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Kean EA, Adeleke OA. Geriatric drug delivery - barriers, current technologies and the road ahead. J Drug Target 2024; 32:1186-1206. [PMID: 39076049 DOI: 10.1080/1061186x.2024.2386626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/17/2024] [Accepted: 07/25/2024] [Indexed: 07/31/2024]
Abstract
The geriatric population encompasses the largest part of the health care system worldwide. Chronic medical conditions are highly prevalent in the elderly, consequently, due to their complex health needs, there is a significant rate of multi-drug therapy. Despite the high numbers of medications prescribed, geriatric patients face several barriers when it comes to successful drug delivery including alterations in cognitive and physical function. The current review highlights the impact of chronic diseases on the ageing population along with how changes in drug pharmacokinetics could impact drug efficacy and safety. Also discussed are applications of administration routes in the geriatric population and complications that could arise. A focus is placed on the traditional and upcoming drug delivery advancements being employed in seniors with a focus addressing obstacles faced by this patient category. Nanomedicines, three-dimensional printing, long-acting formulations, transdermal systems, orally disintegrating tablets, and shape/taste modification technologies are discussed. Several barriers to drug delivery in the elderly have been identified in literature and directions for future studies should focus on addressing these gaps for geriatric drug formulation development including personalised medicine, insights into novel drug delivery systems like nanomedicines, methods for decreasing pill burden and shape/size modifications.ARTICLE HIGHLIGHTSTypically, senior citizens take more medications than any other patient population, yet most drug delivery technologies are not tailored to address the specific cognitive and physical barriers that these individuals encounter.The safety of drug delivery systems in the elderly patients should be prioritised with considerations on changes in pharmacokinetics with age, use of non-toxic excipients, and selecting drugs with minimal off-target side effects.Several commercialised and upcoming drug delivery technologies have begun to address the current limitations that the ageing population faces.Future research should focus on applying novel strategies like 3D printing, personalised medicine, and long-acting formulations to improve drug delivery to elderly patients.
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Affiliation(s)
- Emma A Kean
- Preclinical Laboratory for Drug Delivery Innovations, College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Oluwatoyin A Adeleke
- Preclinical Laboratory for Drug Delivery Innovations, College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Biomedical Engineering, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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2
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Laukkanen JA, Kunutsor SK, Immonen J, Hernesniemi J, Karvanen J, Eskola M. Diabetes and mortality risk in patients undergoing coronary angiography: The KARDIO study. Catheter Cardiovasc Interv 2024; 104:743-750. [PMID: 39219466 DOI: 10.1002/ccd.31212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 08/04/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Diabetes is an established risk factor for adverse cardiovascular outcomes including mortality, but the relationship between diabetes and mortality risk in the presence of the extensive or diffuse form of coronary artery disease (CAD) is controversial. AIMS We evaluated the association between diabetes and mortality risk in patients who underwent coronary angiography using a real-life clinical database. METHODS We utilized the KARDIO registry, which comprised data on demographics, prevalent diseases, including diabetes status, cardiovascular risk factors, coronary angiographies, and other interventions in 79,738 patients. Hazard ratios (HRs) (95% confidence intervals [CIs]) for the association between prevalent diabetes and all-cause mortality were estimated. RESULTS During a median follow-up of 5.5 years, 11,896 all-cause deaths occurred. In analyses adjusted for age, smoking status, hypertension, family history of CAD, dyslipidaemia, urgency of intervention, body mass index, sex, and sex-age interaction, the HR (95% CI) for mortality comparing diabetes with no diabetes was 1.44 (1.38, 1.50). Following additional adjustment for the degree of CAD (1-3 vessels disease) as confirmed by angiography, the HR (95% CI) for mortality remained similar 1.43 (1.36, 1.49). The association did not vary significantly across several relevant clinical characteristics except for a stronger association in those with a family history of CAD than those without (p = 0.034) and former smokers than nonsmokers (p = 0.046). CONCLUSION In patients undergoing coronary angiography, diabetes is associated with an increased mortality risk, independent of several risk factors including the degree of CAD. The association may be modified by family history of CAD and smoking status.
