Diabetes In General Population Research Articles

Factors Affecting the Awareness of Diabetic Retinopathy: An Observational Cross-Sectional Study.

Diabetes mellitus (DM) is a chronic metabolic disease characterized by elevated blood glucose levels. Over time, it can lead to serious complications in the eyes, heart, blood vessels, kidneys, and nerves, being the leading cause of blindness among working-age patients. This descriptive observational cross-sectional study aims to evaluate the factors affecting the awareness of the general adult diabetic population about their chronic disease and its complications. A survey was distributed anonymously among diabetic patients in different parts of Jordan over four months (January 2023-April 2023), targeting diabetic patients (DMT2 or adults DMT1). The link was sent via WhatsApp to willing candidates. Data collected included age, sex, region, education, home blood sugar (BS) testing, knowledge about cumulative blood sugar test (HbA1c), eye affection by DM, optician role, and doctor and nutritionist follow-up visits. A chi-squared test or Fisher's exact test explored the association between categorical data; a z-test was applied for column proportion differences. An alpha level of 0.05 was deemed statistically significant. IBM SPSS Statistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York) was used for data analysis. The sample comprised 447 diabetic adults aged 18-80 years. The majority were school-educated or school leavers (278; 62.2%); 20 (4.5%) held a master's or PhD degree. The largest group had DM for one to five years. Insulin was the sole treatment for 188 patients (42.1%), while oral hypoglycemic agents (OHA) were used by 170 patients (38%) as the only anti-DM medication. A total of 174 patients (38.9%) had never been seen by an ophthalmologist, and 153 (34.2%) believed an optometrist checkup suffices. Although 381 (85.2%) reported knowing DM affects the eyes, 272 (60.9%) believed they needed to see an ophthalmologist only when experiencing eye symptoms. Less than half (186; 41.6%) had an HbA1c reading of 7% or less. There was a significant correlation between education level and awareness of DM and diabetic retinopathy (DR): HbA1c, regular home BS checkups, early DR symptoms, and optometrist visits. Significant variations in awareness were noted across Jordan's major areas. Diabetics with abnormal HbA1c who visited a nutritionist were almost triple those who did not. The main information source about DM and DR was the treating physician for 298 (66.7%) respondents. Awareness of DM and DR in Jordan is not satisfactory for assisting patients in their long journey with minimal complications. A national awareness campaign utilizing social media and a sustainable screening program prioritizing the north, south, and middle regions of Jordan are needed.

Artificial intelligence-based prediction of diabetic retinopathy evolution (EviRed): protocol for a prospective cohort

IntroductionAn important obstacle in the fight against diabetic retinopathy (DR) is the use of a classification system based on old imaging techniques and insufficient data to accurately predict its evolution....

Association of anti-diabetic drugs and COVID-19 outcomes in patients with diabetes mellitus type 2 and cardiomyopathy

There is a scarcity of information on the population with diabetes mellitus type 2 and cardiomyopathy (PDMC) in COVID-19, especially on the association between anti-diabetic medications and COVID-19 outcomes. Study is designed as a retrospective cohort analysis covering 2020 and 2021. Data from National Diabetes Registry (CroDiab) were linked to hospital data, primary healthcare data, the SARS-CoV-2 vaccination database, and the SARS-CoV-2 test results database. Study outcomes were cumulative incidence of SARS-CoV-2 positivity, COVID-19 hospitalizations, and COVID-19 deaths. For outcome predictors, logistic regression models were developed. Of 231 796 patients with diabetes mellitus type 2 in the database, 14 485 patients had cardiomyopathy. The two2-year cumulative incidence of all three studies' COVID-19 outcomes was higher in PDMC than in the general diabetes population (positivity 15.3% vs. 14.6%, p = 0.01; hospitalization 7.8% vs. 4.4%, p < 0.001; death 2.6% vs. 1.2%, p < 0.001). Sodium-Glucose Transporter 2 (SGLT-2) inhibitors therapy was found to be protective of SARS-CoV-2 infections [OR 0.722 (95% CI 0.610–0.856)] and COVID-19 hospitalizations [OR 0.555 (95% CI 0.418–0.737)], sulfonylureas to be risk factors for hospitalization [OR 1.184 (95% CI 1.029–1.362)] and insulin to be a risk factor for hospitalization [OR 1.261 (95% CI 1.046–1.520)] and death [OR 1.431 (95% CI 1.080–1.897)]. PDMC are at greater risk of acquiring SARS-CoV-2 infection and having worse outcomes than the general diabetic population. SGLT-2 inhibitors therapy was a protective factor against SARS-CoV-2 infection and against COVID-19 hospitalization, sulfonylurea was the COVID-19 hospitalization risk factor, while insulin was a risk factor for all outcomes. Further research is needed in this diabetes sub-population.

