Diabetes Outpatient Clinic Research Articles

Changes in health, lifestyle, and wellbeing of children with type 1 diabetes and their parents during the pandemic

ObjectiveThe COVID-19 pandemic restrictions have substantially affected people’s health and rapidly changed their daily routines. This is a prospective study that investigated the impact of the pandemic on primary school children with Type 1 diabetes and their parents during the first lockdown in Kuwait.MethodsA questionnaire battery related to mental health, well-being, and lifestyle was administered at baseline in Summer 2019 (face-to-face, at a diabetes outpatient clinic) and at follow-up during lockdown in Summer 2020 (via telephone, in adherence with COVID-19 restrictions). Data were collected for 70 dyads with children aged 9–12 years.ResultsSignificant differences were found in most scores for both children and parents. Their mental health worsened to a higher level of depression, anxiety, stress, and a poor level of wellbeing. The average scores on the follow-up tests fell within a clinical range on these measures. Significant differences in their lifestyle, compared to before the lockdown, included decreased levels of physical activity and lower healthy core nutritional intake.ConclusionsOur findings indicate that the COVID-19 lockdown has had a significant psychological and possibly physiological impact on children with Type 1 diabetes and their parents. We conclude that there is a need for mental health support services focusing on these groups. Although full lockdown restrictions will have stopped in the past year, post-pandemic stressors may be expected to continue to adversely affect this cohort.

Prevalence of Vitamin B12 Deficiency in Patients With Type 2 Diabetes Mellitus on Metformin Therapy: A Cross-Sectional Study.

Background Metformin is frequently prescribed as a first-line oral hypoglycemic drug to treat insulin resistance-causing type 2 diabetesmellitus (T2DM). Long-term metformin use results in vitamin B12 deficiency, which is frequently overlooked and undiagnosed. A severe deficit may cause severe anemiaand gastrointestinal, or neurological issues. Studies are scarce onthis issue in Pakistani patients with T2DM. The current study aimed to estimate the prevalence of metformin-induced vitamin B12 deficiency in T2DM patients and to explore how it relates to metformin dosage or duration of therapy. Methodology A descriptive cross-sectional study was conducted on 260 T2DM patients using metformin therapy for more than a year and attending the outpatient diabetes clinic and the medicine department of Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan, from August 2022 to October 2023. All socio-demographic, clinical, and general characteristics were collected. Blood samples were taken to measure the serum vitamin B12 levels, and based on these levels, deficient and normal group characteristics were compared. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). Results Based on the serum levels of vitamin B12 of the studied T2DM on the metformin regimen, the overall prevalence of vitamin B12 deficiency was found to be 36.54% (95). The B12 deficiency was higher among the age group of 41-50 years (109, 41.9%), female gender (150, 57.7%, p-value=0.0035), urban residents (194, 74.6%), non-smokers (197, 75.8%), and with a history of chronic disease (131, 50.4%). There was a statistically significant difference in vitamin B12 levels based on T2DM duration (p=0.012), with a higher prevalence in patients with a longer diabetes history of more than two years. There was no discernible statistical relationship between patients receiving different dosages of metformin (odds ratio (OR)=0.8627; 95% confidence interval (CI) (0.5195, 1.4326); p-value=0.568), durations of metformin (OR=0.7400; 95% CI (0.442, 1.2325); p-value=0.247), or intake of vitamin B12 (OR=0.8532; 95% CI (0.5073, 1.4351); p-value=0.549). Conclusion The prevalence of vitamin B12 deficiency impacted more than one-third of T2DM patients using metformin (36.54%). The risk of vitamin B12 deficiency may increase in females with higher metformin dosages and longer durations of treatment. Furthermore, a statistically significant correlation exists between vitamin B12 deficiency and the longer duration of T2DM. These findings highlight the relevance of routinely monitoring serum levels of vitamin B12 among those with T2DM, especially when metformin is being given for over a year or at doses greater than 1000 mg per day. These preventive strategies will aid in the early detection of vitamin B12 deficiency, allowing patients to be treated with supplementation before problems such as anemia or neuropathies arise, resulting in improved quality of life and a lower socioeconomic burden.

