Self-reported Diabetes Mellitus Research Articles

Collegiate Athletes With Diabetes: Baseline Medical Comorbidities and Preseason Concussion Testing Performance.

People with diabetes mellitus (DM) are at increased risk for adverse health events and complications throughout their lifetime. Whether DM significantly affects collegiate athletes' concussion baseline testing performance remains unclear. To (1) describe the prevalence of DM and associated comorbidities and (2) compare concussion baseline testing performance between student-athletes with DM and student-athletes without DM (NoDM). Retrospective, cross-sectional study. University. Using the Concussion, Assessment, Research and Education (CARE) Consortium research database, we matched athletes with self-reported DM (N = 229) by institution, sex, age, sport, position, testing year, and concussion history to athletes with NoDM (N = 229; total sample mean age = 19.6 ± 1.4 years, women = 42%). Descriptive statistics and χ2 tests of independence with subsequent odds ratios were calculated. Independent-samples t tests compared baseline symptoms, neurocognitive testing, and balance performance between athletes with DM and athletes with NoDM. Effect sizes were determined for significant group differences. At baseline, athletes with DM had higher rates of self-reported pre-existing balance disorders, sleep disorders, seizure disorders, motion sickness, learning disorders, vision and hearing problems, psychiatric disorders, depression, bipolar disorder, nonmigraine headaches, and meningitis than athletes with NoDM (P values < .05). We found balance differences between groups (P = .032, Cohen d = 0.17) such that, on average, athletes with DM had 1 additional error on the Balance Error Scoring System (DM = 13.4 ± 6.5; NoDM = 12.1 ± 5.9). No other comparisons yielded significant results. Although athletes with DM had high rates of self-reported balance disorders, sleep disorders, seizures, and meningitis, their baseline neurocognitive testing results were largely identical to those of athletes with NoDM. Our findings suggested that nonclinically meaningful differences were present in concussion baseline balance testing but no significant differences were noted in cognitive testing; however, the effect of DM on concussion recovery remains unknown.

Associations Between Dietary Patterns and Kidney Health Assessed in the Population-Based CHRIS Study Using Reduced Rank Regression

ObjectiveWhile diet plays a key role in CKD management, the potential for diet to impact CKD prevention in the general population is less clear. Using a priori knowledge, we derived disease-related dietary patterns (DPs) through reduced rank regression (RRR) and investigated associations with kidney function, separately focusing on generally healthy individuals and those with self-reported kidney diseases, hypertension or diabetes mellitus. Methods8,686 participants from the population-based Cooperative Health Research in South Tyrol (CHRIS) study were split into a group free of kidney disease, hypertension and diabetes (n=6,133) and a group with any of the three conditions (n=2,553). Diet was assessed through the self-administered GA2LEN food frequency questionnaire (FFQ) and DPs were derived through RRR selecting FFQ-derived sodium, potassium, phosphorus and protein intake as mediators. Outcomes were creatinine-based estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), CKD and microalbuminuria. Multiple linear and logistic models were used to assess associations between RRR-based DPs and kidney outcomes separately in the two analytic groups. ResultsWe identified three DPs, where high adherence reflected high levels of all nutrients (DP1), high potassium-phosphorus and low protein-sodium levels (DP2), and low potassium-sodium and high protein-phosphorus levels (DP3), respectively. We observed heterogeneous associations with kidney outcomes, varying by analytic group and sex. Kidney outcomes were much more strongly associated with DPs than with single nutrients. ConclusionRRR is a feasible approach to estimate disease-related DPs and explore the combined effects of nutrients on kidney health. Heterogeneous associations across kidney outcomes suggest possible specificity to kidney function or damage. In individuals reporting kidney disease, hypertension or diabetes, specific dietary habits were associated with better kidney health, indicating that disease-specific dietary interventions can be effective for disease control.

