Adult Diabetes Mellitus Patients Research Articles

Eye care service utilization and associated factors among diabetic patients in Africa: A Systematic Review and Meta-Analysis

Introduction'Vision 2020, the Right to Sight', jointly coordinated by the World Health Organization's program for the prevention of blindness and deafness and the international agency for the prevention of blindness, was launched in 1999, however, the initiative faces many challenges to hitting its target. One of the challenges for this is, the absence of comprehensive data regarding eye care service utilization among diabetes mellitus patients in Africa. Therefore, this study was aimed at assessing the prevalence of eye care service utilization and associated factors among adult diabetes mellitus patients in Africa. MethodsThis systematic review and meta-analysis was conducted as per the international preferred reporting items for systematic review and meta-analysis protocols (PRISMA) guidelines. Published articles were searched using reputable databases (PubMed, Cochrane Library) and Web searches (Science Direct, African Journals Online, and Google Scholar). Quality appraisal was assessed based on the Joanna Briggs Institute's (JBI) critical appraisal checklist. The extracted data was exported to STATA version 11 (STATA Corp., LLC) for further analysis. Heterogeneity between the results of primary studies was assessed using Cochran's Q chi-square test and quantified with the I2 statistics. Publication bias was assessed by visual inspection of the funnel plot and Egger's regression tests. ResultsThe database search found 26,966 articles. The pooled prevalence of eye care service utilization among diabetic patients in Africa is found to be 40.92 % (95 % CI: 27.14–54.70, P < 0.001). Good knowledge (POR = 3.57, 95 % CI: 2.67–4.76), good attitude (POR = 5.68, 95 % CI: 4.20–7.68), age greater than 65 years old (POR = 7.11, 95 % CI: 3.86–13.10), urban residence (POR = 5.03, 95 % CI: 2.12–11.96), and disease duration greater than 6 years (POR = 3.81, 95 % CI: 2.25–6.45) were factors associated with eye care service utilization. ConclusionThis meta-analysis revealed that a high proportion of people with diabetes failed to use eye care services. Older age, good knowledge, urban residence and longer duration of illness were found to be the contributing factors for the utilization of eye care services in diabetes mellitus patients. Therefore, by considering the negative impact of low eye care service utilization, it is important to improve the habit of regular screening of the eye into routine assessment of diabetes mellitus follow up targeting patients with older age and longer duration of illness to reduce the magnitude of the problem.

#635 Effect of multi-biomarker panels based on urinary N-terminal osteopontin on prediction of diabetic kidney disease in patients with diabetes mellitus

Abstract Background and Aims Diabetic kidney disease (DKD), occurs in 20–40% of patients with diabetes mellitus (DM), is the leading cause of end-stage renal disease (ESRD). DKD is a clinical diagnosis mainly based on the persistent albuminuria and reduced estimated glomerular filtration rate (eGFR) [1]. However, increased UACR and reduced eGFR are the final consequences due to DKD, novel biomarkers are critical for predicting DKD development. Osteopontin (OPN) is a profibrotic adhesion phosphoprotein that participates in cell chemotaxis, adhesion, migration, and proliferation, as well as extracellular matrix (ECM) hyperplasia. Hyperglycemia could enhance OPN gene expression through the activation of the renin-angiotensin system (RAS), mTOR pathway, NF-κB, and TGF-β pathway and then cause podocyte injury and ECM hyperplasia. Therefore, OPN upregulation is not only the result of various pathophysiological processes in DKD, but also results in kidney injury. Osteopontin (OPN) could predict incident DKD in DM patients [2], N-terminal OPN (ntOPN) has a stronger profibrotic adhesion effect than full-length OPN. This study aims to reveal the clinical benefit of ntOPN as a potential marker to identify DM patients at high risk of DKD, and establish ntOPN-based diagnostic and forecast models for renal outcomes in DM patients. Method We performed a cross-sectional study of 316 adults with Type 1 DM≥ 5 years or Type 2 DM, then followed by a prospective observational cohort study of 143 adult DM patients without renal involvement at baseline and follow-up for at least one year. During the follow-up period, the primary endpoint was “DKD occurrence”, defined as the presence of one of the following conditions in DM patients [3]: (1) repeat UACR ≥30 mg/g at least 2 of 3 measurements within 3 to 6 months; (2) eGFR &amp;lt;60 mL/min/1.73 m2 for more than three months; (3) renal pathological findings were consistent with DKD. The secondary endpoint was “DKD progression”, which included: (1) eGFR sustained decreased by at least 25%; (2) development of ESRD, and/or need for renal replacement therapy; (3) death from the renal cause. Logistic regression analysis was performed to analyze the relationship between parameters and the events of DKD occurrence and progression. Receiver operator characteristic (ROC) analysis was used to assess the predictive ability of established models for clinical endpoints. Results The median value of urinary ntOPN (UntOPN) was 44.15 ng/ml in the cross-sectional cohort, DKD prevalence was significantly higher in the high UntOPN group than in the low UntOPN group. The ROC curves of UntOPN, urinary neutrophil gelatinase-associated lipocalin (UNGAL), and their combination indicated that both combination and ntOPN alone perform better than UNGAL for DKD diagnosis (Fig. 1A). In the prospective cohort, UntOPN was an independent risk factor and further improved the predictive ability for DKD occurrence and DKD progression than UNGAL (Figs. 1B and 1C). Based on the parameters detected as risk factors for DKD occurrence and progression, we set up a series of multi-biomarker panels for DKD prediction using UntOPN, UNGAL, serum cystatin C, serum creatinine (Scr), UACR, and TCH/HDL-C ratio. Compared with the model of Scr + UACR, the area under ROC curve (AUC) of the six-biomarker model was higher, and also ranked the highest among the six ROC curves in predicting 1-year risk of DKD occurrence and DKD progression (Figs. 1B and 1C). Conclusion Our results showed that urinary ntOPN is associated with DKD development, and elevated urinary ntOPN is an independent predictor for DKD occurrence and progression. Compared with the traditional biomarkers of Scr + UACR, our multi-biomarker models based on urinary ntOPN performed better in predicting DKD development, which could provide more accurate tools for DKD risk prediction, thereby improving the renal prognosis in DM patients.

