Adult Diabetic Patients Research Articles

The Association Between Elevated Thyroid-Stimulating Hormone Levels and Prolonged Length of Stay Among Adult Diabetic Patients Hospitalized in Internal Medicine Departments: A Large Historical Cohort Study

Background/Objectives: Type 2 diabetes mellitus (DM2) and hypothyroidism are two of the most common endocrine disorders in clinical practice. Hospital length of stay (LOS) is a quality metric of the health systems. We evaluated the association between elevated thyroid-stimulating hormone (TSH) levels and prolonged LOS among all adult patients (age ≥ 18 years) with DM admitted to our Internal Medicine departments between 2014 and 2022. Methods: Data on patient characteristics, LOS, and in-hospital mortality were collected. A TSH level > 4.7 μIU/mL was considered as being elevated. A LOS > 75th percentile and in-hospital mortality were defined as being prolonged. Univariate and multivariable analyses were applied, and propensity score matching controlled for differences between patients with normal and those with elevated TSH levels. Results: Of the 19,066 study participants (median age 75.6 years, IQR 75.9–83.3), 1524 (7.9%) had elevated TSH levels, and prolonged LOS was significantly more common among them (before matching: 38.6% vs. 29.1%, p < 0.001; after matching: 38.7% vs. 32.6%, p = 0.001). After adjustment for potential confounders, elevated TSH levels were also associated with prolonged LOS (OR = 1.22, 95% CI 1.07–1.39, p = 0.002). Conclusions: Elevated TSH levels in diabetic patients hospitalized in Internal Medicine departments are associated with prolonged LOS, emphasizing the importance of identifying hypothyroidism among them.

Dietary practices and associated factors among adult diabetic patients at academic tertiary-level hospitals in central Ethiopia: convergent mixed study

BackgroundDiabetes mellitus (DM) is one of the most prevalent chronic diseases worldwide. Despite the existence of national strategies to prevent potential complications, DM-related morbidities and mortality continue to rise in Ethiopia. Although studies have been conducted regarding dietary practices among DM patients in the country, there is a lack of in-depth understanding of the situation.ObjectiveTo assess dietary practices and associated factors among adult DM patients at academic tertiary-level hospitals in central Ethiopia in 2024.MethodsA concurrent mixed-methods study was conducted from January 01 to 30, 2024, involving 420 adult DM patients. Participants were selected using a simple random sampling technique for the quantitative study. A purposive sampling technique was used to select sixteen participants for qualitative analysis. For the quantitative study, a self-administered structured questionnaire was used to collect data, and in-depth interviews were conducted for the qualitative part. Multivariate binary logistic regressions were used to assess the explanatory variables associated with dietary practice. A thematic analysis was performed for qualitative data.ResultOf 420 eligible participants, 406 (96.7%) participated in the study. The overall proportion of good dietary practices among participants was 172 (42.4%). Being female, residing in urban areas, having a family history of DM, and having good dietary knowledge were significantly associated with better dietary practices. From the qualitative analysis, two themes emerged "Living as before and not adhering to diabetic dietary recommendations" and "Barriers to adherence to effective eating practices."Conclusions and recommendationsLess than half of adult DM patients had good dietary practices. Sex, geographic location, family history of DM, and level of knowledge of diabetic diet were associated with dietary practice. Intervention programs on awareness creation and training to improve the dietary practice by stakeholders were recommended.

Factors affecting time to recovery from diabetic ketoacidosis in adult diabetic patients in Alexandria Main University Hospital

BackgroundDiabetic ketoacidosis (DKA) is a life-threatening condition as a complication of diabetes and represents a significant healthcare global burden. The current study goal was to determine factors affecting time to recovery from DKA in Alexandria Main University Hospital.Patients and methodsOne hundred fifty patients who had been admitted with DKA were included in this study. All patients were managed with hospitalization for IV fluids, continuous intravenous insulin infusion, electrolyte correction, as well as detection and treatment of the predisposing factor until the full resolution of DKA.ResultsMales contributed to 58.7% of the total patients in this study with a mean age of 32.16 ± 15.06 years. DKA mean time of resolution was 18.76 ± 14.07 h. The majority of patients were with T1DM (86%), while T2DM were 14%. Missed insulin dose was the leading precipitating factor (60.7%) followed by infections (38.7%). There was a statistically significant relationship between DKA resolution time with age, time of presentation, type of diabetes, initial pH, initial serum K+ level, initial HCO3− level, initial anion gap, initial base excess, and initial RBS (p value < 0.001).ConclusionDelayed time of resolution from DKA was associated with initial lower pH, initial lower HCO3− level, initial lower base excess level, initial higher anion gap level, type 2 diabetes mellitus, patients on pre-mixed insulin regimen, old patients, delayed time for seeking medical care, and abnormal serum K+ level.