The combination between praziquantel treatment and fatty liver disease in relation to diabetes mellitus in Northeast of Thailand

Diabetes mellitus (DM) is a growing global public health concern, including Thailand. Prior research has established an association between fatty liver disease (FLD) and DM. Moreover, the distribution of DM was also found in liver fluke endemic areas where praziquantel (PZQ) was used prevalently. However, limited information exists regarding factors associated with DM, specifically in FLD patients undergoing PZQ treatment. Our study aimed to evaluate the association between the combination of PZQ treatment and FLD diagnosis, and DM in Northeast Thailand. We conducted the study among participants in northeastern Thailand with self-reported DM diagnosis and PZQ treatment history using health questionnaires. Additionally, FLD diagnosis was confirmed through ultrasonography from the Cholangiocarcinoma Screening Program data collected from 2013-2022. We employed multilevel mixed-effect logistic regression to assess the association between the combination of PZQ treatments and FLD diagnosis, and DM, represented as adjusted odds ratios (AOR) and their 95% confidence intervals (CI). Of 756,431 participants, the overall DM prevalence was 7%. Notably, 10.45% of individuals with FLD+ and 8.23% with PZQ+ were found to have DM. Specifically, the prevalence of DM in individuals with PZQ+ and FLD-, PZQ- and FLD+, and PZQ+ and FLD+ combinations were 7.14%, 10%, and 11.81%, respectively. In comparison to PZQ- and FLD-, participants with PZQ+ and FLD-, PZQ- and FLD+, and PZQ+ and FLD+ were associated with DM (AOR = 1.27; 95% CI: 1.24-1.30, AOR = 1.8; 95% CI: 1.76-1.85, and AOR = 2.19; 95% CI: 2.12-2.27, respectively). In conclusion, the combination of PZQ and FLD plays a crucial role in the association with DM, particularly in individuals with PZQ+ and FLD+. Our findings emphasize the importance of DM screening, with special attention to individuals with a combination of PZQ treatment and FLD diagnosis, in order to promote early detection and management of DM in Northeast Thailand.

Self-reported diabetes mellitus among seafarers: occupational and sociodemographic predictors.

Seafarers are at increased risk of diabetes due to their lifestyle and working conditions on board ships. There is, however, limited evidence regarding the magnitude of diabetes and its risk factors. In this study, we aimed to assess the prevalence of self-reported diabetes among seafarers on board ships and identify risk factors associated with it. A cross-sectional epidemiological survey was conducted among seafarers aboard ships between November and December 2022. The study enrolled a total of 4,500 seafarers aged 18 and older. Data were collected using anonymous, standardized questionnaires. The association between the outcome variable and the independent variables was assessed using binary logistic regression models. In total, 2,986 participants were included in the study. The prevalence of self-reported diabetes among seafarers was found to be 8.2% (95% CI: 7.2-9.2). Self-reported diabetes prevalence among officers and non-officers was 7% and 9%, respectively. The mean age of study participants was 37.96 ± 10.22, while the mean age of participants with diabetes was 47.5 ± 9.46. Independent predictors of self-reported diabetes mellitus were age (51+ years) [adjusted odds ratio (AOR): 3.52, 95% confidence interval (CI): 1.46-8.95], rank (non-officer) [AOR: 1.65; 95% CI: 1.14-2.40], worksites (engine) (AOR: 2.08, 95% CI: 1.19-3.77), work experience (10-20 years) (AOR: 4.66, 95% CI: 2.33-10.05), work experience (21+ years) (AOR: 5.01, 95% CI: 2.32-11.55), working hours per week (57-70 hours) (AOR: 1.57, 95% CI: 1.08-2.31), working hours per week (71+ hours) (AOR: 1.80, 95% CI: 1.17-2.80), self-reported hypertension (AOR: 1.44, 95% CI: 1.03-1.99), overweight (AOR: 1.74; 95% CI: 1.24-2.47), and obesity (AOR: 2.93; 95% CI: 1.84-4.65). This study revealed that one in twelve seafarers between the ages of 19 and 70 have self-reported diabetes. The present study identified significant risk factors associated with diabetes. Risk factor mitigation strategies aimed at high-risk groups should be implemented on board ships.

Awareness of the diagnosis, treatment, and control of diabetes mellitus in Brazil.

