Unknown Diabetes Research Articles

Identification of atypical pediatric diabetes mellitus cases using electronic medical records

IntroductionThere are no established methods to identify children with atypical diabetes for further study. We aimed to develop strategies to systematically ascertain cases of atypical pediatric diabetes using electronic medical...

Necrotizing Fasciitis of Odontogenic Origin in a Patient with Unknown Diabetes Mellitus: A Case Report and Literature Overview

Necrotizing fasciitis (NF) is a life-threatening emergency that requires prompt and aggressive surgery with broad-spectrum antibiotherapy and resuscitation. This report aims to raise the index of suspicion for NF allowing early diagnosis mainly in patients with diabetes mellitus and who received non-steroid-anti-inflammatory. A 52-year-old man, without noticeable illness, was admitted for progressive submandibular swallowing, following wisdom tooth extraction, with extensive cervical redness centred by skin depression. The patient’s chief complaint was a sore throat, trismus and intensive pain leading to self-administration of non-steroid-anti-inflammatory drugs. Laboratory tests revealed an unknown diabetes mellitus. Enhanced Computed Tomography revealed the disappearance of fascial planes and tissular swelling containing multi-space emphysema with an airway compromise. The patient underwent surgical debridement of the involved fascial spaces and necrotic tissues until normal bleeding was obtained combined with intensive resuscitation and 37 inpatient days allowed patient rescue without soft tissue sequelae. Thus, Odontogenic NF should be suspected in patients with diabetes mellitus who have taken non-steroid-anti-inflammatory medication especially when there are discrepancies between signs of toxicity and deceptive clinical symptoms of an odontogenic infection. Computed tomography is crucial for prompt diagnosis, therapeutic management and postoperative assessment. Removal of the odontogenic focus simultaneously combined with thorough surgical debridement with broad-spectrum antibiotherapy and resuscitation improves survival rates and reduces visceral morbidity and soft tissue sequelae. Otherwise, Oral health education and care mainly in high-risk patients remain a key to prevent this serious health problem.

Screening system for the detection of unknown or poorly controlled diabetes mellitus in a tertiary hospital: A retrospective study.

Hospitalization may be a valuable chance for the detection of unknown and uncontrolled diabetes mellitus (DM). There is a screening tool at our hospital: in case of high inpatient plasma glucose level, an A1c value is added if no available from the last 3 months. Our objective was to analyse the population with A1c ≥ 9% detected through this system from 2021 to 2023. A retrospective study was performed. Three thousand five hundred seventy-two patients were screened. We studied 243 patients with A1c ≥ 9%. Fourty-eight patients (19.8%) had unknown DM. The Endocrinology department was consulted in 39 cases (16%). In most of the cases (51%), there was not a mention in the discharge report, nor changes in the usual treatment (65.4%). Ninety patients (37%) improved A1c. Most of the ones that improved (58.9%) had a correct follow-up, compared with those who did not (23.5%) (p < 0.01). Measurement of A1c during hospitalization can help us to diagnose unknown or poorly controlled DM. Therapeutic inertia and delayed diagnosis are two problems associated to DM that are confirmed by our data.

Inaccurate diagnosis of diabetes type in youth: prevalence, characteristics, and implications.

Classifying diabetes at diagnosis is crucial for disease management but increasingly difficult due to overlaps in characteristics between the commonly encountered diabetes types. We evaluated the prevalence and characteristics of youth with diabetes type that was unknown at diagnosis or was revised over time. We studied 2073 youth with new-onset diabetes (median age [IQR] = 11.4 [6.2]years; 50% male; 75% White, 21% Black, 4% other race; overall, 37% Hispanic) and compared youth with unknown versus known diabetes type, per pediatric endocrinologist diagnosis. In a longitudinal subcohort of patients with data for ≥ 3years post-diabetes diagnosis (n = 1019), we compared youth with steady versus reclassified diabetes type. In the entire cohort, after adjustment for confounders, diabetes type was unknown in 62 youth (3%), associated with older age, negative IA-2 autoantibody, lower C-peptide, and no diabetic ketoacidosis (all, p < 0.05). In the longitudinal subcohort, diabetes type was reclassified in 35 youth (3.4%); this was not statistically associated with any single characteristic. In sum, among racially/ethnically diverse youth with diabetes, 6.4% had inaccurate diabetes classification at diagnosis. Further research is warranted to improve accurate diagnosis of pediatric diabetes type.

