World Diabetes Foundation Research Articles

A Mass Media Campaign for Screening of Hyperglycemia in Pregnancy and Postpartum Follow-up: A Major Challenge in Resource-Constrained Settings, WDF-GDM Project, Pakistan

Abstract Background: Pakistan’s collaboration with the World Diabetes Foundation (WDF) introduced a pioneering and unparalleled initiative to enhance maternal and child healthcare. The mass media campaign for the detection of hyperglycemia in pregnancy (HIP) via screening, management, and prevention is a significant component of this collaboration to reduce the impact of hyperglycemia on maternal-fetal health and have insight on postpartum follow-up (PPFU) trends. Materials and Methods: WDF-GDM Project encompassed an extensive mass media campaign across 29 cities in 10 regions of Pakistan. The primary objective was to establish a national standard for screening and diagnostic standards of HIP, training healthcare providers in blood glucose (BG) screening, treatment, PPFU, as well as disseminating information about pre-conception counseling. The DIPSI method, which is a single-step, non-fasting oral glucose tolerance test with a diagnostic threshold of 140 mg/dL (7.8 mmol/L), was employed as a screening and diagnostic test. Results: A total of 17,392 pregnant women of diverse ethnic backgrounds attended antenatal visits; 77.2% (n = 13,417) underwent BG screening based on DIPSI criteria, irrespective of the period of gestation. The overall prevalence of HIP was 35.7% with gestationally impaired glucose tolerance at 25.7%, and gestational diabetes mellitus (GDM) at 9.97% postpartum, approximately 4767 women were eligible for PPFU. Among these, 7% experienced fetal loss. Of the 2376 women who completed PPFU, 81% were normoglycemic, 9% had impaired fasting glucose, 8% had impaired glucose tolerance, and 2% were diagnosed with diabetes. About 75% of women who had hyperglycemia during pregnancy reverted to normoglycemia postpartum, while a small percentage continued to have persistent diabetes. Conclusion: This study highlights a GDM prevalence of 9.97% in Pakistan and depicts the positive outcome where many women returned to normoglycemia after childbirth. Factors such as previous pregnancies, body mass index, and history of fetal loss were identified as contributors to the development of hyperglycemia during pregnancy. The WDF-GDM initiative’s approach and comprehensive methodology provide better insights for future maternal healthcare strategies in similar settings nationally and globally.

P040 STRENGTHENING PRIMARY HEALTH SYSTEMS FOR HYPERTENSION: THE CASE OF HEARTS IMPLEMENTATION IN GUATEMALA

Hypertension is considered the leading cause of death and disability worldwide due to the multiple complications it entails. Hypertension contributes to 40% of the total cardiovascular diseases worldwide. In Guatemala, the burden of hypertension is increasing, with a prevalence of 32.2%. Hypertension alone is responsible for 12% of deaths in the country. The World Health Organization's (WHO) HEARTS is global to local initiative that consists in a technical package represents a public health approach to hypertension control, with a strong foundation in the effective and sustainable delivery of care for chronic diseases in primary care centers and their communities. Since 2017, Resolve to Save Lives, WHO, and other partners have supported the implementation of the HEARTS hypertension control program in public health care centers in LMICs (Low- and Middle-Income Countries). The goal was to establish a model for hypertension control suitable for broader expansion. By December 2022, 12.2 million hypertensive patients had been treated in the program across 33 participating LMICs. A pilot study integrating the diabetes module (HEARTS-D) into the implementation of the hypertension care model has been conducted in two health areas (Sololá and Chiquimula) since 2023. Starting in 2024, the execution of a project funded by the World Diabetes Foundation (WDF) will be carried out to expand these strategies by implementing a national comprehensive care model for diabetes and hypertension in the country. In 2021, a pilot study focused on the implementation of the model was conducted, resulting in a fourfold increase in the treatment rate of patients and a 14% increase in the proportion achieving blood pressure control. These results support the feasibility of implementing the HEARTS model for blood pressure control in the healthcare system of LMICs. The integration of the model in Guatemala since November 2022 enhances previous efforts and solidifies the country's commitment to integrating timely responses in the management of these conditions and the implementation of standardized treatment.

Head-to-head comparison of the WHO STEPwise approach with immediate unattended and delayed unattended automated blood pressure measurements during household-based screening: a diagnostic accuracy study in Lesotho