To estimate the proportions of awareness, treatment, and control of diabetes mellitus (DM) in the Brazilian adult population. This is a cross-sectional study, with data from a representative sample of the Brazilian population, taken from the National Health Survey(PNS 2014/2015). Outcomes were defined based on glycated hemoglobin (HbA1c) measurements, self-reported DM diagnosis, and use of hypoglycemic agents or insulin. The proportion of DM awareness, treatment, and control was estimated according to sociodemographic characteristics, health conditions, and access to health services, and their respective 95% confidence intervals. DM prevalence in the Brazilian population was of 8.6% (95%CI: 7.8-9.3): 68.2% (95%CI: 63.9-72.3) were aware of their diagnosis, 92.2% (95%CI: 88.6-94.7) of those who were aware were undergoing drug treatments, and, of these, 35.8% (95%CI: 30.5-41.6) had controlled HbA1c levels. The proportions of DM awareness, control, and treatment were lower in men aged 18 to 39 years, individuals with low education, without health insurance, and beneficiaries of the Bolsa Família program. Approximately one in ten Brazilians has DM. A little more than half of this population is aware of their diagnosis, a condition measured by HbA1c dosage and clinical diagnosis. Among those who know, the vast majority are undergoing drug treatments. However, less than half of these have their HbA1c levels controlled. Worse scenarios were found in subgroups with high social vulnerability.

Association between uncontrolled diabetes and periodontal disease in US adults: NHANES 2009–2014

This study examined the relationship between uncontrolled diabetes and periodontal disease (PD) among adults in the United States. We used data from the 2009–2014 National Health and Nutrition Examination Survey (NHANES) with a sample of 6108 adults ages 30 and over. To measure PD status, we used the Centers for Disease Control and Prevention/American Academy of Periodontology’s standards. To classify DM status (no DM, DM with HbA1c < 9%, diabetes with HbA1c ≥ 9%),we used self-reported Diabetes Mellitus (DM) diagnosis and laboratory report of HbA1c. Approximately 8.5% of the sample had controlled DM, and 1.7% had uncontrolled DM, for a total of 10.2% DM in the analysis. Multivariate logistic regression showed that compared to those without DM, PD was significantly increased with controlled DM (adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) 1.01–1.73, p < 0.05) and even more with uncontrolled DM (aOR = 2.48, 95% CI 1.52–4.04, p < 0.001), after adjusting for covariates. Factors that reduced the prevalence of PD included annual dental visits, female gender, and college education. Factors that significantly increased PD prevalence were cigarette smoking, non-white race, income < 200% Federal Poverty Level, and older age (age > 50 years). In conclusion, uncontrolled DM was significantly associated with higher odds of PD among adults in the US.

The assessment of geriatric malnutrition, geriatric depression and associated co-morbidities among forcibly displaced Myanmar nationals in Bangladesh.

To assess the nutritional status and depression of the elderly forcibly displaced Myanmar nationals (FDMN) in Bangladesh and determine the associated factors of geriatric depression (GD). This was a community-based, cross-sectional study among elderly FDMN. The Mini Nutritional Assessment Short-Form (MNA@-SF) and Geriatric Depression Scale Short-Form (GDS-15 SF) were used to determine malnutrition and GD, respectively. The study was conducted between November 2021 and March 2022 in Kutupalong Refugee Camp, Cox's Bazar, Bangladesh. The study participants were elderly FDMN aged ≥ 60 years (n 430). The mean age and BMI were 71·7(±7·8) years and 21·94(±2·6) kg/m2, respectively. There was a high prevalence of self-reported diabetes mellitus (32·1 %), hypertension (26·7 %), hypotension (20 %), skin diseases (28·4 %) and chronic obstructive pulmonary disease (16·5 %). The prevalence of malnutrition was 25·3 %, and another 29·1 % were at risk. The prevalence of GD was 57·9 %, and co-occurrences of GD and malnutrition were seen in 17·5 % of participants. GD was significantly higher among elderly people with malnutrition (adjusted OR, AOR = 1·71, 95 % CI: 1·01, 2·89). FDMN aged ≥ 80 years were at higher risk of GD (AOR = 1·84, 95 % CI: 1·01, 3·37), and having fewer than five members in the household was an independent predictor of GD. Diabetes mellitus (AOR = 1·95, 95 % CI: 1·24, 3·08) and hypotension (AOR = 2·17, 95 % CI: 1·25, 2·78) were also significantly associated with an increased risk of GD. A high prevalence of GD and malnutrition was observed among elderly FDMN in Bangladesh. The agencies working in Cox's Bazar should focus on geriatric malnutrition and GD for the improvement of the health situation of FDMN in Bangladesh.

The association between bedtime at night and diabetes in US adults: Data from National Health and Nutrition Examination Survey (NHANES) 2015-March -2020 pre-pandemic.