Missed Appointments and the Potential Correlation between Personal Characteristics, Personality, and Familial Characteristics and Missed Appointments for Adults with Diabetes Mellitus at the Primary Care Unit of Khon Kaen Province.

Regular follow-up treatment is important for the management of diabetes and to reduce the risk of complications. In this study, we aimed to evaluate the proportion of adult diabetic patients who miss appointments, in addition to the potential correlation between personal characteristics, personality, and the context of family structure and characteristics and missed appointments by adult patients with type 2 diabetes. This study was a cross-sectional descriptive study. The data were gathered through self-administered questionnaires and the patient medical records of 106 individuals who received healthcare services at the Khon Kaen Province primary care unit. Data were gathered from 1 November 2023 to 28 December 2023. Adjusted odds ratios (aORs) and Chi-Square statistics were used to evaluate the relationships with multivariate analyses via multinomial logistic regression and the Kruskal-Wallis test. The majority of patients in the sample, 39.62%, regularly missed appointments. There was a significant association between occasionally missed appointments and middle adulthood (p-value 0.013) and regular exercise (p-value 0.025). A moderate level of the agreeableness personality trait showed a significant association with missed appointments (p-value 0.042). It is important to have a comprehensive understanding of the patient's personality and family characteristics to effectively plan their healthcare and provide optimal support for diabetes treatment.

Diabetic health literacy and associated factors among patients with diabetes attending follow-up in public hospitals of Northeastern Ethiopia: a multicentre cross-sectional study

ObjectiveTo assess the magnitude of diabetic health literacy (DHL) and associated factors among diabetes patients attending follow-up at public hospitals in Northeastern Ethiopia.DesignAn institution-based cross-sectional study was conducted from 24...

Real-World Effectiveness of Oral Semaglutide in Indian Adult Diabetic Patients: Evaluation of EMR-based Data

Abstract Introduction: Diabetes is increasingly becoming a significant health concern globally, including in India, where its prevalence continues to increase. Being overweight often acts as a catalyst for developing diabetes, exacerbating the condition and increasing the risk of other serious health complications such as heart disease, kidney problems, and nerve damage. Peptide-based molecules like semaglutide have proved their efficacy in controlling glycated hemoglobin (HbA1c) levels and body weight in diabetic patients. Objective: The present study aims to determine the effectiveness of oral semaglutide in a real-world setting. Materials and Methods: This retrospective study included patients ≥18 years of age prescribed oral semaglutide with a follow-up visit between 80 and 160 days post-prescription and had baseline body mass index (BMI) ≥ 30 kg/m2 and HbA1c levels ≤10.0%. The primary endpoints were to assess changes in HbA1c level, BMI, and body weight from the baseline. The secondary endpoints were to determine the changes in postprandial blood sugar (PPBS), fasting blood sugar (FBS), and blood pressure. The analysis also encompassed data on comorbid conditions and concomitant medications prescribed. Results: A total of 188 patients met the study eligibility criteria. At the follow-up visit, a statistically significant mean reduction of 0.34% in HbA1c levels and a weight loss of 1.83 kg were observed. The average duration between baseline and follow-up visit was 114.14 ± 21.5 days. The mean reduction in the BMI was 0.73 kg/m2 (P &lt; 0.001). During the follow-up visit, the PPBS level decreased by 9.95 mg/dL and the FBS level decreased by 5.02 mg/dL. Additionally, the effect of semaglutide on blood pressure was evident, with a reduction in systolic blood pressure by 1.69 mm Hg and diastolic blood pressure by 1.30 mm Hg. The most common comorbid condition was dyslipidemia (66.49%), followed by hypertension (51.60%) and obesity (39.36%). Conclusion: Semaglutide demonstrated significant reductions in glycemic parameters, body weight, and blood pressure.

Blue Index as a Comprehensive, Patient-centered Assessment of Care in Diabetic Patients.