Nutritional guidance through digital media for glycemic control of women with gestational diabetes mellitus: a randomized clinical trial.

To compare the effectiveness of outpatient nutritional guidance supplemented by digital media with exclusively standard outpatient nutritional guidance in pregnant women with gestational diabetes mellitus (GDM). This was a randomized, patient-blinded clinical trial conducted at the Diabetes and Pregnancy outpatient clinic from February 2021 to January 2023. Pregnant women with GDM were randomly allocated into two groups: the control group received exclusively outpatient nutritional guidance, and the Intervention Group received outpatient nutritional guidance along with reminders via WhatsApp. Dietary intake (calories, carbohydrates, lipids, proteins, and fibers) was evaluated using 24 h dietary recalls. Glycemic control and the need for pharmacological treatment were also assessed. A total of 81 women were included, 34 allocated to the control group, and 47 to the intervention group. Patients were followed for a period of 4-8weeks. Significant differences were observed in some points of glycemic control between the two groups over the follow-up period. There were no statistical differences in pharmacological therapy (p=0.498); 188 24 h dietary recall were conducted inthe control group and 290 in the intervention group. Astatistically significant increase in lipid intake was observed in the intervention group over the follow-up period compared to the control group (p<0.001). No changes in calorie intake, other macronutrients, or fiber consumption were noted. Glycemic control was significantly improved with the addition of frequent text reminders about dietary choices, and a significant increase in lipid intake was seen in all women, more so in the reminder group.

Diabetes knowledge, health literacy and diabetes self-care among older adults living with diabetes in Alexandria, Egypt

BackgroundType 2 diabetes is a rising health problem, especially in older adults. Health literacy and the degree of diabetes knowledge are among the factors that may influence diabetes self-care activities. The aim of this study was to assess factors affecting self-care activities among older adults living with type 2 diabetes in Alexandria, Egypt.MethodsA cross-sectional study included 400 older adults over the age of 60 with type 2 diabetes, recruited from diabetes outpatient clinics affiliated to the health insurance organization in Alexandria, Egypt. A predesigned, structured interview questionnaire was used to assess sociodemographic factors, personal habits, medical history, and drug history. The All Aspects of Health Literacy Scale (AAHLS) and the numeracy section of the Short Test of Functional Health Literacy in Adults (STOFHLA) were used to assess the level of health literacy. Diabetes Knowledge Test 2 (DKT2) was used to assess diabetes knowledge and Summary of Diabetes Self-care Activities scale was used to assess self-care activities. Multiple logistic regression analysis was used to examine the relationship between health literacy and self-care.ResultsThe mean age of the participants was 65.75 ± 5.15 years, and 56.2% of them were males. The mean duration of diabetes was 10.61 ± 5.28 years, 14.3% were illiterate, and 37.2% were university graduates. Positive correlations were found between health literacy, diabetes knowledge, and diabetes self-care activities (p < 0.001). Health literacy and diabetes knowledge were found to be significant predictors of diabetes self-care activities in older adults (aOR = 1.132; 95% CI:1.062–1.207, p < 0.001 and aOR = 1.313; 95% CI: 1.178–1.464, p < 0.001; respectively).ConclusionsHealth literacy and diabetes knowledge were found to be predictors of good self-care activities in older adults living with diabetes. Health educators and health care professionals should focus on health education and the enhancement of diabetes knowledge to improve self-care activities and eventually glycemic control in older adults living with diabetes.

Scoring Health Behaviors of Patients with Type 2 Diabetes.

Background and Objectives: Millions of people worldwide suffer from diabetes. The ever-increasing number of patients poses a huge challenge to healthcare systems. The purpose of this study was to evaluate the lifestyle and self-monitoring of type 2 diabetes patients using the Healthy Lifestyle and Self-Monitoring Questionnaire. Material and Methods: The analyses conducted were based on data collected using the Polish version of the Healthy Lifestyle and Self-Control Questionnaire among 104 patients diagnosed with type 2 diabetes who were treated at the Diabetes Outpatient Clinic. The in-house study also included an analysis of the relationship between lifestyle habits and disease acceptance and chronic disease functioning. Results: Respondents scored statistically significantly higher for the Healthy Lifestyle and Self-Monitoring Questionnaire than the norms assume, and the largest differences were observed in terms of the healthy dietary choices subscale (t = 8.07; p < 0.05). Only for the subscale of organized exercise were no statistically significant differences found (t = 0.50; p = 0.620). Conclusions: Type 2 diabetes is one of the diseases in which lifestyle not only contributes to its development but is also associated with its course and treatment outcomes. Reinforcing a health-promoting lifestyle is one of the cornerstones of treating patients with type 2 diabetes.

