Increasing Prevalence Of Diabetes Research Articles

Identifying relevant diabetes and hypertension control management guidelines in primary healthcare and community settings in Indonesia: A Delphi survey.

The burden of non-communicable diseases (NCDs) in Indonesia is increasing, as evidenced by the latest Indonesian National Health Research, which shows an increase in diabetes prevalence, from 6.9% in 2013 to 10.9% in 2018, and hypertension, from 25.8% in 2013 to 34.1% in 2018. Hence, effective actions in community and primary health care (PHC) facility settings are necessary to tackle the burden of diabetes and hypertension, especially in low- and middle-income countries. The Indonesian government has issued numerous guidelines regarding NCDs. However, not all these guidelines can be applied to communities or PHCs. This study aimed to identify priority guidelines to support the community and PHC for NCD management using the Delphi survey method. These prioritized guidelines will serve as valuable resources for developing relevant, operational and comprehensive modules for community cadres and PHC staff involved in NCD management. The Delphi survey involved 25 experts and comprised three rounds using a questionnaire: 1) identification and assessment of guidelines, 2) assessment of the importance of guidelines, and 3) nomination of the three main priority guidelines. The results revealed three priority guidelines: NCD management guidelines, technical guidelines for Pos Pembinaan Terpadu (POSBINDU) NCDs, and integrated services for NCDs in PHC facilities. Additionally, priority guidelines were used to develop operational modules for community cadres and PHC staff in NCDs management. In conclusion, utilizing the Delphi method serves as a scientific approach to identify priority guidelines crucial for supporting the community and PHC in managing NCDs, particularly in countries with contexts similar to Indonesia.

Prediabetes and cardiovascular risk factors: the effectiveness of a guided self-determination counselling approach in primary health care, a randomized controlled trial

BackgroundIdentify individuals who are at risk of Type 2 diabetes, who also are at a greater risk of developing cardiovascular disease is important. The rapid worldwide increase in diabetes prevalence call for Primary Health Care to find feasible prevention strategies, to reduce patient risk factors and promote lifestyle changes. Aim of this randomized controlled trial was to investigate how a nurse-lead Guided Self-Determination counselling approach can assist people at risk of type 2 diabetes to lower their coronary heart disease risk.MethodsIn this randomized controlled study, 81 people at risk of developing type 2 diabetes were assigned into an intervention group (n = 39) receiving Guided Self-Determination counselling from Primary Health Care nurses over three months and a control group (n = 42) that received a diet leaflet only. Measurements included the Finnish Diabetes Risk Score questionnaire and biological measurements of Hemoglobin A1c protein, Body Mass Index, fasting blood glucose, Blood pressure, Cholesterol, High-density lipoprotein, and triglycerides, at baseline (time1), 6 (time2) and 9 months (time 3).ResultsA total of 56 participants, equal number in intervention and control groups, completed all measurements. A significant difference between the intervention and control groups, in coronary heart disease risk was not found at 6 nor 9-months. However, within-group data demonstrated that 55.4% of the participants had lower coronary heart disease risk in the next ten years at the 9-month measurement. Indicating an overall 18% relative risk reduction of coronary heart disease risk by participating in the trial, with the number needed to treat for one to lower their risk to be nine. Within the intervention group a significant difference was found between time 1 and 3 in lower body mass index (p = 0.046), hemoglobin A1c level (p = 0.018) and diastolic blood pressure (p = 0.03).ConclusionsAlthough unable to show significant group differences in change of coronary heart disease risk by this 12-weeks intervention, the process of regular measurements and the guided self-determination counselling seem to be beneficial for within-group measures and the overall reduction of coronary heart disease risk factors.Trial registrationThis study is a part of the registered study ‘Effectiveness of Nurse-coordinated Follow-Up Programme in Primary Care for People at Risk of T2DM’ at www.ClinicalTrials.gov (NCT04688359) (accessed on 30 December 2020).

