American Diabetes Association Research Articles

"No sufro, estoy bien/I am not suffering, so I am doing OK": A mixed method exploration of individual and network-level factors and Type 2 Diabetes Mellitus (T2DM) among Mexican American adults in New York City.

The prevalence of type 2 Diabetes Mellitus (T2DM) is 2-3 times greater among Mexican Americans than non-Latino whites, and Mexican Americans are more likely to develop T2DM at younger ages and experience higher rates of complications. Social networks might play a crucial role in both T2DM etiology and management through social support, access to resources, social engagement, and health behavioral norms. To quantitatively identify the social network features associated with glycated hemoglobin (HbA1c) in a community sample of Mexican immigrants residing in New York City, and to explore the extent to which these quantitative findings converge with qualitative narratives of their lived experiences. This study used a convergent mixed methods design. To collect personal network data, we used EgoWeb, and obtained 1,400 personal network ties from 81 participants. HbA1c readings were collected using dried blood spots and categorized according to the laboratory criteria of the American Diabetes Association. Additional survey data were collected using Qualtrics software. To investigate the significance of the network-level factors after accounting for the socioeconomic and demographic individual-level factors that the literature indicates to be associated with T2DM, we used a multiple regression model on quantitative data sources. For the qualitative portion of the study, we selected a subset of individuals who participated in the quantitative portion, which represented 500 personal network ties from 25 participants. We conducted in-depth interviews guided by the visualization of these ties to explore who was helpful or difficult in managing their health and health behaviors. Individual-level indicators associated with lower HbA1c scores were body mass index (β = -0.07, p<0.05), and healthy eating index scores (β = -0.03, p<0.02). The network-level predictor associated with higher HbA1c levels was the percentage of diabetic alters in the network (β = 0.08, p <0.001, with a 25% increase in the percentages associated 2.0 change in HbA1c levels. The qualitative data highlighted that most of the diabetes-related information diffused through the social networks of our participants was related to dietary practices, such as reducing sugar and red meat consumption, eating out less, and reducing portion sizes. Notably, even among those with elevated levels and diabetes-related health complications, HbA1c was not considered a part of the lay descriptions of good health since they were not "suffering." Participants regarded doctors as the ultimate authority in diabetes care, even if they had supportive members in their personal networks. Our study provides quantitative evidence for the significant role of diabetic network members in the etiology and management of T2DM among Mexican Americans. Our qualitative findings suggest important ley terms for T2DM management and the importance of physicians, which could be included in in future social networks studies seeking to diffuse diabetes-related health information for T2DM prevention and management efforts in this population.

Association between glycaemic control and malnutrition in older adults with type 2 diabetes mellitus: a cross-sectional study.

Malnutrition is a major problem among older adults with type 2 diabetes mellitus (T2DM). Some studies suggest that well glycaemic control increases the risk of frailty due to reduced intake. Therefore, it could be hypothesised that adequate glycaemic controlled patients may be at risk of malnutrition. This study aimed to examine, in older adults with T2DM, the association between adequate glycaemic control and malnutrition as well as identify the risk factors for malnutrition. Data including general characteristics, health status, depression, functional abilities, cognition and nutrition status were analysed. Poor nutritional status is defined as participants assessed with the Mini Nutritional Assessment as being at risk of malnutrition or malnourished. Adequate glycaemic control refers to an HbA1c level that meets the target base in the American Diabetes Association 2022 guidelines with individualised criteria. There were 287 participants with a median (interquartile range) age of 64 (61-70) years, a prevalence of poor nutrition, 15 %, and adequate glycaemic control, 83·6 %. This study found no association between adequate glycaemic control and poor nutrition (P = 0·67). The factors associated with poor nutritional status were low monthly income (adjusted OR (AOR) 4·66, 95 % CI 1·28, 16·98 for income < £118 and AOR 7·80, 95 % CI 1·74, 34·89 for income £118-355), unemployment (AOR 4·23, 95 % CI 1·51, 11·85) and cognitive impairment (AOR 5·28, 95 % CI 1·56, 17·93). These findings support the notion that older adults with T2DM should be encouraged to maintain adequate glycaemic control without concern for malnutrition, especially those who have low income, unemployment or decreased cognitive functions.