The Impact of Glycemic Control on Sodium-Glucose Co-Transporter 2 Inhibitor-Associated Genitourinary Infections.

Patients with type 2 diabetes (T2D) are at an increased risk of genital urinary (GU) infections, with the risk increasing with higher A1Cs. Given the broad adoption of sodium-glucose co-transporter 2 inhibitors (SGLT2is) in patients with T2D, both providers and patients need to be aware of common adverse effects associated with these medications, specifically GU infections. However trials involving SGLT2is looked at patients with an average A1C of less than 9%, and thus, the incidence of GU infections may not truly reflect the general diabetic population. The purpose of this study is to assess the association between GU infections in patients started on SGLT2is and A1C levels. A retrospective study was conducted on patients seen in an adult, primary care clinic, at New York City Health and Hospitals, South Brooklyn Health. Men and nonpregnant, nonlactating women >18 years old with a diagnosis of T2D who were initiated on an SGLT2i between January 2018 and January 2023 were included in the analysis. The primary endpoint is to compare the risk of GU infections in patients with T2D who were started on SGLT2is, regardless of dose, with hemoglobin A1C of >9% to those with hemoglobin A1C <9% at baseline. Three hundred and twenty-eight patients were eligible based on specified inclusion and exclusion criteria. Overall, there was a statistically significant difference in the number of GU infections that occurred in patients with a baseline A1C >9% compared with those with an A1C <9% (95% confidence interval [CI] = 1.05-2.88; P = 0.041). Type 2 diabetes patients initiated on SGLT2is may experience an increased risk of GU infection, especially in those patients with an A1C of 9% or greater. Further research is necessary to validate and expand upon these findings.

Psychiatric and Substance Use Disorders and Their Association With Clinical Outcomes in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome

BackgroundDiabetic Ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening conditions that send nearly 180,000 patients to the ICU each year, with mortality rates up to 5-10%. Little is known about the impact of concurrent psychiatric disorders on specific DKA/HHS outcomes. Identifying these relationships offers opportunities to improve clinical management, treatment planning, and mitigate associated morbidity and mortality. MethodsWe conducted a retrospective review including adult DKA/HHS admissions within a large Massachusetts hospital system from 2010 – 2019. We identified patients admitted inpatient for DKA or HHS, then filtered by ICD-9-CM, ICD-10-CM codes for psychiatric diagnoses that were present in patients EMR at any point in this observational period. Outcomes included number of inpatient admissions for DKA/HHS, age of death, rates of discharging against medical advice (AMA) from any inpatient admission, and ESRD/dialysis status. Multivariate regression was conducted using R software to control for variables across patients and evaluate relationships between outcomes and concurrent psychiatric disorders. Significance was set at p <0.05. Results7756 patients were admitted for DKA or HHS, 66.9% of which had a concurrent psychiatric disorder. 54.5% of these patients were male, 70.4% White, and an average age of 61.6 years. This compares with 26.1% with concurrent psychiatric condition within the general diabetes population, 52.1% of which were male, 72.1% White, and an average of 68.2 years . A concurrent psychiatric disorder was associated with increased odds of rehospitalization (aOR= 1.62 95%Cl 1.35 - 1.95, p<0.001), of being diagnosed with end-stage renal disease and on dialysis (aOR = 1.02 95% Cl 1.002 – 1.035, p = 0.02), and in leaving AMA (aOR = 6.44 95%Cl 4.46 – 9.63, p <0.001). The average age of death for those with a concurrent psychiatric disorder had an adjusted mean difference in years of -7.5 years (95% Cl -9.3 5.8) compared to those without a psychiatric disorder. Conclusion66.9% of patients with DKA/HHS have a concurrent psychiatric disorder. Patients with a concurrent psychiatric disorder admitted for DKA/HHS were more likely to have multiple admissions, to leave AMA, to be on renal dialysis, and have a lower age of mortality.

