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1.
Ann Palliat Med ; 10(8): 9157-9164, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34488401

RESUMEN

BACKGROUND: Both atrial fibrillation (AF) and diabetes mellitus (DM) are documented risk factors for stroke; however, whether glycemic control is associated with the prevalence of stroke remains unclear in patients with AF and DM. The purpose of this study was to investigate the association between glycemic control assessed by continuous glucose monitoring (CGM) and the risk of stroke. METHODS: In total, 510 AF patients with DM from April 2013 to June 2017 were included. The subcutaneous sensor of CGM was inserted after hospital admission and lasted for 72 consecutive hours. Time in range (TIR), a novel metric derived from CGM, was defined as the time spent in the target range (3.9-10 mmol/L). A logistic regression model was constructed by regarding TIR as a categorical variable and a continuous variable, respectively. RESULTS: The mean age of the 510 enrolled patients was 69.8 years. Patients who had previously suffered from stroke had a markedly lower TIR than those without diagnosed stroke (55.1%±19.0% vs. 64.2%±15.1%, P<0.001). Compared to patients with TIR ≤46%, the risk of stroke decreased significantly with increasing TIR quartiles: adjusted odds ratios (ORs) of 0.80 for TIR of 46-65%, 0.64 for TIR of 65-81%, and 0.59 for TIR of >81% (all P<0.001). Taking TIR as a continuous variable, the adjusted OR was 0.89 [95% confidence interval (CI): 0.82-0.95] per 10% increment in TIR. CONCLUSIONS: This study found that better TIR is independently associated with a decreased risk of stroke in patients with AF and DM.


Asunto(s)
Fibrilación Atrial , Diabetes Mellitus , Accidente Cerebrovascular , Anciano , Fibrilación Atrial/epidemiología , Glucemia , Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus/epidemiología , Control Glucémico , Humanos , Accidente Cerebrovascular/epidemiología
2.
Front Endocrinol (Lausanne) ; 12: 688071, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34489863

RESUMEN

Coronavirus disease 19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to scale and threaten human health and public safety. It is essential to identify those risk factors that lead to a poor prognosis of the disease. A predisposing host genetic background could be one of these factors that explain the interindividual variability to COVID-19 severity. Thus, we have studied whether the rs4341 and rs4343 polymorphisms of the angiotensin converting enzyme (ACE) gene, key regulator of the renin-aldosterone-angiotensin system (RAAS), could explain the different outcomes of 128 COVID-19 patients with diverse degree of severity (33 asymptomatic or mildly symptomatic, 66 hospitalized in the general ward, and 29 admitted to the ICU). We found that G allele of rs4341 and rs4343 was associated with severe COVID-19 in hypertensive patients, independently of gender (p<0.05). G-carrier genotypes of both polymorphisms were also associated with higher mortality (p< 0.05) and higher severity of COVID-19 in dyslipidemic (p<0.05) and type 2 diabetic patients (p< 0.01). The association of G alleles with disease severity was adjusted for age, sex, BMI and number of comorbidities, suggesting that both the metabolic comorbidities and the G allele act synergistically on COVID-19 outcome. Although we did not find a direct association between serum ACE levels and COVID-19 severity, we found higher levels of ACE in the serum of patients with the GG genotype of rs4341 and rs4343 (p<0.05), what could explain the higher susceptibility to develop severe forms of the disease in patients with the GG genotype, in addition to hypertension and dyslipidemia. In conclusion, our preliminary study suggests that the G-containing genotypes of rs4341 and rs4343 confer an additional risk of adverse COVID-19 prognosis. Thus, rs4341 and rs4343 polymorphisms of ACE could be predictive markers of severity of COVID-19 in those patients with hypertension, dyslipidemia or diabetes. The knowledge of these genetic data could contribute to precision management of SARS-CoV-2 infected patients when admitted to hospital.


