frequent in VKA diabetic group compared to DOACs diabetic group; furthermore, the incidence of major bleeding was higher with VKA in nondiabetic and diabetic group, compared to patients with DOACs. Among DOACs, we recorded a higher incidence of bleeding (minor and major) with dabigatran compared to rivaroxaban, apixaban and edoxaban in nondiabetic and diabetic patients. CONCLUSION: DOACs seem to be metabolically favourable in diabetic patients. Regarding incidence of bleeding, DOACs with the exception of dabigatran, seem better than VKA in diabetic patients.

Prevalence, Awareness, Treatment and Control of Diabetes in India From the Countrywide National NCD Monitoring Survey.

Background: To determine the prevalence, awareness, treatment and control of diabetes mellitus (DM) and associated factors amongst adults (18-69 years) in India from the National Noncommunicable Disease Monitoring Survey (NNMS). Methods: NNMS was a comprehensive, cross-sectional survey conducted in 2017-18 on a national sample of 12,000 households in 600 primary sampling units. In every household, one eligible adult aged 18-69 years were selected. Information on NCD risk factors and their health-seeking behaviors were collected. Anthropometric measurements, blood pressure and fasting capillary blood glucose were measured. DM was defined as fasting blood glucose (FBG) ≥126 mg/dl including those on medication. Awareness, treatment, and control of DM were defined as adults previously diagnosed with DM by a doctor, on prescribed medication for DM, and FBG <126 mg/dl, respectively. The weighted data are presented as mean and proportions with 95% CI. We applied the Student t-test for continuous variables, Pearson's chi-square test for categorical variables and multivariate regression to determine the odds ratio. For statistical significance, a p-value < 0.05 was considered. Results: Prevalence of DM and impaired fasting blood glucose (IFG) in India was 9.3% and 24.5% respectively. Among those with DM, 45.8% were aware, 36.1% were on treatment and 15.7% had it under control. More than three-fourths of adults approached the allopathic practitioners for consultation (84.0%) and treatment (78.8%) for diabetes. Older adults were associated with an increased risk for DM [OR 8.89 (95% CI 6.66-11.87) and were 16 times more aware of DM. Better awareness, treatment and control levels were seen among adults with raised blood pressure and raised cholesterol. Conclusions: The prevalence of DM and IFG is high among adults, while the levels of awareness, treatment and control are still low in India, and this varied notably between the age groups. Multifaceted approaches that include improved awareness, adherence to treatment, better preventive and counseling services are crucial to halt diabetes in India. Also, expanding traditional systems of medicine (Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy [AYUSH]) into diabetes prevention and control practices open solutions to manage this crisis.

Trends in the Prevalence and Incidence of Opium Abuse and its Association with Coronary Artery Risk Factors in Adult Population in Iran: Findings from Kerman Coronary Artery Disease Risk Factors Study.

Background: The prevalence of opium addiction in Iran is high probably due to the belief that opium has preventive effects against cardiovascular diseases. In the second phase of Kerman coronary artery disease risk factors study, the prevalence, incidence rate, and the association between opium use and other coronary artery disease risk factors (CADRFs) were assessed. Methods: In a cross-sectional study (2014-2018), 9996 inhabitants of Kerman, southeastern Iran, aged 15-80 years were recruited to the study. After taking fasting blood samples, the participants were examined or interviewed for demographic data and CADRFs, including opium use. The participants were categorized into "never", "occasional", and "dependent" users. The association between opium use and CADRFs was assessed with adjusted regression analysis (Stata v.11 software). Results: The overall prevalence of opium consumption was lower than that of five years earlier (P<0.01). The prevalence was currently higher in men than women and decreased in men between the two phases (P<0.001). There was a positive correlation between opium use and depression (P<0.001), anxiety (P<0.05), and a negative association with the level of physical activity (P<0.001). The five-year incident rate of dependent and occasional opium use was 4.2 and 3.9 persons/100 person-years, respectively. The incidence of opium use was higher in diabetic, hypertensive, depressed, anxious, and obese subjects. Conclusion: The study did not demonstrate any protective effects of opium on CADRFs. Considering the higher rate of opium use in subjects with hypertension, diabetes, obesity, and psychological disorders, the health authorities should implement educational programs to warn and correct the unsafe belief.

