Prevalence Of Uncontrolled Diabetes Research Articles

Development and validation of a risk assessment tool for uncontrolled type 2 diabetes among patients in South Karnataka, India

IntroductionDiabetes is a chronic medical condition with severe complications mainly caused due to unhealthy lifestyles in genetically susceptible individuals. This study attempts to develop a non-invasive risk assessment tool to...

Prevalence and predictors of uncontrolled type 2 diabetes mellitus in primary healthcare centers in Taif

Background: Chronic complications of uncontrolled diabetes include microvascular issues, such as nephropathy, neuropathy, and retinopathy, and macrovascular complications, such as coronary artery disease, peripheral artery disease, stroke, diabetic encephalopathy, and diabetic foot. Objectives: The aim of this study was to assess the prevalence of uncontrolled diabetes and its levels and to determine its contributing factors among diabetes mellitus (DM) patients in Saudi Arabia. Methods: A cross-sectional study was carried out among type 2 diabetic patients who were followed up at primary healthcare centers (PHCCs), under the Ministry of Health, in Taif city in the western province of Saudi Arabia. Data were collected using a formal interview questionnaire consisting of three sections: demographic data, clinical and laboratory data, and predictors of uncontrolled diabetes. Results: The study included 277 type 2 diabetic patients. The prevalence of the uncontrolled disease was 42.2%. Multivariate logistic regression analysis found that using therapy for immunological disorders [odds ratio (confidence interval, "CI"): 1.23 (1.07-3.59), p-value = 0.042) and having a DM duration of more than 15 years [odds ratio (CI): 2.15 (1.99-4.58), p-value= 0.003] were risk factors for uncontrolled DM. Conclusion: Most of type 2 diabetic patients who were followed up at PHCCs had uncontrolled DM. Therefore, organizing an educational program for diabetic patients regarding the importance of keeping glycemic control and factors that could affect it is warranted.

Prevalence and control status of T2DM in Bangladesh: finding from a nationally representative survey

Abstract Background With around 10 million diagnosed patients, Bangladesh remains at the forefront of the global type 2 diabetes mellitus (T2DM) epidemic. A comprehensive understanding of the current T2DM scenario is required to curb the disease burden. In this study, we aimed to identify the prevalence, associated factors, and control status of T2DM in Bangladesh. Methods This cross-sectional survey was conducted in 15 randomly selected community-based clusters in Bangladesh. Around 1,000 adults aged ≥18 years from each cluster were selected. Face-to-face interviews, anthropometric measurement, biospecimen collection, and point of care blood test were performed. Individuals with Fasting Blood Sugar (FBS) ≥126 mg/dl or previously diagnosed with T2DM by a qualified health provider were considered T2DM cases. Multivariate logistic regression analysis was performed to identify factors associated with T2DM. Results Data of 13,674 individuals were analysed for this study. The overall prevalence of T2DM was 10.0%, among whom 29.2% were undiagnosed. Among previously diagnosed patients, 64.9% had uncontrolled diabetes (FBS≥126 mg/dl). The prevalence of uncontrolled diabetes was higher among elderly, female, and urban participants. Patients with hypertension, high waist-hip ratio and high serum cholesterol had 2.20 times (95% CI: 2.17-2.23, p < 0.001), 3.53 times (95% CI: 3.47-3.59, p < 0.001) and 2.53 times (95% CI: 2.48-2.59, p < 0.001) higher odds of having T2DM, respectively. Conclusions One out of every ten adults in Bangladesh had T2DM, and a substantial proportion of them had undiagnosed and uncontrolled diabetes. This finding indicates the lack of preparedness of the country's health system to address the problem. Pertinent stakeholders should adopt a multi-sectoral approach to develop comprehensive policies and implement target-specific interventions, e.g., population-based screening program, primary care based T2DM service, and community mobilisation to combat the T2DM epidemic. Key messages As the T2DM burden is high in Bangladesh, policy makers should adopt a collaborative approach to develop and implement effective public health programs for prevention and control of T2DM. As the burden of uncontrolled T2DM is high in Bangladesh, the country’s health system should ensure early diagnosis and provision of quality care at affordable cost for T2DM patients.