Implementing point-of-care hemoglobin A1C testing in an obstetrics outpatient clinic.

A1C ≥6.0% is associated with increased risk of adverse outcomes in pregnant diabetic patients. A1C testing is recommended by the American Diabetes Association as a secondary measure of glycemic control in pregnant patients. To determine the utility of A1C point-of-care testing (POCT) during pregnancy to facilitate rapid counseling and diabetes care, particularly in relatively low-income transient patient populations. We performed a single-center, retrospective analysis of patients presenting to an outpatient obstetrics office with routine, in-laboratory A1C testing, before and after the implementation of POCT for A1C (n = 70 and n = 75, respectively). Demographics, results, physician referral to a nutritionist, counseling, and outcomes were retrieved from patient electronic medical records. In total, 9% and 23% of the in-laboratory and POCT groups, respectively, were referred for nutrition services (P = .02). Of these, 22% of the in-laboratory group and 42% of the POCT group received immediate counseling (P < .01). An inverse correlation was observed between A1C level at study entry and gestational weeks at delivery, with a Pearson r value of -0.39 (-0.58 to -0.16) for the in-laboratory group and -0.38 (-0.57 to -0.14) for the POCT group. No statistically significant difference in pregnancy outcomes was observed. Implementation of A1C POCT was associated with immediate counseling and management of the health of pregnant patients, but was not associated with improved outcomes, in a low-resource patient population.

Does Second Trimester Maternal Serum Zonulin Level Predict Gestational Diabetes Mellitus?

Zonulin, a protein that regulates intestinal permeability, has attracted attention as a potential biomarker for GDM. Therefore, this study aims to investigate whether there are differences in zonulin levels between the GDM group and control groups, especially between those receiving different treatments (diet and insulin). Based on this idea, we included 90 patients with a gestational age between 24 and 28 weeks in our study. While GDM was not detected in 33 of these patients, as a result of OGTT, 57 patients were diagnosed with GDM and these patients were followed throughout their pregnancy. Gestational diabetes was diagnosed by an OGTT performed between 24 and 28 weeks of gestation according to American Diabetes Association (ADA) standards. During follow-up, GDM patients were divided into two groups according to whether they required insulin treatment. Plasma zonulin levels were determined using enzyme-linked immunosorbent assay (ELISA) techniques. The GDM group had significantly higher plasma zonulin levels than the control group (p < 0.005). According to our research, zonulin may be a non-invasive biomarker involved in the etiology of GDM. Large-scale research on this topic is still needed.

Analysis of Nutritional Composition and Glycemic Control in Patients with Gestational Diabetes Mellitus

Background:The association between meal content and glycemic control is not well-understood in pregnancy, limits our ability to counsel patients regarding the optimal diet. We therefore sought to evaluate the relationship between maternal dietary content and glycemic control.&#x0D; Methods:This is a secondary analysis of the GDM-MOMS study, which was a randomized controlled pilot trial that compared glycemic targets in 60 pregnant individuals with GDM and either overweight or obesity. During the pilot trial, participants wore a blinded continuous glucose monitor (CGM) for two five-day periods, with the first data collection between 12-32 weeks and the second data collection between 32-36 weeks. During the time that participants wore their CGM, they also collected 3-day food diaries with detailed information regarding intake and cooking technique. These food diaries are being entered into the Nutrition Data System for Research (NDSR) software, which analyzes nutritional composition for each meal. Glycemic control as assessed by CGM will then be assessed based on maternal nutritional intake.&#x0D; Results:The American Diabetes Association recommends a 2,000-calorie daily diet with a minimum of 175g of carbohydrates (with 35% of the total calories coming from carbohydrates), 71g of protein, and 28g of fat. Preliminary data extracted from NDSR includes nutritional analysis of 38 daily food diaries from 14 patients. 12/38 (31.6%) food logs show consumption of less than 35% of their total calories from carbohydrates, with the other 26 consuming 36-62%. Glycemic load can be used to assess how a patient’s diet affects their glycemic levels. 25/38 (65.8%) of food logs demonstrate a daily glycemic load (GL) of 100, with the other 13 showing daily GLs rangingfrom 108-252.&#x0D; Conclusions and Further Directions:Further analyses will assess post-meal glycemic response using both patient-monitored glucose values and reports from their CGM to determine which types of diets allow for optimal glycemic control.

