Burden Of Diabetes Research Articles

Gender differences in the management and outcomes of acute coronary syndrome in indians: A systematic review and meta-analysis

BackgroundGender differences in acute coronary syndrome (ACS) outcomes have been noted in global data, which however did not analyse Indian data. No prior systematic review and meta-analysis (SRM) has addressed this important aspect of gender bias in Indian women with ACS. Hence this SRM aimed to address this knowledge gap. MethodsElectronic databases were searched for studies in ACS comparing cardiovascular disease presentation, treatment received and outcomes in women and men from India. Primary outcomes were to evaluate gender-differences in 30-day death and major adverse cardiovascular events (MACE). Secondary outcomes were to evaluate gender-differences in presentation, management and mortality. The SRM is registered with PROSPERO (CRD42023477286). ResultsFrom initially screened 3753 articles, data from 9 studies (61,185 patients) were analysed. Women with ACS had higher prevalence of diabetes [Odds ratio (OR) 1.65(95%CI:1.33–2.04); p < 0.001; I2 = 95 %] and hypertension [OR2.06(95%CI:1.88–2.25); p < 0.001; I2 = 42 %]. Smoking was significantly lower in women [OR 0.05(95%CI:0.03–0.07); p < 0.001; I2 = 87 %]. Non-ST elevation myocardial infarction (NSTEMI) was significantly higher in women [OR 1.92(95%CI:1.66–2.21); p < 0.001; I2 = 0 %]. Diagnostic angiography [OR 0.64(95%CI:0.56–0.74); p < 0.001; I2 = 46 %] and percutaneous coronary interventions [OR0.71(95%CI:0.55–0.92); p = 0.01; I2 = 92 %] were significantly lower in women. Women had significantly higher 30-day mortality [Hazard ratio (HR)2.26(95%CI:2.01–2.55); p < 0.001; I2 = 6 %], 1-year mortality [HR2.41(95%CI:1.89–3.07); p < 0.001; I2 = 53 %], in-hospital death [HR1.88(95%CI:1.19–2.96); p = 0.007; I2 = 92 %], stroke [HR 1.84 (95%CI:1.34–2.52); p < 0.001; I2 = 0 %] and MACE outcomes [OR 2.05 (95%CI:1.78–2.35); p < 0.001]. Use of aspirin, clopidogrel, beta-blockers and nitrates were significantly lower in women. ConclusionOur study highlights worse outcomes in Indian women with ACS. Higher burden of diabetes and hypertension, decreased used of PCI and lesser aggressive pharmacotherapy may be some of the contributing factors.

Advances in diabetes technology within the digital diabetes ecosystem.

Ongoing innovations in glucose monitoring, insulin delivery, and telehealth technologies have created a digital diabetes ecosystem populated by connected tools and technologies that have been shown to improve clinical outcomes, lower costs, and reduce the burden of diabetes. Advances in connected continuous glucose monitoring devices, insulin pumps, and insulin pens have led to the development of automated insulin delivery systems that modulate insulin infusion based on sensor glucose data. Similar integrations of continuous glucose monitoring and connected blood glucose meter data into "smart" pens have lessened the guesswork of intensive insulin management for individuals who prefer traditional injection therapy. A growing number of health apps that can be accessed through smartphones and wearable devices provide information and advice that support individuals in adopting healthier lifestyles. The differences in features and functionality give users the ability to select the devices that best meet their unique requirements and preferences. This article reviews the most current digital diabetes technologies and discusses how the connectivity of these tools can create an overarching architecture of feedback mechanisms that monitor an individual's health status, motivate and enhance adherence to self-management, and provide advice and decision-support tools to clinicians as well as other members of the health care team to make living with diabetes more manageable.