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Affiliation(s)
- Jari A Laukkanen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Wellbeing Services County of Central Finland, Jyväskylä, Finland
| | - Setor K Kunutsor
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, Saint Boniface Hospital, University of Manitoba, Winnipeg, Canada
| | - Jaakko Immonen
- Department of Medicine, Wellbeing Services County of Central Finland, Jyväskylä, Finland
| | - Jussi Hernesniemi
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha Karvanen
- Department of Mathematics and Statistics, University of Jyvaskyla, Jyväskylä, Finland
| | - Markku Eskola
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
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Heshmat R, Darvishi A, Abdi Dezfouli R, Nikkhah A, Radmanesh R, Moslemi E. A short-term economic evaluation of early insulin therapy compared to oral anti-diabetic drugs in order to reduce the major adverse events in type 2 diabetes patients in Iran. Curr Med Res Opin 2024; 40:765-772. [PMID: 38533582 DOI: 10.1080/03007995.2024.2333425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE While there are some recommendations about early insulin therapy in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients, there is not sufficient evidence on this strategy's cost-effectiveness. This study compared early insulin therapy versus oral anti-diabetic drugs (OADs) for managing T2DMusing a cost-effectiveness analysis approach in Iran. METHODS In this economic evaluation, a decision analytic model was designed. The target population was newly diagnosed type 2 diabetic patients, and the study was carried out from the perspective of Iran's healthcare system with a one-year time horizon. Basal insulin, Dipeptidyl peptidase-4 (DPP-4) inhibitors, and Thiazolidinediones (TZDs) were compared in this evaluation. The main outcome for assessing the effectiveness of each intervention was the reduction in the occurrence of diabetes complications. Strategies were compared using the incremental cost-effectiveness ratio (ICER), and deterministic and probabilistic sensitivity analyses were carried out. RESULTS The DPP-4 inhibitors strategy was the dominant strategy with the highest effectiveness and the lowest cost. Early insulin therapy was dominated (ICER: $-53,703.18), meaning that it was not cost-effective. The sensitivity analyses consistently affirmed the robustness of the base case findings. The probabilistic sensitivity analysis indicated probabilities of 77%, 22%, and 1% for DPP-4 inhibitors, TZDs strategies, and early insulin therapy, respectively, in terms of being cost-effective. CONCLUSION In terms of cost-effectiveness, early insulin therapy was not cost-effective compared to OADs for managing newly diagnosed T2DM patients. Future studies in this regard, utilizing more comprehensive evidence, can yield more accurate results.
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Affiliation(s)
- Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Darvishi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Abdi Dezfouli
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Adeleh Nikkhah
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Radmanesh
- Department of Pharmacoeconomics and Pharmaceutical Management, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Elham Moslemi
- Department of Pharmacoeconomics and Pharmaceutical Management, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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4
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Soileau LG, Nguyen A, Senthil A, Boullion JA, Talbot NC, Ahmadzadeh S, Shekoohi S, Kaye AD, Varrassi G. Bromocriptine and Colesevelam Hydrochloride: Novel Therapies for Type II Diabetes Mellitus. Cureus 2023; 15:e50138. [PMID: 38192911 PMCID: PMC10771968 DOI: 10.7759/cureus.50138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/07/2023] [Indexed: 01/10/2024] Open
Abstract
The increasing prevalence of type II diabetes mellitus (T2DM) is a worldwide healthcare concern. Over the years, our understanding of T2DM has grown considerably in uncovering the pathophysiology of the disease and, in turn, understanding how improved treatment methods can be used to slow disease progression. Some long-term complications that are responsible for most T2DM mortalities include cardiovascular disease, neurological decline, and renal failure. In treating T2DM, it is important that not only glycemic control be obtained but also control of associated complications. Bromocriptine and colesevelam hydrochloride have both been approved by the Food and Drug Administration (FDA) to treat T2DM but are not readily used in practice. These medications are known to treat glycemic dysregulation via unconventional mechanisms, which might contribute to their potential to provide protection against common diabetic complications such as cardiovascular disease. In order to ensure that these overlooked medications become more readily used, it is vital that more research be performed to further elucidate their efficacy in a clinical setting. Future studies should continue to provide clinicians a better understanding of the role these medications have on the treatment of T2DM such as their ability to be used in combination with other commonly used T2DM medications or as monotherapies.
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Affiliation(s)
- Lenise G Soileau
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Angela Nguyen
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Aarthi Senthil
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Jolie A Boullion
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Norris C Talbot
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Vivanco-Rojas O, López-Letayf S, Londoño-Angarita V, Magaña-Guerrero FS, Buentello-Volante B, Garfias Y. Risk Factors for Diabetic Retinopathy in Latin America (Mexico) and the World: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:6583. [PMID: 37892721 PMCID: PMC10607496 DOI: 10.3390/jcm12206583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Diabetic retinopathy (DR) is one of the main complications of diabetes, and the management of the main control parameters explains only an 11% reduction in the risk of progressing to DR, leaving 89% to be explained by other factors or correlations between the usual factors that are currently unknown. The objective of this systematic review and meta-analysis is to evaluate the similarities and differences between the possible risk factors for developing DR when comparing the world to Latin American populations. The search was performed first for Latin American (LA) populations and a second search for non-Latin American (Non-LA) populations. Using the PRISMA guidelines, five articles were found to be relevant for each of the groups. The patients who had elevated systolic blood pressure (SBP) developed DR more frequently than the patients without retinopathy (Z = 2.1, p = 0.03), an effect measured in the population at a global level (GL), behavior that becomes not significant when the LA and non-LA populations are grouped separately; relevant to this is that the diagnosis of hypertension (HBP) grouped globally and stratified does not present a risk factor for DR (Z = 0.79, p = 0.42). This indicates that SBP is a risk factor for the world population and that, by separating it into different regions, the omission could cause it not to be considered a possible risk factor. In conclusion, the relationship between the increase in DR associated with the risk factors present in different populations, the limited research conducted in Latin America, and the cultural, social, economic, and genetic differences makes for a complex condition, which reflects the necessity of researching in a more integrated way.