Prevalence of diabetes mellitus in females living in Kabul in 2022

Introduction: Diabetes is a multifaceted metabolic disorder characterized by increased levels of blood glucose, resulting from several factors that impede proper glucose regulation in affected individuals. This study aims to investigate the relationships between age and blood glucose levels in non-pregnant women in Kabul in 2022. Materials and Methods: A retrospective cross-sectional descriptive study was conducted in Kabul, Afghanistan, involving patients attending the City Medical Complex in 2023. Blood samples were collected after fasting, and blood glucose levels were assessed using the enzymatic approach. Hyperglycemia was defined using the criteria of the American Diabetes Association. Data were analyzed using SPSS V.18, with a chi-square test for quantitative data, an independent t-test, and an analysis of variance for qualitative data. Results: The study involved 5102 participants aged 5 to 88 years, with a mean FBS level of 153.18 ± 70.315 mg/dl. 30.5% had normal FBS, 15.8% were pre-diabetic, and 53.7% had diabetes. Age distribution varied significantly across FBS groups, with diabetics having the highest age range (54.68 years) and normals having the smallest (44.07 years). Discussion: The correlation between aging and diabetes is intricate and diverse. Numerous elements contribute to this association, encompassing the heightened occurrence of diabetes as individuals grow older and the influence of diabetes on the aging progression itself.

Prevalence of diabetes mellitus in females living in Kabul in 2022

Introduction: Diabetes is a multifaceted metabolic disorder characterized by increased levels of blood glucose, resulting from several factors that impede proper glucose regulation in affected individuals. This study aims to investigate the relationships between age and blood glucose levels in non-pregnant women in Kabul in 2022. Materials and Methods: A retrospective cross-sectional descriptive study was conducted in Kabul, Afghanistan, involving patients attending the City Medical Complex in 2023. Blood samples were collected after fasting, and blood glucose levels were assessed using the enzymatic approach. Hyperglycemia was defined using the criteria of the American Diabetes Association. Data were analyzed using SPSS V.18, with a chi-square test for quantitative data, an independent t-test, and an analysis of variance for qualitative data. Results: The study involved 5102 participants aged 5 to 88 years, with a mean FBS level of 153.18 ± 70.315 mg/dl. 30.5% had normal FBS, 15.8% were pre-diabetic, and 53.7% had diabetes. Age distribution varied significantly across FBS groups, with diabetics having the highest age range (54.68 years) and normals having the smallest (44.07 years). Discussion: The correlation between aging and diabetes is intricate and diverse. Numerous elements contribute to this association, encompassing the heightened occurrence of diabetes as individuals grow older and the influence of diabetes on the aging progression itself.

Modern methods for assessing compensation of diabetes mellitus. Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes

Background. An integral part of diabetes mellitus (DM) management is its timely diagnosis. The reference method to study the quality of glycemic control is evaluating the level of glycated hemoglobin (HbA1c) as one of the most accessible and informative tools. However, the introduction of novel technologies, namely the use of continuous glucose monitoring (CGM), has given patients with DM, their relatives and healthcare professionals an access to new indicators of glycemic control such as time in range (TIR), time above range and time below range. These indicators are criteria for compensation of carbohydrate metabolism according to the 2023 American Diabetes Association guidelines. The purpose of the study was to compare the effectiveness of using glucometers and the FreeStyle Libre system for flash glucose monitoring in patients with DM. Materials and methods. An examination of 60 patients with type 2 DM who received insulin therapy was conducted. They were aged 45–65 years, with DM duration of 5 ± 2 years. All participants were divided into two equal groups of 30 people each. The first group consisted of patients with CGM devices, the second group used glucometers for daily glycemic control. Additional CGM parameters were used: glucose coefficient of variation, glucose management indicator, which shows the probable level of HbA1c. Results. When evaluating the data obtained from patients who used CGM, it is important to note their high adherence to the use of flash glucose monitoring. The use of CGM made it possible to achieve compensation of carbohydrate metabolism faster compared to patients who used glucometers to correct glycemia. Discontinuation of CGM resulted in poorer glycemic control. The obtained results prove that the compensation of patients depends primarily on their motivation, willingness to follow medical prescriptions, careful glycemic control, and compliance with medical recommendations. Conclusions. For better control of the DM course, patients should use CGM. In order to assess diabetes compensation, it is not enough to consider only TIR. Time below range indicating hypoglycemia, time above range indicating hyperglycemia, glucose management indicator should also be taken into account. Discontinuation of CGM resulted in a loss of approximately half of the initial TIR gain achieved while using CGM. CGM is more favored among patients than a 7-point self-monitoring of blood glucose.