Inequalities in the diagnosis of 275 chronic conditions in UK primary care between 2006 and 2021: a cohort study

BackgroundHealth inequalities in the UK have been brought to the forefront of public health concerns, especially disparities in life expectancy and health quality of socioeconomically deprived and minority ethnic populations. This study systematically examined the incidence and prevalence of 275 chronic conditions which present in UK primary care, describing inequalities across diverse population subgroups. MethodsWe conducted a population-based retrospective cohort and cross-sectional study using primary care data from Clinical Practice Research Datalink Gold (986 general practices), from Jan 1, 2006 to Dec 31, 2023. We studied chronic conditions responsible for over 10 000 days of hospital activity. Incidence and prevalence estimates were calculated annually, stratified by sex, age, ethnicity (UK high-level), and GP practice deprivation, and standardised using UK mid-year population estimates for 2021. We used statistical process control to describe variation and identify outlier conditions in population subgroups. A public dashboard was created to explore the outputs. FindingsThe study included 13 419 645 participants. Hypertension was the most prevalent condition in 2019 (22·47%). Black, Asian, Others, and Mixed had over 30% lower chance of any given diagnosis than overall population. Depression showed a gradient of increasing prevalence with increasing deprivation, but for actinic keratosis, a condition associated with sun exposure, prevalence increased in less deprived populations. In a cardiometabolic conditions deep dive, minority groups had increased diabetes prevalence, but lower rates of myocardial infarction. InterpretationThis study provides a crucial resource for addressing health disparities in the UK. Lower prevalence in Black, Asian, and Mixed ethnicities is likely to be underdiagnosis and not a 30% lower disease prevalence, highlighting an urgent need across many conditions for tailored healthcare strategies to ensure equitable diagnosis and treatment access. Detailed population breakdowns in this dataset generates insight that can guide the development of more inclusive health policies, ultimately reducing health inequalities and improving public health outcomes. FundingNone.

Trends in diabetes morbi-mortality and its association with abdominal obesity among Tunisian adults

Abstract Introduction Tunisia is undergoing rapid nutritional transition, with increasing rates of abdominal obesity. Coupled with rising diabetes prevalence, it poses significant challenges to public health. This study aimed to estimate the morbi-mortality prevalence and trends of diabetes among Tunisian adults, particularly examining its association with abdominal obesity. Methods We conducted a secondary data analysis on adults aged 35 to 70 from three national surveys in Tunisia, in 1996 (n = 3513), 2005 (n = 7700), and 2016 (n = 6007) respectively. Mortality data was sourced from the Tunisian National Information System on Causes of Death in 2020. The underlying cause of death was determined using the IRIS software, following WHO guidelines for tabulating mortality statistics. Diabetes was defined according to the American Association of Diabetes criteria. Abdominal obesity was defined as a waist-to-height ratio ≥ 0.6. We performed chi-squared test for trend analysis. Results A total of 17220 participants were analyzed. We found a significant upwards trend in diabetes prevalence (p < 10-3): it increased from 13.1%[11.9-14.3] in 1996 to 15.1% [12.5-17.4] in 2005, then to 20.5%[18.9-22.1] in 2016. Linear trend test concluded to significant increase in diabetes prevalence estimated at 56.6% in two decades. Diabetes was significantly associated with abdominal obesity (Odds ratio (OR)=2.17[2.11-2.21]). Diabetes was the leading cause of death among Tunisian adults in 2020 (n = 22715). The proportional mortality due to diabetes was estimated at 6.2% (n = 1407) (6.4% for men and 6% for women). The age group with the highest proportional mortality due to diabetes was 65-70 years old (44.6%). Conclusions Our findings highlight the burden of diabetes on public health in Tunisia and its association with abdominal obesity. Hence the urgency to strengthen comprehensive preventive and control measures to alleviate its repercussions among the Tunisian population. Key messages • The prevalence of diabetes increased significantly amongTunisian adults in the past two decades. • Immediate implementation of targeted interventions and policy measures is imperative to effectively address this issue.

Nationwide trends in major cardiovascular risk factors in England in the last 2 decades: Health Survey of England 2003-2019