WHO introduced the STEPwise approach to surveillance (STEPS) to monitor trends in non-communicable diseases. For arterial hypertension, the STEPS protocol takes the average of the last two out of three standard blood pressure measurements (SBPM). This study assesses the diagnostic accuracy of SBPM, same-day and next-day unattended automated measurement (uABP), with 24 h ambulatory measurement (24h-ABPM) as reference. This diagnostic accuracy study was done within a population-based household survey on cardiovascular risk factors in two districts in Northern Lesotho. Adults (aged ≥ 18 years) with elevated SBPM (defined as ≥140/90mmHg), and 2:1 age- and sex-matched participants with normal SBPM during the survey were recruited. Following SBPM, first uABP readings were obtained on survey day. Afterwards, participants received a 24h-ABPM device. Second uABP readings were taken 24h later, after retrieval of the 24h-ABPM. The main outcome was overall diagnostic accuracy of all screening measurements (SBPM, first uABP, and second uABP), determined using area under the receiver operating characteristic curve (AUROC), with 24h-ABPM as a reference. Between November 2, 2021 and August 31, 2022, 275 participants (mean age 58 years (SD: 16 years), 163 (59%) female) were enrolled, 183 of whom had elevated and 92 had normal SBPM. Mean difference between systolic daytime 24h-ABPM and screening measurements was highest for SBPM (mean difference:-13mmHg; 95% CI:-14 to-11). Mean difference between diastolic daytime 24h-ABPM and diastolic SBPM was-2mmHg (95% CI:-4 to-1), whereas no difference was found for mean diastolic first uABP (mean difference:-1mmHg; 95% CI:-2.0 to 0.3); and mean diastolic second uABP (mean difference: 1.0mmHg; 95% CI:-0.4 to 2.3). White coat hypertension was highest with SBPM (55 [20%]), followed by first uABP (27 [9.8%]), and second uABP (18 [6.5%]). Using systolic daytime 24h-ABPM as a reference, the uABPs had higher AUROC (first uABP: 87% [95% CI: 83-91]; second uABP: 88% [95% CI: 84-92]); SBPM: (79% [95% CI: 74-85]). This difference was significant between first uABP and SBPM (P=0.0024), and between second uABP and SBPM (P=0.0017). uABP had better diagnostic performance than SBPM. Integration of uABP into STEPS protocol should be considered. Swiss Agency for Development and Cooperation under the ComBaCaL project, and the World Diabetes Foundation.

Pendekatan Berbasis U-Net untuk Segmentasi Hard Exudate dalam Citra Fundus Retina

World Health Organization estimates that globally, 422 million adults over the age of 18 lived with diabetes in 2014. It is also supported by the World Diabetes Foundation estimates that more than 439 million people will be threatened with diabetes by 2030. One of the diseases caused by diabetes is diabetic retinopathy which can cause impaired vision to blindness. Damage to blood vessels and damage to the nerve fibers of the eye are called exudates, which are blood spots containing yellowish-colored fats that have an erratic shape. The types of exudates are divided into two, namely hard exudate and soft exudate. Soft exudate is also known as cotton wool spots and appears with a whitish color with less pronounced edges. While hard exudate occurs due to leakage of proteins and lipid vessels of the retina. The shape appears sharp and bright. To find out where the hard exudate is located in the retinal fundus image, experts or doctors are still looking manually, so it takes a long time to find out location of the hard exudate. Therefore, this research work, contributes to segmenting hard exudate using deep learning, which the method is U-Net. The final result of hard exudates segmentation using U-Net methods is validated with ground truth images by measuring accuracy, sensitivity, and specificity metric score. The results of hard exudate segmentation show for the U-Net metric score is 0.993, 0.454, and 0.997 respectively.

Prevalence and socio-demographic distributions of meeting RMI Guidelines for Healthy Living among elementary school children in Majuro, Republic of Marshall Islands: a cross-sectional population-based survey

Childhood obesity is high in Republic of Marshall Islands (RMI). We report the prevalence and socio-demographic distribution of selected obesity-related risk factors among children in Majuro, RMI. Sixteen elementary schools were approached and students and parents in Grades 1, 3, and 5 invited to participate in this cross-sectional population-based survey. Accelerometry and a questionnaire were used to collect data on children's physical activity (PA), sleep, screen time and dietary behaviours. Descriptive statistics and mixed-effects logistic regression were used to examine differences in the proportions of children meeting selected RMI Healthy Living Guidelines by sex, school grade and school sector. Thirteen schools and 958 children were recruited, of which 892 (52.2% girls; mean age 9.3±1.8 years) provided useable data. Around 90% met the PA, 29% screen time, 13% sleep, 69% sugar-sweetened beverage and 56% highly processed food guidelines. The proportion meeting individual guidelines was higher among children in Grade 1 compared with Grade 5. Being a girl (0.27; 95% CI 0.16, 0.46) was associated with lower odds of meeting the PA recommendation. Compared with children from Grade 1, those in Grade 5 had lower odds of meeting the PA (0.28; 95% CI 0.15, 0.55), screen time (0.60; 95% CI 0.40, 0.89), sleep duration (0.33; 95% CI 0.18, 0.59), sugar-sweetened beverage (0.35; 95% CI 0.23, 0.53), and consumption of highly processed foods recommendations (0.49; 95% CI 0.33, 0.72). While most children in RMI are adequately active, resources are needed to promote healthier levels of screen time, sleep, sugar-sweetened beverage and highly processed food consumption, especially among older children. This study was funded by World Diabetes Foundation; Canvasback Missions, RMI; NHMRC Australia (APP1176858); Pacific Community.

Ramadan fasting and weight change trajectories: Time-varying association of weight during and after Ramadan in low-income and refugee populations.