Quantifying association and disparities between diabetes complications and COVID-19 outcomes: A retrospective study using electronic health records.

Despite established relationships between diabetic status and an increased risk for COVID-19 severe outcomes, there is a limited number of studies examining the relationships between diabetes complications and COVID-19-related risks. We use the Adapted Diabetes Complications Severity Index to define seven diabetes complications. We aim to understand the risk for COVID-19 infection, hospitalization, mortality, and longer length of stay of diabetes patients with complications. We perform a retrospective case-control study using Electronic Health Records (EHRs) to measure differences in the risks for COVID-19 severe outcomes amongst those with diabetes complications. Using multiple logistic regression, we calculate adjusted odds ratios (OR) for COVID-19 infection, hospitalization, and in-hospital mortality of the case group (patients with diabetes complications) compared to a control group (patients without diabetes). We also calculate adjusted mean difference in length of stay between the case and control groups using multiple linear regression. Adjusting demographics and comorbidities, diabetes patients with renal complications have the highest odds for COVID-19 infection (OR = 1.85, 95% CI = [1.71, 1.99]) while those with metabolic complications have the highest odds for COVID-19 hospitalization (OR = 5.58, 95% CI = [3.54, 8.77]) and in-hospital mortality (OR = 2.41, 95% CI = [1.35, 4.31]). The adjusted mean difference (MD) of hospital length-of-stay for diabetes patients, especially those with cardiovascular (MD = 0.94, 95% CI = [0.17, 1.71]) or peripheral vascular (MD = 1.72, 95% CI = [0.84, 2.60]) complications, is significantly higher than non-diabetes patients. African American patients have higher odds for COVID-19 infection (OR = 1.79, 95% CI = [1.66, 1.92]) and hospitalization (OR = 1.62, 95% CI = [1.39, 1.90]) than White patients in the general diabetes population. However, White diabetes patients have higher odds for COVID-19 in-hospital mortality. Hispanic patients have higher odds for COVID-19 infection (OR = 2.86, 95% CI = [2.42, 3.38]) and shorter mean length of hospital stay than non-Hispanic patients in the general diabetes population. Although there is no significant difference in the odds for COVID-19 hospitalization and in-hospital mortality between Hispanic and non-Hispanic patients in the general diabetes population, Hispanic patients have higher odds for COVID-19 hospitalization (OR = 1.83, 95% CI = [1.16, 2.89]) and in-hospital mortality (OR = 3.69, 95% CI = [1.18, 11.50]) in the diabetes population with no complications. The presence of diabetes complications increases the risks of COVID-19 infection, hospitalization, and worse health outcomes with respect to in-hospital mortality and longer hospital length of stay. We show the presence of health disparities in COVID-19 outcomes across demographic groups in our diabetes population. One such disparity is that African American and Hispanic diabetes patients have higher odds of COVID-19 infection than White and Non-Hispanic diabetes patients, respectively. Furthermore, Hispanic patients might have less access to the hospital care compared to non-Hispanic patients when longer hospitalizations are needed due to their diabetes complications. Finally, diabetes complications, which are generally associated with worse COVID-19 outcomes, might be predominantly determining the COVID-19 severity in those infected patients resulting in less demographic differences in COVID-19 hospitalization and in-hospital mortality.