Development of eco-friendly spectrophotometric methods for analysis of metformin hydrochloride and linagliptin in presence of metformin toxic impurity in their pure and dosage forms: Validation, practicality and greenness studies

Metformin is considered as type 2 diabetes first line treatment according to American Diabetes Association and European Association. But, in some cases, di- or tri - therapy should be prescribed for glycemic management, prevention of the maximum dose side effects and induced effectiveness. Co-administration of Linagliptin with metformin has many benefits on diabetic patients such as decrease the possibility of hypoglycemia. For the first time, novel and reliable techniques were developed and verified for the concurrent quantification of metformin hydrochloride and linagliptin, while accounting for the existence of metformin toxic impurity 1-cyanoguanidine in their pure and dosage forms. Method (A) utilizes the zero-order spectrophotometric approach to quantitatively determine the concentration of linagliptin. The measurements are performed at a wavelength of 295 nm. The double divisor derivative ratio spectrophotometric method is used in Method (B) to measure the amounts of metformin and cyanoguanidine at 252 nm and 219 nm wavelengths, respectively. The spectrophotometric method (C) for determining metformin and cyanoguanidine at 252 nm and 223 nm, respectively, is based on the single divisor derivative ratio-zero crossing technique. The obtained findings were subjected to statistical comparison with the reported method, revealing no statistically significant differences. The Green Analytical Procedure Index (GAPI) and Analytical GREEnness Metric approach (AGREE) determined that these approaches had a high degree of environmental friendliness. Additionally, the proposed strategy was deemed to be practical according to the Blue Applicability Grade Index (BAGI) assessment tool.

Glycemic control and cardiovascular outcomes in patients with diabetes and coronary artery disease according to triglyceride-glucose index: a large-scale cohort study

BackgroundThe role of triglyceride-glucose (TyG) index, an insulin resistance indicator, in glycemic management for diabetic patients with coronary artery disease (CAD) was still unknown. Therefore, we aimed to explore the association between glycemic control and cardiovascular (CV) outcomes in patients with diabetes and CAD according to different TyG index levels.MethodsA total of 9996 diabetic patients with angiograph-proven CAD were consecutively recruited from 2017 to 2018 at Fuwai Hospital. Patients were assigned into 3 groups according to TyG index tertiles (T) (T1: <8.895; T2: 8.895-9.400; T3: ≥9.400). According to American Diabetes Association guidelines, controlled glycemia was defined as targeting glycosylated hemoglobin Alc (HbA1c) < 7%. The primary endpoint was CV events including CV death, nonfatal myocardial infarction, and nonfatal stroke.ResultsDuring a median 3-year follow-up, 381 (3.8%) CV events occurred. Overall, high TyG index (T3) was associated with increased risk of CV events (hazard ratio [HR]: 1.40; 95% confidence interval [CI]: 1.02–1.94) compared with the lowest TyG index (T1) after multivariable adjustment. Upon stratification by the TyG index, in fully adjusted models, controlled glycemia was associated with reduced risk of CV events in the high TyG index (T3) subgroup (HR: 0.64; 95%CI: 0.42–0.96) but not in the low (T1; HR: 0.79; 95%CI: 0.53–1.16) and moderate (T2; HR: 0.84; 95%CI: 0.56–1.25) TyG index subgroups.ConclusionsControlled glycemia was associated with improved CV outcomes in patients with diabetes and established CAD, especially in those with high TyG index levels. Our study, for the first time, provided valuable information that TyG index could help making risk stratification on the glycemic management in diabetic patients with CAD.