Asunto(s)
COVID-19/genética , Diabetes Mellitus/genética , Dislipidemias/genética , Variación Genética/genética , Hipertensión/genética , Peptidil-Dipeptidasa A/genética , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/diagnóstico , COVID-19/epidemiología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Dislipidemias/diagnóstico , Dislipidemias/epidemiología , Femenino , Hospitalización/tendencias , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Factores de Riesgo , Índice de Severidad de la Enfermedad , España/epidemiología
3.
BMC Psychol ; 9(1): 130, 2021 Aug 31.
Artículo en Inglés | MEDLINE | ID: mdl-34465377

RESUMEN

BACKGROUND: Symptoms of depression and anxiety are common in adults with cardiovascular diseases (CVDs) and diabetes mellitus (DM). The literature on depression and anxiety in CVDs and DM populations is extensive; however, studies examining these relationships over time, directly compared to adults without these conditions, are still lacking. This study aimed to investigate trends in depression and anxiety symptom prevalence over more than 20 years in adults with CVDs and DM compared to the general population. METHODS: We used data from the population-based Trøndelag Health Study (HUNT), Norway, including adults (≥ 20 years) from three waves; the HUNT2 (1995-97; n = 65,228), HUNT3 (2006-08; n = 50,800) and HUNT4 (2017-19; n = 56,042). Depressive and anxiety symptom prevalence was measured independently by the Hospital Anxiety and Depressions scale (HADS) in sex-stratified samples. We analyzed associations of these common psychological symptoms with CVDs and DM over time using multi-level random-effects models, accounting for repeated measurements and individual variation. RESULTS: Overall, the CVDs groups reported higher levels of depression than those free of CVDs in all waves of the study. Further, depressive and anxiety symptom prevalence in adults with and without CVDs and DM declined from HUNT2 to HUNT4, whereas women reported more anxiety than men. Positive associations of depression and anxiety symptoms with CVDs and DM in HUNT2 declined over time. However, associations of CVDs with depression symptoms remained over time in men. Moreover, in women, DM was associated with increased depression symptom risk in HUNT2 and HUNT4. CONCLUSIONS: Depression and anxiety symptoms are frequent in adults with CVDs. Further, our time trend analysis indicates that anxiety and depression are differentially related to CVDs and DM and sex. This study highlights the importance of awareness and management of psychological symptoms in CVDs and DM populations.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus , Adulto , Ansiedad/epidemiología , Enfermedades Cardiovasculares/epidemiología , Depresión/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino , Noruega/epidemiología , Prevalencia
4.
Rev Peru Med Exp Salud Publica ; 38(2): 254-260, 2021.
Artículo en Español, Inglés | MEDLINE | ID: mdl-34468572

RESUMEN

OBJECTIVE: To describe the characteristics of adult patients with tuberculosis (TB) and diabetes mellitus (DM) in Peru, and to explore the association of DM and mortality in people with TB. MATERIALS AND METHODS: We carried out a secondary analysis of the database of the Management Information System of Tuberculosis of the Tuberculosis Prevention and Control Directorate of the Ministry of Health of Peru. Adult patients who started treatment with the scheme for drug-sensitive TB in 2016, 2017 and 2018 were included. We carried out a descriptive analysis of patients with TB and DM, and an exploratory analysis to assess the association of DM with mortality using a Poisson regression to determine the relative risk (RR). RESULTS: We registered 67,524 adults with drug-sensitive TB, of which 6,529 (9.7%) people were reported as having TB and DM; and 4,048 (6.0%) had HIV infection. Of the patients reported with TB and DM, most were men (60.2%) with a median age of 53 years. Regarding mortality, people with TB and DM had a higher frequency of death compared to those with TB without DM (7.2% vs 5.4%). In the exploratory analysis of factors associated with mortality, DM had a crude RR of 1.32 (95% CI: 1.20-1.50); however, this association varied in the adjusted model with a RR of 0.93 (95% CI: 0.84-1.04). CONCLUSIONS: DM is the most frequent comorbidity in patients with TB in Peru, although no association with higher mortality was found.