Abstract Cardiovascular disease (CVD) accounts for a quarter of deaths annually in the UK, with more than 7.6 million people living with the disease. Hypertension, diabetes, and obesity are among the most prevalent modifiable risk factors for CVD, and the strategies to reduce the incidence and prevalence of these CV risk factors are deemed the most effective to reduce this immense toll. In the UK, over the last few decades, several health policy decisions and pathways have been developed to reduce this toll. We used data from 11 nationally representative, cross-sectional surveys from the Health Survey of England between 2003 and 2019 to evaluate trends in the prevalence of these CV risk factors and whether there has been any population-wide improvement in them. These surveys have cumulative information on 94,100 adults, and we applied sample weights, accounting for oversampling and nonresponse. We used "period definitions and cut-offs" to define those with diabetes. For example, for undiagnosed diabetes, we used glycated haemoglobin cut-off equivalent of 7% or more for years before 2011 and the current diagnostic threshold of > 6.5% thereafter. This was done to facilitate and compare the trends after accounting for changes in medical practice and understanding across this period. Similarly, hypertension was defined as doctor-diagnosed hypertension or in its absence regular use of antihypertensive medications or blood pressure ≥ 140/90mmHg (period diagnostic threshold remains unchanged during). Python and STATA were used to conduct analyses, and Join Point regression software was used to develop and compare trends. In England, from 2003-2019, mean population BMI consistently increased over this period, rising by 0.8kg/m2 from 27.6 to 28.8 kg/m2. Obesity prevalence (BMI ≥30kg/m2) increased by 5.4% from 22.6% to 28.0%. Concurrently, mean glycated haemoglobin increased by 0.36% from 6.18% to 6.54%, surpassing the current diabetes diagnostic threshold. Diabetes period prevalence surged from 4.2% to 11.6%, a trend consistent when the current diagnostic threshold was alternatively applied across all periods. Conversely, doctor-diagnosed and total hypertension (including those who are unaware) prevalence exhibited a slight decrease (1.4% and 3%, respectively), mirrored by reductions in population-wide mean systolic and diastolic blood pressure by 4.6mmHg and 1.9mmHg. These results suggest that, with the total population in England standing at 56.3 million in 2019, an estimated 15.8 million adults were within the obese BMI range, 6.5 million had diabetes and 17.6 million had hypertension. The obesity epidemic is likely fuelling the increase in diabetes prevalence. These findings underscore the importance of prioritising obesity reduction in public health initiatives, aiming to subsequently curb diabetes prevalence. Hypertension still remains a major CV risk factor, affecting almost one third of the adult population.

Diabetic Mastopathy – A Case Report

Introduction: Diabetic mastopathy is a rare benign condition that can occur in patients with long standing Type I or II diabetes mellitus male or female of any age. Diabetic mastopathy is a fibroinflammatory condition that resembles carcinoma of breast. Here, we report a case of Type II Diabetic female patient with suspicious breast lump in right breast Case presentation: A 62 year old female presented with complaints of lump in right breast for 10 days. Clinically, hard lump of size 8x6 cm was palpable in upper outer quadrant. Trucut biopsy showed features of Diabetic mastopathy. Patient undergone wide local excision and biopsy confirmed the diagnosis. Post operative period was uneventful. Discussion: Diabetic mastopathy is an uncommon tumor-like proliferation of fibrous tissue of the breast, clinically and radiologically mimicking breast cancer. Histopathologically, it involves periductal, perilobular and perivascular lymphocytic infiltration. Primary excision with adequate normal tissue margins is the treatment of choice Conclusion: Diabetic mastopathy is a rare clinical entity, however due to increase in prevalence of Diabetes, diagnosis of Diabetic mastopathy should be considered in patients with breast lumps

The Evaluation of the protective roles of canagliflozin and zinc sulphate on body weight and hepatic histology in diabetic dyslipidemia

The significant increase in diabetes prevalence in the past decade has placed a considerable strain on the global healthcare system, especially in developing nations such as Pakistan. Although current therapy options effectively manage blood glucose levels, their accompanying adverse effects can hinder patient adherence. This study investigates the therapeutic properties of Canagliflozin, a SGLT-2 inhibitor, recognized for its tolerance and supplementary advantages on body weight and blood pressure, when used in combination with Zinc Sulphate. Zinc is acknowledged for its function in the regulation of hyperglycemia and dyslipidemia. The study involved the use of a type-2 diabetic rat model, induced by a high-fat diet and streptozotocin to examine the separate and combined impacts of Canagliflozin and Zinc Sulphate on the liver's histology. A total of forty-eight male Sprague-Dawley rats were separated into six groups and the treatments were delivered for eight weeks. Body weights were observed and histological evaluations of the liver were performed with the NASH-CRN scoring system. The findings exhibited a notable decrease in body weight among the diabetic-induced groups in comparison to the normal control. The combined utilization of Canagliflozin and Zinc Sulphate showed a heightened efficacy in managing diabetes related weight loss and steatosis of liver in the rat model having type-2 diabetes. This indicates a possible combined treatment strategy that should be further investigated to enhance the management of hepatic steatosis in individuals with diabetes. The study also proposes the potential for using a reduced dosage of Canagliflozin in combination with Zinc, so limiting adverse effects.