Assessment of diabetes health takes into account metabolic, nonmetabolic, and self-care measures like diet, exercise, follow-up, and habits. On the other hand, the index of complications includes the macro- and microvascular complications of diabetes along with foot complications. The Blue Index (BI) is a composite assessment of both diabetic health-related parameters and systemic complications stemming from diabetes. The present study aimed to evaluate the diabetes control status of the patients as a single index. A prospective, observational study included a total of 100 adult diabetic patients in whom diabetic health status (DHS) and Komplications Score (KS) were assessed for cardiovascular/macrovascular, microvascular, and foot complications. The BI was calculated as a composite ratio, and measures were obtained at baseline, after 3 months, and at 6 months. Data were statistically analyzed. Diabetic health status significantly increased at the 3rd month and the 6th month, respectively, compared to baseline (p = 0.000). KS significantly decreased at the 3rd month and the 6th month, respectively, compared to baseline measures (p = 0.000). The composite BI scores showed a steady increase of 9.62 at the 3rd month and 13.14 at the 6th month, respectively, compared to baseline. Assessing based on the duration of diabetes detection, the scores of DHS, KS, and BI showed similar changes. Assessing based on patients' gender, DHS was significantly higher in females at baseline compared to males, with gradual improvement in scores over time for both genders. Contrastingly, KS was significantly lower in males compared to females, with scores showing gradual decrement over the time frame, signifying improvement in complications. DHS was significantly correlated with the duration of diabetes detection (p = 0.001) and age (p = 0.01). The BI is a simple tool that incorporates various parameters covering different aspects of diabetes care, including complications. It may be used not only by endocrinologists but also by all physicians as a tool to monitor and improve diabetic care.

Barriers for adherence to diabetic retinopathy screening among Saudi adult population, 2023

BACKGROUND: One common and blinding consequence of diabetes is diabetic retinopathy. However, adherence to regular screening remains a challenge for Saudi adults. The goal of this study is to investigate and identify the barriers that hinder Saudi diabetic adults from adhering to screening for diabetic retinopathy. MATERIALS AND METHODS: This cross-sectional study was conducted in a sample of adult diabetic patients throughout Saudi Arabia. Data was collected using a self-administered validated questionnaire comprising following five primary sections: sociodemographic information, profile of diabetes, knowledge of diabetic retinopathy, behaviors, and hurdles to diabetic retinopathy screening. Sample selected using snowball sampling technique. Questionnaire was converted into Google Forms and was shared with study participants via E-mail and several social media sites, including Facebook and WhatsApp during November and December 2023. Data analyzed using SPSS; mean and standard deviation were calculated for continuous variables, whereas categorical data was presented as frequency and percentage. Logistic regression analysis determined barriers for adherence to screening for diabetic retinopathy. RESULTS: The mean age of the study group was 61.6 ± 15 years, and 58.3% were female. Out of 393 respondents, 71% had undergone retinopathy screening in the past few months; 29.0% had a history of diabetic retinopathy. Participants who knew about retinopathy were eight times more likely to have eye screening compared to those who did not know about retinopathy (odds ratio = 8.05, P &lt; 0.001). Less screening chance was observed among those who had acquired their knowledge from the Internet (odds ratio = 0.23, P = 0.002) or relatives (odds ratio = 0.21, P = 0.002) compared to those who had been advised by their physicians. CONCLUSION: These findings underscored the multifaceted nature of barriers to regular screenings within the Saudi Arabian healthcare system. By understanding and addressing these barriers, healthcare systems can enhance the effectiveness of screening programs and improve health outcomes.

Impact of Lifestyle and Demographic Factors on Diabetes-Associated Complications; A Cross-Sectional Study

Globally, the prevalence of Diabetes Mellitus (DM), a leading cause of death and morbidity, is rising, adults with DM have the highest prevalence of chronic illness. This study pursuits to assess and evaluate the impact of life style and demographic factors that aggravates the diabetic complications. Methods: A cross-sectional study design was carried out in adult diabetic patients. The study was a nationally based study in Lahore, Pakistan, target population was Medical OPDs and Diabetic Care centers. Participants includes both gender with age 20 year to 70 years who’s diagnosed with type 2 Diabetes Mellitus. The study variables include the demographic information, patient assessment, regarding the life style, face to face interview through self-structured questionnaire and anthropometric measurement were taken from every participant (weight, height). SPSS version 20.0 was used for data analysis. Results: The sample of this study consisted of 189 (51.1%) females and 181(48.9%) male respondents (N=370). The descriptive Statistics of gender of respondents giving standard deviation of 0.501 and variance of 0.251. As all the respondents are diabetic patients so while cross tabulating the gender with Obese scale 167 of the total population fall in normal weight scale, 110 are categorized as overweight and 33 as obese. The people with good knowledge about their life style impact on Diabetes complications were relatively less affected. Conclusions: The findings alert the medical practitioner informed the patients about the significance of impact of sedentary lifestyle on diabetic’s complications. Regular screening for diabetic patient is necessary for the early detection of complications by skilled health professionals.