Effect of platelet-rich plasma on healing of lower extremity diabetic skin ulcers: A meta-analysis.

The aim of this research is to explore the therapeutic efficacy of platelet-rich plasma (PRP) on the cutaneous ulceration of diabetes mellitus (DM). From the beginning of the database until January 2024, we looked through several databases to obtain randomised, controlled PRP studies to treat the wound healing of DM in adult patients. The Cochrane Collaboration's Risk-Of-Bias Instrument was used to evaluate the risk of bias in randomised, controlled studies. Funnel plots, sensitivity analyses and Egger regression tests were employed to determine the reliability and effectiveness of the meta-analyses. Depending on the degree of heterogeneity, a fixed or random effect model has been used. The statistical significance was determined to be below 0.05. Altogether 281 trials were collected from the database and entered into Endnote Software for screening, and 15 trials were analysed. It was found that PRP was associated with a higher rate of wound healing (OR, 3.23; 95% CI, 2.42, 4.31 p < 0.0001). PRP was associated with a reduction in the risk of post-operative wound infection (OR, 0.46; 95% CI, 0.21, 0.99 p = 0.05). PRP was associated with a reduction in the risk of amputations amongst those with DM (OR, 0.50; 95% CI, 0.30, 0.84 p = 0.009). Overall, PRP treatment for DM is expected to improve the rate of wound healing, decrease the risk of wound infection and decrease the risk of amputations.

Self-care practices and its associated factors among adult diabetes mellitus patients in public hospitals of Sidama region, Southern Ethiopia: a cross-sectional study

Self-care practices and its associated factors among adult diabetes mellitus patients in public hospitals of Sidama region, Southern Ethiopia: a cross-sectional study

The Association Between Serum Magnesium and Type 2 Diabetes Mellitus in Adult Patients at a Tertiary Hospital in Malaysia

Introduction: Magnesium (Mg) has an important role in glucose metabolism and acts as a cofactor for many enzymatic reactions. However, Mg deficiency frequently goes unnoticed. The aim of this study was to determine the association between serum Mg and type 2 diabetes mellitus (T2DM). Methods: A cross-sectional study was done among T2DM patients who were followed-up at the Diabetic Clinic at Hospital Melaka. Serum Mg test was added to the routine investigations of all patients with diabetes who participated. Results: Prevalence of hypomagnesaemia was 21.5%. There was a significant difference in age, duration of T2DM and diabetic complications that include retinopathy, neuropathy, nephropathy, coronary heart disease and cerebrovascular accident as well as all laboratory parameters except high-density lipoprotein cholesterol between the hypomagnesaemia and normomagnesaemia groups. Glycated haemoglobin (HbA1c), fasting plasma glucose and duration of diabetes independently predicted serum Mg levels in T2DM patients. Conclusion: These findings support the use of serum Mg as an indirect biomarker of glycaemic control in T2DM patients, whereby hypomagnesaemia indicates poor control.