Pregnancy and diabetic retinopathy

Background: An increase in the worldwide prevalence of diabetes, especially among younger populations, has led to a higher prevalence of pre-existing diabetes among pregnant women. The precise mechanisms underlying the development or progression of diabetic retinopathy (DR) during pregnancy are not entirely understood. This narrative review incorporates all available data to offer fresh insights into the pathogenesis and mechanisms of the pregnancy-induced development and/or progression of DR. Moreover, the author aims to offer clinical recommendations for DR both before conception and during pregnancy to appropriately counsel these susceptible patients. Methods: A literature search was performed using various combinations of the following keywords: diabetes, pregnancy, diabetic retinopathy, ocular, eye, retina, microangiopathy, mechanism, pathophysiology, hyperglycemia, hypoxia, neovascularization, growth factors, immune system, blood flow, and recommendations. The search was conducted using PubMed/MEDLINE, ISI Web of Science, Scopus, and Google Scholar, and only English articles published from January 1, 2020, to December 31, 2023, involving human participants, were considered. The International Diabetes Federation Diabetes Atlas website was searched for clinical recommendations. Results: Pregnancy-induced hyperglycemia, blood flow changes, growth factors, and the immune system play important roles in the development and progression of DR. Hyperglycemia leads to significant stress on the capillary endothelium through increased glucose flux via the polyol and hexosamine pathways, activation of protein kinase C, and increased formation of advanced glycation end-products. These pathways act in several ways that may lead to increased oxidative stress, inflammation, and vascular blockage. Thus, eye examinations are crucial before, during, and up to 12 months after pregnancy. Individuals with severe non-proliferative and proliferative DR should gradually decrease their blood glucose levels to near-normal levels over a period of 6 months before conception. Statins and medications inhibiting the renin–angiotensin system should be discontinued before pregnancy or at the initial antenatal visit if they are still being used. Retinal examinations should be performed shortly after conception and during the first trimester using tropicamide eye drops and digital imaging. Subsequent examinations should be scheduled based on DR severity at the initial examination. Conclusions: While the precise mechanism underlying the progression of DR during pregnancy remains uncertain, the available literature suggests that pregnancy-induced hyperglycemia, blood flow changes, growth factors, and the immune system play important roles in its development and progression. Pregnant women with diabetic eye manifestations benefit from the expertise of multidisciplinary teams comprising ophthalmologists, diabetologists, and gynecologists to improve both maternal and perinatal outcomes. Moreover, postpartum follow-up requires special attention.

Early prediction of the impact of public health policies on obesity and lifetime risk of type 2 diabetes: A modelling approach.

Help public health decision-making requires a better understanding of the dynamics of obesity and type 2 diabetes and an assessement of different strategies to decrease their burdens. Based on 97,848 individual data, collected in the French Health, Health Care and Insurance Survey over 1998-2014, a Markov model was developed to describe the progression of being overweight to obesity, and the onset of type 2 diabetes. This model traces and predicts 2022-2027 burdens of obesity and type 2 diabetes, and lifetime risk of diabetes, according to different scenarios aiming at minimum to stabilize obesity at 5 years. Estimated risks of type 2 diabetes increase from 0.09% (normal weight) to 1.56% (obesity II-III). Compared to the before 1995 period, progression risks are estimated to have nearly doubled for obesity and tripled for type 2 diabetes. Consequently, over 2022-2027, the prevalence of obesity and type 2 diabetes will continue to increase from 17.3% to 18.2% and from 7.3% to 8.1%, respectively. Scenarios statibilizing obesity would require a 22%-decrease in the probability of move up (scenario 1) or a 33%-increase in the probability of move down (scenario 2) one BMI class. However, this stabilization will not affect the increase of diabetes prevalence whereas lifetime risk of diabetes would decrease (30.9% to 27.0%). Combining both scenarios would decrease obesity by 9.9%. Only the prevalence of obesity III shows early change able to predict the outcome of a strategy: for example, 6.7%-decrease at one year, 13.3%-decrease at two years with scenario 1 stabilizing obesity at 5 years. Prevalences of obesity and type 2 diabetes will still increase over the next 5 years. Stabilizing obesity may decrease lifetime risks of type 2 diabetes without affecting its short-term prevalence. Our study highlights that, to early assess the effectiveness of their program, public health policy makers should rely on the change in prevalence of obesity III.