An assessment of perceived patient satisfaction and glycaemic control pattern among adult diabetics attending a tertiary care clinic in north central Nigeria

Background: Patient satisfaction as one of the indicators of patient centered care, has taken a central point in the management of chronic diseases such as diabetes mellitus. Aim/objectives: This study aimed to assess perceived patient satisfaction and glycaemic control among adult diabetics attending the General Out-Patient Clinic. Methodology: This was a cross-sectional study conducted between September 2021 and November 2021 involving 134 adult diabetic patients selected by systematic random sampling. Data was collected by interviewer administered questionnaire. Height, weight, blood pressure measurements and fasting blood glucose assay were done. Data was analyzed with the Statistical Package for Social Sciences (SPSS) version 25. Analysis was done at the 5% level of significance with p &lt; 0.05 considered statistically significant. Results: A larger population (81) of the participants were females representing 60.4%. The mean age of the patients was 51.82 ± 12.19 years. The level of perceived patient satisfaction and glycaemic control were 88% and 37.3% respectively. Blood pressure status was the only independent predictor for patient satisfaction. Ethnicity, level of education, occupation and average monthly income showed statistically significant relationship with glycaemic control. Furthermore, comorbidity, perceived patient satisfaction, medication adherence, BMI and blood pressure status also showed statistically significant association with glycaemic control. Conclusion: Less than 40% of participants achieved good glycaemic control despite high level of perceived patient satisfaction (88%) in this study.

Low estimated glomerular filtration rate and proteinuria among adult diabetic patients in a tertiary hospital in Eastern Uganda - a cross-sectional study

BackgroundChronic kidney disease (CKD) is one of the most common complications of diabetes mellitus (DM). Diabetes mellitus contributes to about 66% of CKD cases globally. CKD results in increased morbidity and mortality and advanced stages often require kidney replacement therapy that is unaffordable for the majority of the patients. Developing countries have scanty data regarding CKD burden in diabetic patients.ObjectivesThis study aimed at determining the prevalence of low estimated glomerular filtration rate (eGFR) and proteinuria and associated clinical and socio-demographic factors among adult diabetic patients attending the diabetic clinic of Mbale Regional Referral Hospital (MRRH).MethodsA cross-sectional study was conducted at the adult diabetic clinic of MRRH in Eastern Uganda. A total of 374 adult diabetic patients were enrolled. A urine sample for urine albumin creatinine ratio (UACR) determination and a venous blood sample for measurement of serum creatinine were obtained from each participant. The eGFR was determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and CKD was staged according to the Kidney Disease Improving Global Outcomes (KDIGO) classification.ResultsA total of 318 (85%) participants had an eGFR of ≤ 60 mL/min/1.73m2, UACR of ≥ 30g/g, or both. Only 6.1% were aware. Age, duration of DM, hypertension, and dyslipidemia were associated with low eGFR and proteinuria.ConclusionThere is a high prevalence of low eGFR and proteinuria among DM patients, 85% of the participants had these markers of CKD and the majority of them were undiagnosed. Over half of the DM patients had an eGFR consistent with advanced CKD. Strengthening routine screening for CKD biomarkers and equipping DM clinics with more diagnostic resources is recommended.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and diabetic kidney disease in patients with diabetes in the United States: a cross-sectional study