Trends in the epidemiology of chronic kidney disease in patients with diabetes in Russian Federation according to the Federal diabetes register (2010–2022)

BACKGROUND: Chronic kidney disease (CKD) in diabetes mellitus (DM) is a supranosological concept that characterizes multifactorial kidney damage associated with increased cardiovascular and mortality risk, which determines the high medical and social significance of this problem in diabetic patients.AIMS: To assess the clinical and epidemiological characteristics of CKD in adult DM patients with type 1(T1) and type 2 (T2) in Russian Federation (RF) in 2010–2022 according to the Federal Register of Diabetes Mellitus (FDR) and to present the capabilities of the register’s analytical tools for assessing organ-protective therapy and predicting the risk of pathology.MATERIALS AND METHODS: We have used the database of FRD (http://diaregistry.ru), 85 regions of the RF. The data are presented as of 01.01.2023 and in dynamics for the period 2010–2022.RESULTS: The CKD prevalence in adult DM patients in RF in dynamics 2010→2022 showed in an increase in the rate for T1 from 21.5 to 27.1% (1.3 times), for T2 from 5.2 to 19.1% (3.7 times). The incidence of new CKD cases was 153.3→106.3/10 000 adult patients in T1, and 64.3→212.8/10 000 adult patients in T2. The analysis of the distribution by CKD stage indicates improved diagnosis of the complication. In the structure of new cases of CKD in the dynamics of 2010→2022. The proportions of patients with low and moderate combined risk of cardiovascular events and end-stage renal failure according to KDIGO criteria increased for T1 63.7→82.4%, for T2 64.5→77.4%. The proportions of patients with very high risk progressively decreased for T1 12.3→4.0%, for T2 13.1→1.6%. The average age of onset of CKD increased by an average of 6 years in persons with type 1 and type 2 diabetes (35.6→42 years, 63.3→69.3 years, respectively), with the dynamics of the average DM duration at the time of CKD development: in T1 11.5→14.8 years, in T2 7.4→7.8 years. The cause of terminal CKD in the structure of mortality in DM patients took only in T1 patients 5.6% and in T2D — 2.0%. A retrospective analysis of factors influencing the fatal outcome of DM patients with COVID-19 showed the significance of a history of CKD in T2DM patients, which increases the risk of death by 1.49 times (95% CI 1.01–2.04). Analysis of the structure of glucose-lowering therapy in T2DM patients and CKD indicates a more frequent prescription of drugs from the group of SGLT-2 inhibitors, DPP-4 inhibitors, and GLP-1 receptor antagonists compared to the general cohort of T2DM. There is the CKD prognosis calculator in the FRD, which allows assessing the risk of developing of pathology within 5 years in a particular patient based on a set of the most significant predictors, which included 6 factors for T1 and 11 factors for T2. CONCLUSIONS: Epidemiological trends in the prevalence of CKD over a 13-year period indicate the growing importance of this problem in DM patients who are at risk. Along with the positive trends in the development of pathology with a longer duration of diabetes, in clinical practice the problem remains of untimely detection of CKD with impaired renal function at advanced stages. The progressive nature of the course and the negative impact of kidney damage on the risks of premature mortality in patients determine the priority of preventive diagnostic and therapeutic strategies aimed at compliance with the standard of examination, detection of pathology in the early stages and a multifactorial approach to nephroprotection, according to clinical recommendations.

Risk of type 2 diabetes mellitus in adult patients with atopic dermatitis

AimsThis study aimed to investigate the subsequent risk of type 2 diabetes mellitus (T2D) in adults newly diagnosed with atopic dermatitis (AD). MethodsThis propensity score-matching cohort study used data from the National Health Insurance Service–National Sample Cohort (NHIS–NSC) 2.0 database in South Korea from 2002 to 2015. The adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using a Cox proportional hazards model, for the new onset of T2D (ICD-10 code, E11) in AD patients compared to the matched controls. Subgroup and sensitivity analyses were also conducted. ResultsEach of the 36,692 individuals in the AD group and matched control group was included in the analysis. The risk of T2D in the AD group was significantly higher than that of the matched controls in the adjusted model (adjusted HR 1.44; 95% CI 1.27–1.63, P <.001). The results of subgroup analysis by sex, age, and body mass index were consistent with the results of the primary analysis. Sensitivity analyses using different T2D and/or AD definitions also showed consistent results. ConclusionsThe significant risk of subsequent T2D in adult AD patients suggested the necessity for efforts to prevent T2D in AD patients.

The Prevalence and Associated Predictors for Diabetes Mellitus in Adult Patients With Thyroid Nodules.