Association of four health behaviors in Life's Essential 8 with the incidence of hypertension and diabetes mellitus

BackgroundThe association between health behaviors and the risk of developing hypertension and diabetes is not fully understood. We aimed to examine the association between four health behaviors involved in Life's Essential 8, the American Heart Association's key measures for improving and maintaining cardiovascular health, and the incidence of hypertension and diabetes. MethodsThis observational cohort study used the JMDC Claims Database between 2005 and 2021, which is a health check-up and claims database. We analyzed 2,912,183 participants without a history of hypertension, diabetes, cardiovascular disease, or renal failure. Non-ideal health behaviors included smoking, slow gait speed, eating fast, and poor sleep quality. ResultsDuring 1140 ± 877 days, 201,385 hypertension and 142,156 diabetes events were recorded. In a multivariable Cox regression analysis, the risk of hypertension and diabetes increased with an increasing number of non-ideal health behaviors. The hazard ratios (HRs) (95% confidence interval [CI]) per 1-point increase in non-ideal health behavior components for hypertension and diabetes were 1.11 (1.10–1.11) and 1.08 (1.08–1.09), respectively. Each health behavior was independently associated with the incidence of hypertension and diabetes. A 1-point improvement in health behaviors was associated with a lower risk of developing hypertension (HR 0.94, 95% CI 0.93–0.95) and diabetes (HR 0.95, 95% CI 0.94–0.96). ConclusionFactors that can be substituted for the four health behaviors involved in Life's Essential 8 can stratify the risk of hypertension and diabetes, and improving these health behaviors is useful in preventing hypertension and diabetes in general population.

Primary hypocholesterolemia and risk of new-onset diabetes in general population

Primary hypocholesterolemia and risk of new-onset diabetes in general population

Association between serum ALT levels and incidence of new-onset diabetes in general population of Japanese: a longitudinal observational study (ISSA-CKD)

ObjectiveWe aimed to clarify the relationship between serum alanine transaminase (ALT) levels and incidence of new-onset diabetes in a Japanese general population.SettingPopulation-based retrospective cohort study using annual health check-up data...

Heart rate variability and incident type 2 diabetes in general population.

Hyperglycemia and autonomic dysfunction are bidirectionally related. We investigated the association of longitudinal evolution of heart rate variability (HRV) with incident type 2 diabetes (T2D) among the general population. We included 7630 participants (mean age 63.7 years, 58% women) from the population-based Rotterdam Study who had no history of T2D and atrial fibrillation at baseline and had repeated HRV assessments at baseline and during follow-up. We used joint models to assess the association between longitudinal evolution of heart rate and different HRV metrics (including the heart-rate corrected standard deviation of the normal-to-normal RR intervals (SDNNc), and root mean square of successive RR-interval differences (RMSSDc)) with incident T2D. Models were adjusted for cardiovascular risk factors. Bidirectional Mendelian randomization (MR) using summary-level data was also performed. During a median follow-up of 8.6 years, 871 individuals developed incident T2D. One standard deviation (SD) increase in heart rate (hazard ratio [HR], 1.20, 95% confidence interval (CI), 1.09-1.33), and log(RMSSDc) (1.16, 95% CI 1.01-1.33) were independently associated with incident T2D. The HRs were 1.54 (95% CI 1.08-2.06) for participants younger than 62 years and 1.15 (95% CI 1.01-1.31) for those older than 62 years for heart rate (p for interaction <0.001). Results from bidirectional MR analyses suggested that HRV and T2D were not significantly related to each other. Autonomic dysfunction preceeds development of T2D, especially among younger individuals, while MR analysis suggests no causal relationship. More studies are needed to further validate our findings.

Screening Diabetes in General Populations by Point-of-Care HbA1c Measurements at Pharmacies: Aichi Model for Medical Collaboration

Screening Diabetes in General Populations by Point-of-Care HbA1c Measurements at Pharmacies: Aichi Model for Medical Collaboration

Association of healthy lifestyles on the risk of hypertension, type 2 diabetes mellitus, and their comorbidity among subjects with dyslipidemia.