COVID-19-Related Laboratory Analyte Changes and the Relationship Between SARS-CoV-2 and HIV, TB, and HbA1c in South Africa.

We conducted a retrospective analysis on data of all adults tested for SARS-CoV-2 across our laboratory network in South Africa over a 4-month period. Out of 842,197 tests, 11.7% were positive and 88.3% negative. The prevalence of HIV was 6.25 and 6.31% in the SARS-CoV-2-positive and SARS-CoV-2-negative cohort, respectively (p=0.444). However, the prevalence of HIV-positive individuals in the critical cohort (9.15%) was higher than in the noncritical group (6.24%) (p=0.011). Active tuberculosis infection was approximately 50% less in SARS-CoV-2-positive than in SARS-CoV-2-negative individuals. The prevalence of uncontrolled diabetes was 3.4 times higher in SARS-CoV-2-positive cases but was not higher in the critical vs. noncritical cases (p=0.612). The neutrophil-to-lymphocyte ratio, coagulation markers, urea, and cardiac- and liver-related analytes were significantly elevated in the critical compared to noncritical cases. Platelet count and creatinine concentration did not differ significantly between the two groups. These findings do not support increased prevalence of HIV or tuberculosis in individuals with SARS-CoV-2 infection but do suggest an association of increased disease severity with HIV-positive status. Uncontrolled diabetes was positively associated with a significantly higher prevalence of SARS-CoV-2, and our investigation into analyte changes associated with SARS-CoV-2 disease severity supported previous findings of raised inflammatory markers, coagulation markers, liver- and cardiac-related analytes, and urea but not for creatinine and platelet count.

Association of Geographic Differences in Prevalence of Uncontrolled Chronic Conditions With Changes in Individuals’ Likelihood of Uncontrolled Chronic Conditions

The prevalence of leading risk factors for morbidity and mortality in the US significantly varies across regions, states, and neighborhoods, but the extent these differences are associated with a person's place of residence vs the characteristics of the people who live in different places remains unclear. To estimate the degree to which geographic differences in leading risk factors are associated with a person's place of residence by comparing trends in health outcomes among individuals who moved to different areas or did not move. This retrospective cohort study estimated the association between the differences in the prevalence of uncontrolled chronic conditions across movers' destination and origin zip codes and changes in individuals' likelihood of uncontrolled chronic conditions after moving, adjusting for person-specific fixed effects, the duration of time since the move, and secular trends among movers and those who did not move. Electronic health records from the Veterans Health Administration were analyzed. The primary analysis included 5 342 207 individuals with at least 1 Veterans Health Administration outpatient encounter between 2008 and 2018 who moved zip codes exactly once or never moved. The difference in the prevalence of uncontrolled chronic conditions between a person's origin zip code and destination zip code (excluding the individual mover's outcomes). Prevalence of uncontrolled blood pressure (systolic blood pressure level >140 mm Hg or diastolic blood pressure level >90 mm Hg), uncontrolled diabetes (hemoglobin A1c level >8%), obesity (body mass index >30), and depressive symptoms (2-item Patient Health Questionnaire score ≥2) per quarter-year during the 3 years before and the 3 years after individuals moved. The study population included 5 342 207 individuals (mean age, 57.6 [SD, 17.4] years, 93.9% men, 72.5% White individuals, and 12.7% Black individuals), of whom 1 095 608 moved exactly once and 4 246 599 never moved during the study period. Among the movers, the change after moving in the prevalence of uncontrolled blood pressure was 27.5% (95% CI, 23.8%-31.3%) of the between-area difference in the prevalence of uncontrolled blood pressure. Similarly, the change after moving in the prevalence of uncontrolled diabetes was 5.0% (95% CI, 2.7%-7.2%) of the between-area difference in the prevalence of uncontrolled diabetes; the change after moving in the prevalence of obesity was 3.1% (95% CI, 2.0%-4.2%) of the between-area difference in the prevalence of obesity; and the change after moving in the prevalence of depressive symptoms was 15.2% (95% CI, 13.1%-17.2%) of the between-area difference in the prevalence of depressive symptoms. In this retrospective cohort study of individuals receiving care at Veterans Health Administration facilities, geographic differences in prevalence were associated with a substantial percentage of the change in individuals' likelihood of poor blood pressure control or depressive symptoms, and a smaller percentage of the change in individuals' likelihood of poor diabetes control and obesity. Further research is needed to understand the source of these associations with a person's place of residence.