Obesity is a significant driver of the global burden of non-communicable diseases. Fasting is one approach that has been shown to improve health outcomes. However, the effects of Ramadan fasting differ in that the type, frequency, quantity, and time of food consumption vary. This phenomenon requires in-depth evaluation considering that 90% of Muslims (~2 billion people) fast during Ramadan. To address this issue, we evaluated the pattern of weight change during and following Ramadan for a total of 52 weeks. The study was conducted in Amman, Jordan. Between 2012 and 2015, 913 participants were recruited as part of a trial investigating the efficacy of a weight loss intervention among those with or at risk for diabetes. Weight was measured weekly starting at the beginning of Ramadan, and changes were analyzed using discrete and spline models adjusted for age, sex, and trial group. Results show slight weight gain within the first two weeks and weight loss in the subsequent weeks. During the first week of Ramadan, the estimate for a weight reduction was 0·427 kg, (95% CI: -0·007, 0·861), increasing to 1·567 kg, (95% CI: 2·547, 3·527) at week 26. There was clear evidence of gradual weight gain from about 4 to 15 weeks and a drop towards the end of the investigation at week 28 (-0·12kg, 95% CI: -0·89, 0·56). Our results show that weight changes occurred during and after Ramadan. Weight fluctuations may affect health risks, and thus, findings from this study can inform interventions. Public health agencies could leverage this period of dietary change to sustain some of the benefits of fasting. The authors (DEZ, EFD) acknowledge the Mulago Foundation, the Horace W. Goldsmith Foundation, Robert Wood Johnson Foundation, and the World Diabetes Foundation. TRIAL REGISTRATION. Clinicaltrials.gov registry identifier: NCT01596244.

IDF21-0542 Sharing “a.ma.dia” Experiences of how the Institution Have Faced COVID-19 Issues

Background: As part of low-income countries, Madagascar is actually at the 186th place as poorest country around the world.Regarding the diabetes context, the specialists are not sufficient. Then, it becomes mandatory for the diabetic person to go to the sanitarian structure which is the most accessible. These structures don’t have the adequate skills for a better follow-up and care of diabetes.A.MA.DIA is the Madagascar diabetes association composed by 47 000 diabetic members for a total of fourteen centers in twelve regions of the island.As a reference, the main activities of A.MA.DIA are: diabetes care and consultation especially for different complications (teeth and mouth, eyes, foot care), hospitalization, therapeutic education, sensitization, diabetes screening and his related complications.The main issues of diabetes in Madagascar during the covid period are the increased number of diabetes complications.A.MA.DIA was forced to receive complicated cases of diabetes and covid despite the few places we had at our Diabetes Clinic in Antananarivo: 21 beds of hospitalization.A.MA.DIA also faced many issues: lack of oxygen, lack of medicines, lack of individual protection equipment.Aim: This study aims to share A.MA.DIA experiences of how our institution have faced covid-19. The goal is to show the importance of having a Diabetes Clinic for a Diabetes association in case of extreme situation.Method: First, we have chosen to study the impacts of covid-19 in medical, social and economical aspects from 2020 to 2021.Second, we have realized some activities as solutions of the burdensFinally, we have observed the results for each aspect.Results:IMPACTS:The number of diabetes complications has increased:•55% of the total consultation get imbalance to their diabetes.•36% of the hospitalization represents chest diseases by virus•18% of the hospitalized diabetics died of covid-19 syndromDue the high cost of medicines and the lack of money:•55% of diabetics coming for consultation missed their treatment•53% of the hospitalized diabetics could not afford the cost of oxygen. The bottle of 10m3 costs 70$.Due to the lack of individual protection equipment:•The price of the equipment increased at about 800%Due to the restriction for moving from a region to another:•Diabetic people do not have access to specialized care and medicinesSOLUTIONS:•90% of public centers for primary care in Antananarivo have received glucometers under help of A.MA.DIA and the world diabetes Foundation project.•Oxygen project was conducted by buying new machines (extractor)•Individual protection was reinforced•The access to diabetes and hypertension medicines was facilitated•10% of diabetics were vaccinatedRESULTS:•The number of diagnosed persons has increased at about 10%•The number of consulted persons has increased at about 30%•After the vaccine period, the chest diseases by virus have decreased at about 50%Discussion: The impacts of covid-19 on diabetics have made diabetes as a priority for Malagasy leaders.The commitment of Diabetic association in the integrated management of diabetes is a major key for the development of the association as well as for the protection of diabetic people.

Prevalence and Risk Factors for Gestational Diabetes in Aswan, Egypt According to International Association of the Diabetes and Pregnancy Study Groups (IADPSG)