Quality of life in opium-addicted patients with coronary artery disease as measured with WHOQOL-BREF.

OBJECTIVE: Several factors can influence the quality of life in patients with coronary artery disease (CAD). The goal of this research was to measure quality of life in opium-addicted patients with CAD in order to assess the effect of CAD risk factors on their quality of life. METHOD: The WHOQOL-BREF questionnaire was completed through interviews with 275 patients who underwent isolated coronary artery bypass surgery in Tehran Heart Centre between May and September 2006. RESULTS: No significant differences were found in the mean scores of the four domains of quality of life between the addicted and non-addicted patients. Furthermore, the evaluation of QOL in the groups with CAD risk factors showed that the mean QOL domains were statistically similar between opium addicted and non-opium addicted patients. In the addicted group, men had a higher psychological health score than women. A previous history of myocardial infarction reduced the psychological score in this group. Also, in the addicted patients with a history of diabetes mellitus, social functioning was better than that of the non-diabetics. CONCLUSIONS: The different domains of quality of life in our opium-addicted and non-addicted patients with CAD were similar; and among all the major risk factors for coronary artery disease, only female gender and a previous history of myocardial infarction could influence quality of life in the opium-addicted patients.

Prevalence and association of co-morbidities in diabetic patients along with prescription patterns in Delhi-NCT, India.

BACKGROUND: Diabetes is rising at an alarming rate in India and the national capital forms a significant part of the nation's diabetic population. The metabolic disorder is no more a disease specific to the rich countries but has also markedly spread its roots in middle-income countries. OBJECTIVE: To ascertain the prevalence of associated co-morbidities in the diabetic population of Delhi, a metropolitan city in India. Moreover, this study was conducted to help with adding information to the limited shreds of evidence of diabetes prevalence in Delhi along with the usually preferred therapies. MATERIALS AND METHODS: A cross-sectional, observational, survey-based study was conducted on people (n = 798) of different age groups (18 years and above) belonging to different regions of Delhi. All subjects were enrolled after obtaining oral consent. Detailed information about clinical, demographic and metabolic profiles was obtained with the help of a pre-structured, open-ended questionnaire. The data were analyzed, and the correlation between diabetes and several other fields was drawn. RESULTS: Out of the 798 diabetic patients 458 (57.39%) were males and 340 (42.60%) were females. The presence of diabetes was higher in the age group of 50-60 years irrespective of the gender. CO-MORBIDITIES: 54.13% of patients suffered with additional co-morbidities which is significantly high. The associated co-morbidities found in the survey included Hypertension, Hypothyroidism, Dyslipidemia, Obesity, Coronary Artery Diseases etc. About 30.57% of patients suffered from hypertension making it the most commonly associated co-morbidity. The other diseases included hypothyroidism (11.52%), Dyslipidemia (10.27%), Obesity (9.27%) etc. MEDICATION: Majority of patients i.e about 60.65% received oral hypoglycemic agents (including patients receiving both insulin and oral hypoglycemic agents). About 19.92% of patients were prescribed with insulin. 14.16% of patients were found to be following diet control and yoga with about 3.13% more females the males. A small percentage of patients (5.25%) were also following alternative systems (Ayurvedic/Unani/Homeopathic) of treatment. Overall, amongst oral hypoglycemic agents, the combination of metformin and DPP4 inhibitors (Vildagliptin, Sitagliptin) was being prescribed majorly i.e 16.41%. CONCLUSION: The number of diabetic population is high in Delhi. It was evident that a significant percentage of diabetic patients suffered from additional diseases that may lead to worsening of the health conditions. Thus, there is an urgent need to educate and spread awareness amongst the masses about the potential benefits of lifestyle modifications like the incorporation of a healthy diet and physical activities. Additionally, continuous and regular tests should be taken to avoid further complications.