Diabetes mellitus (DM) and thyroid nodules (TNs) with the risk of malignancy are increasing globally. Hence, we conducted this study to evaluate the prevalence and the associated predictors for DM among adult patients with TNs in Royal Commission Hospital, Kingdom of Saudi Arabia (KSA). A retrospective study was conducted between January 1, 2015 and December 31, 2021. Patients with documented TNs based on the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) were recruited. Then the prevalence and associated risk factors for DM were assessed. Three hundred ninety-one patients who had TNs were recruited. The median (interquartile range (IQR)) age was 46.00 (20.0) years, and 332 (84.9%) of the patients were females. There was a high prevalence of DM (24.0%) among adult patients with TNs. In the univariate analysis, there were significant associations between diagnosed DM among adult patients with TNs and age, gender, 25-hydroxyvitamin D (25(OH)D) level, hypertension, bronchial asthma, free triiodothyronine (FT3), white blood cell count, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides. In the multivariate analysis, there were significant associations between diagnosed DM among adult patients with TNs and age (odds ratio (OR) 1.037 (95% confidence interval (CI) 1.012 - 1.062)), hypertension (OR 0.374 (95% CI 0.203 - 0.689)), FT3 level (OR 0.635 (95% CI 0.412 - 0.980)), LDL (OR 0.643 (95% CI 0.456 - 0.907)) and HDL (OR 0.654 (95% CI 0.465 - 0.919)). There was a high prevalence of DM among patients with TNs. Age, hypertension, FT3, LDL and HDL were significantly associated with DM and TNs.

Serum Ferritin Levels and Other Associated Parameters with Diabetes Mellitus in Adult Patients Suffering from Beta Thalassemia Major.

Although beta thalassemia major (BTM) patients are properly treated with blood transfusions in accompany with iron chelation therapy, they suffer from complications, such as diabetes mellitus (DM). The purpose was to detect the critical serum ferritin level and other parameters correlated with DM among adult BTM patients. Also, it was to study whether each of these parameters is associated with a certain period of age. This study included 200 adult BTM patients. A cross-sectional study was carried out. Patients clinical and laboratory variables, such as ferritin levels, and fasting blood glucose (FBS) were extracted from medical records at Zagazig University Hospital, Egypt. Liver and cardiac iron contents were assessed using MRI T2* methods. Statistical analysis was performed using IBM SPSS V26.0 software package. The overall frequency of DM over the total sample equals 6.5%. There were no impaired fasting glucose (IFG) in the medical records. Statistical significance between serum ferritin and DM was (P = 0.014). The serum ferritin 2500 ng/mL with age group (27-<32) years-old were risk factors. The distributions of DM according to BMI were (3.5%) of class overweight. Significant association between DM and BMI was (r = 0.357, P < 0.001). Liver MRI T2* has significant correlation with serum ferritin, but cardiac MRI T2* was poorly correlated. Association between liver and cardiac MRI T2* was not found. Age group (27-<32) years-old and ferritin >2500 ng/mL should be properly treated immediately. The serum ferritin and BMI of class "overweight" were risk factors for DM. Factors such as diet should be followed. Serum ferritin can be used for estimating liver iron content for economic factors. But cardiac MRI T2* must be performed for evaluating cardiac iron accurately.

Effect of metformin on outcomes of patients treated with immune checkpoint inhibitors: a retrospective cohort study.

Immune checkpoint inhibitors have transformed the treatment landscape of cancer treatment, but only a fraction of patients responds to treatment, leading to an increasing effort to repurpose clinically approved medications to augment ICI therapy. Metformin has been associated with improved survival outcomes in patients undergoing conventional chemotherapy. However, whether metformin provides survival benefits in patients receiving immune checkpoint inhibitors (ICIs) is unknown. We performed a retrospective cohort study at two tertiary referral centers in Taiwan. All adult diabetes mellitus patients who were treated with ICIs between January 2015 and December 2021 were included. The primary and secondary outcomes were overall survival (OS) and progression-free survival (PFS), respectively. In total, 878 patients were enrolled in our study, of which 86 patients used metformin and 78 patients used non-metformin diabetes medications. Compared with non-users, metformin users had a longer median OS (15.4 [IQR 5.6-not reached] vs. 6.1 [IQR, 0.8-21.0] months, P = 0.003) and PFS (5.1 [IQR 2.0-14.3] vs. 1.9 [IQR 0.7-8.6] months, P = 0.041). In a univariate Cox proportional hazard analysis, the use of metformin was associated with a reduction in the risk of mortality (HR: 0.53 [95% confidence interval: 0.35-0.81], P = 0.004) and disease progression (HR: 0.69 [95% CI 0.49-0.99], P = 0.042). The use of metformin remained associated with a lower risk of mortality after adjusting for baseline variables such as age, cancer stage, and underlying comorbidities (OS, HR: 0.55 [95% CI 0.34-0.87], P = 0.011). Similarly, the use of metformin was associated with a lower risk of disease progression. Importantly, the use of metformin before ICI initiation was not associated with a reduction in mortality (HR: 0.61 [95% CI 0.27-1.42], P = 0.25) or disease progression (HR: 0.69 [95% CI 0.33-1.43], P = 0.32). The use of metformin is associated with survival benefits in patients undergoing immunotherapy. Prospective clinical trials are warranted to define the role of metformin in augmenting immunotherapy.