Background: The prevalence of diabetes in Egypt has significantly increased exceeding international rates. Egypt is now ranked ninth highest in the world in terms of the disease according to IDF, 2019. Objective: Estimation of the prevalence of gestational diabetes mellitus (GDM) in Aswan Governorate in Egypt and determination of the risk factors associated with GDM. Patients and methods: Our study was a prospective study, which carried out in the Antenatal Clinic in the Obstetrics and Gynecology Department, Aswan University Hospital from July 2016 to July 2017. The pregnant women were collected form Aswan Governorate as part of a Gestational Diabetes care in Upper Egypt project in collaboration with World Diabetes Foundation. Our study included 1000 pregnant woman. All participants were screened for GDM at 24-28 weeks of gestation. Universal screenings for GDM were performed for the participants using oral glucose tolerance test (OGTT) according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations 2017. Results: According to IADPSG criteria, 17.5% of the screened cases had GDM, 16.8% had fasting blood glucose level ≥ 92 mg/dL, 15.5% had 1-hour OGTT ≥180 mg/dL and 16.7% had ≥153 mg/dL. It was found that the age ≥ 25 years and multiparity were significantly higher in GDM than in Non-GDM. Pregnant women living in rural areas and working women were significantly protected against GDM than those from urban areas. Both family history of diabetes and previous history of GDM represented the major risk factor in our studied group (P < 0.001 & < 0.001 respectively). 40.4 % of studied group exhibited no definite risk factors. There were significant increases in systolic B.P, diastolic B.P in GDM group versus non-GDM (p < 0.001 & p < 0.001 respectively). BMI was significantly higher in GDM than non-GDM (p = 0.024). Conclusion: GDM was highly prevalent in Aswan Governorate with a rate of 17.5%. The major risk factors of GDM were family history of DM and previous history of GDM, increase in age >25 and multiparity and obesity.

Prevalence and Risk Factors for Gestational Diabetes in Aswan, Egypt According to International Association of the Diabetes and Pregnancy Study Groups (IADPSG)

Background: The prevalence of diabetes in Egypt has significantly increased exceeding international rates. Egypt is now ranked ninth highest in the world in terms of the disease according to IDF, 2019. Objective: Estimation of the prevalence of gestational diabetes mellitus (GDM) in Aswan Governorate in Egypt and determination of the risk factors associated with GDM. Patients and methods: Our study was a prospective study, which carried out in the Antenatal Clinic in the Obstetrics and Gynecology Department, Aswan University Hospital from July 2016 to July 2017. The pregnant women were collected form Aswan Governorate as part of a Gestational Diabetes care in Upper Egypt project in collaboration with World Diabetes Foundation. Our study included 1000 pregnant woman. All participants were screened for GDM at 24-28 weeks of gestation. Universal screenings for GDM were performed for the participants using oral glucose tolerance test (OGTT) according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations 2017. Results: According to IADPSG criteria, 17.5% of the screened cases had GDM, 16.8% had fasting blood glucose level ≥ 92 mg/dL, 15.5% had 1-hour OGTT ≥180 mg/dL and 16.7% had ≥153 mg/dL. It was found that the age ≥ 25 years and multiparity were significantly higher in GDM than in Non-GDM. Pregnant women living in rural areas and working women were significantly protected against GDM than those from urban areas. Both family history of diabetes and previous history of GDM represented the major risk factor in our studied group (P < 0.001 & < 0.001 respectively). 40.4 % of studied group exhibited no definite risk factors. There were significant increases in systolic B.P, diastolic B.P in GDM group versus non-GDM (p < 0.001 & p < 0.001 respectively). BMI was significantly higher in GDM than non-GDM (p = 0.024). Conclusion: GDM was highly prevalent in Aswan Governorate with a rate of 17.5%. The major risk factors of GDM were family history of DM and previous history of GDM, increase in age >25 and multiparity and obesity.

6 voces en 10 minutos: Educación terapéutica en mujeres con diabetes gestacional (EDUGEST)

6 voces en 10 minutos: Experiencias en educación en ArgentinaEducación terapéutica en mujeres con diabetes gestacional (EDUGEST)El objetivo del programa es optimizar el diagnóstico, la calidad de atención y el tratamiento de embarazadas con diabetes gestacional (DG), capacitando al equipo de salud e implementando un programa de educación terapéutica destinado a esta población.Materiales y métodos: estudio multicéntrico, prospectivo, caso control de embarazadas con diagnóstico de DG con criterio ALAD, que se atienden en maternidades de hospitales de Corrientes, Resistencia, Ciudad Autónoma de Buenos Aires y Provincia de Buenos Aires. Convenio de trabajo entre Facultad de Medicina de la UNNE y World Diabetes Foundation (2016-2020).

1381-P: Association of Implementation of a Comprehensive Peripregnancy Management Plan with Pregnancy Outcomes among Chinese Pregnant Women with Type 1 Diabetes