Accuracy and reliability of the Ipswich touch test in identifying loss of protective sensation among diabetic patients

ObjectiveTo evaluate the accuracy of the Ipswich touch test compared to the 10-g monofilament test for identifying of loss of protective sensation in Thai patients with diabetes mellitus. MethodsA cross-sectional observational study was conducted on Thai patients with diabetes mellitus who attended routine annual foot check-ups in an outpatient diabetes clinic. The loss of protective sensation was assessed by the Ipswich touch test and compared with the Semmes-Weinstein 10-g monofilament test. Sensitivity, specificity, predictive values and likelihood ratios were calculated to measure the accuracy of the Ipswich touch test against 10-g monofilament as a reference standard. The interrater reliability of the Ipswich touch test was assessed by two raters. ResultsIn a study of 283 diabetic patients, 10-g monofilament detected a 25 % prevalence of loss protective sensation. The Ipswich touch test demonstrated a good diagnostic accuracy, with a sensitivity of 70.8 %, specificity of 98.6 %, and an area under the curve of 0.85 when compared to 10-g monofilament. Positive and negative predictive values were 94.4 % and 90.8 % respectively. The positive likelihood ratio was 49.82, and the negative likelihood ratio was 0.30. Interrater reliability, assessed with two raters in a subset of 93 participants, yielded a kappa of 0.88, indicating almost perfect agreement. ConclusionsThe Ipswich Touch Test demonstrated good accuracy and interrater reliability compared to the standard 10-g monofilament, thus establishing its effectiveness as a valuable diagnostic tool for identifying loss of protective sensation among diabetic patients. However, its relatively low sensitivity suggests it should be used with caution as a screening tool.

Ten years trajectories of estimated glomerular filtration rate (eGFR) in a multiethnic cohort of people with type 1 diabetes and preserved renal function

ObjectivesWe aim to evaluate estimated glomerular filtration rate (eGFR) patterns of progression in a multiethnic cohort of people with type I diabetes mellitus and with baseline eGFR ≥45 mL/min/1.73 m2.DesignObservational...

Triglyceride to high-density lipoprotein cholesterol ratio as a marker of non-alcoholic fatty liver disease in type 2 diabetes

Type 2 diabetes mellitus (T2DM) and non-alcoholic liver disease (NAFLD) shared a common feature, insulin resistance (IR), which is marked by a change in the lipoprotein fraction, namely increased triglycerides (TG) and decreased high-density lipoprotein cholesterol (HDL-C) levels. Blood lipids are routinely examined in T2DM patients; thus, our study aimed to investigate the performance of TG/HDL-C ratio values to identify hepatic steatosis, the earliest manifestation of nonalcoholic fatty liver disease (NAFLD), in T2DM patients. One hundred adult T2DM patients over 30 years old were recruited from the diabetes outpatient clinic at the Dr. Soetomo General Academic Hospital from August to October 2023. Data regarding sociodemographics, medication, glycosylated hemoglobin (HbA1c), lipid profiles, and FibroScan with controlled attenuation parameter (CAP) were collected from all participants. The group with hepatic steatosis (CAP≥237 dB/m) had a higher body mass index (BMI), higher TG levels, and TG/HDL-C ratio values. The TG/HDL-C ratio was significantly correlated with CAP values. Hepatic steatosis can be identified using the TG/HDL-C ratio with a cut-off value of 2.83 (sensitivity:72.4%; specificity:71.4%). An elevated TG/HDL-C ratio is associated with a higher risk (OR:6.562; p&amp;lt;0.05) of having hepatic steatosis. The TG/HDL-C ratio is a potential marker to predict NAFLD in T2DM patients.

Mortality patterns in Dutch diabetes outpatients.