Asunto(s)
Diabetes Mellitus , Infecciones por VIH , Tuberculosis , Adulto , Comorbilidad , Diabetes Mellitus/epidemiología , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Perú/epidemiología , Factores de Riesgo , Tuberculosis/complicaciones , Tuberculosis/epidemiología
5.
World J Gastroenterol ; 27(30): 4939-4962, 2021 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-34497428

RESUMEN

Pancreatic cancer (PC) is often associated with a poor prognosis. Long-standing diabetes mellitus is considered as an important risk factor for its development. This risk can be modified by the use of certain antidiabetic medications. On the other hand, new-onset diabetes can signal towards an underlying PC in the elderly population. Recently, several attempts have been made to develop an effective clinical tool for PC screening using a combination of history of new-onset diabetes and several other clinical and biochemical markers. On the contrary, diabetes affects the survival after treatment for PC. We describe this intimate and complex two-way relationship of diabetes and PC in this review by exploring the underlying pathogenesis.


Asunto(s)
Diabetes Mellitus , Neoplasias Pancreáticas , Anciano , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Detección Precoz del Cáncer , Humanos , Hipoglucemiantes/uso terapéutico , Neoplasias Pancreáticas/epidemiología , Factores de Riesgo
6.
Curr Diab Rep ; 21(9): 34, 2021 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-34480653

RESUMEN

PURPOSE OF REVIEW: Acute care re-utilization, i.e., hospital readmission and post-discharge Emergency Department (ED) use, is a significant driver of healthcare costs and a marker for healthcare quality. Diabetes is a major contributor to acute care re-utilization and associated costs. The goals of this paper are to (1) review the epidemiology of readmissions among patients with diabetes, (2) describe models that predict readmission risk, and (3) address various strategies for reducing the risk of acute care re-utilization. RECENT FINDINGS: Hospital readmissions and ED visits by diabetes patients are common and costly. Major risk factors for readmission include sociodemographics, comorbidities, insulin use, hospital length of stay (LOS), and history of readmissions, most of which are non-modifiable. Several models for predicting the risk of readmission among diabetes patients have been developed, two of which have reasonable accuracy in external validation. In retrospective studies and mostly small randomized controlled trials (RCTs), interventions such as inpatient diabetes education, inpatient diabetes management services, transition of care support, and outpatient follow-up are generally associated with a reduction in the risk of acute care re-utilization. Data on readmission risk and readmission risk reduction interventions are limited or lacking among patients with diabetes hospitalized for COVID-19. The evidence supporting post-discharge follow-up by telephone is equivocal and also limited. Acute care re-utilization of patients with diabetes presents an important opportunity to improve healthcare quality and reduce costs. Currently available predictive models are useful for identifying higher risk patients but could be improved. Machine learning models, which are becoming more common, have the potential to generate more accurate acute care re-utilization risk predictions. Tools embedded in electronic health record systems are needed to translate readmission risk prediction models into clinical practice. Several risk reduction interventions hold promise but require testing in multi-site RCTs to prove their generalizability, scalability, and effectiveness.


Asunto(s)
COVID-19 , Diabetes Mellitus , Diabetes Mellitus/epidemiología , Humanos , Tiempo de Internación , Alta del Paciente , Readmisión del Paciente , Estudios Retrospectivos , SARS-CoV-2
7.
Rev Med Chil ; 149(2): 210-216, 2021 Feb.
Artículo en Español | MEDLINE | ID: mdl-34479265

RESUMEN

BACKGROUND: Hyperglycemia during hospital stay is associated with adverse outcomes. AIM: To characterize the frequency of hyperglycemia in a tertiary hospital and to correlate it with length of hospital stay (LOS). MATERIAL AND METHODS: Review of medical records of hospitalized patients. Demographic data and laboratory data, previous diabetes mellitus (DM) history, current main diagnosis, unit of hospitalization and the two highest capillary blood glucose values from the analyzed period were recorded for each patient. LOS was obtained from electronic clinical records. RESULTS: 210 subjects, aged 60 ± 19 years (104 women) were included. 113 patients (54%) developed hyperglycemia ≥ 140 mg/L. Thirty one percent of these had a previous history of diabetes and 29% had stress hyperglycemia (SHG). Patients with a history of DM had a higher average blood glucose than those with SHG (238.9 and 178.2 mg/dL, respectively, p < 0.01) and a greater percentage of cases with a blood glucose above 180 mg/dL (72 and 40.0%, respectively, p < 0.01). Hospital LOS was significantly longer in patients with hyperglycemia ≥ 140 mg/dL as compared with those with normoglycemia (29.3 and 12.8 days, respectively, p < 0.01). This association remained significant when introduced in a linear regression analysis including diagnosis, decreased glomerular filtration rate (GFR) and hospitalization unit (p < 0.01). CONCLUSIONS: Hyperglycemia during hospitalization affects more than half of hospitalized patients and is associated with a longer length of stay.