The purpose of this study was to investigate the relationship between bedtime at night and the risk of diabetes in adults. We extracted data from 14,821 target subjects from the NHANES database for a cross-sectional study. The data on bedtime came from the question in the sleep questionnaire: "What time do you usually fall asleep on weekdays or workdays?". Diabetes was defined as fasting blood sugar ≥ 126mg/dL, or glycohemoglobin ≥ 6.5%, or 2-hour Oral Glucose Tolerance Test blood sugar ≥ 200mg/dL, or taking hypoglycemic agent and insulin, or self-reported diabetes mellitus. A weighted multivariate logistic regression analysis was conducted to explore the relationship between bedtime at night and diabetes in adults. From 19:00 to 23:00, a significantly negative association can be found between bedtime and diabetes(OR, 0.91 [95%CI, 0.83, 0.99]). From 23:00 to 02:00, The relationship between the two was positive(OR, 1.07 [95%CI, 0.94, 1.22]), nevertheless, the P values was not statistically significant(p = 0.3524). In subgroup analysis, from 19:00-23:00, the relationship was negative across genders, and in males, the P-values were still statistically significant(p = 0.0414). From 23:00-02:00, the relationship was positive across genders. Earlier bedtime (before 23:00) increased the risk of developing diabetes. And this effect was not significantly different between male and female. For bedtime between 23:00-2:00, there was a trend of increasing the risk of diabetes as the bedtime was delayed.

Changes in masticatory performance and the new onset of diabetes mellitus in older adults: a 5-year longitudinal study.

Although masticatory performance is affected by age-related reduction in number of teeth (or treatment), the relationship between longitudinal changes in masticatory performance and diabetes mellitus is unknown. This longitudinal study investigated the association between changes in masticatory performance and new-onset diabetes mellitus among community-dwelling Japanese older adults. The data of 214 older adults living in Ohnan Town, Shimane, Japan, who participated in two surveys conducted between 2012 and 2017 were analyzed. Diabetes mellitus was defined as a hemoglobin A1c level ≥ 6.5% or self-reported diabetes mellitus. The masticatory performance (measured by number of gummy jelly pieces collected after chewing) was evaluated by dental hygienists. Masticatory performance was categorized into two groups (high or low) based on the median in each survey; further, four groups (Group A: remained consistently high, Group B: changed from low to high, Group C: remained consistently low, Group D: changed from high to low) were used to determine longitudinal changes in masticatory performance. Logistic regression was used to analyze the association between changes in masticatory performance and new-onset diabetes mellitus. Overall, 10.3% of participants had diabetes mellitus at the follow-up survey. Multivariate analysis showed that Group D (odds ratio 8.69, 95% confidence interval 1.98-38.22) was positively associated with the development of diabetes mellitus compared with Group A after adjusting for sex, age, body mass index, alcohol consumption, physical activity, and eating speed. Deteriorating masticatory performance for 5years may cause diabetes mellitus among older adults.

Comparison of complete and spatial sampling frames for estimation of the prevalence of hypertension and diabetes mellitus.

A complete sampling frame (CSF) is needed for the development of probability sampling structures; utilisation of a spatial sampling frame (SSF) was the objective of the present study. We used two sampling methods, simple random sampling (SRS) and stratified random sampling (STRS), to compare the prevalence estimates delivered by a CSF to that by a SSF when applied to self-reported hypertension and diabetes mellitus in a semi-urban setting and in a rural one. A CSF based on Geodatabase of all households and all individuals was available for our study that focused on adults aged 18-69 years in the two settings. A single digitized shapefile of solely household regions/structures as SSF was developed using Google Earth and employed for the study. The results from the two sampling frames were similar and not significantly different. All 95%CI calculations contained the prevalence rates of the two medical conditions except for one occasion based on STRS and CSF. The SRS based on CSF showed a minimum 95% CI width for diabetes mellitus, whereas SSF showed a minimum 95% CI width for hypertension. The coefficient of variation exceeded 10.0% on six occasions for CSF but only once for SSF, which was found to be as efficient as CSF.

Access and Use of Health Services by People with Diabetes from the Item Response Theory.