Using nephropathy as an outcome to determine the HbA1c diagnostic threshold for type 2 diabetes

ObjectiveThe hemoglobin A1c (HbA1c) diagnostic threshold for type 2 diabetes (T2D) of 6.5 % (48 mmol/mol) was based on the prevalence of retinopathy found in populations not known to have T2D. It is unclear if nephropathy has a similar HbA1c threshold, partly because it is a rarer complication of early diabetes. This cohort study investigated a very high diabetes prevalence population to determine if a better diagnostic HbA1c value can be established for predicting nephropathy rather than retinopathy in subjects without T2D. MethodsThe urine albumin:creatinine ratios (UACRs) of 2920 healthy individuals from the Qatar Biobank who had an HbA1c ≥ 5.6 %. were studied. Nephropathy was defined as a UACR≥30 mg/g and its prediction by HbA1c was assessed using cut-points ranging from 5.7 to 7.0 % to dichotomize high from low HbA1c. ResultsAlthough there was a significant trend for an increased prevalence of abnormal UACR as the HbA1c threshold increased (p < 0.01), significance was due mostly to subjects with HbA1c ≥ 7.0 % (53 mmol/mol). The odds ratios for abnormal UACR were similar over the 5.7–6.9 % HbA1c threshold range, with a narrow odds ratio range of 1.2–1.6. Utilizing area-under-receiver-operating characteristic curves, no HbA1c threshold <7.0 % was identified as the best predictor of nephropathy. ConclusionEven in a population with a high prevalence of known and unknown diabetes, no HbA1c threshold <7.0 % could be found predicting an increased prevalence of nephropathy. This means there is not a requirement to change the existing retinopathy-based HbA1c threshold of 6.5 % to also accommodate diabetes nephropathy risk.

Epidemiology of type 2 diabetes and prediabetes in the adult population of the Republic of Moldova (preliminary data)

Introduction. Type 2 DM accounts for over 95% of all diabetes cases worldwide and represents an important and independent cardio-metabolic risk factor. This is the first national study (Epidemiological study of widespread endocrine pathologies (diabetes, obesity) in the Republic of Moldova and its management strategy) that analyzes the prevalence of type 2 diabetes mellitus (DM), prediabetes, obesity, and dyslipidemia in the adult population of Moldova. Material and methods. This is an epidemiological cross-sectional study with cluster random sampling. A face-to-face interview was conducted with the participants using a pre-tested semi-structured questionnaire. All biochemical tests were performed in a certified laboratory. Statistical analysis used Spearman’s correlation test, chi-square, and Wilcoxon tests. The Research Ethics Committee of Nicolae Testemițanu State University of Medicine and Pharmacy (Minutes 3 from December 28 2020) approved this study. Results. 728 individuals were enrolled, of which 2.5% had unknown DM. Advanced age, obesity, and dyslipidemia were influencing factors for diabetes. 21.4% of participants had prediabetes, with a higher prevalence in men than in women (28.3 % versus 18.9 %). Only 23.2% of men and 30.4% of women had a BMI within the normal range. Abdominal circumference (AC) values greater than 102 cm and 88 cm in men and women, respectively, were determined in 39.4% of men and 53.8% of women. Conclusions. Our study showed an increased prevalence of carbohydrate metabolism disorders, including prediabetes, as well as a high prevalence of abdominal obesity. Persons with unknown diabetes mellitus have been identified.

More rapid bone mineral density loss in older men with diabetes: The Osteoporotic Fractures in Men (MrOS) Study.

Type 2 diabetes mellitus (T2D) is associated with more rapid bone loss in women, but less evidence is available for men or those with prediabetes. To determine whether bone loss rate is affected by diabetes status in older men, we analyzed data from the Osteoporotic Fractures in Men (MrOS) study. The multisite MrOS study enrolled 5,994 men aged ≥65 years. Diabetes status was defined by self-report, diabetes medication use, or elevated fasting serum glucose at baseline. Hip bone mineral density (BMD) was measured by dual energy x-ray absorptiometry (DXA) at baseline and a follow-up visit after 4.6 ± 0.4 years. This analysis included 4095 men, excluding those without a follow-up DXA or with unknown diabetes status. Changes in hip BMD in participants with normoglycemia (NG), prediabetes, or T2D, excluding thiazolidinedione (TZD) users, were evaluated using generalized linear models (GLM). Diabetes medication use and BMD loss among those with T2D were also evaluated with GLM. In adjusted models, loss in hip BMD was greater in men with T2D (- 2.23%: 95% CI: -2.54 to -1.91; p<0.001) but not in men with prediabetes (-1.45%; 95% CI -1.63 to -1.26; p=0.33) compared to NG (-1.57%: 95% CI -1.73 to -1.41). Among men with T2D, TZD, insulin and sulfonylurea use were associated with greater hip BMD loss. Men with T2D, but not prediabetes, experienced an accelerated bone loss compared to participants with normoglycemia. More rapid bone loss predicts increased risk of fractures and mortality in broader populations.