BackgroundAdherence to a healthy lifestyle could reduce the risk of hypertension and diabetes in general populations; however, whether the associations exist in subjects with dyslipidemia remains unclear. This study aimed to investigate the integrated effect of lifestyle factors on the risk of hypertension, type 2 diabetes mellitus (T2DM), and their comorbidity among subjects with dyslipidemia.MethodsIn total of 9,339 subjects with dyslipidemia were recruited from the baseline survey of the Guangzhou Heart Study. A questionnaire survey and medical examination were performed. The healthy lifestyle score (HLS) was derived from five factors: smoking, alcohol drinking, diet, body mass index, and leisure-time physical activity. Odds ratios (ORs) with 95% confidence interval (95% CI) were calculated by using the logistic regression model and the multinomial logistic regression after adjusting for confounders.ResultsThe prevalence of hypertension, T2DM, and their comorbidity was 47.65, 16.02, and 10.10%, respectively. Subjects with a higher HLS were associated with a lower risk of hypertension, T2DM, and their comorbidity. In comparison to the subjects with 0–2 HLS, the adjusted ORs for subjects with five HLS was 0.48 (95% CI: 0.40–0.57) and 0.67 (95% CI: 0.54–0.84) for hypertension and T2DM. Compared with subjects with 0-2 HLS and neither hypertension nor T2DM, those with five HLS had a lower risk of suffering from only one disease (OR: 0.48, 95% CI: 0.40–0.57) and their comorbidity (OR: 0.35, 95% CI: 0.26–0.47).ConclusionsThe results suggest that the more kinds of healthy lifestyle, the lower the risk of hypertension, T2DM, and their comorbidity among subjects with dyslipidemia. Preventive strategies incorporating lifestyle factors may provide a more feasible approach for the prevention of main chronic diseases.

Awareness on Oral Disorders in Diabetes Mellitus among General Population in Chennai

Objective: To evaluate the awareness on oral manifestation of diabetes in general population in Chennai. Background: Diabetes mellitus (DM), according to the World Health Organization is a silent epidemic which affects large number of people around the world and is directly related to the oral health status of the patients. DM is a metabolic disorder of multiple etiologies due to disturbances of carbohydrate, fat, and protein metabolism. It is characterized by chronic hyperglycemia, and it is associated with oral disorders, cardiovascular, and renal complications. These complications result in diminished quality of life and reduced life expectancy. Although dental caries was comparatively low in diabetics, periodontal status was compromised. Awareness on diabetes and increase risk of oral disorders in diabetic patient is comparatively less than awareness on systemic diseases in general population. Hence, this study was conducted to evaluate awareness and educate them by reinforcing the importance of oral health care in diabetes. Methodology: A total of 159 self‑completion questionnaires were distributed to assess the main objectives of the study. Results: The awareness of public toward increased risk for oral diseases in diabetes is low compared to their awareness of systemic diseases. On average, only 41.8% people is aware of an oral complication of DM, which is very low and 58.2% of population is unaware of a complication of DM. Conclusion: People were found to have little knowledge on oral manifestation of DM. To promote proper oral health and to reduce the risk of oral diseases, health professionals in both the dental and medical fields need to take the responsibility to develop programs to educate the public about the oral manifestations of diabetes and its complications on oral health.

Developing a simple and practical decision model to predict the risk of incident type 2 diabetes among the general population: The Di@bet.es Study

AimsTo develop a simple multivariate predictor model of incident type 2 diabetes in general population. MethodsParticipants were recruited from the Spanish Di@bet.es cohort study with 2570 subjects meeting all criteria to be included in the at-risk sample studied here. Information was collected using an interviewer-administered structured questionnaire, followed by physical and clinical examination. CHAID algorithm, which collects the information of individuals with and without type 2 diabetes, was used to develop a decision tree based type 2 diabetes prediction model. Results156 individuals were identified as having developed type 2 diabetes (6.5% incidence). Fasting plasma glucose (FPG) at the beginning of the study was the main predictive variable for incident type 2 diabetes: FPG ≤ 92 mg/dL (ref.), 92–106 mg/dL (OR = 3.76, 95%CI = 2.36–6.00), > 106 mg/dL (OR = 13.21; 8.26–21.12). More than 25% of subjects starting follow-up with FPG levels > 106 mg/dL developed type 2 diabetes. When FPG <106 mg/dL, other variables (fasting triglycerides (FTGs), BMI or age) were needed. For levels ≤ 92 mg/dL, higher FTGs levels increased risk of incident type 2 diabetes (FTGs > 180 mg/dL, OR = 14.57; 4.89–43.40) compared with the group of FTGs ≤ 97 mg/dL (FTGs = 97–180 mg/dL, OR = 3.12; 1.05–9.24). This model correctly classified 93.5% of individuals. ConclusionsThe type 2 diabetes prediction model is based on FTGs, FPG, age, gender, and BMI values. Utilizing commonly available clinical data and a simple blood test, a simple tree diagram helps identify subjects at risk of developing type 2 diabetes, even in apparently low risk subjects with normal FPG.