Effect of opium addiction on diabetes.

BACKGROUND: Type 2 diabetes is a common disorder that is recognized as a major health problem in Iran. Diabetes is a major cause of morbidity, mortality, and economic burden to the society. Some people believe that smoking opium can reduce serum glucose and lipids in diabetes mellitus. This study was designed to compare blood glucose and lipids in opium addicts with non-addicts among patients with type 2 diabetes. METHODS: In this case, control study subjects were chosen from type 2 diabetic patients. Twenty-three males with type 2 diabetes and addicted to opium were selected as the case group, and 46 patients with no addiction to opioid drugs were chosen as control group. Blood Sugar (BS), glycated hemoglobin (HbA1C), lipids and microalbumin in urine were measured in two groups. RESULTS: Our results showed that the mean FBS and 2-hour post prandial were significantly different between two groups. (P = .04). No significant difference was observed in HbA1C, triglyceride, total cholesterol, LDL, and HDL between the two groups (P > .05). CONCLUSIONS: Our finding showed that while opium might decrease blood glucose temporarily, it had no clear and long-lasting effects on blood glucose, as it had no significant effect on HbA1c.

Knowledge, Attitude, and Practice Related to Diabetes Mellitus Among Diabetics and Nondiabetics Visiting Homeopathic Hospitals in West Bengal, India.

High prevalence of undiagnosed cases of diabetes mellitus and poor knowledge, awareness, and practice has increased premature death, costly complications, and financial burden. A cross-sectional survey was conducted in November 2014 on 273 diabetics and 355 nondiabetics in 3 government homeopathic hospitals in West Bengal, India. A self-administered questionnaire assessing knowledge, awareness, and practice related to diabetes was used. A total of 17.5% to 29.3% of the participants were aware of the normal blood sugar level. Lack of insulin, frequent urination, hypertension, and poor wound healing were identified most frequently as the cause, symptom, association, and complications. A total of 35.5% to 46.5% said that diabetes was preventable; 14.1% to 31.9% knew that diabetes was controllable rather than curable. Consumption of planned diet, avoiding sugar, and testing blood sugar were the most frequently identified components of healthy lifestyle, diabetic diet, and diagnostic domain. Diabetics had higher knowledge and awareness than nondiabetics (P < .0001); still the latter need to be made aware and knowledgeable to curtail the ever-increasing burden of diabetes.

Opium consumption in men and diabetes mellitus in women are the most important risk factors of premature coronary artery disease in Iran.

We performed this study to compare of CAD risk factors in young male and female in Iran. In an analytic cross-sectional study, two groups of patients were evaluated with and without Coronary artery disease. The result of study suggests that there is a relationship between CAD and diabetes mellitus, increasing level of LDL and lipoprotein A in women, While CAD in men had more relation with smoking and opium use. High prevalence and uncontrolled diabetes mellitus in females and relatively high prevalence of opium consumption in males result in different premature CAD patterns.

Pacientes diabéticos sin cobertura de salud: Utilización de medicamentos, adherencia y complicaciones derivadas de su patología de base / Diabetic patients without health coverage: drug use, adherence and complications arising from their underlying disease

Objetivo: realizar un Estudio de Utilización de Medicamentos de los pacientes diabéticos atendidos en el Hospital Josefina Prieur (HJP) de la ciudad de Villa Allende (Córdoba, Argentina), determinar consumo de medicamentos antidiabéticos, grado de adherencia al tratamiento y pacientes afectados por complicaciones derivadas de la diabetes.Método: Estudio observacional, descriptivo y transversal, sobre pacientes diabéticos atendidos en el HJP que pertenecen al Programa Córdoba Diabetes (ProCorDia) durante los meses de Mayo a Diciembre de 2011.Conclusiones: Del total de medicamentos antidiabéticos dispensados, el 40,50% correspondió al subgrupo A10B (hipoglucemiantes orales) y el 59,50% al subgrupo A10A (Insulinas). Se observó una buena adherencia al tratamiento Pacientes diabéticos sin cobeRtuRa de salud: utilización de medicamentos, adheRencia y comPlicaciones deRivadas de su Patología de base Recibido: 23 de enero de 2013. Aprobado: 23 de mayo de 2013.