Economic Burden of Diabetes: A Review of Literature

Economic Burden of Diabetes: A Review of Literature

Healthcare Concern: The High Rate of Diabetes in Southeastern Nigeria

Diabetes mellitus is an escalating public health crisis globally, and its impact is profoundly felt in Southeastern Nigeria, where the prevalence of diabetes stands at approximately 24%, significantly higher than both national and global averages. This review examines the epidemiology, risk factors, health impacts, and management challenges associated with diabetes in this region. Key contributors to the high diabetes rates in Southeastern Nigeria include genetic predispositions, rapid urbanization, lifestyle changes, and socioeconomic disparities. The health implications of diabetes are severe, encompassing complications such as neuropathy, nephropathy, and cardiovascular disease, which lead to a diminished quality of life and increased mortality. Challenges in managing diabetes are compounded by inadequate healthcare infrastructure, limited access to specialized care, and cultural factors influencing treatment adherence. Effective strategies for diabetes management in Southeastern Nigeria require comprehensive public health interventions, enhanced healthcare infrastructure, and culturally tailored educational programs. Future research should focus on filling gaps in epidemiological data, understanding rural healthcare barriers, and evaluating the effectiveness of targeted interventions. A collaborative approach involving government, healthcare providers, and communities is crucial for mitigating the diabetes burden and improving health outcomes in the region. Keywords: Diabetes mellitus, Southeastern Nigeria, epidemiology, risk factors, healthcare challenges, public health interventions.

Ten Recommendations for Accelerating Hypertension and Diabetes Control to Reduce Stroke, Heart, and Renal Disease with the Aim to Save Lives in Cameroon Through Partnerships and Collaborations.

Hypertension and diabetes are currently the most common, treatable, and controllable cardiovascular and metabolic risk factors for stroke, heart, and renal diseases in Cameroon. Hypertension affects 30% of adults aged≥20years with 90% as uncontrolled cases, while type 2 diabetes affects 6% of the same population, with 70% remaining underdiagnosed. Despite publication of the first Roadmap on raised blood pressure by the World Heart Federation in 2015, the Pan African Society of Cardiology Roadmap in 2017, andthe technical package for cardiovascular disease management in primary health care (WHO-HEARTS) in 2020, very little progress has been made in improving the diagnosis, treatment, and control of cardiovascular risk factors and diseases in Cameroon. The Cameroon Cardiac Society and a dozen Cameroon non-communicable diseases societies, national organizations from the community and the civil society, along with researchers and members of academia and the health sector, came together under the patronage of representatives of the government to propose new strategies to improve hypertension and diabetes control and save lives in Cameroon. Two simple and practical algorithms for the management of hypertension and diabetes were developed. The ten recommendations tailored to be efficiently implemented in our country were summarized under the acronym 'A SMART VIEW' (Awareness, Screening, Manufacture, Activity, Research, Task-shifting, HIV/AIDS, Insurance, Education, and WHO-HEARTS). It is our hope that all stakeholders will further collaborate to remove barriers and enhance facilitators to deploy the proposed actions and reduce the burden of uncontrolled hypertension and untreated diabetes in Cameroon.

Household economic burden of type-2 diabetes and hypertension comorbidity care in urban-poor Ghana: a mixed methods study

BackgroundNon-communicable diseases (NCDs) predispose households to exorbitant healthcare expenditures in health systems where there is no access to effective financial protection for healthcare. This study assessed the economic burden associated with the rising burden of type-2 diabetes (T2D) and hypertension comorbidity management, and its implications for healthcare seeking in urban Accra.MethodsA convergent parallel mixed-methods study design was used. Quantitative sociodemographic and cost data were collected through survey from a random community-based sample of 120 adults aged 25 years and older and living with comorbid T2D and hypertension in Ga Mashie, Accra, Ghana in November and December 2022. The monthly economic cost of T2D and hypertension comorbidity care was estimated using a descriptive cost-of-illness analysis technique from the perspective of patients. Thirteen focus group discussions (FGDs) were conducted among community members with and without comorbid T2D and hypertension. The FGDs were analysed using deductive and inductive thematic approaches. Findings from the survey and qualitative study were integrated in the discussion.ResultsOut of a total of 120 respondents who self-reported comorbid T2D and hypertension, 23 (19.2%) provided complete healthcare cost data. The direct cost of managing T2D and hypertension comorbidity constituted almost 94% of the monthly economic cost of care, and the median direct cost of care was US$19.30 (IQR:10.55–118.88). Almost a quarter of the respondents pay for their healthcare through co-payment and insurance jointly, and 42.9% pay out-of-pocket (OOP). Patients with lower socioeconomic status incurred a higher direct cost burden compared to those in the higher socioeconomic bracket. The implications of the high economic burden resulting from self-funding of healthcare were found from the qualitative study to be: 1) poor access to quality healthcare; (2) poor medication adherence; (3) aggravated direct non-medical and indirect cost; and (4) psychosocial support to help cope with the cost burden.ConclusionThe economic burden associated with healthcare in instances of comorbid T2D and hypertension can significantly impact household budget and cause financial difficulty or impoverishment. Policies targeted at effectively managing NCDs should focus on strengthening a comprehensive and reliable National Health Insurance Scheme coverage for care of chronic conditions.