Asunto(s)
Diabetes Mellitus , Hiperglucemia , Glucemia , Diabetes Mellitus/epidemiología , Femenino , Hospitalización , Humanos , Hiperglucemia/epidemiología , Tiempo de Internación , Estudios Retrospectivos
8.
Nihon Ronen Igakkai Zasshi ; 58(3): 417-423, 2021.
Artículo en Japonés | MEDLINE | ID: mdl-34483169

RESUMEN

OBJECTIVE: The purpose of this study was to investigate the relationship between a history of falls and being homebound in elderly diabetic patients. METHODS: The subjects were diabetic patients ≥65 years old visiting the outpatient clinic of Ise Red Cross Hospital. Patients were defined as being confined if they went out less than once a day, and their history of falls in the past year was investigated. Adjusted odds ratios for being homebound were calculated using a logistic regression analysis with a dependent variable of being homebound and explanatory variables of a history of falls and adjustment factors (age, sex, duration of diabetes, HbA1c, cardiovascular disease, cognitive and functional decline, depression, living alone, isolation, and diabetes treatment). RESULTS: A total of 564 patients (319 men and 245 women) were included in the study. The numbers of patients with a history of falls and who were homebound were 198 (35.1%) and 88 (15.6%), respectively. The adjusted odds ratio for being homebound to a history of falls was 2.69 (95% confidence interval, 1.31 to 5.52; P=0.007). CONCLUSION: In this study, a history of falls was significantly associated with being homebound. It is important to pay close attention to homebound elderly diabetic patients with a history of falls.


Asunto(s)
Diabetes Mellitus , Personas Imposibilitadas , Anciano , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino
10.
BMJ Open ; 11(8): e048436, 2021 08 17.
Artículo en Inglés | MEDLINE | ID: mdl-34404707

RESUMEN

INTRODUCTION: This study was conducted to investigate the incidence and time trend of lower limb amputation (LLA) among people with and without diabetes. RESEARCH DESIGN AND METHODS: This retrospective population-based cohort study was based on the national claims data in Japan, comprising a total population of 150 million. Data of all individuals who had LLA from April 2013 to March 2018 were obtained. We analysed the sex-adjusted and age-adjusted annual LLA rate (every fiscal year) in people with and without diabetes for major and minor amputation. To test for time trend, Poisson regression models were fitted. RESULTS: In the 5-year period, 30 187 major and 29 299 minor LLAs were performed in Japan. The sex-adjusted and age-adjusted incidence of major and minor LLAs was 9.5 (people with diabetes, 21.8 vs people without diabetes, 2.3, per 100 000 person-years) and 14.9 (people with diabetes, 28.4 vs people without diabetes, 1.9, per 100 000 person-years) times higher, respectively, in people with diabetes compared with those without. A significant decline in the annual major amputation rate was observed (p<0.05) and the annual minor amputation rate remained stable (p=0.63) when sex, age and people with and without diabetes were included as dependent variables. CONCLUSIONS: This is the first report of the national statistics of LLAs in Japan. The incidence of major and minor LLAs was 10 and 15 times higher, respectively, in people with diabetes compared with those without. A significant decline in the major amputation rate was observed, and the annual minor amputation rate remained stable during the observation period. This information can help to create an effective national healthcare strategy for preventing limb amputations, which affect the quality of life of patients with diabetes and add to the national healthcare expenditure.