Prevalence and associated factors of physical inactivity among adult diabetes mellitus patients in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

Physical inactivity has been viewed as an emerging public health problem in developing countries including Ethiopia. Diabetes mellitus (DM) is a group metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion, function, or both. Its prevalence increases with changing lifestyles including physical inactivity across the globe. However, there is limited research, and not yet received attention in Ethiopia. This study aimed to assess the prevalence and associated factors of physical inactivity among adult diabetic patients in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia. An institutional-based cross-sectional study design was conducted among 308 participants from February to June 2018 at Felege Hiwot Referral Hospital. A face-to-face interview was conducted using a structured questionnaire by trained data collectors. Participants were selected through a systematic random sampling technique. Physical inactivity was assessed by the international physical activity questionnaire (IPAQ). Collected data were entered in Epi info version 7 and transferred to SPSS version 20 for analysis. A summary of descriptive statistics and multiple binary logistic regression analyses were computed to identify associated factors of physical inactivity among adult diabetic patients. P < 0.05 with 95% CI was considered statistically significant. The overall prevalence of physical inactivity among diabetic patients was 30.5% ( 95% CI: 22.8–33.5%). Gender (AOR = 1.5, 95% CI: 1.1, 3.62), Old age (AOR = 18.17, 95% CI: 22.7, 61.9) Residence (AOR = 4.24, 95% CI: 1,12,16.028), Low self-efficacy (AOR = 20.59, 95% CI: 10.598, 41.608), Poor attitude (AOR = 2.75, 95%CI: 1.44,5.28), and Lack of social support (AOR = 4.22, 95% CI: 1.28,4.07) were found significantly predictor factors of physical inactivity. The prevalence of physical inactivity in this study was high. Being female, old age, dwelling in an urban, having low efficacy, poor attitude, and lack of social support was greater risk factors for being physically inactive. Diabetic education should focus on engagement in physical activity by overcoming barriers to performing physical activity. Government and health professionals should emphasize that evidence-based physical activity important to change their attitudes and require reaching a consensus on social support by their families.

Correlation between glycaemic variability and prognosis in diabetic patients with CKD.

Glycaemic variability (GV), rather than glucose level, has been shown to be an important factor associated with in-hospital mortality. The coefficient of variation of glucose (GLUCV) is one of the methods used to evaluate GV. However, the clinical significance of GLUCV in diabetes mellitus (DM) patients diagnosed with chronic kidney disease (CKD) as a risk factor for long-term adverse changes is unknown. In this retrospective study, we extracted data of adult DM patients diagnosed with CKD from the Medical Information Mart for Intensive Care (MIMIC-IV). We sought to investigate the relationship between GV and in-hospital mortality as well as 30-day mortality. A non-parametric test was used to compare baseline characteristics between groups. Kaplan-Meier analysis and Cox regression model were used to analyse the risk factors associated with in-hospital and 30-day mortality. A total of 1572 DM patients with CKD were included in our data analysis. The quartile of the GLUCV values was used to assign subjects to 4 groups: GLUCV1 (GLUCV < 24), GLUCV2 (24 ≤ GLUCV < 31), GLUCV3 (31 ≤ GLUCV < 39) and GLUCV 4 (GLUCV ≥ 39). COX regression analysis revealed that the GLUCV was an independent risk factor for in-hospital and 30-day mortality [GLUCV2 group (HR = 0.639, 95% CI: 0.454-0.899, p = 0.010), GLUCV3 group (HR = 0.668, 95% CI: 0.476-0.936, p = 0.019), and GLUCV3 group (HR = 0.726, 95% CI: 0.528-0.999, p = 0.049)]. The Kaplan-Meier survival curve was steeper in the GLUCV1 and GLUCV4 groups, and the survival rate decreased in a time-dependent manner. Herein, we validated GV as a mortality risk factor for DM patients with CKD. Therefore, monitoring and adjusting GV in hospitalized patients might have a significant treatment benefit.