Neutrophil: Lymphocyte and Platelet: Lymphocyte ratios measured before transplantation and their correlation with new-onset diabetes post-transplantation in renal transplant recipients

PurposeOur goal was to evaluate the neutrophil:lymphocyte (NLR) and platelet:lymphocyte (PLR) ratios measured before transplantation and their correlation with new-onset diabetes after transplantation (NODAT) in renal transplant recipients. Patients and methodsWe conducted our study in 324 adult patients consecutively admitted to Military Hospital 103, Ha Noi, Viet Nam, who received kidney allografts from living donors. These patients were followed-up during the first 2 years post-transplantation for NODAT. We examined the association between NLR and PLR measured prior to transplantation in patients with NODAT: NLR and PLR were calculated based on the results of the complete blood count. The criteria for diagnosis of a fully symptomatic NODAT case were based on the guidelines established by the American Diabetes Association and included fasting venous blood glucose and glycosylated hemoglobin A1c (HbA1c) levels, with or without an oral glucose tolerance test. ResultsThe overall rate of NODAT during the two years after kidney transplantation was 13.6%. We found mean values of age and body mass index (BMI), and median values of NLR, PLR, high sensitivity C-reactive protein (hs-CRP) levels, and the arteriosclerosis ratio in the NODAT group to be significantly higher than those of the non-NODAT group (all p < 0.05). Furthermore, an adjusted multivariate regression analysis showed that age (area under the curve [AUC] = 0.727, p < 0.001), BMI (AUC = 0.846, p < 0.001), serum hs-CRP levels (AUC = 0.884, p < 0.001), NLR (AUC = 0.888; p < 0.001), and PLR (AUC = 0.818; p < 0.001) had predictive value for NODAT. ConclusionNLR and PLR measured before transplantation were good predictors for NODAT in the first 2 years post-renal transplantation.

Factors linked to poor glycemic control in an outpatient diabetic clinic: a cross-sectional study in Saint-Nicolas Hospital, Haiti

Background Adequate glycemic control prevents acute complications and reduces the risk of long-term complications, the use of services, and societal costs. In clinical practice, achieving good glycemic control for a diabetic patient over the long term is a challenge, considering the complexity of the factors. No study to date has been carried out on diabetic patients and the factors that may be linked to poor glycemic control in Haiti. The main objective of this study was to identify factors related to poor glycemic control in diabetic patients. Methods This analytical cross-sectional study was designed to evaluate the long-term management of diabetic patients. Patients seen in an outpatient clinic in Saint-Nicolas Hospital (Saint-Marc, Haiti) from March to May 2022 were recruited. During this period, 268 diabetic patients were seen during their routine medical visits, of which 226 met our criteria and agreed to participate. They were interviewed by the examiners, with questions that allowed us to assess the association of poor glycemic control according to the American Diabetes Association objectives, with demographic and clinical factors identified from our literature review. The analysis included descriptive, bivariate and multivariate logistic regression using Epi Info 7.2.2.6. P value &lt;0.05 was considered statistically significant. Results The majority, 84.96%, was of female sex with a mean age of 60 ±9.87. More than half of the patients (59.29%) had their diagnosis for at least 5 years, and 67.26% had poor glycemic control. According to the Morisky score, 50.88% had good adherence. The main comorbidities were hypertension and obesity/overweight, 95% and 59%, respectively. Multivariate analysis after logistic regression showed that pathological proteinuria (odds ratio (OR)= 2.20, 95% confidence interval (CI) 1.0356 - 4.6920, p=0.04) and patients receiving both oral hypoglycemic drugs and insulin (OR=2.58, 95% CI: 1.0613 - 6.3109, p=0.03) increased the probability of having poor glycemic control. Conclusions Patients on oral hypoglycemic drugs and insulin who also had pathological proteinuria were linked to poor glycemic control. Strengthening patient education before optimizing pharmacological treatment would improve glycemic control, preventing renal complications. A larger study considering other potential barriers would be necessary to add further knowledge to what this study has presented.

Medicare formulary restrictions for glucagon-like peptide 1 receptor agonists and sodium glucose cotransporter 2 inhibitors used in type 2 diabetes mellitus: 2019-2023.