Objective: To carry out a drug usage study with diabetic patients treated at Josefina Prieur Hospital (HJP) Villa Allende city (Córdoba, Argentina) to determine anti-diabetic drug consumption, degree of treatment adherence, and amount of patients with complications arising from diabetes.Method: Observational, descriptive, cross-sectional study carried out on diabetic patients treated at the HJP belonging to the program “Programa Córdoba Diabetes” (ProCorDia), from May to December 2011. Drug consumption was determined in DDDs per 1000 inhabitants per day. Adherence was defined by the number of drug provisions for each patient during eight months. The presence of complications was obtained from records of drug delivery to patients receiving other medication besides anti-diabetic ones. Results: From 98 patients, 73 had some type of complication. The consumption of antidiabetic drugs in DDD per 1000 inhabitants per day was: Regular Insulin 1.990, NPH Insulin 6.244, Glibenclamide 2.826, Gliclazide 0.281, Metformin 2.497.Conclusions: From all anti-diabetic drugs dispensed, 40.50% belonged to subgroup A10B (oral hypoglycemic agents) and 59.50% to subgroup A10A (insulin). Good adherence to drug therapy was observed (mean = 81.63%, mode = 100%). A 74.49% of patients presented complications.

Association between opium abuse and comorbidity in diabetic men.

The aims of this study were to determine the prevalence of opium abuse in diabetic men and to investigate its association with comorbidity. The study population was comprised of 312 consecutive diabetic men aged 20 years or older residing in the study area in 2005. The prevalence of self-reported opium abuse was 11.2%. Opium use was associated with low socioeconomic status, smoking, tea consumption, and a higher prevalence of erectile dysfunction (ED) and severe depression. The prevalence of severe depression was 22.8% among 35 men who used opium and 13.4% among 277 who did not use it. The prevalence of moderate or severe ED was 85.7% among opium users and 66.1% among non-users. The risk of ED was two times (95% CI 1.0-7.4) higher in opium users compared with nonusers.

Diabetes, estado actual / Diabetes, present state

La diabetes mellitus (DM) abarca un grupo de desórdenes metabólicos causados por una hiperglucemia inducida por defectos en la secreción de la insulina, fallas en la acción de dicha hormona sobre los tejidos o una combinación de ambos problemas. En los últimos años, la diabetes mellitus se ha convertido en uno de los problemas de salud más importantes en México, no sólo por el considerable número de personas que la padecen, sino también por las complicaciones que genera. Cada vez es mayor la población en riesgo de padecen por causas como la obesidad, la tensión emocional, la mala alimentación y el sedentarismo. En este texto se analizan las generalidades de tan importante epidemia (como la considera la Organización Mundial de la Salud), así como los distintos tipos en que se clasifica, sus factores de riesgo, las probables complicaciones y los tratamientos que la acompañan. (AU)

Diabetes mellitus (DM) covers a group of metabolic disorders caused by hyperglycemia-induced defects in insulin secretion, failure in its hormonal action in tissues, or a combination of both. In recent years, diabetes mellitus has turn out to be one of the major health problems in Mexico, not only by the number of people who have it, but also because of the complications that they suffer. Every year the population at risk becomes higher because of obesity, lifestyle, poor diet and sedentary habits. This text discusses the general aspects of this epidemic disease (such as the WHO considers it), the different types in which is classified, as well as their risk factors, the probable complications and treatments.