Prevalence trends and racial-ethnic disparities of diabetes and prediabetes among children and adolescents in the United States from 2019 to 2021

ObjectiveThis study investigated disparities in diabetes and prediabetes prevalence among US children and adolescents using 2019–2021 National Health Interview Survey (NHIS) data. With rising trends in diabetes, understanding prevalence rates and associated disparities is crucial for targeted interventions. MethodsAnalyzing a cross-sectional sample of 19,490 participants aged 3–17, we employed NHIS data to calculate prevalence rates. Stratification by sociodemographic factors, race/ethnicity, and family income allowed for in-depth analyses. ResultsBetween 2019 and 2021, overall diabetes prevalence was 1.18%, comprising 0.87% prediabetes and 0.46% diabetes rates. Disparities were evident, with higher prediabetes rates in non-Hispanic black and Hispanic children and elevated diabetes rates in non-Hispanic white and Hispanic children. Subgroup analyses revealed associations within age, gender, education, and income strata. ConclusionsThe study highlighted potential increases in diabetes prevalence from 2017 to 2021 and persistent racial/ethnic disparities. The 12–17 age subgroup exhibited significant disparities, emphasizing the need for early intervention. Targeted strategies were imperative to mitigate diabetes and prediabetes prevalence in vulnerable populations, particularly non-Hispanic black and Hispanic children. This study underscored the urgency of addressing health disparities for improved overall well-being and healthcare outcomes.

The Scope of Precision Medicine in Management of Type 2 Diabetic Patients with Hypertension

There is an exponential increase in prevalence of diabetes and hypertension worldwide and more so in India, and despite of numerous state and national awareness programs and evidence-based approach in management of these diseases, the burden of mortality and morbidity, instead of decreasing, has been rapidly climbing upwards. Hence, there is definite need of precision medicine approach, even though the pathway would be challenging, can provide more precise treatment to an individual based on his/her genetic, phenotypic, and metabolic make up.

Current knowledge of morbidities and direct costs related to diabetic foot disorders: a literature review.

Diabetes is a chronic disease associated with numerous complications including diabetic foot disorders, which are associated with significant morbidity and mortality as well as high costs. The costs associated with diabetic foot disorders comprise those linked to care (direct) and loss of productivity and poor quality of life (indirect). Due to the constant increase in diabetes prevalence, it is expected that diabetic foot disorder will require more resources, both in terms of caregivers and economically. We reviewed findings on management, morbidity, mortality, and costs related to diabetic foot disorder.

Area-level deprivation and individual-level socioeconomic correlates of the diabetes care cascade among black south africans in uMgungundlovu, KwaZulu-Natal, South Africa.

South Africa is experiencing a rapidly growing diabetes epidemic that threatens its healthcare system. Research on the determinants of diabetes in South Africa receives considerable attention due to the lifestyle changes accompanying South Africa's rapid urbanization since the fall of Apartheid. However, few studies have investigated how segments of the Black South African population, who continue to endure Apartheid's institutional discriminatory legacy, experience this transition. This paper explores the association between individual and area-level socioeconomic status and diabetes prevalence, awareness, treatment, and control within a sample of Black South Africans aged 45 years or older in three municipalities in KwaZulu-Natal. Cross-sectional data were collected on 3,685 participants from February 2017 to February 2018. Individual-level socioeconomic status was assessed with employment status and educational attainment. Area-level deprivation was measured using the most recent South African Multidimensional Poverty Index scores. Covariates included age, sex, BMI, and hypertension diagnosis. The prevalence of diabetes was 23% (n = 830). Of those, 769 were aware of their diagnosis, 629 were receiving treatment, and 404 had their diabetes controlled. Compared to those with no formal education, Black South Africans with some high school education had increased diabetes prevalence, and those who had completed high school had lower prevalence of treatment receipt. Employment status was negatively associated with diabetes prevalence. Black South Africans living in more deprived wards had lower diabetes prevalence, and those residing in wards that became more deprived from 2001 to 2011 had a higher prevalence diabetes, as well as diabetic control. Results from this study can assist policymakers and practitioners in identifying modifiable risk factors for diabetes among Black South Africans to intervene on. Potential community-based interventions include those focused on patient empowerment and linkages to care. Such interventions should act in concert with policy changes, such as expanding the existing sugar-sweetened beverage tax.