Glucagon-like peptide 1 receptor agonists (GLP1-RAs) and sodium glucose cotransporter 2 inhibitors (SGLT2is) have proven benefits in patients with type 2 diabetes mellitus related to decreasing cardiovascular events and heart failure hospitalizations as well as preventing the progression of kidney disease. This led the American Diabetes Association (ADA) to update their guidelines in 2022 to recommend GLP1-RAs and SGLT2is as potential first-line options in patients with cardiorenal conditions. Formulary restrictions, such as step therapy and prior authorizations, can limit access to these beneficial medications. To evaluate trends in Medicare formulary restrictions of GLP1-RAs and SGLT2is following the recommendations by the ADA for first-line use. We conducted a retrospective cohort study of Quarter 1 Medicare formulary restrictions on GLP1-RAs and SGLT2is from 2019 to 2023. We analyzed changes in formulary restrictions by year, before and after the ADA first-line recommendations, single vs combination products, and products with and without other indications on a medication level (ie, each unique National Drug Code number on each unique formulary) and formulary level (ie, any prior authorization or step therapy requirements yield formulary restriction). We analyzed 12,212 unique Medicare formularies. GLP1-RAs were 12.5% less likely (relative risk [RR] = 0.87; 95% CI = 0.84-0.91; P < 0.001) and 33.2% less likely (RR = 0.67; 95% CI = 0.60-0.74; P < 0.001) to have restrictions after the ADA guideline changes on a medication and formulary level, respectively. SGLT2is were 87.8% less likely (RR = 0.12; 95% CI = 0.11-0.13; P < 0.001) and 53.0% less likely (RR = 0.47; 95% CI = 0.27-0.80; P = 0.005) to have restrictions after the ADA guideline changes on medication and formulary levels, respectively. Decreasing trends of medications and formularies with restrictions may indicate payers are recognizing GLP1-RAs and SGLT2is as potential first-line agents, aligning with ADA recommendations.

Addressing Chronic Conditions and Social Determinants of Health During the COVID-19 Pandemic.

Chronic conditions or diseases are defined as persistent conditions lasting ≥ 1year requiring either ongoing medical attention or limiting daily living or both (Agency for Healthcare Research and Quality (AHRQ) in Programs: SHARE approach workshop, Agency for Healthcare Research and Quality (AHRQ) (2016) Programs: SHARE approach workshop 2016. https://www.ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/workshop/index.html . Accessed 20 Jan 2017). Physical chronic conditions, including diabetes, hypertension, heart disease, arthritis, and stroke, are prevalent, especially in the older population. Over 90% of older adults have at least 1 and 77% have ≥ 2 chronic conditions (American Diabetes Association (ADA) in Statistics about diabetes, American Diabetes Association (ADA) (2023) Statistics about diabetes. https://diabetes.org/about-us/statistics/about-diabetes . Accessed 20 Apr 2023). Chronic conditions account for $4.1 trillion of the nation's annual healthcare expenditure (Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion in Health and economic costs of chronic conditions, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Health and Economic Costs of Chronic Conditions (2022). https://www.cdc.gov/chronicdisease/about/costs/index.htm . Accessed 7 Jan 2023). There are marked disparities based on age, color, and income, with older people, people of color, and lower-income people having higher treatment costs or even lost wages in response to having chronic conditions. Chronic conditions are the on-the-top leading causes for death with diabetes being the top 7th in the USA in 2019 (Ferguson in Metabolic Syndrome Related Dis, Ferguson et al., Metab Syndr Relat Disord 21:177-187, 2023).

Timely News and Notes for Primary Care Providers from the American Diabetes Association

Timely News and Notes for Primary Care Providers from the American Diabetes Association

Menarche age and the risk of diabetes: A cross-sectional study in South-Eastern Iran.

