Transitioning From an In-Person Intervention to Augmented Text Messaging During COVID-19 in Mexican Americans With Prediabetes: The Starr County Diabetes Prevention Randomized Clinical Trial.

PURPOSE: The purpose of the study was to explore the feasibility of using commonly available technology, such as text messaging, for diabetes prevention in rural Mexican American communities during COVID-19. METHODS: Participants were selected from a diabetes prevention study funded by the National Institutes of Health that, prior to COVID-19, involved in-person group intervention sessions. Participants were predominantly female adults born in Mexico and Spanish-speaking. A subsample (n = 140) was divided into 3 cohorts: (1) 50 who completed the initial in-person intervention prior to the COVID-19 research pause, (2) 60 who needed additional support sessions to complete the intervention and thus received 10 text messages with links to relevant online diabetes prevention videos (TM+), and (3) 30 who received enhanced usual care involving health guidance offered during data collection (control). Repeated measures analysis of covariance was used to evaluate cohort differences at 24 months post baseline. RESULTS: No significant cohort differences were found for depression, eating self-efficacy, alcohol intake, fat avoidance, or sedentary behaviors. Differences in A1C showed both in-person and TM+ cohorts having lower mean A1C levels (5.5%) than the control cohort (5.7%). The TM+ cohort had lower body mass index than other cohorts and a lower diabetes conversion rate (22.2%) compared to the control cohort (28%). Participants indicated preferences for in-person/TM+ combination interventions. The strongest positive feedback was for the TM+ intervention cooking demonstration videos. CONCLUSIONS: Augmented text messaging combined with in-person sessions had similar outcomes to the all in-person strategy and thus has the potential for expanding the reach of diabetes prevention to many Mexican American communities.

Projection of diabetes morbidity and mortality till 2045 in Indonesia based on risk factors and NCD prevention and control programs.

Diabetes Mellitus is one of the biggest health problems in Indonesia but the research on the disease's projection is still limited. This study aimed to make a projection model of prevalence and mortality of diabetes in Indonesia based on risk factors and NCD programs. The study was a quantitative non-experimental study through multiple linear regression models and system dynamics. The baseline projection was created by 2018 data and projections until 2045 involved the dynamization of risk factors and programs, population, and case fatality rate. The model was created from 205 districts data. This study used secondary data from Basic Health Research, BPJS Kesehatan, NCD programs, and Ministry of Health. The prevalence of diabetes in Indonesia is estimated to increase from 9.19% in 2020 (18.69 million cases) to 16.09% in 2045 (40.7 million cases). The prevalence will be lower to 15.68% (39.6 million) if interventions of programs were carried out, and to 9.22% (23.2 million) if the programs were added with prevention of risk factors. The projected number of deaths due to diabetes increases from 433,752 in 2020 to 944,468 in 2045. Deaths due to stroke among diabetes increases from 52,397 to 114,092 in the same period. Deaths from IHD among diabetes increase from 35,351 to 76,974, and deaths from chronic kidney disease among diabetes increase from 29,061 to 63,279. Diabetes prevalence and mortality in Indonesia rise significantly in Indonesia and can be reduced by intervention of several programs and risk factors. This study findings could be source of planning and evaluation of Diabetes prevention and control program at national and provincial level in the future related to risk factors control and program development.

Detección de personas en riesgo de padecer diabetes en la farmacia comunitaria con el test de Findrisc en los años 2014-2021 / Detection of people at risk of diabetes in the community pharmacy with the Findrisc test in the years 2014-2021