BackgroundThis paper investigated the link between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and diabetic kidney disease (DKD) in adult diabetic patients and identified the optimal NHHR value for impacting DKD.MethodsThis cross-sectional research made use of records from the National Health and Nutrition Examination Survey (NHANES) executed between 2005 and 2016. The link of NHHR to DKD risk was analyzed by logistic regression and restricted cubic spline (RCS) models. The stability and reliability of the results were assessed by subgroup analysis and sensitivity analysis.ResultsIn total, 4,177 participants were involved. As a continuous variable, NHHR was markedly connected to an increased risk of DKD (OR 1.07, 95% CI 1.02, 1.12, P < 0.01). When NHHR was grouped in quartiles, relative to the reference set, the highest NHHR group was also linked to a heightened risk of DKD (OR 1.23, 95% CI 1.01, 1.50, P < 0.05). The outcome of RCS show a “J” shaped correlation between NHHR and DKD risk (P for nonlinear = 0.0136). The risk of developing DKD was the lowest when NHHR equals 2.66. Subgroup analysis revealed that the link of NHHR to DKD persisted in participants aged below 40, females, non-smokers, and those without hyperuricemia. Sensitivity analysis demonstrated a certain robustness in this association.ConclusionA meaningful link is present between NHHR and DKD. An NHHR value of around 2.66 could represent the ideal cutoff for assessing DKD risk.

P076 FACTORS INFLUENCING POST-COVID HOME BP AND HR FLUCTUATION WITHIN THE URBAN INDIAN DIABETIC POPULATION

Objective: The impact of COVID-19 on cardiovascular health among adult diabetics remains underexplored, particularly concerning home blood pressure (BP) and heart rate (HR) variability. This study aims to elucidate the factors influencing post-COVID home BP and HR fluctuation within the urban Indian diabetic population. Design and Methods: A cross-sectional study was conducted, involving 1000 adult diabetic patients aged 30 to 80 years with prior COVID-19 infection. Home BP and HR readings were recorded twice daily over seven days, generating 28 measurements. Variability in BP and HR was determined using standard deviation calculations between morning and evening readings, as well as between consecutive measurements. Results: Older age (OR: 1.56, 95% CI: 1.23-1.98), cardiovascular comorbidities (OR: 2.09, 95% CI: 1.67-2.62), diabetes (OR: 1.84, 95% CI: 1.43-2.36), and elevated home BP (OR: 2.35, 95% CI: 1.87-2.95) emerged as independent predictors of increased morning-to-evening home BP variability. Similarly, older age (OR: 1.72, 95% CI: 1.34-2.21) and elevated home BP (OR: 2.14, 95% CI: 1.67-2.75) were determinants of heightened day-to-day BP variability, while a combination of older age (OR: 1.98, 95% CI: 1.52-2.58), female sex (OR: 1.43, 95% CI: 1.11-1.84), cardiovascular disease (OR: 1.89, 95% CI: 1.47-2.44), and elevated home BP (OR: 2.56, 95% CI: 1.98-3.31) predicted greater variability between consecutive readings. Conversely, younger age (OR: 0.76, 95% CI: 0.59-0.98) and elevated home HR (OR: 1.92, 95% CI: 1.51-2.44) were associated with increased morning-versus-evening HR variability. Additionally, younger age (OR: 0.67, 95% CI: 0.51-0.88), female sex (OR: 1.34, 95% CI: 1.04-1.73), and elevated home HR (OR: 1.78, 95% CI: 1.39-2.29) were predictive of greater variability between consecutive HR measurements. Conclusion: Understanding the determinants of home BP and HR variability post-COVID infection is crucial for prognostication and clinical management. Clinicians should prioritize counseling incorporating regular home blood pressure measurements, diabetes management, and cardiovascular disease prevention, particularly for high-risk diabetic patients.

Time to first optimal glycemic control and its predictors among adult type 2 diabetes patients in Amhara Regional State comprehensive specialized hospitals, Northwest Ethiopia