Diabetes Status, c-Reactive Protein, and Insulin Resistance in Community-Acquired Pneumonia-A Prospective Cohort Study.

C-reactive protein (CRP) is commonly used to guide community-acquired pneumonia (CAP) treatment. A positive association between admission glucose and CRP levels has been observed in patients with CAP. The associations between prediabetes, unknown diabetes, acute-on-chronic hyperglycaemia, and CRP levels, and between admission CRP levels and insulin resistance (IR) in CAP, remain unexplored. This study investigated the associations firstly between chronic, acute, and acute-on-chronic hyperglycaemia and CRP levels, and secondly between admission CRP levels and IR in CAP. In a prospective cohort study of adults with CAP, the associations between chronic, acute, and acute-on-chronic hyperglycaemia (admission glucose minus HbA1c-derived average glucose) and CRP levels until admission day 3 were modelled with repeated-measures linear mixed models. IR was estimated with the homeostasis model assessment of IR (HOMA-IR). The association between admission CRP levels and HOMA-IR was modelled with linear regression. In 540 patients, no association between chronic, acute, or acute-on-chronic hyperglycaemia and CRP levels was found. In 266 patients, every 50 mg/L increase in admission CRP was associated with a 7% (95% CI 1-14%) higher HOMA-IR. In conclusion, our findings imply that hyperglycaemia does not influence CRP levels in patients with CAP, although admission CRP levels were positively associated with IR.

Hyperglycemia and glucose variability are associated with worse survival in mechanically ventilated COVID-19 patients: the prospective Maastricht Intensive Care Covid Cohort

BackgroundData on hyperglycemia and glucose variability in relation to diabetes mellitus, either known or unknown in ICU-setting in COVID-19, are scarce. We prospectively studied daily glucose variables and mortality in strata of diabetes mellitus and glycosylated hemoglobin among mechanically ventilated COVID-19 patients.MethodsWe used linear-mixed effect models in mechanically ventilated COVID-19 patients to investigate mean and maximum difference in glucose concentration per day over time. We compared ICU survivors and non-survivors and tested for effect-modification by pandemic wave 1 and 2, diabetes mellitus, and admission HbA1c.ResultsAmong 232 mechanically ventilated COVID-19 patients, 21.1% had known diabetes mellitus, whereas 16.9% in wave 2 had unknown diabetes mellitus. Non-survivors had higher mean glucose concentrations (ß 0.62 mmol/l; 95%CI 0.20–1.06; ß 11.2 mg/dl; 95% CI 3.6–19.1; P = 0.004) and higher maximum differences in glucose concentrations per day (ß 0.85 mmol/l; 95%CI 0.37–1.33; ß 15.3; 95%CI 6.7–23.9; P = 0.001). Effect modification by wave, history of diabetes mellitus and admission HbA1c in associations between glucose and survival was not present. Effect of higher mean glucose concentrations was modified by pandemic wave (wave 1 (ß 0.74; 95% CI 0.24–1.23 mmol/l) ; (ß 13.3; 95%CI 4.3–22.1 mg/dl)) vs. (wave 2 (ß 0.37 (95%CI 0.25–0.98) mmol/l) (ß 6.7 (95% ci 4.5–17.6) mg/dl)).ConclusionsHyperglycemia and glucose variability are associated with mortality in mechanically ventilated COVID-19 patients irrespective of the presence of diabetes mellitus.