Background: Risk of adverse pregnancy outcomes (APOs) remains high among pregnant women with type 1 diabetes (T1D). We aimed to investigate whether implementation of a comprehensive evidence-based peri-pregnancy management plan was associated with lower rates of APOs among these women. Methods: This is a nationwide observational cohort study. A comprehensive evidence-based peri-pregnancy management plan for T1D was launched in 11 centers from 8 cities in China. During 2015-2017 we prospectively collected data from all pregnant women with T1D attending these centers. We compared pregnancy outcomes in this prospective cohort (PC) with two comparison populations. These populations were constructed by compiling data from medical records: the first was a retrospective cohort (RC) of pregnant women with T1D attending the same centers during 2012-2014 before the management plan, and the second was a comparison cohort (CC) of pregnant women with T1D receiving routine care during 2015-2017 in the comparison centers. The comparison centers were another 11 centers from 7 cities with matched socio-economic variables and medical facilities. The main outcome was severe APO comprising maternal mortality, neonatal death, congenital malformation(s), miscarriage in the 2nd trimester, and stillbirth. Results: We included a PC of 133 pregnant women with TID who received the comprehensive management during 2015-2017; a RC of 153 TID pregnancies out of 137544 pregnancies during 2012-2014; and a CC of 116 TID pregnancies out of 165493 pregnancies during 2015-2017. The rate of severe APO was significantly lower in the PC (6.02%) than either the RC (18.30%, adjusted odds ratio[aOR] 0.31, 95% CI 0.13-0.74, P&amp;lt;0.01) or the CC (25.00%, aOR 0.22, 95% CI 0.09-0.52, P&amp;lt;0.001). Conclusions: Implementation of the comprehensive evidence-based peri-pregnancy management plan is associated with lower risk of APOs among Chinese pregnant women with T1D. Disclosure X. Zheng: None. D. Yang: None. S. Luo: None. J. Yan: None. J. Weng: None. Funding National Health and Family Planning Commission of the People’s Republic of China; Foundation for Public Welfare Industry Research Project (201502011); World Diabetes Foundation (WDF14-921)

2375-PUB: The Need of Women with Type 1 Diabetes for Pregnancy-Related Care in China: An Online Questionnaire Study

Background: Pregnancy Related Care (PRC) could reduce the risk of adverse pregnancy outcomes in women with type 1 diabetes (T1D). Little was known about the need of them in China. We aimed to identify their need for PRC. Methods: It was a cross-sectional study on women with T1D by an online questionnaire based on previous in-depth interviews. The questionnaire was advertised via patient community and Wechat. The survey ended when the sample size was reached. The data were analyzed in SPSS 19.0. Results: The survey was conducted from Dec 26, 2016 to Jan 18, 2018. We received 385 responses from 28 provinces of China. Among them, 72.7% were aged 21∼35; 53.5% with T1D for over 5 years; 84.4% had annual income less than $10,000 and 61.6% spent over 30% income on T1D management; 66.0% and 37.4% were on MDI and CSII, respectively. The results were as below. 1) Current status of PRC: only 23.4% reported HbA1c&amp;lt;6.5%; 33.0% ever got pregnant and 48.4% with adverse pregnancy outcomes; only 12.5% thought they got enough knowledge on PRC; 90.4% had worries for pregnancy, including complications, inheritance of T1D, cost and discrimination; 94.5% were willing to attend PRC program. 2) Doctor-patient relationship: 75.0% went to tertiary hospitals for T1D; 80.5% were satisfied with the doctors; 72.5% reported less than 10 minutes per visit while 76.9% asked for over 10 minutes for better communication; 76.8% gained confidence for pregnancy after visit; 84.2% suggested PRC be provided in a multiple disciplinary team. 3) Social support: 86.2% expressed T1D influenced their decision of marriage and childbearing; 44.9% concealed T1D from their family about T1D and 30.5% didn’t think the family would support the decision of pregnancy; 80.3% longed to share experience among peers and 78.7% were more confident after sharing. Conclusion: Women with T1D had various unmet need for PRC, but current practice of PRC was lacking in China. The role of professional and social support should be enhanced to relieve their stress on pregnancy. Disclosure C. Wang: None. S. Luo: None. X. Zheng: None. S. Xiong: None. J. Yan: None. D. Yang: None. L. Qiu: None. B. Yao: None. J. Weng: None. Funding Guangdong Province Science and Technology Program (2018A070701019); National Health and Family Planning Commission of the People's Republic of China (201502011); World Diabetes Foundation (14-921)

Tuberculosis in diabetes: insidious and neglected

Tuberculosis in diabetes: insidious and neglected

Optimized health care for subjects with type 1 diabetes in a resource constraint society: A three-year follow-up study from Pakistan.

BACKGROUNDInadequate health infrastructure and poverty especially in rural areas are the main hindrance in the optimal management of subjects with type 1 diabetes (T1D) in Pakistan.AIMTo observe effectiveness of diabetes care through development of model clinics for subjects with T1D in the province of Sindh Pakistan.METHODSA welfare project with name of “Insulin My Life”, was started in province of Sindh, Pakistan. This was collaborative work of Baqai Institute of Diabetology and Endocrinology, World Diabetes Foundation and Baqai Medical University between February 2010 to February 2013. Under this project thirty-four T1D clinics were established. Electronic database was designed for demographic, biochemical, anthropometric and medical examination. Monthly consultation was part of the standardized diabetes care. All the recruited subjects with T1D were provided free insulins and related materials.RESULTSOut of 1428 subjects, 795 (55.7%) were males and 633 (44.3%) were females. Subjects were categorized into ≤ 5 years of age 103 (7.2%), between 6-12 years 323 (22.6%), between 13–18 years 428 (29.7%) and ≥ 19 years of age 574 (40.2%) groups. Glycemic control as assessed by HbA1c was significantly improved (P < 0.0001) at three years follow up as compared to baseline in all age groups. Decreasing trends of mean self-monitoring blood glucose were observed at different meal timings in all age groups. No significant change was found in the frequency of neuropathy, nephropathy and retinopathy during the study period (P > 0.05).CONCLUSIONThis study gives us long-term longitudinal data of people with T1D in a resource constraint society. With provision of standardized and comprehensive care significant improvement in glycemic control without any change in the frequency of microvascular complications was observed over 3 years.