IDF21-0080 Determinants of acceptability to COVID-19 vaccine among the general public and diabetes population in Israel

Background: The current COVID-19 pandemic has posed a significant public health threat and catastrophic economic consequences around the world. Israel was one of the first countries to offer the innovative COVID-19 vaccine, a step that was accompanied with mixed reactions among the public, causing hesitancy and avoidance by many categorized at high risk for severe COVID-19 disease. Aim: To assess attitudes towards the new COVID-19 vaccine and willingness to get vaccinated among the general public and diabetes population. Method: Cross-sectional study conducted between December 15th and 20th, 2020. Research population included 807 Hebrew speaking Internet users in Israel aged 18 and over, where 503 of them represented the general population and 304 represented the diabetes population in the country. The study questionnaire referred to the worry to become infected in COVID-19, attitudes toward the vaccine and towards seasonal influenza vaccination. Multinomial logistic regression modelling was used for understanding the effect of research variables on willingness to get vaccinated against COVID-19. Results: About 70% of diabetes population compared to 56% of the general public expressed high level of apprehension to become infected with coronavirus. The safety of the vaccine for people with background conditions was perceived higher among people with diabetes (41.1% vs. 30.0% of the general public). Willingness to be vaccinated against COVID-19 was higher among people with diabetes (42% vs. 10% of the general public) while only 10.2% of people with diabetes noted that they are not going to get vaccinated, compared to 16.7% in the general public. All differences were significant (p<0.01). When asked about seasonal flu vaccination this year, 67% of people with diabetes responded positively in comparison to only 37% of the general public. In addition, significant gender differences in attitudes toward COVID-19 and toward vaccination against this disease were evident in both study populations, as women reported higher levels of apprehension from developing COVID-19 than men, lower level of confidence in the safety of the vaccine and lower level of willingness to get vaccinated against. Discussion: These results reflect on tendency of sub-populations and could direct campaign efforts in similar future events.

Cutaneous Manifestation of Diabetes Mellitus in an Unsheltered Male Leading to Emergent Hospitalization

Diabetes mellitus (DM) is one of the most common chronic diseases in the United States. It is characterized by increased patient morbidity and mortality due to the many complications that can arise. Certain dermatological findings can be indicative of poorly controlled DM and can be a useful clue to further management. Persons experiencing homelessness (PEH) with DM often have higher rates of diabetic complications than the general diabetic population. Medical providers caring for PEH in the setting of limited resources should carefully evaluate cutaneous disease as a potential indicator of underlying illness. This physical manifestation of illness can serve to guide the next appropriate steps in management. A 41-year-old unsheltered male with an extensive medical history of hypertension, seizures, chronic diarrhea, and cocaine use was seen at a “foot-washing” medical outreach event. He presented with fevers, chills, and multiple painless right lower extremity ulcerated lesions of unspecified origin. A finger-stick glucose measurement was found to be 650 mg/dL. After immediate administration of 10 units of insulin, he was transported immediately to the emergency department and admitted. His month-long hospital course was complicated and involved the amputation of multiple toes. Preemptive outreach and management could have prevented the marked deterioration of his disease and represents the importance of outreach and regular follow-up with the PEH community.

Commentary: Shifting our focus to diabetic retinopathy is the need of the hour.