Real World Data about the Characteristics of Adult Diabetes Mellitus Patients Visiting Outpatient Department of a Tertiary Care Hospital

Objective: To find our characteristics of adult diabetes mellitus (DM) patients visiting outpatient department (OPD) of a tertiary care hospital. Study Design: Observational, cross-sectional study. Place and Duration: Outpatient department of Medicine, Pakistan Institute of Medical Sciences, Islamabad Pakistan from October 2021 to March 2022. Methodology: We included a total of 200 patients. Inclusion criteria were patients of both genders aged 18 to 70 years having type-1 and type-2 diabetes mellitus with a disease duration history of at least 6 months visiting outpatient department. Socio-demographic data along with DM related characteristics including family history of DM, types of DM, types of medications being used and fasting/postprandial blood glucose levels were recorded. Frequency of various DM related complications at the time of enrollment were also noted. Results: In a total of 200 patients of DM, 129 (64.5%) were male and 71 (35.5%) female. Overall, mean age was 45.03±12.46 years while 91 (45.5%) patients were aged between 31 to 45 years. Mean BMI was 23.33±4.75 kg/m2. Positive family history of diabetes was found in 98 (49.0%) patients. Type-1 diabetes mellitus was reported by 13 (6.5%) patients while remaining 187 (93.5%) patients had type-2 diabetes mellitus. Mean Duration of diabetes was 7.65±7.60 years. There were 91 (45.5%) patients who were using oral plus injectable/insulin medications. Overall, mean fasting blood glucose was 148±49.06 mg/dl while mean 2-hour postprandial blood glucose was 235.07±58.80 mg/dl. Neuropathy was the most common diabetes related complications noted in 91 (45.5%) while gastrointestinal related complications were the 2nd most frequent complications observed in 31 (15.5%). Practical Implications: Vast majority of the DM patients reported hyperglycemia during routine follow ups which arises the need to revisit current management strategies. Conclusion: Majority of the patients with DM were male, middle aged and belonged to urban areas of residence. Nearly half of the DM patients reported neuropathy related complications. Keywords: Diabetes mellitus, neuropathy, hyperglycemia, insulin.

A rare case of Immunoglobulin A dominant post-infectious glomerulonephritis (IgA PIGN) in a young patient

BackgroundImmunoglobulin A dominant postinfectious glomerulonephritis (IgA PIGN) is a unique medical entity that is rare in the paediatric population. It usually presents with severe renal failure, heavy proteinuria, hypertension, and hypocomplementemia and frequently has an unfavourable prognosis. IgA PIGN generally occurs in association with staphylococcal infections and diabetes mellitus in adult patients. Other pathogens include Escherichia coli and Streptococcus sp. Immunofluorescence studies of kidney biopsy samples show IgA as dominant or codominant antibody.Case presentationWe encountered a 3-year-old girl with IgA PIGN presenting with acute renal failure, oedema, hypertension, and heavy proteinuria of 7955 mg/g creatinine. Renal biopsy specimens showed diffuse glomerular endocapillary hypercellularity with prominent neutrophil and monocyte infiltration on light microscopy. Strong deposits of IgA and C3 were observed along the glomerular basement membranes and the mesangium by immunofluorescence microscopy, and electron microscopy revealed the presence of subepithelial humps.The patient was managed with steroid (and probatory antibiotic) therapy and is now undergoing follow-up, with a significant improvement 6 months after the initial presentation (glomerular filtration rate (GFR) and cystatin C clearance rate of 165 ml/min/1.73m2 and 106 ml/min/1.73m2, respectively). No signs of bacterial infection were detectable.ConclusionThis variant of IgA PIGN must be distinguished from other clinical entities, especially IgA nephropathy (mesangial IgA deposits) and postinfectious glomerulonephritis (C3, IgG and occasional IgM capillary loop deposits with or without mesangial distribution), since patients with IgA PIGN may require steroid treatment in addition to antibiotic therapy. Differential diagnosis should also include C3 glomerulopathy.IgA PIGN is a recently identified disease entity that generally manifests in adult patients with both IgA and C3 mesangial and glomerular capillary wall deposits. We present a biopsy-proven case of IgA PIGN that manifested in a patient at an exceptionally young age and that has had a good clinical outcome. To the best of our knowledge, this is the youngest IgA PIGN patient reported thus far.

Impact of Adherence on Treatment Outcomes in Diabetic Patients

Diabetes mellitus is still a burden in Indonesia. Failure of treatment may cause the worsening of this disease. This study aimed to define the association between patient adherence and treatment outcomes. We used a cross-sectional design with data from a public hospital in Java. We collected the patients’ characteristics, medical treatments and treatment outcomes from their medical records. The inclusion criteria were adult diabetes mellitus patients without any comorbidities or complications and using antidiabetic medicine (oral and/or injection). The patients’ adherence was assessed using the MARS questionnaire. We recruited 167 subjects from the hospital. Most of the subjects were male (60.0%), the average age was 60.47 (SD: 10.80), 43.7% had single treatment and 50.3% did not adhere. 58.7% subjects had uncontrolled fasting blood glucose (FBG) and 86.6% subjects had uncontrolled HbA1C. After adjusting for subjects’ characteristics, there was a significant association between FBG and adherence. Adherence may increase FBG by as much as 1.95 times (95% CI: 1.04- 3.65). We also found a significant association between adherence and the treatment outcome. Thus, we recommend that health care for diabetes mellitus patients must be complemented with education to increase adherence and improve outcomes.&#x0D; Keywords: diabetes, adherence, treatment outcomes