Objetivo: analizar los resultados de las campañas de SEFAC de cribado del riesgo de padecer diabetes, realizados en las farmacias comunitarias españolas desde 2014. Métodos: estudio descriptivo acumulativo de los resultados de las campañas del Día Mundial de la Diabetes, en 2014, 2016-2018, 2020 y 2021. Pacientes: usuarios ≥18 años no diagnosticados de diabetes con consentimiento firmado. Variables: puntuación del test de Findrisc, media (m) y desviación estándar (DE) y participantes en intervalos de riesgo, n (%). Variables demográficas (sexo, edad) y antropométricas, índice de masa corporal (IMC) (kg/m2), perímetro de cintura (cm), glucemia capilar m (DE) (mg/dl). Resultados: participaron 1.146 farmacéuticos, 12402 usuarios. 8.799 (70,9 %) tenían IMC ≥25 kg/m2. 7366 (59,4 %) tomaban antihipertensivos. 6047 (48,8 %) con perímetro abdominal excesivo. 5962 (48,0 %) tenían antecedentes familiares de diabetes. El riesgo medio (puntuación Findrisc) fue de 11,3 (4,6), sin diferencias entre sexos (p>0,05). El número de participantes con riesgo alto/muy alto (F≥15) fue 3107 (25,0 %) sin diferencias entre sexos (p>0,05). El riesgo alto/muy alto aumenta con la edad, de 282 (15,1 %) personas de 45-54 años hasta 1695 (40,1 %) personas >64 años. Se derivaron al médico 1762 (14,2 %), sin datos de resultado. Tiempo medio de entrevista: 10,3 (5,3) minutos, sin diferencias entre sexos (p>0,05). Conclusiones: la cuarta parte de los encuestados tenían riesgo alto/muy alto y fueron derivados al médico uno de cada siete. Los factores de riesgo más prevalentes fueron IMC, hipertensión arterial, perímetro abdominal y antecedentes familiares de diabetes. Debe mejorarse la comunicación interprofesional, pues no se obtuvo resultado de las derivaciones al médico. (AU)

Aim: To analyze diabetes risk screening using the Findrisc questionnaire, performed in Spanish community pharmacies (CP) since 2014. Methods: Cumulative descriptive study of the results of the World Diabetes Day campaigns, in 2014, 2016-2018, 2020 and 2021. Subjects: users ≥18 years not diagnosed with diabetes with signed consent. Variables: Findrisc test score m (SD) and participants in risk intervals, n (%). Demographic (sex, age) and anthropometric variables, body mass index (BMI) (kg/m2), waist circumference (cm), capillary glycemia m (SD) (mg/dl). Results: 1146 pharmacists, 12402 users. 8799 (70.9 %) had BMI ≥25 Kg/m2. 7366 (59.4 %) were taking antihypertensive drugs. 6047 (48.8 %) with unhealthy abdominal perimeter. 5962 (48.0 %) had a family history of diabetes. The mean risk (F score) was 11.3 (4.6), with no differences between sexes (p<0.05). The number of participants with high/very high risk (F≥15) was 3107 (25.0%) with no differences between sexes (p<0.05). High/very high risk increased with age, from 282 (15.1%) persons aged 45-54 years to 1695 (40.1%) persons >64 years. A total of 1762 (14.2% of the total) were referred to a physician.Mean interview time: 10.3 (5.3) minutes, with no differences between sexes (p<0.05). Conclusions: One quarter of the respondents were at high/very high risk and one in seven were referred to a physician. The most prevalent risk factors were BMI, hypertension, abdominal circumference and family history of diabetes. Interprofessional communication should be improved, as no results were obtained from referrals to the physician. (AU)

A Vulnerability Index for Mitigation and Prevention of Diabetes Growth in India: A Disaggregated Analysis.

OBJECTIVES: This study aimed to provide a vulnerability index (VI) for identifying vulnerable regions in different states of India, which may serve as a tool for state- and district-level planning for mitigation and prevention of diabetes growth in the country. METHODS: Using data on 13 indicators under 4 domains, we generated domain-specific and overall VIs at state (36 states/union territories) and district levels (640 districts) using the percentile ranking method. The association of diabetes with individuals' socioeconomic status at different levels of regional vulnerability has also been observed through multivariable logistic regression models. RESULTS: On a scale of 0 to 1, there are 13 states with an overall VI of >0.70, of which 5 states are from southern regions of India. A low VI has been achieved by socioeconomically backward states. We observed that prevalence rates and vulnerability levels for most of the top and bottom 11 states are in the same line. District-level analysis showed that the 20 most vulnerable and least vulnerable districts are mostly from coastal and socioeconomically backward states of the country, respectively. Furthermore, logistic regression revealed that rural adults and females are less likely to be diabetic in all vulnerability quartiles. The oldest, Muslims, wealthiest, widowed/deserted/separated, and those with schooling ≤12 years are significantly more likely to be diabetic than their counterparts. CONCLUSION: The constructed VI is vital for identifying vulnerable areas and planners and policy-makers may use this comprehensive index and domain-specific VIs to prioritize resource allocation.