Diabetes is a major public health problem worldwide. This study aimed to determine the relationship between menarche age and overt diabetes in southeast Iran. This cross-sectional study was conducted on 6094 eligible women between the ages of 35 and 70 participating in the Zahedan Adult Cohort Study. Demographic and background data, fertility, anthropometry, and disease history were collected based on a questionnaire. Menarche age was classified into five categories (under 12 years, 12, 13, 14, 15 years and more). Diabetes is defined as a blood sugar of 126 or more according to the definition by the American Diabetes Association. Data analysis was done using SPSS 26 software. Descriptive analysis was performed with frequency, percentage, mean, and standard deviation; and analytical analysis using chi-square and logistic regression tests. The significance level in this study was p < 0.05. The participants' mean age was 49.41 ± 8.88, and the mean age at menarche was 13 ± 1.49. 22.8% (1389 women) of participants with diabetes and 77.2% (4705 women) did not have diabetes. The findings showed that the chance of developing diabetes in women with a menarche age <12 years was significantly higher than in women with a menarche age of 13 years (reference) (OR = 1.23, 95% CI: 0.96, 1.51). This relationship was significant after adjusting variables such as body mass index, education level, fertility factors, history of diabetes, and reproductive diabetes (OR = 1.21, 95% CI: 0.90, 1.44, p = 0.04). Our findings suggest that young age at menarche may be a risk factor for diabetes in adulthood. Further prospective studies are needed to confirm our findings. However, it is suggested to pay attention to it in diabetes screening so that, if possible, by identifying people at risk and implementing prevention programs, the adverse consequences of diabetes can be reduced.

Risk Assessment for Non-Communicable Diseases among Adults of 18 to 29 years Age in a Rural Area of Madurai District, Tamil Nadu, India: A Cross-sectional Study

Introduction: Non-Communicable Diseases (NCDs) are the leading cause of morbidity and mortality globally. In India, the Ministry of Health and Family Welfare reported a rise in mortality rates from 37% in 1990 to 61% in 2016. Additionally, the prevalence of diabetes mellitus and hypertension among young adults was higher than estimated. As the behavioural risk factors are mainly established in adolescence, screening at an earlier age becomes essential. Aim: To estimate the risk for diabetes mellitus and hypertension among individuals aged 18-29 years and to assess the association between the risk factors and at-risk individuals. Materials and Methods: A community-based cross-sectional study was conducted in the field practice area of Madurai Medical College, Madurai, Tamil Nadu, India, to estimate the risk for diabetes mellitus and hypertension among individuals aged 18-29 years. The National Health Mission (NHM) protocol was used for risk assessment, based on American Diabetic Association (ADA) and Joint National Committee (JNC) 8 guidelines. Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) 20.0 software. Results: A total of 154 residents were included in the study. The mean age of the study participants was 24.64±4.70 years. Approximately 60% of the study participants were males and 40% were females. A total of 54% of the participants were married. Most subjects had completed high school (33.8%), followed by 28.6% who completed postgraduation. Disease categorisation revealed that 54 (35%) were non-diabetics, 89 (58%) were pre-diabetics, and 11 (7%) had diabetes mellitus. Similarly, 24 (16%) were non-hypertensive, 115 (75%) had high normal values, and 15 (9%) had probable stage I hypertension. A statistically significant association was observed between hypertension and educational level, alcoholism, Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP), whereas diabetes mellitus was not significantly associated with any variables. The probabilistic prediction for hypertension using the logistic regression model included alcoholism and SBP, which contributed to 25.6% of the variations in prediction hypertension. Conclusion: The study results highlight a significant burden of undiagnosed cases of diabetes and hypertension in the community. This indicates the need for systematic screening, early lifestyle modifications, appropriate treatment, and regular follow-up for such individuals.

Development of a transition program for emerging adults with type 1 diabetes: A quality improvement initiative

BackgroundEmerging adults with type 1 diabetes (T1D) struggle with glycemic management that can be exacerbated by a disorganized transition process. Substantial gaps in care have been noted during this transition period and have been shown to lead to suboptimal health care utilization, worsening glycemic management, increased incidence of serious complications, and mental health challenges. A formal transition program can help prevent gaps in care, improve disease self-management skills, decrease disease burden, and reduce diabetes complications. PurposeThere is an increased focus within the pediatric community to formally prepare young adults with T1D as they transition to the adult health care setting. The purpose of the quality improvement initiative was to develop a transition program for adolescents with T1D in a pediatric endocrinology clinic within an academic medical center. Methods/interventionsThe Institute for Healthcare Improvement Model for Improvement was used to guide this project. Got Transition's® Six Core Elements of Health Care Transition were adapted to the unique needs of the pediatric endocrinology setting by incorporating diabetes-specific transition guidelines recommended by the American Diabetes Association (ADA). A new program was designed to target patients between the ages of 16–18 offering structured transition visits focused on enhancing knowledge and skills related to the management of T1D and improving the transfer of care process between pediatric and adult providers. Key elements of the program were integrated into the electronic health record. A focus group with clinical partners was used to evaluate the acceptability and practicality of the program. ResultsTransition activity within the clinic increased from 12/32–28/32 on the Current Assessment of Healthcare Transition Activities tool. Four themes were identified from clinical partner feedback supporting the acceptability and practicality of program design. ConclusionsThe integration of the Got Transition® framework and the ADA recommendations supports clinicians in meeting the unique needs of adolescents with T1D. Incorporating the transition activities into the electronic health record facilitated integration into the workflow of the clinic providers. This initiative can serve as a model to expand transition activities across pediatric specialty care settings.