Prevalence and associated factors of herbal medicine use among adult diabetes mellitus patients at government hospital, Ethiopia: An institutional-based cross-sectional study

BackgroundDiabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Thus, this study aimed to assess the prevalence and factors associated with HM use among DM patients MethodsA hospital-based cross-sectional study was conducted on 395 diabetic patients visiting the diabetes care service of Debre Tabor General Hospitalfrom August 1 to September 28, 2020. Interview guided self-administered questionnaire was used for data collection. ResultsOut of 395 diabetic patients, 231(58.5%) participants were used herbal medicine. The most dominant herbal products used were M.stenoptela (53.2%), N. sativa (42.0%), Z. officinale (32.5%), A. sativum (20.8%), A. vera (13.4%), P.gracilis(10.4%), T.schimperi(7.5%), V. amygdalina (5.2%), T. foenumgraecum(3.5%),and D.penninervum(2.2%).The odds of HM use in female participants were 1.98 times (AOR=1.98, 95% CI=1.72, 3.25) higher compared to male participants. The odds of HM use among participants who develop DM complications were 1.77 times (AOR=1.77, 95% CI=1.03, 2.83) higher than in participants without DM complications. The odds of HM use among participants with a family history of DM were 2.89 times (AOR=2.89, 95% CI=1.42, 3.19) higher than in participants without a family history of DM. ConclusionThe prevalence of herbal medicine use among diabetic patients was high. Educational level, gender, residence, educational level, duration of DM, presence of DM complication, and family history of DMwere the independent predictors' of HM use.

Effects of continuity of care on health outcomes among patients with diabetes mellitus and/or hypertension: a systematic review

BackgroundThe rising prevalence of non-communicable diseases (NCDs) such as diabetes mellitus (DM) and hypertension (HT) has placed a tremendous burden on healthcare systems around the world, resulting in a call for more effective service delivery models. Better continuity of care (CoC) has been associated with improved health outcomes. This review examines the association between CoC and health outcomes in patients with DM and/or HT.MethodsThis was a systematic review with searches carried out on 13 March 2021 through PubMed, Embase, MEDLINE and CINAHL plus, clinical trials registry and bibliography reviews. Eligibility criteria were: published in English; from 2000 onwards; included adult DM and/or HT patients; examined CoC as their main intervention/exposure; and utilised quantifiable outcome measures (categorised into health indicators and service utilisation). The study quality was evaluated with Critical Appraisal Skills Programme (CASP) appraisal checklists.ResultsInitial searching yielded 21,090 results with 42 studies meeting the inclusion criteria. High CoC was associated with reduced hospitalisation (16 out of 18 studies), emergency room attendances (eight out of eight), mortality rate (six out of seven), disease-related complications (seven out of seven), and healthcare expenses (four out of four) but not with blood pressure (two out of 13), lipid profile (one out of six), body mass index (zero out of three). Six out of 12 studies on diabetic outcomes reported significant improvement in haemoglobin A1c by higher CoC. Variations in the classification of continuity of care and outcome definition were identified, making meta-analyses inappropriate. CASP evaluation rated most studies fair in quality, but found insufficient adjustment on confounders, selection bias and short follow-up period were common limitations of current literatures.ConclusionThere is evidence of a strong association between higher continuity of care and reduced mortality rate, complication risks and health service utilisation among DM and/or HT patients but little to no improvement in various health indicators. Significant methodological heterogeneity in how CoC and patient outcomes are assessed limits the ability for meta-analysis of findings. Further studies comprising sufficient confounding adjustment and standardised definitions are needed to provide stronger evidence of the benefits of CoC on patients with DM and/or HT.

Clinical Use and Limitation of Hemoglobin A1c Examination

Haemoglobin A1c (HbA1c/A1C) is a part of haemoglobin (Hb) that binds to glucose through non-enzymatic reactions. In general, HbA1c is used as a parameter for diagnosis, target therapy and monitoring or prediction of long-term complications of diabetes mellitus (DM) outcome. However, HbA1c can also be used to predict the incidence of DM and vascular outcomes in those without DM. HbA1c above 6.5% is used as the limit for diagnosing DM, and in general, HbA1c &lt; 7.0% is used as the target limit of therapy in adult DM patients. As a parameter for the diagnosis of DM and long-term monitoring, HbA1c has limitations and advantages over blood glucose testing, because HbA1c is strongly influenced by several conditions that affect the life span of erythrocytes where Hb will remain throughout the life of the cell. Likewise, HbA1c cannot assess the variability of blood glucose levels short-termly and cannot determine the presence of hypoglycaemia. With all its limitations, now HbA1c has been established as a parameter to diagnose DM and the most reliable parameter in predicting the incidence of chronic complications from DM.