Socioeconomic inequalities in diabetes prevalence: the case of Egypt between 2008 and 2015

BackgroundThere is a steady increase in diabetes prevalence globally and many studies imply that high socioeconomic status (SES) is inversely related to diabetes prevalence. However, there is scarcity in literature from countries like Egypt regarding this topic.MethodsThis study aims to investigate prevalence of diabetes in Egypt between 2008 and 2015, and the effect of SES. Diabetes prevalence -based on self-reports of past diagnosis- was measured using two datasets Egypt DHS 2008 (10,917 participants) and EHIS 2015 (16,485 participants). Logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) were applied for diabetes controlling for age, gender, educational level, employment status and place of residence. Extend of difference in diabetes prevalence between the two time points was measured by combining the two datasets using the EDHS 2008 as reference.ResultsDiabetes prevalence was higher in 2015 (4.83%) compared to 2008 (3.48%). It was more in women at both time points (4.08% and 5.16% in 2008 and 2015 respectively) compared to men (2.80% and 4.43% in 2008 and 2015 respectively). Older age and living in urban areas were positively related to diabetes prevalence at both time points. Men had a significant higher chance of developing diabetes in 2015 (OR = 1.45, p-value = 0.001). Men with higher education had higher chance of developing diabetes (OR = 1.76), in contrast to women (OR = 0.59). Employment decreased the chance of developing diabetes for men (OR = .72), but had minimal effect on women (OR = 1.06).ConclusionDiabetes prevalence in Egypt has increased between the years 2008 and 2015 and evident social inequalities were found. Women had more diabetes than men and were more affected with low SES. Unlike women, highly educated men had higher chance of developing diabetes in 2015 compared to 2008. This might be attributed to behavioral and sociocultural factors.

Community Social Capital and Population Health Outcomes

While the association between economic connectedness and social mobility has now been documented, the potential linkage between community-level economic connectedness and population health outcomes remains unknown. To examine the association between community social capital measures (defined as economic connectedness, social cohesion, and civic engagement) and population health outcomes (defined across prevalence of diabetes, hypertension, high cholesterol, kidney disease, and obesity). This cross-sectional study included communities defined at the zip code tabulation area (ZCTA) level in all 50 US states. Data were collected from January 2021 to December 2022. Multivariable regression analyses were used to examine the association between population health outcomes and social capital. Adjusted analyses controlled for area demographic variables and county fixed effects. Heterogeneities within the associations based on the racial and ethnic makeup of communities were also examined. In this cross-sectional study of 17 800 ZCTAs, across 50 US states, mean (SD) economic connectedness was 0.88 (0.32), indicating friendship sorting on income; the mean (SD) support ratio was 0.90 (0.10), indicating that 90% of ties were supported by a common friendship tie; and the mean (SD) volunteering rate was 0.08 (0.03), indicating that 8% of individuals within a given community were members of volunteering associations. Mean (SD) ZCTA diabetes prevalence was 10.8% (2.9); mean (SD) high blood pressure prevalence was 33.2% (6.2); mean (SD) high cholesterol prevalence was 32.7% (4.2), mean (SD) kidney disease prevalence was 3.0% (0.7), and mean (SD) obesity prevalence was 33.4% (5.6). Regression analyses found that a 1% increase in community economic connectedness was associated with significant decreases in prevalence of diabetes (-0.63%; 95% CI, -0.67% to -0.60%); hypertension (-0.31%; 95% CI, -0.33% to -0.29%); high cholesterol (-0.14%; 95% CI, -0.15% to -0.12%); kidney disease (-0.48%; 95% CI, -0.50% to -0.46%); and obesity (-0.28%; 95% CI, -0.29% to -0.27%). Second, a 1% increase in the community support ratio was associated with significant increases in prevalence of diabetes (0.21%; 95% CI, 0.16% to 0.26%); high blood pressure (0.16%; 95% CI, 0.13% to 0.19%); high cholesterol (0.16%; 95% CI, 0.13% to 0.19%); kidney disease (0.17%; 95% CI, 0.13% to 0.20%); and obesity (0.08%; 95% CI, 0.06% to 0.10%). Third, a 1% increase in the community volunteering rate was associated with significant increases in prevalence of high blood pressure (0.02%; 95% CI, 0.01% to 0.02%); high cholesterol (0.03%; 95% CI, 0.02% to 0.03%); and kidney disease (0.02%; 95% CI, 0.01% to 0.02%). Additional analyses found that the strength of these associations varied based on the majority racial and ethnic population composition of communities. In this study, higher economic connectedness was significantly associated with better population health outcomes; however, higher community support ratios and volunteering rates were both significantly associated with worse population health. Associations also differed by majority racial and ethnic composition of communities.