BackgroundInadequate glycemic management in type 2 diabetes Mellitus patients is a serious public health issue and a key risk factor for progression as well as diabetes-related complications. The main therapeutic goal of preventing organ damage and other problems caused by diabetes is glycemic control. Knowing when to modify glycemic control in type 2 diabetes Mellitus is crucial for avoiding complications and early drug intensifications.MethodsAn institutional based retrospective follow-up study was undertaken among 514 eligible adult diabetes patients in Amhara region Comprehensive Specialized Hospitals, Northwest Ethiopia, from January 2017 to January 2022. Simple random sampling technique was used to select study participants. The Kaplan Meier curve was used to assess the survival status of categorical variables, and the log-rank test was used to compare them. The cox proportional hazard model was fitted to identify the predictors of time to first optimal glycemic control. Variables with a p-value < 0.05 were considered to be statistically significance at 95% confidence interval.ResultsA total of 514 patient records (227 males and 287 females) were reviewed in this study. The median time to first optimal glycemic control among the study population was 8.4 months IQR (7.6–9.7). The predictors that affect the time to first optimal glycemic control were age group ((AHR = 0.63, 95% CI = 0.463, 0.859 for 50–59 years), (AHR = 0.638, 95% CI = 0.471, 0.865 for 60–69 years), and (AHR = 0.480, 95% CI = 0.298, 0.774 for > = 70 years)), diabetes neuropathy (AHR = 0.629, 95% CI = 0.441,0.900), hypertension (AHR = 0.667, 95% CI = 0.524, 0.848), dyslipidemia (AHR = 0.561, 95% CI = 0.410, 0.768), and cardiovascular disease (AHR = 0.681, 95% CI = 0.494, 0.938).ConclusionThe median time to initial optimal glycemic control in type 2 diabetes Mellitus patients in this study was short. Age between 50 and 59 years and 60–69, diabetes neuropathy, hypertension, dyslipidemia, and cardiovascular disease were predictor’s of time to first glycemic control. Therefore, health care providers should pay extra attention for patients who are aged and who have complications or co-morbidities.

Effects of empagliflozin and dapagliflozin on serum humanin, MOTS-c levels, nitrosative stress, and ferroptosis parameters in diabetic patients with heart failure

Sodium-glucose cotransporter 2 (SGLT2) inhibitors produce cardioprotective effects on heart failure (HF), even in the absence of diabetes. However, the underlying mechanisms of this cardioprotective effect remain unexplored. The purpose of this study was to examine the effects of SGLT2 inhibitors on serum MOTS-c, humanin levels, nitrosative stress, and ferroptosis parameters in diabetic patients with HF with reduced ejection fraction (HFrEF). A total of 74 adult diabetic patients with HFrEF and 37 healthy controls were included in this prospective study. Half of the patients were using SGLT2 inhibitors (empagliflozin or dapagliflozin) for at least two months. Serum nitric oxide and 3-nitrotyrosine levels were markedly higher in diabetic patients with HFrEF than the control (P < 0.001), but these elevations were inhibited with SGLT2 inhibitors. Although SGLT2 inhibitors had no marked effect on humanin levels, they significantly augmented MOTS-c levels when compared to the control. SGLT2 inhibitors augmented GPX4 but inhibited ACSL4 levels when compared to diabetic patients with HF. However, TFRC levels were increased in the patient group (P < 0.001 for all) but not modified with SGLT2 inhibitors. Our results suggest that increased nitrosative stress is significantly depressed by SGLT2 inhibitors. This study was the first to show that SGLT2 inhibitors can stimulate MOTS-c, but not humanin, in diabetic patients with HFrEF. SGLT2 inhibitors reduced ferroptosis through elevation of GPX4 and suppression of ACSL4 levels. Our data suggest that SGLT2 inhibitors could produce cardioprotective effects through relieving ferroptosis, inhibiting nitosative stress, and stimulating mitochondrial MOTS-c release.

Evaluation of Common Risk Factors of Diabetic Nephropathy among Diabetic Adults

Background: Diabetic nephropathy (DN) is a specific micro vascular complication of diabetes mellitus (DM), approximately one third of affected diabetic patients eventually develop DN. The level of albuminuria is highly correlated with the intraglomerular pressure which is the key determinant of DN. A number of risk factors were suggested for the development of DN. Objective: To evaluate the common risk factors of diabetic nephropathy and to determine the association of different risk factors with diabetic nephropathy among adult diabetic patients. Methods: This cross-sectional study was conducted at the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. A total of one hundred twenty-eight (128) adult diabetic patients were enrolled. We identified nephropathy among them by doing albumin creatinine ratio (ACR) on spot urine and carried out relevant laboratory investigations. Common risk factors of diabetic nephropathy like- hypertension (HTN), overweight/obesity, family history of HTN/DM/DN, duration of DM, glycated hemoglobin (HbA1C) and dyslipidemia were evaluated accordingly. Result: Among 128 study population, 52 (40.6%) patients were found to have diabetic nephropathy. Of them, 27.3% had microalbuminuria, 13.3% had macroalbuminuria. Hypertension, overweight/obesity, family history of HTN/DM and dyslipidemia were observed to be significantly higher in nephropathy group than those in the non-nephropathy group (p&lt;0.05). Hypertension, dyslipidemia and duration of diabetes mellitus were the independent predictors for diabetic nephropathy. Conclusion: The prevalence of diabetic nephropathy is high (40.6%) among diabetic adults. Several risk factors are significantly associated with diabetic nephropathy. Hypertension, dyslipidemia and duration of diabetes mellitus are the independent predictors for diabetic nephropathy.