Implementation of a clinical guideline for detection of gestational diabetes in primary care

Gestational diabetes (GD) impacts maternal and fetal morbidity. In 2012, the World Diabetes Foundation provided financing project in Barranquilla (Colombia), aimed to implement a clinical guide for the diagnosis and treatment of this condition. To estimate the adherence of the guide in primary care centers. A Cross-sectional study of pregnant women suspected of having gestational diabetes. Pregnant women were classified according to the week of admission to the prenatal control program: < week 24 or later. Women with a fasting blood glucose over 92 mg/dL and under 126 mg/dL or with some positive result to the oral glucose tolerance test were included. Nine percent (1,887 women) of 21,699 registries of pregnant women, were at risk for gestational diabetes. Of these, 1,880 registries with complete data were analyzed. Sixty nine entered the program at less than 24 weeks of pregnancy and 71% had had a fasting blood glucose measured in the first control. In 69.2% of these women, criteria for gestational diabetes was met. A glucose tolerance test was suggested to women with a blood glucose below 92 mg/dl. Among 72% of the latter, the glucose tolerance test met the criteria for gestational diabetes. Among the 498 women who entered the program after 24 weeks of gestation, 68% met the criteria for gestational diabetes with the fasting blood glucose levels. In 90 women, a glucose tolerance test was performed and 80% met the criteria for gestational diabetes. An adequate adherence to guidelines favors the detection of pregnant women with gestational diabetes.

Metabolic Syndrome - A New Paradigm: Need for Capacity Building of Health Care Workers for Early Screening in the Rural Indian Population

Background: We continue to experience an inexorable transition from communicable to chronic non-communicable diseases (NCD), worldwide. This is especially true in India, where it appears that metabolic syndrome (MetS) is increasing in prevalence due to rapid economic growth, change in food intake and physical inactivity have lead to increase in MetS. However access to health service is poor in India and proper assessment for metabolic disease is often lacking. Accredited Social Health Activists(ASHA) are available throughout India for doing house to house assessment and providing health care, a potential solution for identifying people with abnormal metabolic factors. The aim of this study was to conduct capacity building of ASHA workers for screening of metabolic syndrome in rural India and identify people in rural India with features of MetS. Methods: After obtaining approval from institutional ethics committee 300 ASHAs were trained under World Diabetes Foundation fundedproject (WDF15-941) about aspects ofMetS, diabetes mellitus and diabetic foot. Hand holding training activities were held for each ASHA intheir respective area of practice. This was conducted by project staffs. Participants over the ageof 30 years were screened for the presence of MetS. Random blood glucose (RBS), blood pressure, body mass index (BMI) and waist circumference were measured. Results: A total of 38,346 people were screened for the presence of metabolic syndrome,of which13,911(36.3%) were found to have MetS of which 4200(35.9%) were male and 9,711(37.2%) were female. Those with type 2 diabetes mellitus(T2DM) 1,555(36.7%) also had MetS. Among 3 diagnostic criteria, waist circumference was the highest with 34.1%. Individual with impaired random glucose levels have 1.5 times more risk of developing metabolic syndrome adjusted for age and gender. Conclusion: In conclusion, MetS was present in 36.3% participants residing in rural part of Indiai.e one third of the population. Amongst people with T2DM 36.7% had MetS. The result suggest better screening and early identification of these people will help in proper treatment which might reduce the risk of cardiovascular diseases. Funding: The field screening was conducted as a part of ongoing project funded by World Diabetes Foundation WDF 15-941 “Diabetic Foot care: Stepping Ahead”. Declaration of Interest: The author(s) declare no potential conflict of interest with respect to the research, authorship, and/or publication of this article. Ethical Approval: The study was initiated after obtaining the approval from institutional research committee and institutional ethics committee (IEC 700/2015).

Protocol for systematic review and meta-analysis of sex hormones and diabetes risk in ageing men and women of African ancestry

AimTo present the protocol of a systematic review and meta-analysis of the available evidence examining the association between sex hormones and type 2 diabetes risk in ageing men and women...