Diabetes and associated cardiovascular complications: The role of microRNAs

Diabetes mellitus (DM) refers to a complex cluster of metabolic disorders characterized by hyperglycemia caused by inadequate insulin secretion, insulin resistance, or excessive glucagon secretion. If not correctly treated, the prolonged effects of DM-associated metabolic perturbations lead to systemic vascular complications and cardiovascular disease (CVD), the principal cause of mortality among patients with DM. Given the increase in the global prevalence of diabetes, novel diagnostic and therapeutic procedures are necessary for its effective identification and treatment. Recent findings point to an important role of microRNA (miRNAs) in DM initiation and progression, as well as the occurrence of associated cardiovascular complications. miRNAs are short, highly conserved, single-stranded, non-coding RNAs that contribute to the maintenance of physiological homeostasis through the regulation of crucial processes such as metabolism, cell proliferation, and apoptosis. The increased availability of high-throughput methodologies for identifying and characterizing non-coding RNAs has led to considerable interest in miRNAs as potential biomarkers and therapeutic agents for DM. In this review, we first comprehensively detail the regulatory miRNAs involved in the pathophysiology of DM and diabetic cardiomyopathy (DCMP). Subsequently, we summarize findings regarding the utility of several of these miRNAs as potential prognostic and diagnostic biomarkers for DM and DM-associated CVD. Finally, we evaluate the potential of miRNA-based therapeutic approaches for treating DM and DCMP in the clinical setting.

Arsenic metabolism, diabetes prevalence, and insulin resistance among Mexican Americans: A mendelian randomization approach.

Differences in arsenic metabolism capacity may influence risk for type 2 diabetes, but the mechanistic drivers are unclear. We evaluated the associations between arsenic metabolism with overall diabetes prevalence and with static and dynamic measures of insulin resistance among Mexican Americans living in Starr County, Texas. We utilized data from cross-sectional studies conducted in Starr County, Texas, from 2010-2014. A Mendelian randomization approach was utilized to evaluate the associations between arsenic metabolism and type 2 diabetes prevalence using the intronic variant in the arsenic methylating gene, rs9527, as the instrumental variable for arsenic metabolism. To further assess mechanisms for diabetes pathogenesis, proportions of the urinary arsenic metabolites were employed to assess the association between arsenic metabolism and insulin resistance among participants without diabetes. Urinary biomarkers of arsenic metabolites were modeled as individual proportions of the total. Arsenic metabolism was evaluated both with a static outcome of insulin resistance, homeostatic measure of assessment (HOMA-IR), and a dynamic measure of insulin sensitivity, Matsuda Index. Among 475 Mexican American participants from Starr County, higher metabolism capacity for arsenic is associated with higher diabetes prevalence driven by worse insulin resistance. Presence of the minor T allele of rs9527 is independently associated with an increase in the proportion of monomethylated arsenic (MMA%) and is associated with an odds ratio of 0.50 (95% CI: 0.24, 0.90) for type 2 diabetes. This association was conserved after potential covariate adjustment. Furthermore, among participants without type 2 diabetes, the highest quartile of MMA% was associated with 22% (95% CI: -33.5%, -9.07%) lower HOMA-IR and 56% (95% CI: 28.3%, 91.3%) higher Matsuda Index for insulin sensitivity. Arsenic metabolism capacity, indicated by a lower proportion of monomethylated arsenic, is associated with increased diabetes prevalence driven by an insulin resistant phenotype among Mexican Americans living in Starr County, Texas.

1256-P: Should Clinical Guidelines for Diabetes Screening Use Waist Circumference Instead of Body Mass Index?

Introduction: Diabetes is increasing in the US. The USPSTF and ADA recommend screening based on body mass index (BMI). We evaluated if waist circumference was a better predictor of diabetes than BMI. Methods: We used NHANES (2015-2018). We identified nonpregnant adults ages ≥20 years (N=10,614). A mediation analysis was performed, assessing if the association of BMI (kg/m2) with diabetes prevalence was mediated by waist circumference (cm), using survey weighted logistic regression. Estimates were US representative. Results: We identified 233,874,251 weighted adults. A one-point BMI increase was associated with a 0.95% (95% CI: 0.84%, 1.07%, P<0.001) increase in diabetes prevalence. Similarly, a one-centimeter increase in waist circumference was associated with a 0.51% (95% CI: 0.46%, 0.55%, P<0.001) increase in diabetes prevalence. After adjusting for waist circumference, BMI was not associated with diabetes prevalence (P<0.001) (Figure), while waist circumference continued to predict diabetes prevalence by 0.87% (95% CI: 0.73%, 1.01%, P<0.001) per one-centimeter increase. The association of BMI for diabetes prevalence was fully mediated by waist circumference (indirect effect ≥ total effect). Conclusion: The predictive ability of BMI for diabetes is fully mediated by waist circumference. Clinical guidelines could consider waist circumference to replace BMI in screening guidelines. Disclosure R.Aggarwal: None. N.Chiu: None. D.L.Bhatt: Board Member; Bristol-Myers Squibb Company, Research Support; Lexicon Pharmaceuticals, Inc., Sanofi, Lilly, Boehringer Ingelheim Inc., AstraZeneca, Novo Nordisk.