A study on placental expression of neuronal markers in intrauterine growth restriction

Introduction and Aim: The restriction of intrauterine growth (IUGR) has a 20% recurrence rate and is one of the leading causes of postnatal illness and death. The diagnosis of intrauterine retardation refers to the infant's increased risk of neurological issues over an extended period, neonatal morbidity, and mortality, and in utero death. Materials and Methods: One hundred placenta samples were collected and divided into cases and controls. Clearance from the ethics committee was taken from the institute prior to the commencement of this study. Exclusion criteria include the patients with multiple pregnancies, unknown gestational age, gestational diabetes, and HIV. The inclusion criteria are the singleton pregnancy, normal and cesarean section, maternal age between 18-35 years and GA between 34 – 41 weeks. Standard immunohistochemistry protocols were followed for the study and glial fibrillary acidic protein (GFAP), neuron specific enolase (NSE) markers were used as neuronal markers. Results: Strong immunoreactivity of glial fibrillary acidic protein and neuron specific enolase was observed in fetal growth restriction placenta indicating perinatal brain damage of neonate. Conclusion: In our study we observed strong positive immunoreactivity of GFAP and NSE in IUGR only. This study suggests that these markers are used to predict brain damage in IUGR neonates.

Prevalence and impact of chronic dysglycaemia among patients with COVID-19 in Swedish intensive care units: a multicentre, retrospective cohort study

ObjectiveUsing glycated haemoglobin A1c (HbA1c) screening, we aimed to determine the prevalence of chronic dysglycaemia among patients with COVID-19 admitted to the intensive care unit (ICU). Additionally, we aimed to...

Insulin Dependence is Associated with Poor Long-Term Outcomes Following AAA Repair

While prior studies have confirmed the protective effect of diabetes on abdominal aortic aneurysm (AAA) development, much less is known about the effect of diabetes, and in particular insulin dependence, on outcomes following AAA repair. In this study, we aim to evaluate the role of insulin dependent diabetes on short- and long-term outcomes following open and endovascular AAA repair. The Vascular Implant Surveillance and Interventional Outcomes Network (VISION), a registry linking the Vascular Quality Initiative (VQI) data with Medicare claims, was queried for patients who underwent open or endovascular AAA repair from 2011 to the present. Exclusion criteria were unknown diabetes status, prior aortic intervention, maximum aneurysm diameter < 45mm at presentation and Medicare Advantage coverage due to inconsistent follow-up. Patients were stratified based on diabetes status (no diabetes vs diabetes) and insulin-dependence (no diabetes or non-insulin dependent diabetes vs insulin dependent diabetes). Of the 38,437 cases in the VISION endovascular aortic aneurysm (EVAR) and open aortic aneurysm repair (OAR) databases, 21,943 met inclusion criteria. Perioperative outcomes after OAR were comparable between diabetic and non-diabetic patients. However, diabetic patients undergoing EVAR were significantly more likely to have a post-operative myocardial infarction (1.0% vs 0.6%, p = .04) and have a 30-day readmission (10.9% vs 8.8%, p<.001). Insulin-dependent diabetic patients were more likely to require a 30-day readmission after OAR (24.5% vs 13.5%, p = .02) and EVAR (15.1% vs 9.0%, p <.001), however, only IDDM patients undergoing EVAR experienced higher rates of postoperative MI (1.9% vs 0.7%, p <.01). After propensity score matching, patients with insulin dependent diabetes undergoing EVAR were additionally at increased risk of mortality at one-, three- and five-year follow-up with the highest risk occurring at the one-year mark (HR 1.79, p <.0001), while IDDM patients undergoing OAR were only at a significantly increased risk of mortality at five-year follow-up (HR 1.90, p = .01). Patients with insulin-dependent diabetes have greater than 14% one-year mortality following open or endovascular aneurysm repair, compared to 8% for all others. Our findings raise questions about whether insulin-dependent diabetics should have a higher size threshold for prophylactic repair, although further studies are needed to address this question and consider the influence of glycemic control on these outcomes.

Prevalence of increased risk of type 2 diabetes in general practice: a cross-sectional study in Norway