Abstract P295: Residential Segregation Is Associated With Uncontrolled Diabetes Among Brazilian Adults: The Brazilian Longitudinal Study Of Adult Health (elsa-brasil)

Introduction: The prevalence of type-2 diabetes is increasing globally with the sharpest increases occurring in low and middle-income countries. Residential segregation results in increased exposure to adverse neighborhood environments that may inhibit the successful management of diabetes. Moreover, due to historical and contemporary forms of structural racism, marginalized racial groups are more likely to live in these environments. Using a spatial measure of neighborhood-level economic residential segregation (hereafter, segregation) we examined the association between segregation and uncontrolled diabetes in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: The sample included 828 Black, Brown/Mixed-Race, and White participants ages 35-74 with diagnosed diabetes and complete, geocoded information from the baseline examination of ELSA-Brasil (2008-2010). Residential segregation was based on data from the 2010 IBGE demographic census and calculated for study-defined neighborhoods using the local G i * statistic— a spatially weighted z-score that represents how much a neighborhood’s income composition deviates from the larger metropolitan area. Uncontrolled diabetes was based on 2017 ADA criteria and defined as HbA1c ≥ 7%. Multivariable logistic regression models were used to test cross-sectional associations between segregation and uncontrolled diabetes. Results: Black and Brown participants were more likely than Whites to live in highly segregated neighborhoods. The prevalence of uncontrolled diabetes increased across low, medium, and high levels of segregation (23.1% vs. 37.8% vs. 47.7%, respectively). In multivariable models adjusting for age, gender, race, education, income, and study site, segregation was positively associated with uncontrolled diabetes (OR: 1.20, 95% CI: 1.07-1.56). The association was attenuated but remained statistically significant in models adjusting for neighborhood characteristics, behavioral risk factors and time since diabetes diagnosis. (OR: 1.16; 95% CI: 1.05-1.28). In models that included segregation as a categorical variable, individuals living in highly segregated neighborhoods had a 2-fold higher risk of uncontrolled diabetes compared to individuals living in less segregated neighborhoods (High Segregation, OR: 2.20, 95% CI: 1.35-3.58; Medium Segregation, OR: 1.65, 95% CI: 1.08-2.51). Conclusions: Residential segregation may lead to disparate diabetes-related morbidity among urban-dwelling adults in Brazil. Moreover, the disproportionate clustering of Blacks and Browns within segregated neighborhoods implicates segregation as a potential driver of racial inequalities in these outcomes. Policies and/or structural interventions designed to improve neighborhood conditions may be viable strategies to improve the management of diabetes in this setting.

Prevalence of Uncontrolled Type 2 Diabetes Mellitus And Its Associated Factors Among People Within Southern Part of Bangladesh

Background: Diabetes is a disorder which is very much related to a quality of lifestyle. Bangladesh is one of the countries having highest number of diabetes patients. Most of the population in this country used to take high glycemic indexed foods. In this study, we aimed to evaluate the quality of life of diabetic patients of the southern part and Chattogram city to investigate how controlled and uncontrolled diabetes is related to their lifestyle and socio-economic factors.
 Materials and methods: A multi-center, crosssectional study, conducted in five centers of Chattogram, in 2018-2019, registered 1,888 type 2 DM participants, tested for HbA1c and interviewed face-to-face for other information. Logistic regression analysis was conducted to identify factors associated with UDM. Descriptive analysis and chi square test were done to see the statistical significance between various parameters.
 Results: Among the study population nearly 72% were uncontrolled diabetes patients. The prevalence of uncontrolled diabetes in age <60 years was highly significant. Number of female uncontrolled diabetes patients were significantly higher. People having low income and lower level of education were more prone to uncontrolled diabetes.
 Conclusion: Health workers at the diabetic hospitals should intensify education and counselling of diabetics. Modifiable risk factors such as education, food and physical activity be considered as potential targets of interventions in southern part of Bangladesh.
 JCMCTA 2019 ; 30 (2) : 92-98