Preventable incidence cases from non-communicable diseases attributable to insufficient physical activity in Chile.

OBJECTIVES: Lack of sufficient physical activity (PA) has been associated with an increased risk of several non-communicable diseases (NCDs) and all-cause mortality. This study aimed to estimate the number of preventable incidence cases of NCDs attributable to insufficient PA in the Chilean population. STUDY DESIGN: Comparative risk assessment modelling study. METHODS: This study examined data from 5834 participants aged ≥20 years from the Chilean National Survey (2016-2017). PA was assessed by the Global Physical Activity Questionnaire (GPAQ), and metabolic equivalent of tasks (METs) were assigned according to PA intensity. Estimated incidence cases of NCDs in Chile in 2019 were obtained from the Global Burden of Disease study. Relative risks for breast cancer, colon cancer, ischaemic heart disease, diabetes and stroke were obtained from a published meta-analysis and applied to the prevalence of insufficient PA estimates through the potential impact fraction equation. RESULTS: High levels of PA (≥8000 MET-min/week) could potentially avoid more than 22,000 (64.6 %) incidence NCD cases, ranging from 498 (10.1 %) preventable cases of breast cancer to 5629 (14.7 %) cases of diabetes. Other modelled scenarios also showed to reduce the incidence cases of all five NCDs but to a lesser extent; where at least PA recommendation was achieved, preventable NCDs were reduced by 6522 cases (18.7 %), and where a 10 % relative reduction in insufficient PA level in the population was achieved, preventable NCDs were reduced by 651 (1.8 %) cases. CONCLUSIONS: The study results provide estimates for the incidence cases of preventable NCDs attributable to insufficient PA, highlighting the important role of PA in NCD prevention in Chile.

Copenhagen Diabetes Consensus (CODIAC) 2021: User involvement in diabetes care, prevention and research.

AIMS: User involvement is pivotal for health development, but there are significant gaps in our understanding of the concept. The Copenhagen Diabetes Consensus on User Involvement in Diabetes Care, Prevention and Research (CODIAC) was established to address these gaps, share knowledge and develop best practices. METHODS: A literature review of user involvement was undertaken in diabetes care, prevention and research. Moreover, a Group Concept Mapping (GCM) survey synthesized the knowledge and opinions of researchers, healthcare professionals and people with diabetes and their carers to identify gaps between what is important for user involvement and what is being done in practice. Finally, a consensus conference discussed the main gaps in knowledge and practice while developing plans to address the shortcomings. RESULTS: The literature review demonstrated that user involvement is an effective strategy for diabetes care, prevention and research, given the right support and conditions, but gaps and key challenges regarding the value and impact of user involvement approaches were found. The GCM process identified 11 major gaps, where important issues were not being sufficiently practised. The conference considered these gaps and opportunities to develop new collaborative initiatives under eight overall themes. CONCLUSIONS: User involvement is effective and adds value to diabetes care, prevention and research when used under the right circumstances. CODIAC developed new learning about the way in which academic and research knowledge can be transferred to more practice-oriented knowledge and concrete collaborative initiatives. This approach may be a potential new framework for initiatives in which coherence of process can lead to coherent outputs.

Significance of Soy-Based Fermented Food and Their Bioactive Compounds Against Obesity, Diabetes, and Cardiovascular Diseases.