Management of Blood Sugar Degrees in Hyperglycemia in Pregnancy (Hip) Reduces Perinatal, Infant Morbidity &amp; Mortality as a Result of a Large Prospective Cohort Learn From Up, India

Background: Gestational diabetes mellitus (GDM) is a glucose intolerance that occurs or is identified for the first time all through pregnancy. Perinatal &amp; Neonatal morbidity mortality is significant in pregnant women in GDM with extra hazard of growing diabetes later in life. Uttar Pradesh is a largest state of India with one of the highest rate of the infant as well as maternal mortality which might be, at least partially due to GDM. Thus, Careful evaluation, administration &amp; Training of HCPs for GDM can improve the outcomes in National health Mission supported Govt funded Program, supported by World Diabetes foundation, Denmark. Aims &amp; Objectives: Primary objective of this study to be determine the Maternal-Fetal outcomes of GDM and management of Hyperglycemia in Pregnancy HIP reduces Neonatal &amp; Perinatal Mortality as per the NHM, GOI Guidelines for GDM, As this will go long way help us in reduction of Perinatal &amp; infant mortality. Thus, this study was once undertaken to recognize the extent of the burden on the healthcare and formulating further policy for Implementation of Gestational Diabetes Program in the largest state of Uttar Pradesh. Materials and Methods: A prospective cohort study was done for 2 year from October 1, 2016, to September 31, 2018, at 828 GDM screening units as a part of the Gestational Diabetes Prevention and Control Project, Uttar Pradesh approved by the Indian Government in the state of Uttar Pradesh, India, largest state with second Highest MMR &amp; IMR, A total of 515,532 pregnant women were screened during their 16–32th weeks of pregnancy by impaired oral glucose test (OGTT) as per NHM Guidelines for GDM, 12784 GDM &amp; 7287 Non GDM maternal and perinatal outcomes were followed up in both GDM and non‑GDM categories in the 2 year (2016-2018) after blood sugar management (September 2016-October 2018) was executed at 828 (DHs, CHCs &amp; PHCs healthcare) facilities, 515532 Pregnant Women have been screened at 16-20 Weeks &amp; 24th-28 weeks of pregnancy as per Guidelines of National health Mission, GOI Guideline. Results: Perinatal mortality increased significantly from 2.6% to 9.1% when blood sugar levels increased from 120 mg/dl to 199 mg/dl and above. Perinatal mortality in GDM cases were significantly to the control of blood sugar levels (P &lt; 0.0001). Relative Risk of Stillbirth, Perinatal &amp; neonatal mortality have been respectively 2.5, 2.3 &amp; 2.5 times greater in GDM compare Non GDM (Table 1). Most of the GDM used to be identified in primigravida (52%). It was also found in our study those GDM who were strictly controlled with Hyperglycemia in pregnancy (HIP) to &lt;120 mg/dl, Post Prandial blood sugar, have lowest risk for perinatal and neonatal mortality compare to those GDM pregnant women Blood sugars were not controlled, Risk for Perinatal mortality increases steadily and reaches 9.1% beyond blood sugar&gt; 200 mg/dl. Conclusion: All the Pregnant women need screening in Public health facilities &amp; Implementation of National health Mission, GOI Guidelines for GDM has to be followed to improve outcome for Mother and Newborn, As the lack of information about GDM amongst pregnant women is high, to decrease the risk, increase awareness &amp; full Implementation of NHM GDM Guidelines is key to Perinatal and neonatal mortality reduction in Public health care facilities where large number of ANC visit for Maternal and fetal health care.

Pre-Gestational Diabetes Mellitus and Adverse Pregnancy Outcomes in 6.4 Million Women in Rural China During 2010-2016: A Population-Based, Cohort Study

Background: Pre-gestational diabetes mellitus (pGDM) and elevated fasting blood glucose level are associated with increased risk of maternal, perinatal and neonatal morbidity and mortality. Only 30.1% of those with diabetes had been previously diagnosed in China. It was reported that nearly 50.0% of Chinese population is the rural population in the population census data in 2014. It has been verified the effects of glucose level during pregnancy on adverse pregnancy outcomes. However, data of the relationship between glucose level before pregnancy and its pregnancy outcomes is scarce. We investigated the epidemiology of reproductive-aged women in China, aiming to provide the data for the prevalence of pGDM and its association with pregnancy outcomes. Methods: Data are from a nationwide sample of women of reproductive age who participated in National Free Preconception Health Examination service in 31 provinces of rural China during 2010-16. Study population characteristics were presented as mean (SD) for continuous variables and number (percentages) for categorical variable, and analysis of variance and chi square test were used to test association between each level of blood glucose concentration, risk factors and adverse outcome. Findings: Of 7,094,807 registered women (age 20-49 years), 6,447,339 were included in analyses. The incidence of pGDM and IFG was 76,297 (1.18%) and 847,737 (13.15%), respectively. Only 917 (1.20%) women were aware that they had pGDM in rural China. Among women without previously diagnosed DM, there is a positive linear association between FPG levels and incidence of combined (counted when occurrence of any of the adverse outcome) and multiple adverse pregnancy outcome(counted when having ≥2 adverse outcomes at the same time) when FPG level was divided into 7 groups ( 10mmol/L). Interpretation: The awareness rate of pGDM prevalence in rural China is extremely low. The management of pGDM is unsatisfactory in women diagnosed with pGDM. PGDM is associated with an increased risk of adverse maternal, perinatal and neonatal outcomes across all levels of FPG. Further analysis is need to support decision on the cut-off point for increased risk of adverse outcome and target blood glucose level before pregnancy to achieve satisfactory outcome. Policy decision on adoption of an extensive screening of pGDM in prepregancy examination and strategies for pGDM and adverse pregnancy outcome control from a broader perspective require more evidence on cost-effectiveness of such approaches. Funding: The National Key Research and Development Program of Reproductive Health & Major Birth Defects Control and Prevention (Grant no. 2016YFC1000402); World Diabetes Foundation (Grant no. WDF14-908). National Natural Science Foundation (Grant no. 81402757) Declaration of Interest: We declare that we have no conflicts of interest. Ethical Approval: This study was approved by the Institutional Research Review Boards at NHFPC and Peking University First Hospital, and all participants provided written informed consent.