Adherence to the monitoring of metabolic syndrome in patients receiving antipsychotics in outpatient clinics in Saudi Arabia.

Monitoring protocols have been developed because patients taking atypical antipsychotics are more prone to developing metabolic syndrome, which leads to possible increased mortality and morbidity. The aim of this study was to assess the degree of adherence to the recommendations of metabolic syndrome monitoring. This study was conducted in two large psychiatric facilities in the Eastern Province of Saudi Arabia. A retrospective analysis of the medical records of 350 patients taking antipsychotic medications was done, and an assessment was made of the frequency of metabolic monitoring at each of the intervals as suggested by the American Diabetes Association. Data was analyzed using SPSS; descriptive statistics. were computed and Chi-square test was used to determine statistical significance for association between categorical variable. The mean age of the patients was 34.9 ± 18 years; 64.6% were males. Olanzapine was the most prescribed medication (43.7%, n = 153), followed by quetiapine (17.4%, n = 61). Only one-third of the patients (29.6%) completed all the baseline parameters. Documentation of baseline parameters was low for glucose level (38.9%), lipid panel (17.3%), weight (25.2%), and waist circumference (1.4%). Adherence to yearly monitoring was much lower than at baseline (mean percentage: 29.6% vs. 1.7%). Furthermore, 45% of the patients were classified as obese and 10% had metabolic comorbidity. Individuals with mental illness who were taking antipsychotics did not undergo proper metabolic screening during antipsychotic treatment. Barriers to adherence to the monitoring guidelines should be examined and addressed. Giving assistance to practitioners to recall the required laboratory tests and vitals at certain intervals could help improve metabolic monitoring practices.

Identifying gestational diabetes mellitus and assessing risk factors in affected women: a comprehensive study.

Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication associated with adverse health outcomes for both mothers and offspring. This study aimed to identify risk factors for GDM, a condition with a rapidly increasing global prevalence. We conducted a study involving 474 pregnant women who attended the obstetrics outpatient clinic of Kafkas University Faculty of Medicine Hospital between January 2022 and June 2023. Risk factors for GDM were assessed based on criteria recommended by the American Diabetes Association and the Committee on Practice of the American College of Obstetricians and Gynecologists. Statistical analyses, including descriptive statistics, Chi-square tests, Mann-Whitney U tests, and multivariate logistic regression. Individuals with GDM (mean age: 31.26±6.09 years) were significantly older than those without GDM (mean age: 28.36±4.89 years; p<0.001). Obesity prevalence was higher in the GDM group (32.5%) compared to the non-GDM group (14.3%; p<0.001). Individuals with GDM had higher rates of pre-diabetes (3.3% vs. 0.3%; p=0.007), a history of gestational diabetes (25.2% vs. 5.7%; p<0.001), high blood sugar in previous pregnancies (13.8% vs. 1.4%; p<0.001), and diabetes mellitus in 1st-degree relatives (40.7% vs. 20.3%; p<0.001). GDM was associated with increased pregnancies (p<0.001), preterm births (p<0.001), macrosomic babies (p=0.026), congenital anomalies (p=0.011), high cholesterol (p=0.036), and polyhydramnios (p=0.001) in previous pregnancies, as well as polyhydramnios in the index pregnancy (p=0.008). Regular exercise in previous pregnancies differed significantly based on GDM presence (p=0.037). Recognizing modifiable risk factors is crucial for preventing GDM and reducing associated health risks. Healthcare providers should be vigilant, especially among those with a family history of GDM, previous GDM, advanced maternal age, and other risk factors. Early lifestyle interventions show promise. Further research is needed for accurate GDM prediction.