Diabetes in Israel- do all patients receive equal care?

Abstract Background Diabetes Mellitus (DM) is associated with micro- and macro-vascular complications, leading to high burden of morbidity and mortality. Populations of low socioeconomic position (SEP) in various countries were found to have increased prevalence of the disease, worse glycemic control, and increased complications. We aimed to examine whether there are social disparities in diabetes care in Israel, as reflected in a national program for quality indicators. Methods The Israel National Program for Quality Indicators in Community Healthcare obtains data from electronic medical records from all health plans, covering the entire Israeli population. In 2017, 497,397 individuals aged >18 years were identified with DM. DM prevalence, quality of care indicators, including process and intermediate outcomes were explored by SEP categories (1-10), determined according to residential addresses. Results DM prevalence in Israeli adults in 2017 was 9.7%, showing a strong SEP gradient, with higher prevalence in individuals of lower SEP. No SEP disparities were observed in process indicators with overall rates of documentation of hemoglobin A1c (HbA1c) of 90.9%, ophthalmologic examinations of 72.5%, and kidney function examinations of 92.5%. However, strong SEP disparities were observed in the prevalence of uncontrolled diabetes (HbA1c≥9%), with an overall rate of 10.0%, and a 5.4-times higher rate in diabetics of the lowest SES level (23.5%) compared with the highest SEP level (4.3%). A somewhat weaker gradient was seen for the well-control of DM (HbA1c<7-8%, according to duration of disease and age), with an overall rate of 69.7%, and a 1.7 ratio, comparing diabetics of the highest vs the lowest SEP level. Conclusions These findings suggest that access to care does not explain SEP disparities in diabetes control in Israel. There is a need to explore the underlying social, cultural, and possibly the benefits-policy determinants of poor control among individuals of low SEP. Key messages Wide socioeconomic disparities are present among Israeli adults in diabetes mellitus prevalence and control rates, but not in care processes indicators. These findings call for a deeper understanding of the determinants and perhaps a revision of current social benefits policy, which may encourage lack of glycemic control.

The Effect of the Supportive Educative Nursing Program on Glycemic Control in Vietnamese Patients with Uncontrolled Type 2 Diabetes Mellitus: a Randomized Controlled Trial

Background: The prevalence of uncontrolled diabetes has dramatically increased. Nursing interventions in this area are limited. This study was a randomized controlled trial design that aimed to test the effect of the supportive educative nursing program on glycemic control in Vietnamese patients with uncontrolled type 2 diabetes mellitus. Methods: Eighty-four participants were randomly assigned to an experimental (n=41) and a control group (n=43). Participants in the experimental group received the supportive educative nursing program while the control group received routine care. The glycated hemoglobin (Hb A1C ) level was measured as an indication of glycemic control on day one, before implementation of the program, and at 3 months after, following program implementation. Descriptive statistics, the Chi-square test and the Fisher exact test were used to analyze the data. Results: After 3 months of program implementation, the mean score of Hb A1C level in the experimental group (Mean = 8.47%, SD = 1.27) was lower than that in the control group (Mean = 9.4%, SD = 1.36). Moreover, the proportion of glycemic control in the experimental group was significant higher than that in the control group (p<.02). Conclusions: This finding suggests that a self-care education intervention can improve glycemic control level of Vietnamese patients with uncontrolled type 2 diabetes mellitus which leads to better quality of patients’ life.