The initiatives started under the VISION 2020 program have made a huge impact on global eye health, especially in developing countries like India. One such initiative is the organization of outreach camps to identify and treat patients with avoidable blindness. The programs related to the diseases requiring one-time treatment like cataract and refractive errors have achieved huge success.[1] On the contrary, the programs associated with the diseases requiring long-term follow-up like diabetic retinopathy (DR) and glaucoma are still in their nascent steps. With the increasing life expectancy, sedentary lifestyle, and changing dietary pattern, diabetic retinopathy is expected to become a major health problem of the community.[2] We congratulate the authors for performing a thorough systemic review on the prevalence of DR in India in the published article in the current issue of the Indian Journal of Ophthalmology.[3] The authors have performed an excellent meta-analysis of the various risk factors evaluated by the previous studies, gender being the only exception.[3] The evaluation of gender as a risk factor in epidemiological studies is important as several studies have shown a gender bias in health-seeking behavior.[4] The authors have correctly highlighted that most of the previous studies have been performed in South India and it is difficult to extrapolate the prevalence of DR in one region to other parts of the country as India is a conglomerate of people with different ethnicity, dietary habits, and probably genetic makeup. Hence, a nationwide study or multiple studies with the same inclusion/exclusion and evaluation criteria to determine the prevalence of DR, sight-threatening DR (STDR), and diabetic macular edema (DME) are needed. The dietary habits vary with the geographical, cultural as well as socio-economic profile of people. Studies are warranted to evaluate the influence of different Indian dietary habits on DR and the indigenous diet(s) found to be beneficial should be promoted.[5] The job profile and sedentary lifestyle have also been found to influence the incidence of DR. Sedentary behavior is defined as any activity (sitting or reclining position) that is associated with minimal energy expenditure, i.e., ≤1.5 metabolic equivalents.[6] Kohli et al.[7] showed that the incidence of DR in state bus drivers was higher than that reported among the general diabetic population in India, which they hypothesized may be due to long working hours. Similarly, other professions which predispose to high risk of developing DR should be established. The sample size of the study needs to be carefully calculated so that it has adequate power to evaluate the influence of the region and different parameters like dietary habits, rural-urban status, age, gender, socio-economic status, per-capita income, level of education, level of health-seeking behavior, and access to general and ophthalmic health care. The presence of other systemic diseases like hypertension, dyslipidemia, and chronic renal disease has a significant effect on the prevalence of DR, STDR, and DME. Such studies will go a long way in projecting the prevalence of DR in the future. This will help to formulate government policies and plan strategies for capacity building to screen and treat the ever-increasing load of patients of DR. One of the difficulties in performing such studies is the availability of retina specialists for diagnosing and grading DR. However, the recent technological advances can be used to fill in this gap. The use of nonmydriatic fundus cameras and telemedicine has reduced the need for the retina specialist to travel to the various sites of cluster selection. The use of artificial intelligence (AI) to analyze retinal images can further enhance speed, accuracy, and consistency. However, a legal framework for the use of AI in DR screening is necessary before planning any large-scale studies.[8] The last step is to create public awareness. It should be highlighted that in contrast to cataract, the management of DR is complex and needs life-long treatment. Just like diabetes itself, the management of DR does not end with a single time intervention. The need for a regular life-long follow-up as well as multiple sessions and modalities of treatment like laser, intravitreal injections, and vitrectomy should be emphasized.

Prevalence and Determinants of Type 2 Diabetes among the Pulmonary Tuberculosis Cases in Nepal: A Cross Sectional Study

Background Since prehistoric time to the earlier 20th century, diabetes was accounted as comorbidity among tuberculosis patients, which is reducing the treatment efficiency.&#x0D; Objective To investigate the prevalence and determinants of type 2 diabetes mellitus among tuberculosis patients in central development region of Nepal.&#x0D; Method An analytical cross-sectional study was conducted by using structured questionnaire. Face to face interview as well as reviewing of the medical records of the tuberculosis cases has been performed during September 2018 - February 2019. The systematic random sampling was applied to select 306 tuberculosis cases. Then the respondents were examined for blood glucose level as well as Glycated haemoglobin (HbA1c) level to identify TB with Diabetes Mellitus. The proportion of respondents with fasting blood glucose level ≥ 126 mg/dl or a random blood glucose ≥ 200 mg/dl was considered as Tuberculosis with Diabetes Mellitus cases. Similarly, haemoglobin A1C ≥ 7% was accessed as amplified risk for tuberculosis. Multiple logistic regression was performed to analyse the factors associated with Tuberculosis with Diabetes Mellitus by using STATA. P value &lt; 0.05 was taken as statistically significant.&#x0D; Result A total of 306 tuberculosis patients were included in the study. The mean ± standard deviation of age of participants was 36.82±15.94 years. The proportion of male slightly exceeded than that of female with a ratio of 1.73:1. The prevalence of TBDM was 17.32% (95% CI: 13.05-21.58) of all diagnosed tuberculosis cases. Our multivariable analysis identified the factors those were associated with TBDM were age ≥ 45 years (adj.OR=3.97, 95% CI 1.81-8.71, p value 0.001), patients residing in the urban areas (adj.OR=9.75, 95% CI 1.99-47.6, p value 0.005), had Body Mass Index (BMI) &lt;18.5 Kg/m2 (adj.OR=3.20, 95% CI 1.58-6.51, p value 0.001), had diastolic blood pressure ≥ 80 mmHg (adj.OR=2.34, 95% CI 1.17-4.66, p value 0.015) and patients who were treated with Cat II and Cat III tuberculosis treatment regimens (adj.OR=2.65, 95% CI 1.22-5.73, p value 0.013).&#x0D; Conclusion The prevalence of type 2 diabetes mellitus among tuberculosis patients was higher than prevalence of diabetes in general population of Nepal and it was higher among male, urban residents, patients with low BMI and the older aged tuberculosis patients.