Soybean-based fermented foods are commonly consumed worldwide, especially in Asia. These fermented soy-products are prepared using various strains of Bacillus, Streptococcus, Lactobacillus, and Aspergillus. The microbial action during fermentation produces and increases the availability of various molecules of biological significance, such as isoflavones, bioactive peptides, and dietary fiber. These dietary bio active compounds are also found to be effective against the metabolic disorders such as obesity, diabetes, and cardiovascular diseases (CVD). In parallel, soy isoflavones such as genistein, genistin, and daidzin can also contribute to the anti-obesity and anti-diabetic mechanisms, by decreasing insulin resistance and oxidative stress. The said activities are known to lower the risk of CVD, by decreasing the fat accumulation and hyperlipidemia in the body. In addition, along with soy-isoflavones fermented soy foods such as Kinema, Tempeh, Douchi, Cheonggukjang/Chungkukjang, and Natto are also rich in dietary fiber (prebiotic) and known to be anti-dyslipidemia, improve lipolysis, and lowers lipid peroxidation, which further decreases the risk of CVD. Further, the fibrinolytic activity of nattokinase present in Natto soup also paves the foundation for the possible cardioprotective role of fermented soy products. Considering the immense beneficial effects of different fermented soy products, the present review contextualizes their significance with respect to their anti-obesity, anti-diabetic and cardioprotective roles.

A self-management system for preventing hyperglycemia through blood glucose level prediction and nudge-based food amount reduction.

In recent years, the number of diabetic patients has been increasing rapidly all over the world. Diabetes cannot be completely cured once it develops, so it is important to prevent diabetes before it develops. To prevent the onset of diabetes, it is necessary to avoid prolonged hyperglycemia after meals. In this paper, we propose a self-management system to help users prevent diabetes. The system monitors blood glucose levels in real time, calculates foods to be reduced taking into account the user's preferences, and presents them to the user as soon as the system predicts that the planned diet will cause high blood glucose. We designed and conducted two experiments to show the effectiveness of the proposed system. Experiment 1 was to construct and evaluate a model for predicting blood glucose levels two hours later. Experiment 2 was to evaluate the degree of satisfaction with the food and recommendations, and the acceptability of the recommendations by participants who actually used the proposed system. The results of Experiment 1 showed that the constructed model was able to predict blood glucose levels with an RMSE of 7.66 and MAE of 4.66. As a result of Experiment 2, we found the recommended intake was more acceptable if it reflected the user's preferences.

Sleeping More Hours Per Day Than Working Can Prevent New-Onset Diabetes.

Objectives: We expressed the combined effect by the ratio of daily sleep time to daily work time. The aim of this study was to discussed the predictive ability of daily sleep hours/work hours (SH/WH) ratio for diabetes risk. Methods: Cox proportional hazards regression was used to calculate the hazard ratios (HRs) of new-onset diabetes. Restricted cubic spline analyses were performed to visualize the influence trend of SH/WH ratio and diabetes risk. Results: The RCS model revealed a non-linear and L-shaped correlation between SH/WH ratio and diabetes risk. Compared with the participates with SH/WH ratio <1, those with a ratio ≥1 had a lower risk of developing diabetes. The multivariable adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of new-onset diabetes in Q2, Q3, Q4 and Q5 groups compared with Q1 group were 0.82 (0.57, 1.19), 1.05 (0.69, 1.59), 0.57 (0.36, 0.91), 0.66 (0.42, 1.06). The Kaplan-Meier curve showed that Q4 group had lower cumulative incidence. Conclusion: Sleeping longer than working (SH/WH ratio ≥1) can reduce risk for developing diabetes. A minimal risk observed at 1.10-<1.37 (the fourth quintile) of SH/WH ratio.

Non-communicable Diseases Week: Best Practices in Addressing the NCDs Burden from Tanzania.