The objective of this study was to analyze the indicators of access and use of health services in people with diabetes mellitus. This study used data from the National Health Survey, conducted in Brazil in 2013. The National Health Survey was carried out with adults aged 18 years or older residing in permanent private households in Brazil. Indicators from 492 individuals with self-reported diabetes mellitus living in the Central-West region of the country were analyzed. Item response theory was used to estimate the score for access to and use of health services. Multiple linear regression was used to analyze factors associated with scores of access and use of health services by people with diabetes mellitus. The mean score of access estimated by the item response theory and use estimated was 51.4, with the lowest score of zero (lowest access and use) and the highest 100 (highest access and use). Among the indicators analyzed, 74.6% reported having received medical care in the last 12 months and 46.4% reported that the last visit occurred in primary care. Only 18.9% had their feet examined and 29.3% underwent eye examinations. Individuals of mixed-race/skin color and those residing outside capital and metropolitan regions had lower access and use scores when compared to white individuals and residents of state capitals, respectively. The study shows several gaps in the indicators of access and use of health services by people with diabetes. People of mixed race/skin color and residents outside the capitals and metropolitan regions had lower scores for access and use, suggesting the need to increase health care in these groups.

Spatial Patterns and Determinants of Diabetes Mellitus in Indian AdultPopulation: a Secondary Data Analysis from Nationally Representative Surveys.

Diabetes mellitus (DM) is a major public health challenge around the world. It is crucial to understand the geographic distribution of the disease in order to pinpoint high-priority locations and focus intervention on the target populations. Hence, this study was carried out to determine the spatial pattern and determinants of type-2 DM in an Indian population using National Family Health Survey-4 (NFHS-4) and Longitudinal Aging Survey in India (LASI). We have adopted an ecological approach, wherein geospatial analysis was performed using aggregated district-level data from NFHS-4 (613 districts) and LASI survey datasets (632 districts). Moran's I statistic was determined and Local Indicators of Spatial Association (LISA) maps were created to understand the spatial clustering pattern of DM. Spatial regression models were run to determine the spatial factors associated with DM. Prevalence of self-reported DM among males (15-50years) and females (15-49years) was 2.1% [95% confidence interval (CI) 2.0-2.3%] and 1.7% (95% CI 1.6-1.8%), respectively. Prevalence of self-reported DM among males and females aged 45years and above was 12.5% (95% CI 11.5-13.5%) and 10.9% (95% CI 9.8-12%). Positive spatial autocorrelation with significant Moran's I was found for both males and females in both NFHS-4 and LASI data. High-prevalence clustering (hotspots) was maximum among the districts belonging to southern states such as Kerala, Tamil Nadu, Karnataka, and Andhra Pradesh. Northern and central states like Madhya Pradesh, Chhattisgarh, and Haryana mostly had clustering of cold spots (i.e., lower prevalence clustered in the neighboring regions). DM burden in India is spatially clustered. Southern states had the highest level of spatial clustering. Targeted interventions with intersectoral coordination are necessary across the geographically clustered hotspots of DM.

Associated Factors With Self-reported Systemic Arterial Hypertension and Diabetes in Brazilian Older Adults: Populational-Based Cross-Sectional Study

Objective: This cross-sectional study aimed to assess the prevalence and associated factors of Systemic Arterial Hypertension (SAH) and Diabetes Mellitus (DM) in older adults. Materials and Methods: Self-reported SAH and DM (outcomes) were obtained through a structured questionnaire. This questionnaire also collected the independent variables (sociodemographic characteristics, use of medication and access to the oral health service). Obesity, physical activity, and tooth loss were assessed using validated instruments. Crude and adjusted Poisson regression with a robust error variance were performed to determine the prevalence ratio (PR) and 95% confidence interval (CI). Results: A total of 282 older adults were included, with the prevalence of 71.28% and 21.63% for SAH and DM, respectively. SAH was significantly associated with increase in the individuals’ age (PR:1.01; 95%CI:1.00–1.02) and the positive diagnosis for obesity (PR:1.24; 95%CI:1.09–1.43). Those that do not use drugs for other conditions (PR:0.74; 95%CI:0.60–0.71) presented significantly lower PR for SAH. Non-sedentary older adults have the lower RP of DM (PR: 0.42; 95%CI: 0.24–0.74). Conclusions: A high prevalence of SAH and DM was observed among the older adults, and the main associated factors were mainly related to demographic characteristics, general health and behavioral habits.