Exploring machine learning approaches for early diabetes risk prediction: A comprehensive examination of health indicators and models

Background: The increased prevalence of morbidity and mortality associated with Type 2 diabetes is due to changing lifestyles, demanding improved disease management measures. To tackle this, scientists are increasingly looking to technological advances, notably machine learning, for illness prevention and management, particularly in non-communicable diseases. The emphasis is on establishing an early detection system to identify Type 2 diabetes risk factors, enabling prompt treatments and preventative steps to reduce the disease’s rising prevalence. Materials and methods: The research aimed to assess the association of diabetes class with health indicators. Five machine learning models were employed with cross-validation techniques to predict early diabetes risk. The performance matrices of the models were evaluated and compared with the existing work. Results: In multivariate analysis, we found polyuria (β=3.492; Aor=32.872; 95% CI=11.09,97.35; p&lt;0.001), polydipsia (β=-4.100; Aor=60.378; 95%CI=18.28,199.37; p&lt;0.001), polyphagia (β=1.181; Aor=3.25; 95%CI=1.23,8.57; p=0.017), genital thrush (β=1.08; Aor=2.96; 95%CI=1.26,7.53; p=0.023), irritability (β=2.28; Aor=9.82; 95%CI=3.41,28.26; p&lt;0.001), and partial paresis (β=1.2406; Aor=3.45; 95% CI=1.35,8.79; p=0.009) are the potential health risk indicators for positive diabetes class. Conclusion: Using an interpretable feature learning approach for early diabetes prediction improves the use of global health data. This method forecasts hazards correctly and gives insights into influential aspects. As a result, a more proactive healthcare strategy is implemented, allowing for more prompt treatments and encouraging a more hopeful future by improving patient outcomes and lowering the total burden of diabetes on individuals and healthcare systems.

Various Diabetes Management Activities: A Comprehensive Overview

Diabetes management is a multifaceted process crucial for preventing complications and improving the quality of life for individuals with diabetes. This comprehensive review explores various aspects of diabetes management, including education, self-monitoring, medication adherence, dietary management, physical activity, psychological support, and technological innovations. Diabetes self-management education (DSME) forms the foundation of effective care, equipping patients with the knowledge and skills necessary for optimal self-care. Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) are essential for tracking and adjusting treatment plans. Medication management, including insulin therapy and oral medications, is vital for maintaining glycemic control, while personalized dietary plans and regular physical activity contribute to overall health. Psychological support and motivational strategies are crucial for addressing the emotional burden of diabetes and sustaining long-term self-care. Technological advancements, such as digital health tools and artificial pancreas systems, enhance diabetes management by providing real-time data and facilitating remote consultations. This review underscores the importance of an integrated approach to diabetes care, combining education, self-monitoring, medication management, lifestyle modifications, psychological support, and technological innovations to achieve better health outcomes and improve patient well-being. Keywords: Diabetes Management, Diabetes Self-Management Education, Insulin Therapy, Oral Medications.

Patient-Centric Outcomes: A Longitudinal Study on the Impact of Multifaceted Interventions in Diabetes and Cardiovascular Health

This longitudinal study investigates the effectiveness of multifaceted interventions in improving patient outcomes in diabetes and cardiovascular health. With an increasing prevalence of these conditions worldwide, there is a pressing need for holistic approaches that address multiple facets of patient care. Our study follows a cohort of individuals diagnosed with diabetes and cardiovascular diseases over five years, examining the impact of comprehensive interventions on various patient-centric outcomes. These interventions encompassed a combination of lifestyle modifications, medication adherence programs, dietary counseling, physical activity promotion, and psychological support. Through rigorous data collection and analysis, we assessed changes in key clinical indicators such as HbA1c levels, lipid profiles, blood pressure, and body mass index, alongside patient-reported outcomes including quality of life, self-efficacy, and satisfaction with care. Additionally, we explored healthcare utilization patterns and economic implications associated with the interventions. Our findings reveal significant improvements in both clinical and patient-reported outcomes among participants engaged in multifaceted interventions compared to those receiving standard care. The interventions demonstrated sustained benefits over the follow-up period, suggesting their long-term efficacy in managing chronic conditions and enhancing overall well-being. Furthermore, our study highlights the importance of personalized, patient-centered approaches in chronic disease management, emphasizing the need for integrated care models that prioritize individual needs and preferences. These insights have profound implications for healthcare policymakers, providers, and stakeholders seeking to optimize outcomes and reduce the burden of diabetes and cardiovascular diseases on patients and healthcare systems.