Diabetes mellitus is a major cause of death. Outpatients with diabetes have more complications than patients in general practice; mortality patterns have only been studied in the total diabetes population. This study aims to assess mortality, causes, and predictors in outpatients with diabetes. A cohort study, included people with diabetes mellitus from the nationwide Dutch Paediatric and Adult Registry of Diabetes (DPARD) visiting diabetes outpatient clinics in 2016-2020. DPARD data were linked to Statistics Netherlands (CBS), comprising data on mortality, ethnicity and education. All-cause and cardiovascular mortality rates were estimated using Cox proportional hazard regression. During a median follow-up of 3.1 years among 12 992 people with diabetes, mortality rates per 10 000 person-years were 67.7 in adult type 1 diabetes and 324.2 in type 2 diabetes. The major cause of non-cardiovascular death was malignancy. During the pandemic years of influenza (2018) and COVID (2020), mortality rates peaked. Age, smoking and an estimated glomerular filtration rate of <60 ml/min were associated with all-cause mortality. In type 2 diabetes, additional factors were male sex, body mass index <20 kg/m2, diabetes duration <1 year and hypertension. Mortality among Dutch outpatients with diabetes is high. Smoking and renal failure were associated with mortality in both types. Further focus on early detection and treatment of mortality-associated factors may improve clinical outcomes.

Stenopool: A Comprehensive Platform for Consolidating Diabetes Device Data.

The growing adoption of diabetes devices has highlighted the need for integrated platforms to consolidate data from various vendors and device types, enhancing the patient experience and treatment. This shift could pave the way for a transition from conventional outpatient diabetes clinics to advanced home monitoring and virtual care methods. Overall, we wished to empower individuals with diabetes and healthcare providers to interpret and utilize information from diabetes devices more effectively. Stenopool integrates most diabetes devices for glucose monitoring and insulin administration in our clinic. The platform was initially developed with inspiration from open-source software, and the current version is a unique digital platform for managing and analyzing diabetes device data. The development process, outcomes, and status are described. Since November 2021, Stenopool has been used in our outpatient clinic to integrate over 30 different diabetes devices from around 7000 individuals. Data are primarily uploaded via wired connections, but also using semi-automated and automated cloud-to-cloud data transfers. The platform offers a streamlined workflow for healthcare providers and displays data from various glucose meter, insulin pump, and continuous glucose monitor (CGM) vendors on a single screen in a manner that healthcare providers can modify. A data warehouse with data from Stenopool and electronical health records is nearing completion, preparing the development of tools for population health management, quality assessment, and risk stratification of patients. Using Stenopool, we aimed to enhance diabetes device data management, facilitate the future for virtual patient care pathways, and improve outcomes. This article outlines the platform's development process and challenges.

Designing nutrition awareness software program for diabetes outpatient clinics and evaluating its effectiveness in a pilot study

Designing nutrition awareness software program for diabetes outpatient clinics and evaluating its effectiveness in a pilot study

Study of the Relationship between Insulin Resistance, Iron Status Markers and Body Weight in a Sample of Egyptian Population

Abstract Background Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Aim of the Work The aim of this study is to investigate the relationship between insulin Resistance, iron Status Markers and body Weight in a sample of Egyptian population. Patients and Methods Our study was case control study conducted on 90 subjects their age was ranging form18 to 70 from diabetes outpatient clinic, and they were divided into 3 groups: Group (1): Non-obese non-diabetic as a control group, Group (2): Obese non diabetic and group (3): Obese diabetic. Results In our study, there was no statistical significant difference found between the three studied groups regarding iron study, Also our study showed that there was statistically non significant correlation between (ferritin level and TIBC), and (ferritin level, HOMA IR), but there was statistical significant positive correlation found between TIBC and FBS (p- value 0.045),Similarly, we did not observe either abnormally high or low ferritin values in our study on subjects with obesity. We found no association between this marker and body weight, in contrast with others. In our study, the higher insulin and HOMA-IR values observed in the subjects with TSAT&amp;lt;20% = 4.2(1.4-11.6) than those with TSAT &amp;gt;20% =2.4 (1.15-6.95), but statistically non significant p- value. The present study also showed that There was statistical significant positive correlation between (T.SAT, serum ferritin), (T.SAT, S.iron) and (T.SAT,SBP) (with p-value 0.03). Our study also showed that there was no statistical significant difference found between patients with T.sat ≤ 20% and those with T.sat &amp;gt; 20% regarding all the studied parameters except ferritin level and iron level was found higher in patients with T.sat &amp;gt;20% than those with T. sat ≤20% with p-value &amp;lt;0.001 and &amp;lt;0.001 respectively. Conclusion Characteristics of iron deficiency or iron overload were not observed in subjects with overweight/obesity and diabetic patients. Our results suggest a complex metabolic dysregulation.