Does awareness of diabetic status increase risk of depressive or anxious symptoms? Findings from the China Multi-Ethnic cohort (CMEC) study

IntroductionPeople with diabetes mellitus (DM) have increased risk of depressive symptoms (DS) or anxious symptoms (AS). This study explores whether awareness of DM will contribute to prevalence of DS or AS. MethodsThe baseline data including 81,717 adults from Southwest China was analyzed. DS and AS were assessed using PHQ-2 and GAD-2. Exposures were defined as 1) having self-reported physician diagnosis of diabetes (self-reported DM), 2) no prior diagnosis of diabetes but meeting diagnostic criteria (newly diagnosed DM), 3) having self-reported physician diagnosis or meeting criteria of non-diabetic diseases (non-diabetic patients), 4) healthy participants. Generalized linear mixed models were used to assess impact of presence and awareness of DM on DS or AS, adjusting for regional and individual related factors. ResultsThe prevalence of DS in self-reported DM, newly diagnosed DM, non-diabetic patient and healthy participants was 7.08 %, 4.30 %, 5.37 % and 3.17 %. The prevalence of AS was 7.80 %, 5.77 %, 6.37 % and 3.91 %. After adjusting for related factors, compared with healthy participants, self-reported DM and non-diabetic patients were associated with DS [AORDS, self-reported = 1.443(1.218,1.710), AORDS, nondiabetic patients = 1.265(1.143,1.400)], while the association between newly diagnosed DM and DS was not statistically significant. The associations between self-reported DM, newly diagnosed DM, non-diabetic patients and AS were all statistically significant. LimitationsDS and AS were assessed through self-report and may suffer recall or information bias. ConclusionsThe association between awareness of diabetes and DS/AS suggests to pay attention to distinguish between self-reported and newly diagnosed DM and screening for DS and AS in diabetic population.

Diabetes-associated thigh muscle degeneration mediates knee osteoarthritis-related outcomes: results from a longitudinal cohort study.

We examined the association between diabetes mellitus (DM) and longitudinal MRI biomarkers for thigh muscle degeneration in patients with knee osteoarthritis (KOA) and their mediatory role in worsening KOA-related symptoms. The Osteoarthritis Initiative (OAI) participants with radiographic KOA (Kellgren-Lawrence grade ≥ 2) were included. Thighs and corresponding knees of KOA patients with versus without self-reported DM were matched for potential confounders using propensity score (PS) matching. We developed and used a validated deep learning method for longitudinal thigh segmentation. We assessed the association of DM with 4-year longitudinal muscle degeneration in biomarkers of muscle cross-sectional area (CSA) and contractile percentage (non-fat CSA/total CSA). We further investigated whether DM is associated with 9-year risk of KOA radiographic progression, knee replacement (KR), and symptoms worsening. Finally, we evaluated whether the DM-KOA worsening association is mediated through preceding muscle degeneration. After PS matching, 698 thighs/knees were included (185:513 with:without DM; average ± SD age:64 ± 8-years; female/male:1.4). Baseline DM was associated with a decreased contractile percent of total thigh muscles and quadriceps (mean difference, 95%CI -0.16%/year, -0.25 to -0.07, and -0.21%/year, -0.33 to -0.08). DM was also associated with an increased risk of worsening KOA-related symptoms (hazard ratio, 95%CI 1.70, 1.18-2.46) but not radiographic progression or KR. The decrease in quadriceps contractile percent partially mediated the increased risk of symptoms worsening in patients with DM. Baseline DM is associated with thigh muscle degeneration and KOA-related symptoms worsening. As a potentially modifiable risk factor, DM-associated longitudinal thigh muscle degeneration may partially mediate the symptoms worsening in patients with DM and coexisting KOA. • Diabetes mellitus (DM) is associated with worsening knee osteoarthritis (KOA)-related symptoms. • As a potentially modifiable factor, DM-associated thigh muscle (quadriceps) degeneration partially mediates the worsening of KOA-related symptoms.

Comparison of Diabetes Mellitus Risk Factors in Mexico in 2003 and 2014.