Effects of Movement Control Order (MCO) During Covid-19 Pandemic on Patients With Diabetes Mellitus (DM) in Malaysian Tertiary Centers

Introduction: The Malaysian government implemented MCO or lockdown for nearly 3 months from 18 Mar to 9 Jun 2020 in response to the Covid-19 pandemic. This restricted access to usual food, workplace, and leisure sports, and also led to reduced clinic attendance. The effects of MCO on patients with chronic lifestyle diseases like DM is unknown. Methodology: This is a cross-sectional study exploring effects of MCO on adult (>18 years) DM patients (both Type 1 and Type 2) attending endocrinologist-run DM clinics in 3 tertiary centres in Malaysia. Glycaemic and metabolic parameters were collected through medical record review while data on healthcare utilisation, dietary and lifestyle habits before MCO (17 Nov 2019 to 17 Mar 2020) and during MCO were collected by investigator-administered questionnaires during routine clinic follow-up after the MCO period (10 Jun to 30 Oct 2020). Results: From a total of 207 patients (56.5% female, 73.4% T2D and 80% on insulin) no significant difference between mean (SD) A1c [8.6(2.39) % vs 8.4(2.14) %; p=0.073] or BMI [29.2(7.57) vs 29.4(9.23)kg/m2; p=0.968] were seen before and during MCO respectively. More than 95% of the patients attended clinic before MCO and at least 20.3% saw either the DM nurse educator, DM pharmacist or dietitian. In contrast, during MCO only 31.4% of patients attended clinic and less than 10% had face-to-face consultation with the DM support team. More patients also reported missing insulin (11.6% vs 7.7%) and not checking blood glucose (17.9% vs 15.5%) during MCO. Before MCO, 61.8% of patients had home-cooked food daily. During MCO this increased to 83.1%. However, there was a trend towards unhealthy eating during MCO. Patients reported eating more frequently with those eating more than 4 meals a day nearly tripled during MCO (18.4% vs 6.8%). In addition, 22% of patients recalled consuming more confectionary; a similar percentage also reported higher consumption of processed food like dry snacks, canned food and instant noodles during MCO. Mean (SD) hours of sleep [6.8 (1.35) vs 7.2 (1.73) hours; p<0.001] and screen time [3.3 (2.51) vs 4.51 (3.10] hours, p< 0.001) increased significantly during MCO compared to before. Notably, before MCO 44% of patients reported no exercise and this increased to 65.7% during MCO. Conclusion: Despite reduced clinic attendance and contact with the DM support team, there were no consequent significant change in A1c or BMI of our DM patients from the 3-month MCO in our short term study. However, a worrying increase in sedentariness and unhealthy eating existed. The imperative need to conduct work or lessons online, among others contributed to the inevitable rise in screen time and reduced physical activity. As the pandemic continues with imposed movement restrictions, the long-term implications of MCO to metabolic health warrant our attention. Innovative strategies to promote healthier living during MCO are urgently needed.

Diabetic Self-Care Knowledge and Associated Factors Among Adult Diabetes Mellitus Patients on Follow-Up Care at North Shewa Zone Government Hospitals, Oromia Region, Ethiopia, 2020.

BackgroundInadequate diabetes self-care knowledge leads to developing diabetic complications and death. Diabetic complications are directly related to the patient’s level of diabetic self-care knowledge.ObjectiveThe purpose of this study was to assess diabetic self-care knowledge and its associated factors among adult diabetes mellitus patients on follow-up care at North Shewa Zone government hospitals, Oromia Region, Ethiopia, 2020.MethodsAn institution-based cross-sectional study was employed using a consecutive sampling technique from January 1 to February 30/2020 among 245 adult diabetes mellitus patients on follow-up care at North Shewa Zone government Hospitals, Oromia Region, Ethiopia. We used Epi data version 3.1 to enter the data and SPSS version 25 for analysis. Both bivariable and multivariable logistic regression was used to identify significant factors for knowledge of diabetic self-care.ResultsIn this study, from a total of 245 diabetic patients, 230 participated giving a response rate of 93.87%. More than half of the study respondents, 156 (67.8%), had good diabetes self-care knowledge and variables such as being employed (AOR; 0.146, 95%; CI 0.18–0.94), having information on diabetic self-care (AOR; 3.003, 95% CI 1.24–5.3) and urban residency (AOR; 0.27, 955 CI 0.099–0.532) were found to be independent factors affecting diabetic self-care knowledge.ConclusionThe magnitude of diabetes self-care knowledge was not adequate and some critical knowledge gaps were also identified in specific areas which reflect that there is a need to improve diabetic self-care knowledge among patients by implementing adequately and continuous diabetic self-care education programs.