Relationship between Serum Zinc Level and Retinopathy in Type 2 Diabetic Patients

Abstract Background Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia caused by insulin resistance (IR) or impaired insulin production. Diabetic retinopathy (DR) is a common microvascular disorder which occurs in type 2 diabetes mellitus (T2DM) patients due to chronic hyperglycemia. Previous studies reported that serum zinc (Zn) was associated with certain diabetic microvascular complications. Objective To evaluate relation between serum zinc level and diabetic retinopathy in patients with type 2 diabetes mellitus. Subjects and Methods The current study included 60 subjects with their ages ranging from 18- 60, selected from diabetes and ophthalmology outpatient clinics of Ain Shams University Hospitals for 7 months in a period from July 2022 to January 2023 with matched age and sex . fasting and post prandial blood glucose, hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP),serum creatnine, LDL, HDL, TG,TC and serum zinc levels were measured among groups. Results The study shows statistically significant difference between DM type II subgroups regarding duration of disease (yrs) being higher in DM II with retinopathy 12.5 (10.5 – 16.5) than DM II without retinopathy 9 (6 – 12) with p &amp;lt; 0.001. serum Zn levels were significantly lower in the DR group than the controls and diabetic without retinopathy.in whole DM type II group, there was statistically significant negative correlation found between zinc level and duration of diabetes, HbA1c, LDL, TC, FBS, 2PP and serum creatinine level, while in DM II without retinopathy there was statistically significant negative correlation found between zinc level and duration of diabetes, LDL, TC and FBS and also in DM type II retinopathy there was statistically significant negative correlation found between zinc level and duration of diabetes, HbA1c, FBS, 2PP and serum cretainine level .There is no statistically significant difference found between control group and DM type II group regarding weight, height and BMI of the studied patients with p-value = 0.108, 0.198 and 0.343; respectively. There is no statistically significant difference found between control group and DM type II group regarding systolic and diastolic blood pressure of the studied patients with p- value = 0.554 and 0.405; respectively. Conclusion Our study suggested that lower serum zinc level in T2D patients was related to higher prevalence of diabetic microvascular complications. Patients with lower serum zinc level were more likely to have a longer duration of diabetes, poorer glucose control, and worse β-cell function. Older age, higher HbA1c level, and the prevalence of DN were risk factors related to the lower serum zinc level.

The Diagnostic Value of Monocyte Count/HDL Cholesterol Ratio as a New Marker in Diabetic Retinopathy

Abstract Background Diabetes mellitus is a set of metabolic diseases characterized by chronic hyperglycemia as a consequence of lack in insulin action, secretion, or both. All of which lead to long-term damage and dysfunction of different organs predominantly the eyes, kidneys, nerves, heart, and blood vessels. Aim of the Work The aim of the study is to investigate the diagnostic value of MHR in diabetes and whether it can be utilized as an indicator of diabetic retinopathy. Patients and Methods This study was a case control study on 100 patients attending diabetes outpatient clinic at Ain shams university hospital 30 male, 70 female. 50 patient with diabetic retinopathy and 50 patient without retinopathy to detect the MHR in each group and to detect whether it can be utilized as an indicator of diabetic retinopathy. Results In this study there is a significant correlation between diabetic retinopathy and MHR, MHR being higher in patient with diabetic retinopathy, with a cut-off level of &amp;gt; 0.01 with 74% sensitivity and 64% specificity. Our study showed a significant relation between long standing duration of diabetes mellitus and diabetic retinopathy. Also there was significant relation between diabetic retinopathy with high glycemic profile with fasting blood sugar and 2 hour post prandial blood sugar and Hba1c. The study also show that there is no significant relation between diabetic retinopathy and weight, height, BMI. Conclusion Diabetic retinopathy (DR) is a major complication of diabetes mellitus (DM), which remains a leading cause of visual loss in working-age populations. MHR being higher in patient with diabetic retinopathy. And can be it can be utilized as an indicator of diabetic retinopathy.