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Affiliation(s)
- Oscar Vivanco-Rojas
- Department of Biochemistry, Faculty of Medicine, Universidad Nacional Autónoma de México, Av. Universidad 3000, Mexico City 04510, Mexico; (O.V.-R.); (S.L.-L.)
- Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana, Chimalpopoca 14, Mexico City 06800, Mexico; (V.L.-A.); (F.S.M.-G.); (B.B.-V.)
| | - Sonia López-Letayf
- Department of Biochemistry, Faculty of Medicine, Universidad Nacional Autónoma de México, Av. Universidad 3000, Mexico City 04510, Mexico; (O.V.-R.); (S.L.-L.)
- Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana, Chimalpopoca 14, Mexico City 06800, Mexico; (V.L.-A.); (F.S.M.-G.); (B.B.-V.)
| | - Valentina Londoño-Angarita
- Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana, Chimalpopoca 14, Mexico City 06800, Mexico; (V.L.-A.); (F.S.M.-G.); (B.B.-V.)
| | - Fátima Sofía Magaña-Guerrero
- Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana, Chimalpopoca 14, Mexico City 06800, Mexico; (V.L.-A.); (F.S.M.-G.); (B.B.-V.)
| | - Beatriz Buentello-Volante
- Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana, Chimalpopoca 14, Mexico City 06800, Mexico; (V.L.-A.); (F.S.M.-G.); (B.B.-V.)
| | - Yonathan Garfias
- Department of Biochemistry, Faculty of Medicine, Universidad Nacional Autónoma de México, Av. Universidad 3000, Mexico City 04510, Mexico; (O.V.-R.); (S.L.-L.)
- Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana, Chimalpopoca 14, Mexico City 06800, Mexico; (V.L.-A.); (F.S.M.-G.); (B.B.-V.)
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Wang H, Akbari-Alavijeh S, Parhar RS, Gaugler R, Hashmi S. Partners in diabetes epidemic: A global perspective. World J Diabetes 2023; 14:1463-1477. [PMID: 37970124 PMCID: PMC10642420 DOI: 10.4239/wjd.v14.i10.1463] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/01/2023] [Accepted: 09/01/2023] [Indexed: 10/09/2023] Open
Abstract
There is a recent increase in the worldwide prevalence of both obesity and diabetes. In this review we assessed insulin signaling, genetics, environment, lipid metabolism dysfunction and mitochondria as the major determinants in diabetes and to identify the potential mechanism of gut microbiota in diabetes diseases. We searched relevant articles, which have key information from laboratory experiments, epidemiological evidence, clinical trials, experimental models, meta-analysis and review articles, in PubMed, MEDLINE, EMBASE, Google scholars and Cochrane Controlled Trial Database. We selected 144 full-length articles that met our inclusion and exclusion criteria for complete assessment. We have briefly discussed these associations, challenges, and the need for further research to manage and treat diabetes more efficiently. Diabetes involves the complex network of physiological dysfunction that can be attributed to insulin signaling, genetics, environment, obesity, mitochondria and stress. In recent years, there are intriguing findings regarding gut microbiome as the important regulator of diabetes. Valid approaches are necessary for speeding medical advances but we should find a solution sooner given the burden of the metabolic disorder - What we need is a collaborative venture that may involve laboratories both in academia and industries for the scientific progress and its application for the diabetes control.