Assessment of burden of prediabetes and diabetes with oral glucose tolerance test in community-based settings of Bengaluru rural district.

Diabetes is a major public health concern in India. The majority of studies done in rural population lack systematic methodology in estimating the prevalence of diabetes mellitus. Objectives of this study were to estimate the burden of prediabetes, type 2 diabetes mellitus and its associated risk factors among adults (18-69) years in rural Bengaluru, Karnataka. A cross-sectional study was conducted among adults aged 18-69 years in three villages of Devanahalli taluk of rural Bengaluru between May and October 2019. Behavioural and metabolic risk factors related to diabetes were assessed using WHO-STEPS instrument and IDSP-NCD risk factor tool. Fasting blood glucose and OGTT test were performed, and WHO diagnostic criteria were used to diagnose diabetes mellitus. Prevalence of prediabetes and type 2 diabetes (T2DM) in rural Bengaluru was found to be 6.3% and 10.9%, respectively. Behavioural risk factors related to diabetes measured in the study population were current tobacco use (32.7%), current alcohol use (9.9%), physical inactivity (46.8%) and unhealthy diet (82.3%). Metabolic risk factors measured were obesity (7.5%), central obesity (46.4%), prediabetes (6.3%) and hypertension (24.3%). More than one-thirds of diabetes and three-fourths of hypertension individuals were newly diagnosed by the population-based screening. The burden of diabetes and its risk factors are high due to the health transition occurring in rural population of Bengaluru. Undiagnosed diabetes mellitus and hypertension in rural population as demonstrated by this study highlight the need to strengthen the population-based screening and diagnosis of T2DM and hypertension (HTN) under the national health programme.

Geographic Variation in First Lower Extremity Amputations Related to Diabetes and/or Peripheral Arterial Disease

BackgroundTo assess trends of first cases of lower extremity amputation (LEA) related to diabetes and/or peripheral arterial disease (PAD), according to areas of residency and neighbourhood material and social deprivation quintiles, in the province of Quebec, Canada. MethodsUsing the Quebec Integrated Chronic Disease Surveillance System, we calculated crude and age-standardized annual incidence rates of first LEA (total, minor, and major) among adults 40 years of age and older with diabetes and/or PAD in fiscal years 2006 and 2019. Area of residency was compiled in 3 categories: (1) Montreal and other census metropolitan areas; (2) midsize agglomerations (10,000-100,000 inhabitants); and (3) small towns and rural areas (< 10,000 inhabitants). We also stratified according to neighbourhood material and social deprivation quintiles. One-year and 5-year all-cause mortality after first LEA were compared according to area of residency. ResultsAmong the 10,275 individuals who had a first LEA, age-standardized LEA rates remained stable between 2006 and 2019, whereas major LEA rates declined in all geographical areas and minor LEA rates increased (31.6%) in small towns and rural areas. In 2019, age-standardized LEA rates were higher in midsize agglomerations and small towns and rural areas compared with census metropolitan areas. Age-standardized LEA rates in 2019 were higher among the most deprived quintile compared with the most privileged quintile for material and social deprivation. No difference was observed in mortality after first LEA according to area of residency. ConclusionsThere are health disparities in the burden of diabetes and PAD related to first LEA in the province of Quebec. To improve preventive care and reduce the burden of LEA, targeted actions should be taken among the most deprived groups and rural settings.

"Effect Of Electroacupuncture On Sensory Peripheral Nerve Function In Diabetic Peripheral Neuropathy: A Randomized Controlled Trial Protocol."