ObjectiveThe prevalence of diabetes mellitus in Mexico is very high. This study aimed to compare the risk factors of diabetes mellitus in Mexican adults in 2003 and in 2014.MethodsThis study had a repeated cross-sectional design. Data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) from Mexico (Wave 0, 2003, and Wave 2, 2014) were compared. Self-reported diabetes mellitus (outcome) was evaluated with the yes/no question: “Have you ever been diagnosed with diabetes mellitus (high blood sugar)?” Bivariate analyses and multivariable logistic regression analyses adjusted for potential risk factors were conducted.ResultsIn 11 years (2003–2014), the prevalence of self-reported diabetes mellitus in Mexican adults increased by 2.6 times in those younger than 50 years (2003: 2.1%; 2014: 5.5%) and by 1.9 times in those ≥50 years (2003: 12.7%; 2014: 24.2%). In 2003, the risk factors associated with diabetes mellitus were female sex (OR 1.344, 95% CI 1.176–1.536), age ≥50 years (OR 6.734, 95% CI 5.843–7.760), being overweight (OR 1.359, 95% CI 1.175–1.571), obesity (OR 1.871, 95% CI 1.583–2.211), and lower physical activity of <600 MET-minutes/week (OR 1.349, 95% CI 1.117–1.630). In 2014, the exposure characteristics significantly associated with diabetes mellitus were female sex (OR 1.244, 95% CI 1.025–1.511), older age ≥50 years (OR 4.608, 95% CI 3.260–6.515), being overweight (OR 1.649, 95% CI 1.305–2.083), obesity (OR 1.778, 95% CI 1.398–2.261), and in those who had not attended/completed primary school (OR 1.360, 95% CI 1.042–1.773).ConclusionThe prevalence of diabetes mellitus in Mexico significantly increased from 2003 to 2014. Female sex, age older than 50 years, and being overweight or obese were significant risk factors in both 2003 and 2014. Not having completed primary school was a new significant risk factor in 2014. Public health policies and strategies should prioritize decreasing the high levels of overweight and obesity, and improve health literacy in Mexico.

Analysis of Perception, Reasons, and Motivations for COVID-19 Vaccination in People with Diabetes across Sub-Saharan Africa: A Mixed-Method Approach.

Diabetes mellitus (DM) is associated with severe COVID-19 infection and complications. This study assesses COVID-19 vaccine acceptance and hesitancy in people with DM, and explores the reasons for not being vaccinated. This was a web-based cross-sectional survey using a mixed-method approach conducted in March–May 2021, corresponding to most Sub-Saharan African (SSA) countries’ early vaccine rollout period. Participants were those aged ≥18 years with self-reported DM in 11 Sub-Saharan African (SSA) countries. Responses to comments on the reasons for vaccine hesitancy and facilitators for vaccine uptake were analyzed. Of the 73 participants with DM, 65.8% were males, older than 35 years (86.3%), had postsecondary education (90%), and a significant proportion were from South Africa (39.7%), Nigeria (28.8%) and Ghana (13.7%). At the time of this study, 64.4% experienced COVID-19 symptoms, 46.6% were tested for COVID-19, of which 19.2% tested positive. Few participants (6.8%) had received a COVID-19 vaccination, 65.8% were willing to take the vaccine when it becomes available in their country, while 26.0% either refused or remained hesitant towards taking the vaccine. The main identified reasons for not taking the vaccine were: advice from religious leaders; concerns about the safety, effects, and efficacy of the vaccines; mistrust of the pharmaceutical companies producing the vaccines and the process of production; the conspiracy theories around the vaccines; and the personal belief of the participants regarding vaccination. However, participants stated they would take the vaccine if they were more educated about it, received positive feedback from those vaccinated, were rewarded for taking the vaccine, or if vaccination became a condition for travel and employment. In conclusion, this study shows that the uptake of the COVID-19 vaccine was very low in this high-risk group. Efforts to increase the uptake of COVID-19 vaccines among people with diabetes are imperative, such as the provision of education and relevant information.

Understanding of front of package nutrition labels: Guideline daily amount and warning labels in Mexicans with non-communicable diseases.