Evaluation of glycemic control, comorbidities, complications and mortality twenty-five-year follow-up at a diabetes outpatient clinic in Brazil

Objective: The objective of this study is to evaluate glycemic control, comorbidities, diabetes-related complications, and mortality among people with DM followed-up at an outpatient clinic based at a Diabetes Association in Brazil. Methods: Sociodemographic, medical and mortality data were obtained from 1,173 patients with type 1 (T1DM) and type 2 diabetes (T2DM) who were evaluated once between 1996-2011 and whose vital status was checked in 2022. Data were analyzed using statistical tests to find out different characteristics between patients with DM1 and DM2. Results: 204 patients had T1DM (17.3%), 969 T2DM (82.6%) and 404 (34.4%) died during the study period (2.8% T1DM and 31.6% T2DM). Among T1DM, 82.3% had inadequate glycemic control, 61.2% had no associated comorbidity and presented varied causes of death. Regarding T2DM, 64.18% had inadequate glycemic control, had more comorbidities, higher rates of smoking and died more frequently due to cardiovascular diseases. Conclusion: Based on glycemic control, current care model provided needs to be rethought to provide more frequent clinical follow-up and structured education. Training health professionals, general practitioners and specialists is urgently needed as well as further long-term prospective studies in this topic.

Burden of Disease in Refugee Patients with Diabetes on the Island of Lesvos-The Experience of a Frontline General Hospital.

We sought to evaluate the degree of hyperglycaemia in refugees with known or recently diagnosed diabetes, to assess cardiovascular comorbidities and diabetes complications, to review and provide available therapeutic options, and to compare, if possible, the situation in Lesvos with other locations hosting refugee populations, thus raising our awareness towards barriers to accessing healthcare and managing diabetes in these vulnerable populations and to propose follow-up strategies. We retrospectively studied 69 refugee patients (68% of Afghan origin, 64% female) with diabetes mellitus (81% with type 2 diabetes), who were referred to the diabetes outpatient clinics of the General Hospital of Mytilene, Lesvos, Greece, between June 2019 and December 2020. Age, Body Mass Index, diabetes duration, glycaemic control (HbA1c and random glucose), blood pressure, estimated renal function, lipid profile, diabetes complications and current medication were documented at presentation and during subsequent visits. For all patients with type 1 diabetes and type 2 diabetes, age at presentation was 17.7 and 48.1 years, BMI 19.6 kg/m2 and 28.9 kg/m2 and HbA1c 9.6% and 8.7%, respectively (all medians). One-third (29%) of patients with type 2 diabetes presented either with interrupted or with no previous pharmacological treatment. Insulin was administered to only 21% of refugees with poorly controlled type 2 diabetes. Only half of the patients (48%) with hypertension were taking antihypertensive medication and one-sixth (17%) were taking lipid-lowering medication. Forty-two per cent (42%) of patients were lost to follow-up. Our results showed that a significant portion of refugees with diabetes have either no treatment at all or have had their treatment discontinued, that insulin is still underutilised and that a significant portion of patients are lost to follow-up. It is essential to enhance our ability to identify refugees who may be at risk of developing diabetes or experiencing complications related to the disease. Additionally, it is important to expand access to crucial treatment and monitoring services. By improving our policies for managing non-communicable diseases, we can better support the health and well-being of these vulnerable populations. Furthermore, it is vital to recognize that Greece cannot bear the burden of the refugee crisis alone; international support and collaboration are necessary to address these challenges effectively.