BackgroundType 2 diabetes (T2D) is a global public health problem, but the onset can be delayed or prevented with adequate intervention in individuals with increased risk. Therefore, a major challenge in general practice is to identify individuals at risk of diabetes. However, limited knowledge is available about the prevalence of high diabetes risk individuals in a primary care population. In a cohort of consecutive patients in general practice we examined the prevalence of known diabetes and estimated risk of diabetes using The Finnish Diabetes Risk Score (FINDRISC) calculator, by sociodemographic and clinical characteristics.MethodsThis study was a cross-sectional study conducted in four general practices in Western and Eastern Norway. A total of 1682 individuals, 20–80 years of age, were assessed for eligibility from May to December 2019. We excluded patients who actively declined participation (n = 112), were lost because of various organization challenges (n = 103) and patients who did not fulfil the inclusions criteria (n = 63). Diabetes prevalence and prevalence of individuals at risk of T2D with 95% confidence intervals (CI) were estimated for the total sample, by age group and for men and women separately. We tested for differences between groups using t-test for continuous variables and chi-square test (Pearson Chi-Square) for categorical variables.ResultsOf 1404 individuals, 132 reported known diabetes, yielding a prevalence of 9.9% (95% CI 8.4–11.6). Among participants without a known diagnosis of diabetes, the following estimates of elevated risk assessment scores were found: FINDRISC score ≥ 11 32.8% (95% CI 30.3–35.4) and FINDRISC ≥ 15 10.0% (95% CI 8.6–11.9). Comparable results were found between the sexes.ConclusionsDetection of unknown diabetes and individuals with increased risk, is of high public health relevance for early implementation of preventive measures aimed to reduce the risk of diabetes and its complications through lifestyle modification. A simple, non-expensive questionnaire, such as FINDRISC, may be valuable as an initial screening method in general practice to identify those in need for preventive measures.

0309 Light exposure before bedtime in pregnancy is associated with a higher risk of gestational diabetes

Abstract Introduction Evidence suggests a link between mistimed light exposure and impaired glucose regulation among nonpregnant adults, yet little is known about the magnitude and significance of evening light exposure during pregnancy. This study examined the relationship between evening light exposure before sleep, during pregnancy, and the incidence of gestational diabetes mellitus (GDM). Methods In this prospective cohort study conducted at 8 U.S. clinical sites, nulliparous women wore a wrist actigraphy monitor and completed a daily sleep diary for seven days between 160 and 216 weeks’ gestation. The primary exposure variable was time spent above 10 lux (dim light) during the three hours preceding sleep onset (“TAT10 pre-sleep”), averaged over valid days of recording and categorized to tercile groups (“High”, “Medium”, “Low”). Primary outcome variable was the incidence of GDM. Associations of TAT10 pre-sleep groups with baseline characteristics, sleep and activity variables were examined with Chi-squared and Kruskal-Wallis rank sum tests. Univariate and multiple logistic regression models were used to characterize the relationship between pre-sleep light exposure and GDM. Results 901 eligible women consented to participate; 758 submitted valid actigraphy recordings. Excluding women with pre-gestational diabetes and those with unknown gestational diabetes status, 741 were included in the analysis. Greater pre-sleep light exposure was associated with an increased risk of GDM (odds ratio [95% confidence interval]: 5.49 [1.8–23.84] in high and 4.05 [1.27–17.94] in medium vs 1 [reference] in low group). Women in the high group had more daytime light and were less likely to be late (midpoint &amp;gt; 5AM) or fragmented (wake after sleep onset ≥ 75th percentile) sleepers. Sleep duration, mean activity level, and light during sleep were not different between groups. After adjusting separately for age, body mass index, race/ethnicity, sleep duration, sleep midpoint, education, employment schedule, season, and daytime light exposure, pre-sleep light exposure remained significantly associated with GDM. Conclusion Increased evening light exposure in pregnancy may be an under-recognized, potentially modifiable risk factor for GDM. Future research should investigate light-targeted interventions as a potential preventive strategy for GDM. Support (if any) R01HL105549, nuMoM2b Network

Glycemic status and health-related quality of life (HRQOL) in populations at risk of diabetes in two Latin American cities