Background: Five million people die every year from non-communicable diseases (NCDs) globally. In Tanzania, more than two-thirds of deaths are NCD-related. The country is investing in preventive and advocacy activities as well as interventions to reduce the burden. Of particular interest, the Ministry of Health (MoH) commemorates NCDs' week using a multisectoral and multi-stakeholders' approach. This paper highlights activities conducted during NCDs week with the aim of sharing lessons for other countries with similar context and burdens. Methods: A thorough review of official reports and the national strategic plans for NCDs was done including the 2020 and 2021 National NCDs' week reports, the National Strategic Plan for NCDs 2015-2020, and the National NCDs agenda. Findings: NCDs week is commemorated annually throughout the country involving the five key activities. First, community awareness and participation are encouraged through media engagement and community-based preventive and advocacy activities. Second, physical activities and sports festivals are implemented with a focus on developing and renovating infrastructures for sports and recreation. Third, health education is provided in schools to promote healthy behaviors for secondary school adolescents in transition to adulthood. Fourth, health service provision and exhibitions are conducted involving screening for hypertension, diabetes, obesity, alcohol use, and physical activities. The targeted screening of NCDs identified 10% of individuals with at least one NCD in 2020. In 2021, a third of all screened individuals were newly diagnosed with hypertension, and 3% were found to have raised blood glucose levels. Fifth, the national NCDs scientific conferences conducted within the NCDs week provide an avenue for stakeholders to discuss scientific evidence related to NCDs and recommend strategies to mitigate NCDs burden. Conclusion: The initiation of NCDs week has been a cornerstone in advocating for NCDs control and prevention in the country. It has created awareness on NCDs, encourage healthy lifestyles and regular screening for NCDs. The multi-stakeholder and multi-sectoral approaches have made the implementation of the mentioned activities feasible and impactful. This has set an example for the united efforts toward NCD control and prevention at national, regional, and global platforms while considering contextual factors during adoption and implementation.

Association of oral care with periodontitis and glycemic control among US adults with diabetes.

BACKGROUND: Studies indicate that treating periodontitis may benefit glycemic control among people with diabetes. It is unclear whether oral self-care such as flossing may reduce risk for periodontitis and improve glycemic control among people with diabetes. The purpose of this study was to examine associations between oral care, specifically, flossing and preventive dental care, with periodontitis and glycemic control, among US dentate adults with diabetes. METHODS: We analyzed data from the National Health and Nutrition Examination Survey 2011-2014 for 892 participants aged 30 years and older with diabetes who completed the periodontal examination and lab test for hemoglobin A1c (HbA1c). Sampling weights were applied. Multivariable logistic regression and multivariable linear modeling were performed to examine the associations of flossing and preventive dental services on periodontal health and HbA1c levels, respectively, controlling for sociodemographic characteristics, health behaviors, and other risk factors. RESULTS: Among U.S. dentate adults with diabetes, 52.1% of flossers and 72.1% of non-flossers had periodontitis (p < 0.001). Flossers were 39% less likely to have periodontitis (Adj. OR 0.61, 95% CI 0.43-0.88) compared to non-flossers. Flossers had an average HbA1c reading 0.30% (95% CI 0.02%-0.58%) lower than non-flossers, adjusted for covariates (p = 0.037). Preventive dental visits were associated with reduced risk for periodontitis (Adj. OR 0.54, 95%CI, 0.38-0.75) but not glycemic control. CONCLUSION: Flossing was associated with periodontal health and glycemic control among US adults with diabetes. Although further research is needed, the findings support that oral self-care may be particularly beneficial for adults with diabetes.

Mitigating the Rising Burden of Non-Communicable Diseases through Locally Generated Evidence-Lessons from Tanzania.