Methamphetamine use and the risk of diabetic ketoacidosis.

Diabetic ketoacidosis (DKA) is a life-threatening condition arising in individuals with insulin-dependent diabetes mellitus, associated with hyperglycaemia and hyperketonaemia. While drugs such as methadone, cocaine and certain prescription medications may precipitate DKA, the potential effect of methamphetamine is unclear. Analysis of autopsy and toxicology case files at Forensic Science SA, Adelaide, South Australia, was therefore undertaken from 1 January to 31 December 2019 of all cases where methamphetamine was detected in post-mortem blood samples. There were 94 cases with 11 diabetics (n = 6 type 1 and n = 5 type 2). Four of the six decedents with type 1 diabetes had lethal DKA (66.7%; age range 30-54 years; average age 44.6 ± 10.5 years; M:F ratio 1:1). This incidence of DKA was higher than that of the general insulin-dependent diabetic population (6%) and also significantly higher than in medico-legal cases (13%; p < 0.05). The clinical and autopsy assessment of insulin-dependent diabetics presenting with DKA should therefore include specific screening for methamphetamine. The increase in both insulin-dependent diabetes and methamphetamine abuse in the community may lead to increases in such cases in medico-legal and health contexts.

1043-P: Diabetic Cardiomyopathy: A Systematic Analysis of Epidemiological Studies

Diabetic cardiomyopathy (DbCM) is a sequela of diabetes. DbCM is characterized by abnormal cardiac structure and/or performance in the absence of coronary artery disease or hypertensive, valvular or congenital heart disease. We aimed to determine the prevalence of DbCM in the United States and EU5. PubMed was queried for epidemiological studies on DbCM from 2010 onwards using the terms (“diabetes” AND “cardiomyopathy”) OR (“diabetic cardiomyopathy”) AND (“incidence” OR “prevalence”). 563 articles were identified, 40 of which were screened for full text review based on the abstract indicating the reporting of original data captured in a general diabetic population. Ten of these were used either directly or to inform our analysis. Four of these studies reported data on DbCM having made appropriate exclusions for atherosclerosis mediated heart failure. However, only 2 of these were ultimately included based on the representativeness of the study population and thus generalisability of results. Many studies were excluded due to heterogeneity in definition of DbCM. Some studies clearly stated DbCM as the indication of interest, taking appropriate measures to exclude cases with a history of atherosclerosis mediated precursors such as coronary artery disease, hypertension, or valvular heart disease. Other studies were not clear in the exclusion criteria and for this reason were excluded. Based on our review, estimates in the literature for DbCM in type 2 diabetes without stringent clinical diagnostic criteria range from 12% to 48%. Of the two studies included in our analysis which clinically define DbCM according to diagnostic guidelines, estimates ranged from 17% to 24%. Our final estimate based on an average of these two was 21%, with some imputations for variation by age. There are ~30 million diabetics in the United States alone and we estimate 21% of diagnosed diabetics also have DbCM, which represents a huge burden of disease for which there is very limited robust epidemiological data. Disclosure R. Perfetti: Stock/Shareholder; Self; Applied Therapeutics. S. Shendelman: Stock/Shareholder; Self; Applied Therapeutics.