Background: Diabetes, a chronic metabolic disorder, affects millions globally, with Type 2 diabetes being the most prevalent. Diabetic Peripheral Neuropathy (DPN) is a common complication, characterized by symptoms such as pain, tingling, and numbness due to peripheral nerve damage. The global burden of diabetes has been rising, particularly in low- and middle-income countries. In India, the number of diabetes cases is projected to reach over 134 million by 2045. Traditional treatments for DPN often have limited efficacy and adverse longterm effects, highlighting the need for alternative therapies. Objective: This study aims to investigate the efficacy of electroacupuncture in improving sensory nerve functions in patients with DPN. Specific acupuncture points will be targeted to assess their impact on vibration perception, hot and cold perception, touch sensitivity, and skin temperature. Methods: A randomized controlled trial will be conducted with 80 participants divided equally into an interventional group and a control group. The interventional group will receive electroacupuncture at specific points (ST44, ST36, ST43, K2, K3, BL60, SP9, and GB41) three times a week for 8 weeks. The control group will continue their usual routine and receive the treatment post-study. Primary outcomes will be measured using the NEURO TOUCH instrument to assess sensory thresholds and skin temperature. Secondary outcomes will include pain assessment using the Visual Analog Scale (VAS). Data will be analyzed using SPSS version 16. Results: The study will evaluate the degree of sensory improvement in peripheral nerves and the effectiveness of electroacupuncture in reducing neuropathic pain. This research seeks to bridge the gap in understanding the mechanisms and efficacy of electroacupuncture in DPN treatment. Conclusion: This study will provide significant insights into the potential benefits of electroacupuncture for DPN, offering an alternative approach to improve the management of this debilitating condition. The findings could inform future clinical practices and guidelines for DPN treatment

"Effect Of Electroacupuncture On Sensory Peripheral Nerve Function In Diabetic Peripheral Neuropathy: A Randomized Controlled Trial Protocol."

Background: Diabetes, a chronic metabolic disorder, affects millions globally, with Type 2 diabetes being the most prevalent. Diabetic Peripheral Neuropathy (DPN) is a common complication, characterized by symptoms such as pain, tingling, and numbness due to peripheral nerve damage. The global burden of diabetes has been rising, particularly in low- and middle-income countries. In India, the number of diabetes cases is projected to reach over 134 million by 2045. Traditional treatments for DPN often have limited efficacy and adverse longterm effects, highlighting the need for alternative therapies. Objective: This study aims to investigate the efficacy of electroacupuncture in improving sensory nerve functions in patients with DPN. Specific acupuncture points will be targeted to assess their impact on vibration perception, hot and cold perception, touch sensitivity, and skin temperature. Methods: A randomized controlled trial will be conducted with 80 participants divided equally into an interventional group and a control group. The interventional group will receive electroacupuncture at specific points (ST44, ST36, ST43, K2, K3, BL60, SP9, and GB41) three times a week for 8 weeks. The control group will continue their usual routine and receive the treatment post-study. Primary outcomes will be measured using the NEURO TOUCH instrument to assess sensory thresholds and skin temperature. Secondary outcomes will include pain assessment using the Visual Analog Scale (VAS). Data will be analyzed using SPSS version 16. Results: The study will evaluate the degree of sensory improvement in peripheral nerves and the effectiveness of electroacupuncture in reducing neuropathic pain. This research seeks to bridge the gap in understanding the mechanisms and efficacy of electroacupuncture in DPN treatment. Conclusion: This study will provide significant insights into the potential benefits of electroacupuncture for DPN, offering an alternative approach to improve the management of this debilitating condition. The findings could inform future clinical practices and guidelines for DPN treatment.

Psychometric properties of the German versions of the Problem Areas in Diabetes Scale for Children (PAID-C) with Type 1 Diabetes and Their Parents (P-PAID-C).

Children with Type 1 diabetes (T1D) and their parent-caregivers often experience diabetes distress due to the daily demands of diabetes management. Regular screening for diabetes distress is needed to prevent the deterioration of metabolic control and the development of mental health disorders. The aim of this analysis was to examine the psychometric properties of the German versions of the Problem Areas in Diabetes Scale for Children (PAID-C) and for caregiver burden in Parents (P-PAID-C). Data were collected from 136 children aged 7-12 years (46.7% females) and 304 parents (Mage = 42.9 (SD 6.1) years; 78% mothers) by using linguistically translated questionnaires in a multicenter study. Confirmatory factor analysis and correlational analyses were conducted. Results confirmed the two-factor model for the PAID-C and the four-factor model for the P-PAID-C with a slight modification. Cronbach's αs for children and parents were 0.88 and 0.92, respectively. The PAID-C and P-PAID-C scores had small positive associations with HbA1c (rs = .220 and .139, respectively, all p < .05) and strong inverse association with the KIDSCREEN-10 index (r = -.643 and -.520, respectively, all p < .001). P-PAID-C scores increased with increasing depressive symptoms measured in nine-item Patient Health Questionnaire among parents (rs = .534, p < .001). The scores produced by the German PAID-C and P-PAID-C were reliable and valid in measuring diabetes burdens. These German versions of PAID can be utilized to assess diabetes-specific distress and to design interventions for children and their parents experiencing high levels of diabetes distress. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adult's Lived Experience Using the Insulin-Only Bionic Pancreas.