Dietary compliance and its determinants among type 2 diabetes patients in Tamale Metropolis, Ghana

BackgroundThe prevalence of type 2 diabetes is currently high and still rising, predominantly in developing countries including Ghana. Type 2 diabetes patients’ adherence to recommended diet is shown to improve their health outcomes. This study investigated dietary compliance and its determinants among type 2 diabetes patients in Tamale Metropolis, Ghana.MethodsThis study employed analytical cross-sectional study design and involved 343 participants selected through systematic random sampling from the outpatient diabetes clinics of Tamale Teaching Hospital, Tamale West Hospital and Tamale Central Hospital. A semi-structured questionnaire was used to document participants’ socio-demographic, lifestyle and clinical characteristics. The modified Morisky dietary adherence scale was used to assess dietary compliance. Bivariate and multivariate analyses were performed to determine the predictors of dietary compliance.ResultsThe mean age of participants was 56.4 ± 15.7 years. More than half of the participants (62.4%) were females. The participants had a higher compliance status (70.6%). The study also revealed that, as a patient’s age increases, compliance decreases [Adjusted odd ratio (AOR): 0.96, 95%, Confidence interval (CI) 0.94–0.99, P = 0.002]. Regarding educational status, patients who completed JHS/Middle School [AOR: 2.458, 95% CI 1.019–5.928, P = 0.045] and SHS/Vocational School [AOR: 2.73, 95% CI 1.08–6.91, P = 0.035] were more likely to comply with dietary recommendations compared to those with no formal education.ConclusionThe rate of dietary compliance was high among the study participants. Age and educational status of participants significantly influenced their dietary compliance, suggesting that these factors should be taken into account when developing strategies to enhance dietary adherence.

Effect of a multicomponent quality improvement strategy on sustained achievement of diabetes care goals and macrovascular and microvascular complications in South Asia at 6.5 years follow-up: Post hoc analyses of the CARRS randomized clinical trial.

Diabetes control is poor globally and leads to burdensome microvascular and macrovascular complications. We aimed to assess post hoc between-group differences in sustained risk factor control and macrovascular and microvascular endpoints at 6.5 years in the Center for cArdiovascular Risk Reduction in South Asia (CARRS) randomized trial. This parallel group individual randomized clinical trial was performed at 10 outpatient diabetes clinics in India and Pakistan from January 2011 through September 2019. A total of 1,146 patients with poorly controlled type 2 diabetes (HbA1c ≥8% and systolic BP ≥140 mm Hg and/or LDL-cholesterol ≥130 mg/dL) were randomized to a multicomponent quality improvement (QI) strategy (trained nonphysician care coordinator to facilitate care for patients and clinical decision support system for physicians) or usual care. At 2.5 years, compared to usual care, those receiving the QI strategy were significantly more likely to achieve multiple risk factor control. Six clinics continued, while 4 clinics discontinued implementing the QI strategy for an additional 4-year follow-up (overall median 6.5 years follow-up). In this post hoc analysis, using intention-to-treat, we examined between-group differences in multiple risk factor control (HbA1c <7% plus BP <130/80 mm Hg and/or LDL-cholesterol <100 mg/dL) and first macrovascular endpoints (nonfatal myocardial infarction, nonfatal stroke, death, revascularization [angioplasty or coronary artery bypass graft]), which were co-primary outcomes. We also examined secondary outcomes, namely, single risk factor control, first microvascular endpoints (retinopathy, nephropathy, neuropathy), and composite first macrovascular plus microvascular events (which also included amputation and all-cause mortality) by treatment group and whether QI strategy implementation was continued over 6.5 years. At 6.5 years, assessment data were available for 854 participants (74.5%; n = 417 [intervention]; n = 437 [usual care]). In terms of sociodemographic and clinical characteristics, participants in the intervention and usual care groups were similar and participants at sites that continued were no different to participants at sites that discontinued intervention implementation. Patients in the intervention arm were more likely to exhibit sustained multiple risk factor control than usual care (relative risk: 1.77; 95% confidence interval [CI], 1.45, 2.16), p < 0.001. Cumulatively, there were 233 (40.5%) first microvascular and macrovascular events in intervention and 274 (48.0%) in usual care patients (absolute risk reduction: 7.5% [95% CI: -13.2, -1.7], p = 0.01; hazard ratio [HR] = 0.72 [95% CI: 0.61, 0.86]), p < 0.001. Patients in the intervention arm experienced lower incidence of first microvascular endpoints (HR = 0.68 [95% CI: 0.56, 0.83), p < 0.001, but there was no evidence of between-group differences in first macrovascular events. Beneficial effects on microvascular and composite vascular outcomes were observed in sites that continued, but not sites that discontinued the intervention. In urban South Asian clinics, a multicomponent QI strategy led to sustained multiple risk factor control and between-group differences in microvascular, but not macrovascular, endpoints. Between-group reductions in vascular outcomes at 6.5 years were observed only at sites that continued the QI intervention, suggesting that practice change needs to be maintained for better population health of people with diabetes. ClinicalTrials.gov NCT01212328.