Asunto(s)
Diabetes Mellitus , Calidad de Vida , Amputación , Estudios de Cohortes , Diabetes Mellitus/epidemiología , Humanos , Incidencia , Japón/epidemiología , Extremidad Inferior/cirugía , Estudios Retrospectivos
11.
Comput Intell Neurosci ; 2021: 5573179, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34462631

RESUMEN

Today, diabetes is one of the most prevalent, chronic, and deadly diseases in the world owing to some complications. If accurate early diagnosis is feasible, the risk factor and incidence of diabetes may be greatly decreased. Diabetes prediction is stable and reliable, since there are only minimal labelling evidence and outliers found in the datasets of diabetes. Numerous works coped with diabetes disease prediction and provided the solution. But the existing methods proffered low accuracy detection and consumed more training time. So, this paper proposed an OWDANN algorithm for diabetes mellitus disease prediction and severity level estimation. The proposed system mainly consists of two phases, namely, disease prediction and severity level estimation phase. In the disease prediction phase, the preprocessing is performed for the Pima dataset. Then, the features are extracted from the preprocessed data, and finally, the classification step is performed by using OWDANN. In the severity level estimation phase, the diabetes positive dataset is preprocessed first. Then, the features are extracted, and lastly, the severity level is predicted using GDHC. The extensive experimental results showed that the proposed system outperforms with 98.97% accuracy, 94.98% sensitivity, 95.62% specificity, 97.02% precision, 93.84% recall, 9404% f-measure, 0.094% FDR, and 0.023% FPR compared with the state-of-the-art methods.


Asunto(s)
Algoritmos , Diabetes Mellitus , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Humanos
12.
Rev Assoc Med Bras (1992) ; 67Suppl 1(Suppl 1): 157-162, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34406303

RESUMEN

OBJECTIVE: To analyze the association between patients with diabetes mellitus and the increased severity and its complications that arise with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: This is a complementary review of literature in which 14 articles published in 2020 were selected. These reviewed articles were written in both Portuguese and English available in the SciELO and PubMed databases. This review also involved searching on websites of international and national organizations in order to gather information published by these bodies about diabetic population and coronavirus disease (COVID-19)-infected individuals. DISCUSSION: The presence of comorbidities in SARS-CoV-2-infected individuals causes an increase in the expression level of angiotensin-converting enzyme 2, facilitating the entry of the virus into the cell. Diabetes causes metabolic and vascular changes, thus weakening the immune system through the inhibition of the innate immune system and the secretion of various inflammatory cytokines. This hyperinflammation can lead to multiple organ failure. The interaction between this comorbidity and COVID-19 can worsen pre-existing diabetes or predispose the onset of diabetes in non-diabetic individuals. CONCLUSIONS: Diabetes mellitus is related to the increased severity and complications of COVID-19. The association between diabetes and COVID-19 creates a devastating double pandemic, as it worsens the prognosis of COVID-19.


Asunto(s)
COVID-19 , Diabetes Mellitus , Comorbilidad , Diabetes Mellitus/epidemiología , Humanos , Pandemias , SARS-CoV-2
13.
J Pak Med Assoc ; 71(7): 1814-1817, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34410253

RESUMEN

OBJECTIVE: To explore the role of social support, depression and anger in diabetic and cardiac patients. METHODS: The cross-sectional study was conducted from April to September 2015 at three public-sector hospitals in Punjab, Pakistan, and comprised cardiac and people with diabetes from outpatient departments. Data was collected using the Siddiqui-Shah depression scale, the interpersonal support evaluation list and the Trait anger and expression scale. Data was analysed using SPSS 21. RESULTS: Of the 200 patients, 101(50.5%) were cardiac and 99(49.5%) were diabetic. Among the cardiac patients, 51(50.5%) were males and 50(49.5%) were females, while the corresponding number among the diabetics were 50(50.5%) and 49(50.5%). Cardiac patients exhibited higher level of depression and received more social support than the diabetic patients (p<0.05). Low social support was a significant negative predictor of anger and depression among diabetic and cardiac patients (p<0.05). CONCLUSIONS: Social support was found to be a significant factor in the treatment of diabetes and cardiac diseases.