1255-P: Prevalence Trends of Diabetes Subgroups in Mexico—A Data-Driven Analysis of Nationally Representative Surveys Spanning 2016–2021

Background: Diabetes subgroups are a promising framework for characterizing diabetes heterogeneity but data on the epidemiology and sociodemographic profile of these subgroups in the Mexican population are sparse. Methods: We conducted a serial cross-sectional analysis of the National Health and Nutrition Survey in Mexico (2016-2021). Diabetes subgroups (obesity related [MOD], severe-insulin deficient [SIID], severe-insulin resistant [SIRD], and age-related [MARD]) were classified using self-normalizing neural networks using HbA1c, time since diabetes diagnosis, HOMA2-IR, HOMA2-B, and BMI. Sociodemographic inequalities were proxied with the social lag index, which captures state-level social disadvantage. Results: Diabetes prevalence in Mexico increased from 13.3% (95%CI 11.5-15.1) in 2016 to 15.8% (95%CI 13.6-17.9) in 2021, with the highest increases in the Northern-Pacific, Central-Pacific, and Center regions. SIDD was the most prevalent diabetes subgroup in Mexico, followed by MOD, MARD, and SIRD. Increases in diabetes prevalence were primarily attributed to MOD and SIRD. SIID had higher aggregation in states with higher social lag (Fig. 1). Conclusion: Diabetes subgroups in the Mexican population display geographic and sociodemographic differences, which may help identify populations at higher risk of health disparities and adverse outcomes. Disclosure N.Antonio villa: None. A.Caballero: None. J.A.Seiglie: Consultant; BDMT Global, Techspert Expert Network. O.Bello-chavolla: None. D.Ramírez-garcía: None. C.Fermin: None. A.Vargas-vázquez: None. M.R.Basile-alvarez: None. A.Nuñez: None. C.D.Paz cabrera: None. L.Fernández chirino: None.

Long-term air pollution exposures on type 2 diabetes prevalence and medication use

BackgroundType 2 diabetes has raised great public health concerns due to its association with the increased risk of several adverse health outcomes. We aimed to investigate the association of criteria air pollutants and traffic density with the prevalence of type 2 diabetes and antidiabetic medication use in California. MethodsA cross-sectional study was conducted using 2005 California Health Interview Survey (CHIS) data, linked with criteria air pollutant exposure measures, including government-monitored ozone (O3), particulate matter (PM10, PM2.5) and nitrogen dioxide (NO2), residential traffic density, and land use regression modeled NOX, NO, and NO2 estimates for Los Angeles County only based on the respondents’ geocoded residential addresses. Weighted logistic regression models were used to examine the influences of 36-month average exposures to each air pollutant and traffic density on diabetes prevalence and medication use. ResultsAmong 31,483 CHIS 2005 state-wide respondents, 6.7% of adults reported having been diagnosed with type 2 diabetes. We observed type 2 diabetes prevalence was positively associated with exposures to O3, PM10, and PM2.5, and with NO, NO2, and NOx only in Los Angeles County. For each 10ppb increase in O3 or 10ug/m3 increase in PM10 or PM2.5, the odds of taking any medication increased by 40%, 56%, and 50%; taking pills increased by 33%, 31%, and 41%; taking insulin increased by 43%, 53%, and 46%; and taking both insulin and pills increased by 70%, 60%, and 88%, respectively. When traffic density within 750 feet of a respondent's home increased by one interquartile, 7% increase in odds of using any medication and taking pills was also observed. ConclusionThis study adds to evidence indicating greater air pollution exposure is associated with increased diabetes prevalence. It also provides new evidence demonstrating a strong association between pollutant exposure and antidiabetic medication use in adult Californians.