Efficacy and Safety of Injectable Dulaglutide 1.5 mg Among Type 2 Diabetes Patients in Clinics at King Saud Medical City, Riyadh, Saudi Arabia

IntroductionType 2 diabetes mellitus is the most common type of diabetes, characterized by varying degrees of insulin resistance and diminishing beta-cell function, which increases the risk of macrovascular and microvascular complications. Dulaglutide is a long-acting glucagon-like peptide-1 receptor agonist that is administered once weekly and approved for treating adults with type 2 diabetes mellitus. It can be used as a monotherapy or in addition to oral hypoglycemic or insulin therapy.AimThis study aims to provide information contributing to assessing the efficacy and safety of weekly 1.5 mg dulaglutide therapy in Saudi adult patients with type 2 diabetes mellitus.MethodsA retrospective single-arm cohort study using a purposive sample to recruit type 2 diabetes mellitus patients on dulaglutide from endocrine and diabetic outpatient clinics in King Saud Medical City (N = 205). Data were collected from participants’ medical profiles and through the phone using interview questionnaires.ResultsMost participants were female and married; approximately 33% had had diabetes for more than 20 years, 41.4% of the sample had third-class obesity, and more than half had used dulaglutide for the last 1–2 years. With therapy, weight, body mass index, hemoglobin A1c, and fasting blood sugar were significantly improved after 6 and 12 months from baseline. The main side effects reported were nausea (52%) and fatigue (28%).ConclusionDulaglutide is a safe and effective therapy that demonstrated favorable glycemic control and weight reduction in obese type 2 diabetes patients of Saudi origin.

Association of type 2 diabetes with family history of diabetes, diabetes biomarkers, mental and physical disorders in a Kenyan setting

This study aimed to determine the degree of family relations and associated socio-demographics characteristics, clinical/physical and mental disorders in type 2 diabetes mellitus in a Kenyan diabetes clinic. This study was part of a large multicentre study whose protocol and results had been published. It took place at the outpatient diabetes clinic at a County Teaching and Referral Hospital in South East Kenya involving 182 participants. We used a socio-demographic questionnaire, the Hamilton Depression (HAM-D) and PHQ-9 rating scales for depression, the MINI International Neuropsychiatric Interview (MINI; V5 or V6) for DSM-5 diagnoses, the WHO-5 Well-being scale and Problem Areas in Diabetes Scale (PAID). We extracted from the notes all physical conditions. We enquired about similar conditions in 1st and 2nd degree relatives. Descriptive, Chi-square test, Fisher’s exact test, one way ANOVA, and Multinomial logistic regression analysis were conducted to test achievements of our specific aims. Of the 182 patients who participated in the study, 45.1% (82/182) reported a family history of diabetes. Conditions significantly (p < 0.05) associated with a degree of family history of diabetes were retinopathy, duration of diabetes (years), hypertension, and depressive disorder. On average 11.5% (21/182) scored severe depression (≥ 10) on PHQ-9 and 85.2% (115/182) scored good well-being (≥ 13 points). All DSM-5 psychiatric conditions were found in the 182 patients in varying prevalence regardless of relations. In addition, amongst the 182 patients, the highest prevalence was poor well-being on the WHO quality of life tool. This was followed by post-traumatic disorders (current), suicidality, and psychotic lifetime on DSM-5. The least prevalent on DSM-5 was eating disorders. Some type 2 diabetes mellitus physical disorders and depression have increased incidence in closely related patients. Overall, for all the patients, the prevalence of all DSM-5 diagnoses varied from 0.5 to 9.9%.