The purpose of this study was to assess adults' perspectives after using the insulin-only Bionic Pancreas (BP) during a 13-week pivotal trial. Automated insulin delivery (AID) systems show promise in improving glycemic outcomes and reducing disease burden for those with type 1 diabetes mellitus (T1D). Understanding the lived experience of those using the BP can help to inform education and uptake of AID devices. Adults ages 19 to 75 (n = 40) participated in age-specific focus groups (19-25, 26-40, 41-64, and 65+) exploring their experiences, thoughts, and feelings about using the BP. Three authors analyzed the focus group data using a hybrid thematic approach. Qualitative analysis of focus groups revealed 14 sub-themes falling into four major themes (diabetes burden, managing glucose levels, daily routine, and user experience). Although participants' overall experience was positive, some reported struggles related to managing out-of-range glucose levels and challenges with the system responding to unique meal schedules and exercise regimens. This study captures patient perspectives regarding their experiences with a new AID system. Patient voice can inform device development and educational approaches for people with T1D. Identifying which patients may benefit the most from wearing this system may facilitate patient/clinician discussions regarding insulin delivery systems that best meet their individualized needs and expectations that may support device uptake and continued use.

Heart Failure Risk Prediction in a Population With a High Burden of Diabetes: Evidence From the Strong Heart Study.

Despite the high burden of diabetes and cardiovascular risk factors in American Indian communities in the United States, prospective studies of heart failure (HF) in this population group are scarce, and the generalizability of previous HF risk scales may be limited. We developed a parsimonious HF risk prediction equation that accounts for relevant risk factors affecting American Indian communities, focusing on diabetes and kidney damage. A total of 3059 participants from the SHS (Strong Heart Study) (56±8 years of age, 58% women) were included. Five hundred seven developed HF. Progressively adjusted Cox proportional hazards models were used to identify risk factors for HF and HF subtypes. Predictors of risk at 5 and 10 years included older age (hazard ratio [HR], 1.79 [95% CI, 1.43-2.25]; HR, 1.68 [95% CI, 1.44-1.95]), smoking (HR, 2.26 [95% CI, 1.23-4.13]; HR, 2.08 [95% CI, 1.41-3.06]), macroalbuminuria (HR, 8.38 [95% CI, 4.44-15.83]; HR, 5.20 [95% CI, 3.42-7.9]), microalbuminuria (HR, 2.72 [95% CI, 1.51-4.90]; HR, 1.92 [95% CI, 1.33, 2.78]), and previous myocardial infarction (HR, 6.58 [95% CI, 2.54-17.03]; HR, 3.87 [95% CI, 2.29-6.54]), respectively. These predictors, together with diabetes diagnosis and glycated hemoglobin were significant at 10 and 28 years. High discrimination performance was achieved (C index, 0.81 [95% CI, 0.76-0.84]; C index, 0.78 [95% CI, 0.75-0.81]; and C index, 0.77 [95% CI, 0.74-0.78] at 5, 10, and up to 28 years of follow up, respectively). Some associations varied across HF subtypes, although diabetes, albuminuria, and previous myocardial infarction were associated with all subtypes. This prospective study of HF risk factors in American Indian communities identifies that smoking, body mass index, and indicators of diabetes control and kidney damage (glycated hemoglobin and albuminuria) are major determinants of HF. Our findings can improve HF risk assessment in populations with a high burden of diabetes.

Predictive Modelling of Diabetes Risk in Population Groups Defined by Socioeconomic and Lifestyle Factors in Canada: A Cross-Sectional Study.