Commentary on: Factors influencing foot care behaviour among patients with diabetes: An integrative literature review by Woo MWJ, CUI J (2023).

The review by Woo etal. reports on factors influencing behaviour in the care of the diabetic foot, wich are common in diabetic patients and have a high risk of infection and amputation. To improve patient's knowledge and education on foot care, this commentary proposes the Barrows cards as an innovative user-friendly educational method. Conclusion and implications for profession and patient care: adapting these cards to adult diabetic patients could prevent future complications, improving quality of life and reduce the risks associated with diabetes. No patient or public contribution.

Prevalence of Depression and Its Associated Factors among Adult Libyan Diabetic Patients Attending Golden Polyclinic, Al-Badri, Tripoli

Background and aims: Depression is a significant public health concern and a common comorbid condition among patients with diabetes mellitus. This study aims to assess the prevalence of depression and its associated factors among patients with diabetes in the Al-Badri polyclinic. Methods: A descriptive cross-sectional study was conducted at Al-Badri Polyclinic from February to April 2024. The presence of depression among diabetes patients was assessed using the 9-item Patient Health Questionnaire (PHQ-9) scale. Data was entered and analyzed by using SPSS software version 26. Results: A total of two hundred and forty-seven participants were enrolled in the study, with 142 (57.5%) being female and 168 (68.0%) aged between 41 and 60 years. The majority of participants (71.7%) were married, and 40.5% were employed. Additionally, 78% had a positive family history of diabetes mellitus. Among the participants, 43.3% were smokers. The duration of diabetes mellitus was more than 10 years for 52.2% of the patients. Approximately two-thirds of the patients (61.5%) were taking tablets for the treatment of DM. The majoring of the patients (98.8%) had an HbA1c level of 6.5 or higher. Approximately one-third of the patients had hypertension as a comorbidity with DM, and 12.1% had heart disease as a complication of diabetes. The overall prevalence of moderate depression among the diabetes patients at the clinic was 24.7%. The majority (70.4%) exhibited mild depression, and 4.9% experienced minimal depression. No cases of severe depression were identified. Factors independently associated with depression included being on age, marital status, insulin therapy, and comorbidities. Conclusion: Depression was prevalent in our diabetic patients. Factors independently associated with this included being on age, marital status, insulin therapy, and comorbidities. The study emphasizes and recommends the importance of identifying and managing depression among diabetes patients. It is also recommended to increase awareness of the benefits of early diagnosis of patients to prevent major forms of depression and cost saving for the health system. Programs for screening depression should be implemented in primary care settings.

Assessment of Health-Related Quality of Life and Its Determinants in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study.

Background Type 2 diabetes mellitus is a complex metabolic disorder associated with several complications that determine the quality of life of the patients. Health-related quality of life (HRQoL) is a measurable outcome of the self-perception of a patient's health which is affected due to age, lifestyle changes, medication, and treatment modalities. This study was undertaken to understand the impact of individual parameters of age, medication type and duration, diabetes-associated complications, and levels of glycated hemoglobin (HbA1c) on the quality of life (QoL) of the patient. Methodology This single-center prospective, cross-sectional study was conducted at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India. Participants were recruited from the Outpatient Department of General Medicine, IGIMS.HRQoL was measured using a validated and reliable EuroQol 5-dimensions 5-levels (EQ-5D-5L) questionnaire developed by the EuroQol Research Foundation, along with the EuroQol-Visual Analogue Scale (EQ-VAS). The eligibility criteria included adult diabetic patients above 18 years of age with complete medical records, who had been treated at the outpatient department for a minimum of three months and could be interviewed. Results The results from this study show that 46% of the patients belonged to the age group of 45-65 years. The quality of health index scores and EQ-VAS scores significantly correlated withage (p-values: 1.11 e-4 and 3.09 e-5; <0.05). Of the subjects,66.4%, 6.7%, and 26.8% were under oral hypoglycaemic agents (OHA), insulin, and both insulin with OHA medications respectively. HbA1C levels werestatistically significantly correlated with mobility, self-care, usual activities, pain or discomfort, and anxiety or depression (p-value 0.032; <0.05), along with self-perception of the patient's health (p-value 0.00026; <0.05).Also, the perception of having slight problems in mobility, self-care, usual activities, pain or discomfort, and anxiety or depression was similar irrespective of gender (EQ-5D-5L score for males: 9.47 and females: 9.3). Despite suffering from diabetes-associated chronic complications, 60.5% of the subjects perceived their overall health to be good as indicated by the scores. Conclusion The self-perception of HRQoL concerning mobility, self-care, usual activities, pain or discomfort, and anxiety or depression was correlated with age, duration of anti-diabetic medication, and HbA1C level. Good mobility, self-care, and performing usual activities reduce anxiety or depression as opposed to age, pain, and discomfort. However, the subjects in this study cohort perceived overall good health in themselves in terms of EQ-VAS and 5D-5L scores, indicating effective diabetic care and management options available to them.