PurposeTo estimate the health-related quality of life (HRQOL) according to glycemic status, and its relationship with sociodemographic and clinical factors in a population at risk of developing type 2 diabetes (T2D).MethodsCross-sectional study, using cluster sampling. Data were collected from 1135 participants over 30 years of age, at risk of developing T2D from the PREDICOL project. Participants' glycemic status was defined using an oral glucose tolerance test (OGTT). Participants were divided into normoglycemic subjects (NGT), prediabetes and diabetics do not know they have diabetes (UT2D). HRQOL was assessed using the EQ-5D-3L questionnaire of the EuroQol group. Logistic regression and Tobit models were used to examine factors associated with EQ-5D scores for each glycemic group.ResultsThe mean age of participants was 55.6 ± 12.1 years, 76.4% were female, and one in four participants had prediabetes or unknown diabetes. Participants reported problems most frequently on the dimensions of Pain/Discomfort and Anxiety/Depression in the different glycemic groups. The mean EQ-5D score in NGT was 0.80 (95% CI 0.79–0.81), in prediabetes, 0.81 (95% CI 0.79–0.83), and in participants with UT2D of 0.79 (95% CI 0.76–0.82), respectively. Female sex, older age, city of residence, lower education, receiving treatment for hypertension, and marital status were significantly associated with lower levels of HRQOL in the Tobit regression analysis.ConclusionsHRQOL of NGT, prediabetes, and UT2D participants was statistically similar. However, factors such as gender, age. and place of residence were found to be significant predictors of HRQOL for each glycemic group.

Consumption of sugar-sweetened beverages and T2D diabetes in the Eastern Caribbean.

Sugar-sweetened beverages (SSB) are implicated in the increasing risk of diabetes in the Caribbean. Few studies have examined associations between SSB consumption and diabetes in the Caribbean. SSB was measured as teaspoon/d using questions from the National Cancer Institute Dietary Screener Questionnaire about intake of soda, juice and coffee/tea during the past month. Diabetes was measured using self-report, HbA1C and use of medication. Logistic regression was used to examine associations. Baseline data from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS), collected in Barbados, Puerto Rico, Trinidad and Tobago and US Virgin Islands, were used for analysis. Participants (n 1701) enrolled in the ECS. Thirty-six percentage of participants were unaware of their diabetes, 33% aware and 31% normoglycaemic. Total mean intake of added sugar from SSB was higher among persons 40-49 (9·4 tsp/d), men (9·2 tsp/d) and persons with low education (7·0 tsp/d). Participants who were unaware (7·4 tsp/d) or did not have diabetes (7·6 tsp/d) had higher mean SSB intake compared to those with known diabetes (5·6 tsp/d). In multivariate analysis, total added sugar from beverages was not significantly associated with diabetes status. Results by beverage type showed consumption of added sugar from soda was associated with greater odds of known (OR = 1·37, 95 % CI (1·03, 1·82)) and unknown diabetes (OR = 1·54, 95 % CI (1·12, 2·13)). Findings indicate the need for continued implementation and evaluation of policies and interventions to reduce SSB consumption in the Caribbean.

Prevalence of prediabetes and undiagnosed diabetes in a large urban middle-aged population: the CARVAR 92 cohort

BackgroundThe aim of this study was to assess the prevalence of prediabetes and unknown diabetes and its long-term change in a large middle-aged urban population.MethodsWe conducted a screening campaign between 2007 and 2018 for cardiovascular risk factors in the western suburbs of Paris including subjects aged 40–70 (CARVAR 92). Among subjects who reported no previous diabetes, prediabetes and undiagnosed diabetes were defined as follows: fasting plasma glucose (FPG) ≥ 6.1 mmol/l (110 mg/dl) and < 7 mmol/l (126 mg/dl) for prediabetes according to WHO criteria (FPG between 5.6 and 6.9 mmol/l according to ADA criteria) and FPG ≥ 7.0 mmol/l for undiagnosed diabetes.ResultsOf the 32,721 subjects in the CARVAR 92 cohort, 32,675 were included in this analysis. The median age of the patients was 56 years [30, 94], 45.4% were male, 5.9% had known diabetes, 36.4% were overweight and 18.7% obese. Among patients without previously known diabetes (n = 30,759), 8.1% had prediabetes according to WHO criteria (27.2% according to ADA criteria) and 2.3% had diabetes. Subjects with prediabetes and unknown diabetes were more likely to be male, older, and overweight or obese than non-diabetic subjects. From 2007 to 2018, the prevalence of prediabetes, unknown diabetes, and known diabetes decreased, except for prediabetes which remained stable for people aged 55–64.ConclusionThe prevalence of prediabetes and unknown diabetes remains high but decreased during a 12-year period. About one-quarter of diabetes cases remain undiagnosed. Our results highlight that there is still a room for screening and cardiovascular prevention campaigns.Trial registration: IRB00012437.

Diabetes Related Deaths in a Tertiary Pediatric Referral Institution in England: The Value of Biochemical Analyses in Post-Mortem Samples.