This study modelled diabetes risk for population groups in Canada defined by socioeconomic and lifestyle characteristics and investigated inequities in diabetes risk using a validated population risk prediction algorithm. We defined population groups, informed by determinants of health frameworks. We applied the Diabetes Population Risk Tool (DPoRT) to 2017/2018 Canadian Community Health Survey data to predict 10-year diabetes risk and cases across population groups. We modelled a preventive intervention scenario to estimate reductions in diabetes for population groups and impacts on the inequity in diabetes risk across income and education. The population group with at least one lifestyle and at least one socioeconomic/structural risk factor had the highest estimated 10-year diabetes risk and number of new cases. When an intervention with a 5% relative risk reduction was modelled for this population group, diabetes risk decreased by 0.5% (females) and 0.7% (males) and the inequity in diabetes risk across income and education levels was reduced. Preventative interventions that address socioeconomic and structural risk factors have potential to reduce inequities in diabetes risk and overall diabetes burden.

Fear of Hypoglycemia and Diabetes Distress: Expected Reduction by Glucose Prediction.

Extended glucose predictions are novel in diabetes management. Currently, there is no solution widely available. People with diabetes mellitus (DM) are offered features like trend arrows and limited predictions linked to predefined situations. Thus, the impact of extended glucose predictions on the burden of diabetes and person-reported outcomes (PROs) is unclear. In this online survey, 206 people with type 1 and type 2 diabetes (T1D and T2D), 70.9% and 29.1%, respectively, who participated in the dia·link online panel and were current continuous glucose monitoring (CGM) users, were presented with different scenarios of hypothetical extended glucose predictions. They were asked to imagine how low glucose predictions of 30 minutes and overnight as well as glucose predictions up to 2 hours would influence their diabetes management. Subsequently, they completed the Hypoglycemia Fear Survey II (HFS-II) and the T1 Diabetes Distress Scale (T1-DDS) by rating each item on a 5-point scale (-2: strong deterioration to +2: strong improvement) according to the potential change due to using glucose predictions. For all glucose prediction periods, 30 minutes, up to 2 hours, and at nighttime, the surveyed participants expected moderate improvements in both fear of hypoglycemia (HFS-II: 0.57 ± 0.49) and overall diabetes distress (T1-DDS = 0.44 ± 0.49). The T1-DDS did not differ for type of therapy or diabetes. People with T1D and T2D would see glucose predictions as a potential improvement regarding reduced fear of hypoglycemia and diabetes distress. Therefore, glucose predictions represent a value for them in lowering the burden of diabetes and its management.

Demographic and geographic distribution of diabetes and pre-diabetes risk in rural settings: results from a cross-sectional, countywide rural health survey in Sullivan County, New York

ObjectiveTo perform a detailed characterisation of diabetes burden and pre-diabetes risk in a rural county with previously documented poor health outcomes in order to understand the local within-county distribution of...

Health Care Expenditure in United States Adults With Heart Failure With and Without Diabetes

The health costs for heart failure (HF) among individuals with and without diabetes can help understand the conjoint burden of diabetes and HF. Using the 2008–2019 US national Medical Expenditure Panel Survey data including 2,019 adults with HF and a 2-part adjusted model, we estimated mean and adjusted incremental direct medical expenditures related to diabetes. The total direct expenditures for individuals with HF increased by 27%: $24,725 (95% confidence interval [CI]: $20,457-$28,993) in 2008-2009 to $31,426 (95% CI: $25,705-$37,147) in 2018-2019. The expenditures rose by 34% among those with diabetes. Inpatient costs represented the highest fraction of costs ∼ 43.3 % and were 8% higher among those with diabetes vs. those without diabetes. The drug costs accounted for 24% of all costs, increased by 44%, and were 86% higher among HF patients with diabetes vs. those without diabetes. The adjusted excess costs among individuals with HF and diabetes vs. HF without diabetes was $6,818 (95% CI: 2,241-11,395); the corresponding excess costs for drugs and medical costs other than drugs were $3,297 (95% CI: 2,168-4,426) and $3,554 (95% CI: -777-7,886). Among US adults with HF, the estimated adjusted total direct excess costs were $5.2 billion per year higher among individuals with diabetes vs. those without diabetes. In conclusion, diabetes is associated with substantially increased health care costs among patients with HF, suggesting the need for an integrated management of diabetes and HF.