Asunto(s)
Depresión , Diabetes Mellitus , Ira , Estudios Transversales , Depresión/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino , Apoyo Social
14.
J Pak Med Assoc ; 71(7): 1885-1888, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34410267

RESUMEN

A study was conducted to assess the number of limbs salvaged among diabetic patients with chronic limb-threatening ischaemia after infra-inguinal bypass surgeries at a low- to middle-income country (LMIC) hospital. It was a retrospective chart review of diabetic patients who underwent infra-inguinal bypass for lower leg revascularisation for chronic limb-threatening ischaemia at the Section of Vascular Surgery, Aga Khan University Hospital, Karachi (Pakistan) from January 2008 till April 2019. Diabetic patients with chronic limb-threatening ischaemia had a salvage rate of 90.5%(29/32) after infra-inguinal bypass surgery in our set up which is comparable to those described in the literature.


Asunto(s)
Diabetes Mellitus , Enfermedad Arterial Periférica , Amputación , Diabetes Mellitus/epidemiología , Humanos , Isquemia/cirugía , Recuperación del Miembro , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
15.
J Pak Med Assoc ; 71(8): 2093-2096, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34418039

RESUMEN

Diabetes mellitus has reached pandemic proportions throughout the globe. Though hyperglycaemia is the hall mark feature of diabetes, there are several variations in its etiology, clinical presentation, and associated complications. Some of these variations have been distinctly described in specific regions and ethnicities across India and other regions in the world. In this commentary we describe these endemic syndromes associated with diabetes to improve their awareness, recognition and management. A focused attention on these relatively neglected clinical challenges would encourage future discussion and research to address these conditions.


Asunto(s)
Diabetes Mellitus , Hiperglucemia , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Humanos , India/epidemiología , Síndrome
16.
J Pak Med Assoc ; 71(8): 2097-2099, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34418040

RESUMEN

Periodontitis is the chronic inflammation of the oral cavity involving the gum, teeth and the supporting bone. Since it appears to have a similar pathophysiology as other microvascular complications of diabetes it can be considered to be the fourth chronic microvascular complication of diabetes mellitus. There is a three-fold increase in risk of periodontal disease among patients with diabetes mellitus. Periodontitis in diabetes is associated with increased myocardial infarctions, strokes and renal related complications, poor glycaemic control and an increase in the risk of dying of cardiorenal causes. However, treatment of periodontal disease has been demonstrated to improve glucose control and reduce inflammatory markers. Improvements in periodontal health among patients with diabetes mellitus can be achieved with better oral health education, oral examination in diabetic clinics during regular visits and annual dental examinations by qualified dentists. Dental treatments for periodontal infections include mechanical disruption of the pathogenic biofilm using scaling and planing, use of systemic antibiotics to treat refractory pathogens and specialized dental surgery in advanced disease.


Asunto(s)
Complicaciones de la Diabetes , Diabetes Mellitus , Hiperglucemia , Enfermedades Periodontales , Periodontitis , Complicaciones de la Diabetes/terapia , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Humanos , Periodontitis/complicaciones , Periodontitis/epidemiología , Periodontitis/terapia
17.
BMJ Open ; 11(8): e045246, 2021 08 12.
Artículo en Inglés | MEDLINE | ID: mdl-34385229