Global Patterns of Mortality in International Migrants: A Systematic Review and Meta-Analysis

Background: 258 million people - 3% of the world's adult population - reside outside of their country of birth, yet there has been no previous global systematic review and meta-analysis of mortality data for these international migrants. We undertook a systematic review and meta-analysis to investigate current knowledge about mortality in international migrants. Methods: The review was carried out in line with PRISMA guidelines and was registered on Prospero (CRD42017073608). We searched the MEDLINE, EMBASE, and Global Health databases for studies on international migrants published between 1 Jan 2001 and 31 March 2017. Primary outcomes were standardised mortality ratios (SMRs) and absolute mortality rates. Meta-analyses were conducted using random effects models. Findings: We identified 12480 articles, of which 106 met our inclusion criteria. Data were included from all global regions and for 92 countries. 5498 SMR or absolute mortality estimates on more than 15.2 million migrants were included. The summary estimate of all-cause SMR for international migrants was lower than one (indicating lower mortality) when compared to the general population in host countries to which they migrate 0·70 (95%CI: 0·65-0·76;I2=99·8%). We estimated that all-cause SMR was lower in both male (0·72 [0·63-0·81]; I2=99·8%) and female (0·75 [0·66-0·84]; I2=99·8%) international migrants compared to the host population. The mortality advantage was evident for refugees (0.50 [0.46-0.56];I2=89·8%), but not for asylum seekers (1.05 [0.89-1.24];I2=54·4%), though there were limited data on these groups. SMRs for all causes of mortality were lower in migrants compared to the host population in the destination country with only two exceptions - infectious diseases and external causes - out of 13 ICD-10 categories. Heterogeneity was high across analyses. Point estimates of age-standardised mortality ranged from 488 in women to 874 in men per 100,000 population. Interpretation: Our analyses found that international migrants experience a mortality advantage compared to host populations, and this advantage persisted across the majority of ICD-10 disease categories. This finding is in contrast to the portrayal of migrants as a health burden and demonstrates that international migrants provide a major health benefit for host countries. Our research also highlights the need for better data on underrepresented and potentially more marginalised groups such as asylum seekers and undocumented migrants. Funding Statement: Wellcome Trust, NIHR, MRC, Alliance for Health Policy and Systems Research, DFID, Fogarty International Center, Grand Challenges Canada, International Development Research Center Canada, Inter-American Institute for Global Change Research, National Cancer Institute, National Heart, Lung and Blood Institute, National Institute of Mental Health, Swiss National Science Foundation, World Diabetes Foundation, UK National Institute for Health Research Imperial Biomedical Research Centre and the the Imperial College Healthcare Charity. Declaration of Interests: RWA and IA undertook paid consultancy work in support of the Doctors of the World 2017 Observatory report - Falling through the cracks: The Failure of Universal Healthcare Coverage in Europe. JSF, LBN, and SH have collaborated on research projects with Doctors of the World UK, which includes research commissioned by the Equality and Human Rights Commission on barriers and enablers to care for asylum seekers and refused asylum seekers in the UK. RWA is supported by a Wellcome Trust Clinical Research Career Development Fellowship (206602/Z/17/Z). SB is supported by an NIHR research methods fellowship. JJM acknowledges receiving additional support from the Alliance for Health Policy and Systems Research (HQHSR1206660), DFID/MRC/Wellcome Global Health Trials (MR/M007405/1), Fogarty International Center (R21TW009982, D71TW010877), Grand Challenges Canada (0335-04), International Development Research Center Canada (106887, 108167), Inter-American Institute for Global Change Research (IAI CRN3036), Medical Research Council (MR/P008984/1, MR/P024408/1, MR/P02386X/1), National Cancer Institute (1P20CA217231), National Heart, Lung and Blood Institute (HHSN268200900033C, 5U01HL114180, 1UM1HL134590), National Institute of Mental Health (1U19MH098780), Swiss National Science Foundation (40P740-160366), Wellcome Trust (074833/Z/04/Z, 205177/Z/16/Z) and the World Diabetes Foundation (WDF15-1224). LBN, SH, and JSF receive funding from the UK National Institute for Health Research Imperial Biomedical Research Centre and the Imperial College Healthcare Charity; SH and LN are funded by the Wellcome Trust (Grant number 209993/Z/17/Z) with co-applicants of RWA, JSF and IA for this work. The views expressed are those of the authors and not those of the Wellcome Trust, NIHR, NHS, NHS Research Scotland, Medical Research Council, Chief Scientist’s Office. Ethics Approval Statement: The review was carried out in line with PRISMA guidelines and was registered on Prospero (CRD42017073608).