Background: The burden of Non-Communicable Diseases (NCDs) is rapidly increasing globally, and low- and middle-income countries (LMICs) bear the brunt of it. Tanzania is no exception. Addressing the rising burden of NCDs in this context calls for renewed efforts and commitment by various stakeholders. This paper highlights local initiatives and strategies to combat NCDs in Tanzania and provides lessons for countries with similar contexts. Methods: We reviewed published and grey literature and conducted policy analysis on NCDs in Tanzania to examine the burden of NCDs and the national response addressing it. The documents included National NCD strategic plans, NCD research agenda, and reports from the World Diabetes Foundation and the World Health Organization. Moreover, a scoping review of ongoing NCD activities and programs in other countries was also conducted to supplement the evidence gathered. Results: The rising burden of NCDs as a result of the epidemiological transition in Tanzania called for the launching of a dedicated National NCD Control and Prevention Program. The Ministry of Health collaborates with local, national, and international partners on NCD prevention and curative strategies. This led to the development of important guidelines and policies on NCDs, including strengthening the capacity of health facilities and healthcare workers, increased community engagement and awareness of NCDs, and increased advocacy for more resources in NCD initiatives. Strong governmental commitment has been vital; this is demonstrated by a renewed commitment to the fight through national NCD week and related advocacy activities conducted annually. To ensure multi-stakeholders' engagement and political commitment, all these activities are coordinated at the Prime Minister's office and provide strong lessons for countries with contexts similar to Tanzania. Conclusion: Multi-stakeholders' engagement, innovative approaches, and coordinated governmental efforts to address NCDs have shone a light on addressing the burden of NCDs and may be sustainable if aligned with locally available resources. Such initiatives are recommended for adoption by other nations to address the burdens of NCDs.

Trends in Preventive Care Services Among U.S. Adults With Diagnosed Diabetes, 2008-2020.

OBJECTIVE: Preventive care services are important to prevent or delay complications associated with diabetes. We report trends in receipt of six American Diabetes Association-recommended preventive care services during 2008-2020. RESEARCH DESIGN AND METHODS: We used 2008-2020 data from the cross-sectional Medical Expenditures Panel Survey to calculate the proportion of U.S. adults ≥18 years of age with diagnosed diabetes who reported receiving preventive care services, overall and by subpopulation (n = 25,616). We used joinpoint regression to identify trends during 2008-2019. The six services completed in the past year included at least one dental examination, dilated-eye examination, foot examination, and cholesterol test; at least two A1C tests, and an influenza vaccine. RESULTS: From 2008 to 2020, proportions of U.S. adults with diabetes receiving any individual preventive care service ranged from 32.6% to 89.9%. From 2008 to 2019, overall trends in preventive services among these adults were flat except for an increase in influenza vaccination (average annual percent change: 2.6% [95% CI 1.1%, 4.2%]). Trend analysis of subgroups was heterogeneous: influenza vaccination and A1C testing showed improvements among several subgroups, whereas cholesterol testing (patients aged 45-64 years; less than a high school education; Medicaid insurance) and dental visits (uninsured) declined. In 2020, 8.2% (95% CI 4.5%, 11.9%) of those with diabetes received none of the recommended preventive care services. CONCLUSIONS: Other than influenza vaccination, we observed no improvement in preventive care service use among U.S. adults with diabetes. These data highlight services and specific subgroups that could be targeted to improve preventive care among adults with diabetes.

[Application progress of implementation research on diabetes management].

Diabetes is one of the most important non-communicable chronic diseases. Although a large amount of clinical evidence on the effectiveness of diabetes prevention and treatment interventions has been established, the current quality of care and results are still insufficient. Implementation Research can bridge the gap between research and practice. Implementation Research on diabetes management can clarify what is effective and what is ineffective in management, and promote the transformation of complex, multi-component interventions into medical practice faster and more effectively. This paper reviews the main research contents and application of implementation research of diabetes management at home and abroad, aiming to provide reference for related research and promote the application of implementation research in diabetes management in China.

Advancing Equity in Diabetes Prevention, Treatment, and Outcomes: Delivering on Our Values.

Diabetes inequities exist from diabetes prevention to outcomes and are rooted in the social drivers (determinants) of health. Historical policies such as "redlining" have adversely affected diabetes prevalence, control, and outcomes for decades. Advancing diabetes equity requires multimodal approaches, addressing both individual-level diabetes education, self-management, and treatment along with addressing social needs, and working to improve upstream drivers of health. All individuals affected by diabetes must advocate for policies to advance diabetes equity at the organizational, local, state, and federal levels. Centering diabetes efforts and interventions on equity will improve diabetes treatment and care for all.