RESUMEN

OBJECTIVES: We assessed the effectiveness of community health workers (CHWs)-led, technology-enabled programme as a large-scale, real-world solution for screening and long-term management of diabetes and hypertension in low-income and middle-income countries. DESIGN: Retrospective cohort design. SETTING: Forty-seven low-income neighbourhoods of Hyderabad, a large Indian metropolis. PARTICIPANTS: Participants (aged ≥20 years) who subscribed to an ongoing community-based chronic disease management programme employing CHWs and technology to manage diabetes and hypertension. PRIMARY AND SECONDARY OUTCOME MEASURES: We used deidentified programme data between 1 March 2015 and 8 October 2018 to measure participants' pre-enrolment and post-enrolment retention rate and within time-interval mean difference in participants' fasting blood glucose and blood pressure using Kaplan-Meier and mixed-effect regression models, respectively. RESULTS: 51 126 participants were screened (median age 41 years; 65.2% women). Participant acquisition rate (screening to enrolment) was 4%. Median (IQR) retention period was 163.3 days (87.9-288.8), with 12 months postenrolment retention rate as 16.5% (95% CI 14.7 to 18.3). Reduction in blood glucose and blood pressure levels varied by participants' retention in the programme. Adjusted mean difference from baseline ranged from -14.0 mg/dL (95% CI -18.1 to -10.0) to -27.9 mg/dL (95% CI -47.6 to -8.1) for fasting blood glucose; -2.7 mm Hg (95% CI -7.2 to 2.7) to -7.1 mm Hg (95% CI -9.1 to -4.9) for systolic blood pressure and -1.7 mm Hg (95% CI -4.6 to 1.1) to -4.2 mm Hg (95% CI -4.9 to -3.6) for diastolic blood pressure. CONCLUSIONS: CHW-led, technology-enabled private sector interventions can feasibly screen individuals for non-communicable diseases and effectively manage those who continue on the programme in the long run. However, changes in the model (eg, integration with the public health system to reduce out-of-pocket expenditure) may be needed to increase its adoption by individuals and thereby improve its cost-effectiveness.


Asunto(s)
Diabetes Mellitus , Hipertensión , Adulto , Presión Sanguínea , Agentes Comunitarios de Salud , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Femenino , Humanos , Masculino , Sector Privado , Estudios Retrospectivos , Tecnología
18.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(8): 952-957, 2021 Aug 06.
Artículo en Chino | MEDLINE | ID: mdl-34445832

RESUMEN

Objective: To investigate the epidemiological characteristics and adherence to hypoglycemic agents of the ischemic stroke patients combined with diabetes. Methods: The study recruited 23 044 ischemic stroke cases from 2013-2015 screening period of China National Stroke Screening Survey. Standardized questionnaires were used to obtain information on demographic data, stroke history, the presence of influence factors, as well as the type of stroke, diagnosis date, frequency, chronic diseases history and hypoglycemic therapy. We used logistics model to investigate the possible risk factors of ischemic stroke combined with diabetes, and calculated the population attributable risk proportion (PARP). We also investigate the adherence to hypoglycemic agents. Results: The mean age of 23 044 ischemic stroke patients was (64.99±9.42) years old, 50.91% were males (11 731). In ischemic stroke patients, 21.52% had diabetes. According to the results of logistics model, ischemic stroke patients with hypertension, dyslipidemia, atrial fibrillation or family history of stroke had higher risk to combine with diabetes, their Odds Ratios (OR) were 2.18 (1.87-2.55), 1.99 (1.78-2.23), 1.64 (1.39-1.92) and 1.19 (1.06-1.33). Considering the prevalence of each influence factor in ischemic stroke patients, atrial fibrillation had the highest PARP (95%CI) of 62.65% (61.27%-63.76%). In ischemic stroke patients combined with diabetes, 70.73% (3 463/4 896) had taken hypoglycemic agents. Conclusion: There still were a large number of ischemic stroke patients combined with diabetes and a low rate of adherence to hypoglycemic agents.


Asunto(s)
Isquemia Encefálica , Diabetes Mellitus , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Anciano , Isquemia Encefálica/complicaciones , Isquemia Encefálica/epidemiología , Diabetes Mellitus/epidemiología , Humanos , Hipoglucemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , Factores de Riesgo , Accidente Cerebrovascular/epidemiología
19.
Ann Clin Lab Sci ; 51(4): 535-539, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34452892