Effectiveness of shared decision-making for glycaemic control among type 2 diabetes mellitus adult patients: A systematic review and meta-analysis.

In diabetes care and management guidelines, shared decision-making (SDM) implementation is explicitly recommended to help patients and health care providers to make informed shared decisions that enable informed choices and the selection of treatments. Despite widespread calls for SDM to be embedded in health care, there is little evidence to support SDM in the management and care of diabetes. It is still not commonly utilized in routine care settings because its effects remain poorly understood. Hence, the current systematic review and meta-analysis aimed to evaluate the effectiveness of SDM for glycaemic control among type 2 diabetes adult patients. Literature sources were searched in MEDLINE, PubMed, Cochrane library and HINARI bibliographic databases and Google Scholar. When these records were searched and reviewed, the PICO criteria (P: population, I: intervention, C: comparator, and O: outcome) were applied. The extracted data was exported to RevMan software version 5.4 and STATA 17 for further analysis. The mean differences (MD) of glycated hemoglobin (HbA1c) were pooled using a random effect model (REM), and sub-group analysis were performed to evaluate the effect size differences across the duration of the follow-up period, modes of intervention, and baseline glycated hemoglobin level of patient groups. The sensitivity analysis was performed using a leave-one-out meta-analysis to quantify the impact of each study on the overall effect size in mean difference HbA1c%. Finally, the statistically significant MD of HbA1c% between the intervention groups engaged in SDM and control groups received usual care was declared at P ˂0.05, using a 95% confidence interval (CI). In the database search, 425 records were retrieved, with only 17 RCT studies fulfilling the inclusion criteria and were included in the meta-analysis. A total of 5416 subjects were included, out of which 2782(51.4%) were included in trial arms receiving SDM and 2634(48.6%) were included in usual diabetes care. The Higgins (I2) test statistics were calculated to be 59.1%, P = 0.002, indicating statistically significant heterogeneity was observed among the included studies, and REM was used as a remedial to estimate the pooled MD of HbA1c% level between patients who participated in SDM and received usual care. As a result, the pooled MD showed that the SDM significantly lowered HbA1c by 0.14% compared to the usual care (95% CI = [-0.26, -0.02], P = 0.02). SDM significantly decreased the level of HbA1c by 0.14% (95% CI = -0.28, -0.01, P = 0.00) when shared decisions were made in person or face-to-face at the point of care, but there was no statistically significant reduction in HbA1c levels when patients were engaged in online SDM. In patients with poorly controlled glycaemic level (≥ 8%), SDM significantly reduced level of HbA1c by 0.13%, 95% CI = [-0.29, -0.03], P = 0.00. However, significant reduction in HbA1c was not observed in patients with ˂ 8%, HbA1c baseline level. Overall, statistically significant reduction of glycated hemoglobin level was observed among T2DM adult patients who participated in shared decision-making compared to those patients who received diabetes usual care that could lead to improved long-term health outcomes, reducing the risk of diabetes-related complications. Therefore, we strongly suggest that health care providers and policy-makers should integrate SDM into diabetes health care and management, and further study should focus on the level of patients' empowerment, health literacy, and standardization of decision supporting tools to evaluate the effectiveness of SDM in diabetes patients.