To establish the incidence of "diabetes-related death" (DRD) in children with known and unknown Diabetes Mellitus (DM) dying unexpectedly, and describe post-mortem (PM) biochemistry findings. PM reports from the previous 16-year period were reviewed. Cases of DRD were extracted. All available demographic, clinical, and autopsy data including laboratory analyses was retrieved. 9/1376 (0.7%) DRD cases were identified. This was attributed to Diabetic Ketoacidosis in 7 and to Death in Bed Syndrome in 2. 4/9 cases were known diabetic and on insulin; whilst in 5/9 cases the diagnosis of DM was at PM. The mean age was 11.6 years (range 2.5-15). At PM, 4 cases were undernourished. The histology demonstrated pancreatic changes in keeping with DM in 3/9 and unremarkable pancreatic findings in 6/9. 3 cases also had autoimmune thyroiditis (1 also had myocarditis and Armanni-Ebstein nephropathy). Toxicological and biochemical analysis showed raised: β-hydroxybutyrate in 6, ketone bodies in 5 cases and raised HbA1c in 3c. Type 1 DM is an infrequent but yet potentially preventable cause of death in children. Our findings highlight the value of routine biochemical and toxicological analysis in all PM examinations of infants and children dying suddenly and unexpectedly.

A study protocol for a cluster randomized controlled trial to test the applicability of the South African diabetes prevention program in the Eastern Cape Province of South Africa

BackgroundConvincing evidence supports the effectiveness of lifestyle interventions in preventing the occurrence of diabetes in high-income countries, however little is known about appropriate interventions for use in African countries, where there are higher relative increases in diabetes prevalence. The South African Diabetes Prevention Programme (SA-DPP) was initiated with the aim of preventing or delaying the occurrence of diabetes among South Africans (SAs), through interventions, targeting lifestyle changes related to diet and physical activity. The purpose of the current project is to implement and evaluate the suitability and applicability of the SA-DPP developed and tailored in urban populations in the Western Cape Province, in peri-urban populations in the Eastern Cape Province of SA.MethodsThe SA-DPP, which is an cluster randomized control trial, will be implemented in adults aged 30–65 years residing in the OR Tambo district, Eastern Cape, SA. Participants will be recruited using self-selected sampling techniques and 24 clusters across peri-urban communities will be randomly allocated to participate in the lifestyle intervention, facilitated by non-professional health workers (NPHW). The diabetes risk screening will follow a two-staged approach, including the community-based screening, using the African diabetes risk score (ADRS), followed by a clinic-based risk status assessment by an oral glucose tolerance test (OGTT) to exclude unknown diabetes. The lifestyle-change objectives of the current programme relate to, 1) < 30% of total energy intake from fat; 2) < 10% of total energy intake from saturated fat; 3) > 15 g of fibre/1000 kcal; 4) > 4 h/week moderate level of physical activity; and 5) > 2% body mass index (BMI) reduction.DiscussionThe SA-DPP could represent a successful model for the prevention of diabetes and potentially other lifestyle-related diseases in SA and other countries in the region that are confronted with similar challenges.Trial registrationPACTR202205591282906.

The association between asymptomatic malaria and blood glucose among outpatients in a rural low-income setting

BackgroundMalaria and haemolysis have been linked to a preponderance of altered glycaemic indices. This study set out to estimate the association between asymptomatic malaria and the Fasting Plasma Glucose (FPG), glycated haemoglobin (HBA1c) and Oral Glucose Tolerance (OGT) tests. MethodsA cross-sectional survey was conducted at a general hospital in eastern Uganda. Eligible participants were patients aged 30–75 years, seeking care at the outpatient department, of unknown diabetes status. Participants were tested for FPG, OGT and HBA1c tests. Multiple linear regression and ROC curve analysis were conducted for the three tests. ResultsA total of 504 participants were enrolled on the study, of whom 78.4% (395) were female. After adjusting for age, sex, and BMI, individuals with asymptomatic malaria had lower average HBA1c [-5 mmol/mol (95% CI, -7 -2) and OGT tests levels [-1.75 mmol/l (-2.6, -0.8)]. The optimal cut-off points for diabetes among individuals with asymptomatic malaria were lower for the HBA1c test [6.5% (47 mmol/mol) versus 6.6% (49 mmol/mol), respectively] but higher for the FPG test (6.6 mmol/l versus 6.2 mmol/l, respectively). ConclusionsThese findings may have implications for diabetes screening in malaria-endemic settings.