RESUMEN

OBJECTIVE: Routine monitoring of hemoglobin A1c (HbA1c) is the standard of care in diabetes mellitus (DM), but adhering to regular laboratory appointments may be challenging when access to care is limited, such as during the initial wave of the COVID-19 pandemic in the United States in 2020. MATERIALS: We evaluated trends in patient encounters and laboratory testing for DM in a pediatric healthcare system from March to September 2019 and during the same period in 2020. RESULTS: Evaluation of 17,367 patient encounters illustrated that the pandemic was associated with significantly fewer in-person office visits and point-of-care HbA1c tests for patients with DM in 2020 relative to 2019. A separate analysis of 7,193 HbA1c results measured by point-of-care testing in the general population found a significant increase in the number of measured HbA1c >14 % in May 2020 relative to 2019, but other measured HbA1c values did not differ. As a means to address lapses in the monitoring of HbA1c due to the pandemic, we evaluated the use of the dried blood spot (DBS) matrix for measurement of HbA1c by the Vitros 5600 chemistry analyzer. DBS HbA1c was well correlated to whole blood (r=0.9889) and exhibited intra- and inter-assay precision from 0.5-3.5%. CONCLUSION: DBS measurement of HbA1c presents a viable alternative to routine in-person laboratory monitoring of DM.


Asunto(s)
Recolección de Muestras de Sangre/métodos , COVID-19/epidemiología , Diabetes Mellitus/sangre , Diabetes Mellitus/epidemiología , Pruebas con Sangre Seca/tendencias , Hemoglobina A Glucada/análisis , Telemedicina/tendencias , Adolescente , Adulto , Anciano , COVID-19/prevención & control , Niño , Preescolar , Diabetes Mellitus/diagnóstico , Pruebas con Sangre Seca/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , SARS-CoV-2/aislamiento & purificación , Telemedicina/métodos , Estados Unidos/epidemiología , Adulto Joven
20.
Malawi Med J ; 33(1): 37-47, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-34422232

RESUMEN

Background: Disability is a major determinant of impaired health and nutritional status. This study aims to assess the health and nutritional status of adults with disability and their relationship with socio-demographic factors. Methods: A descriptive cross-sectional study of 323 adults with disability in support-centers/schools of disability in Enugu Metropolis, Nigeria was conducted. The participants' socio-demographic factors, behavioural characteristics and 24-hour dietary recall were recorded. Blood pressure and anthropometric measurements of height, weight, waist and hip circumference were obtained. The height and weight measurements of non-ambulatory participants were estimated from knee height and mid-arm circumference. Biochemical analyses of blood samples were also performed. Multiple logistic regression was used to assess the effect of socio-demographic factors on health and nutritional status. Results: The participants consisted of females (59.3%) within the age of 20 to 30 years (59.1%). The major area of difficulty was in physical mobility (51.1%) and this occurred mostly in females (26.9%). The participants' mean daily intakes of calorie, protein and fat were below the recommended dietary allowances. The participants were overweight (49.2%), obese (4.6%), hypertensive (29.7%) and diabetic (12.1%). Dyslipidemia (81.8%), anemia (63.6%) and zinc deficiency (51.1%) were highly prevalent among the study group. Gender difference was observed in alcohol consumption (p=0.000), smoking habit (p=0.001), waist circumference (WC)(p=0.000), waist-hip-ratio (WHR) (p=0.000), triglyceride (p=0.026) and haemoglobin concentration (p=0.007). Being boarder was a positive predictor of overweight/obesity (OR= 2.974, 95% CI=1.449-6.104), abnormal WHR (OR=2.893, 95% CI = 1.073-7.801) and hypertension (OR=8.381, 95% CI=1.598-13.959). Female gender was associated with abnormal WC (OR=7.219, 95% CI=3.116-14.228) and WHR (OR=3.590, 95% CI=2.095-6.150) whereas older age-group was associated with overweight/obesity (OR=1.908, 95% CI=1.137- 3.202). Being employed was a negative predictor of hypertension. Conclusion: Overweight/obesity, anemia, zinc deficiency and dyslipidemia were highly prevalent among persons living with disability in Enugu Metropolis.


Asunto(s)
Personas con Discapacidad , Estado de Salud , Desnutrición/epidemiología , Adulto , Estatura , Índice de Masa Corporal , Peso Corporal , Estudios Transversales , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Nigeria/epidemiología , Estado Nutricional , Obesidad/epidemiología , Sobrepeso/epidemiología , Prevalencia , Factores Socioeconómicos , Poblaciones Vulnerables , Circunferencia de la Cintura , Relación Cintura-Cadera , Adulto Joven , Zinc/deficiencia
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