One strategy for the prevention and treatment of non-communicable diseases (NCDs) is the implementation of the front-of-pack labeling (FoPL) in foods and beverages. In 2020, Mexico adopted the warning label system (WL) as a new public health policy, whose aim is to help consumers make healthier food choices. Previously, the Guideline Daily Amount (GDA) was the labelling used it. This paper aims to compare the understanding of two FoPL, the GDA and the WL, through the identification of unhealthy products in Mexicans with NCDs. We analyzed data from 14,880 Mexican adults older than 20 years old with NCDs (overweight-obesity (OW/O), self-reported diabetes mellitus 2 (DM2), or/and hypertension (HT), or/and dyslipidemia (Dys)). Participants were randomly assigned to one of two groups: the GDA labeling or WL. Each group had to respond to a survey and had to classify food products images as healthy or unhealthy according to the labelling system to which they were assigned. The correct classification was determined according to the criteria of Chile’s labeling nutrient profile stage 3. To evaluate the correct classification in each one of the groups we evaluated the differences in proportions. Logistic regression models were used to assess the likelihood to correctly classify the product according to participants’ number of diseases and WL information, taking GDA label as a reference. Participants who used the information contained in the GDA label misclassified food product labels in greater proportion (70%), mostly participants with three or more NCDs (participants with OW/O+ HT+ Dys, represent 42.3% of this group); compared with those who used WL (50%). The odds of correct classification of food products using WL image were two times greater compared to GDA image in participants with NCDs; being greater in participants with three or more NCDs. The study results highlight the usefulness of WL as it helps Mexicans with NCDs to classify unhealthy food products more adequately compared with GDA.

Barriers to depression care among middle-aged and older adults in Taiwan's universal healthcare system

SummaryBackgroundBarriers to depression care differ across countries, highlighting the importance of identifying gaps in health-service coverage for regional health systems. This study aims to identify the bottlenecks of depression care and associated factors.MethodsWe used data from the Taiwan Longitudinal Study on Aging of 2015, included 7675 participants aged 50 years and older. We identified participants with clinically relevant depression using the Center for Epidemiological Studies Depression Scale or Taiwan's National Health Insurance program claims records of depressive disorders. Bottleneck analysis was based on a modified Tanahashi framework with four stages: healthcare accessibility, initial contact, adequate treatment, and effective coverage. Individual factors associated with achieving these stages were estimated using multivariable logistic regression models with multiple imputation.FindingsWe identified 1253 patients with clinically relevant depression; 83% perceived it as convenient to access healthcare, but only 27% had initial contact with health services, 16% received adequate coverage, and 11% achieved effective treatment. In terms of factors associated with initial contact, being female, married, or retired/unemployed; having a high education level, social group engagement, or self-reported diabetes mellitus; exercising regularly; and participating in social leisure activities were associated with increasing contact. Those with alcohol use had a low likelihood of treatment.InterpretationInitial contact constitutes the primary bottleneck of depression care in Taiwan. Improving mental health literacy and enhancing depression screening would be helpful to elevate treatment rates and improve depression care.FundingThis study was supported by a grant from the Ministry of Health and Welfare, Taiwan.

The association between oil spill cleanup-related total hydrocarbon exposure and diabetes

BackgroundAlthough evidence suggests relationships between some crude oil components and glycemic dysregulation, no studies have examined oil spill-related chemical exposures in relation to type 2 diabetes mellitus (DM) risk. This study examined the relationship between total hydrocarbon (THC) exposure among workers involved in the 2010 Deepwater Horizon (DWH) oil spill and risk of DM up to 6 years afterward. MethodsParticipants comprised 2660 oil-spill cleanup or response workers in the prospective GuLF Study who completed a clinical exam and had no self-reported DM diagnosis prior to the spill. Maximum THC exposure was estimated with a job-exposure matrix based on interview data and personal measurements taken during cleanup operations. We defined incident DM by self-reported physician diagnosis of DM, antidiabetic medication use, or a measured hemoglobin A1c value ≥ 6.5%. We used log binomial regression to estimate risk ratios (RRs) for DM across ordinal categories of THC exposure. The fully adjusted model controlled for age, sex, race/ethnicity, education, employment status, and health insurance status. We also stratified on clinical body mass index categories. ResultsWe observed an exposure-response relationship between maximum daily ordinal THC exposure level and incident DM, especially among overweight participants. RRs among overweight participants were 0.99 (95% CI: 0.37, 2.69), 1.46 (95% CI: 0.54, 3.92), and 2.11 (95% CI: 0.78, 5.74) for exposure categories 0.30–0.99 ppm, 1.00–2.99 ppm, and ≥3.00 ppm, respectively (ptrend = 0.03). ConclusionWe observed suggestively increasing DM risk with increasing THC exposure level among overweight participants, but not among normal weight or obese participants.