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Affiliation(s)
- Huan Wang
- College of Bioscience and Biotechnology, Shenyang Agricultural University, Shenyang 110866, Liaoning Province, China
- Rutgers Center for Vector Biology, Rutgers University, New Brunswick, NJ 08901, United States
| | - Safoura Akbari-Alavijeh
- Rutgers Center for Vector Biology, Rutgers University, New Brunswick, NJ 08901, United States
- Department of Food Science and Technology, College of Agriculture, Isfahan University of Technology, Isfahan 84156-83111, Iran
| | - Ranjit S Parhar
- Department of Biological and Medical Research, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Randy Gaugler
- Rutgers Center for Vector Biology, Rutgers University, New Brunswick, NJ 08901, United States
| | - Sarwar Hashmi
- Rutgers Center for Vector Biology, Rutgers University, New Brunswick, NJ 08901, United States
- Research and Diagnostics, Ghazala and Sanya Hashmi Foundation, Holmdel, NJ 07733, United States
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Mohsenpour MA, Samadani M, Shahsavani Z, Golmakani MT, Pishdad GR, Ekramzadeh M. The effect of celery ( Apium graveolens) powder on cardiometabolic factors in overweight/obese individuals with type 2 diabetes mellitus: A pilot randomized, double-blinded, placebo-controlled clinical trial. Food Sci Nutr 2023; 11:5351-5363. [PMID: 37701242 PMCID: PMC10494649 DOI: 10.1002/fsn3.3493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 09/14/2023] Open
Abstract
Celery (Apium graveolens) was shown to have beneficial effects on cardiometabolic factors in animal models. As the progression of type 2 diabetes mellitus (T2DM) adversely affects cardiometabolic factors, we aimed to assess the effects of celery powder on glycemic and anthropometric indices, lipid profile, liver function, oxidative stress, and blood pressure of individuals with T2DM. In a pilot randomized, double-blinded, placebo-controlled clinical trial, 50 eligible adults with T2DM were randomly divided into two groups of intervention and control to consume either 750 mg of celery powder (obtained from fresh celery) or placebo along with a low-calorie diet for 12 weeks, respectively. Dietary intake, physical activity, and cardiometabolic factors were assessed before and at the end of the study. Thirty-six patients finished the study (18 in each group). Consumption of celery powder significantly reduced body fat percentage (p = .021). Between-group analysis for changes in cardiometabolic factors did not show significant differences. Although malondialdehyde was reduced in the intervention group and increased in the control group, between-group changes were not significant. Although the insulin-level change was statistically insignificant, a clinical improvement was observed in the intervention group. A 750-mg daily supplementation of celery powder for 12 weeks did not improve the cardiometabolic factors of patients with T2DM. Further studies are suggested.
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Affiliation(s)
- Mohammad Ali Mohsenpour
- Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food SciencesShiraz University of Medical SciencesShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Mahsa Samadani
- Department of Nutrition, School of Allied Medical SciencesAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Zeinab Shahsavani
- Department of Community Nutrition, School of Nutrition and Food SciencesShiraz University of Medical SciencesShirazIran
| | | | - Gholam Reza Pishdad
- Endocrine and Metabolism Research CenterShiraz University of Medical SciencesShirazIran
| | - Maryam Ekramzadeh
- Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food SciencesShiraz University of Medical SciencesShirazIran
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Ahmed TM, Nassar M, Mohamed HAA, Elhadidy KE, Farhan HM, El Basset ASA, Elmessiery RM, Kamel MF. Evaluation of serum levels of Irisin as a marker of endothelial dysfunction in patients with type 2 diabetes mellitus. Endocrinol Diabetes Metab 2023; 6:e403. [PMID: 36919265 PMCID: PMC10164434 DOI: 10.1002/edm2.403] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION Insulin resistance and obesity have been associated with irisin, a protein in fat cells. The levels of irisin in patients with type 2 diabetes mellitus (T2DM) were significantly lower than those in non-diabetics. This study aimed to examine the relationship between serum irisin levels and endothelial dysfunction in patients with T2DM. METHODS There were 90 participants in this study. We matched 65 patients with T2DM with 25 healthy control participants. A series of tests were performed on the participants, including fasting blood glucose, 2 hours postprandial blood glucose, glycated haemoglobin, triglycerides (TG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), TG/HDL-C ratio and albumin/creatinine ratio. In addition to measuring high-sensitivity C-reactive protein (hs-CRP). Enzyme-linked immunosorbent assay (ELISA) technique was used for estimating irisin concentrations. RESULTS Flow-mediated dilation (FMD) was significantly lower in patients with T2DM; however, there was a non-statistically significant difference between healthy controls and patients with T2DM regarding serum Irisin level. CRP and LDL levels were inversely correlated with circulating irisin levels. In a stepwise regression analysis, only the hs-CRP and LDL were statistically significant in predicting irisin level. CONCLUSIONS In patients with T2DM, serum levels of irisin were inversely correlated with hyperglycaemia, body mass index and per cent body fat; this suggests that detecting irisin levels early can prevent cardiovascular diseases from progressing. According to the study results, serum irisin serves as a predictive marker for early cardiovascular disease, thus preventing the disease from progressing. There is a need for further research in order to understand how irisin contributes to the development of atherosclerosis and the development of diabetic complications.
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Affiliation(s)
- Thoraya Mohamed Ahmed
- Internal Medicine Department at Faculty of MedicineBeni Suef UniversityBeni SuefEgypt
| | - Mahmoud Nassar
- Internal Medicine Department at Icahn School of Medicine at Mount Sinai, NYC Health+HospitalsQueensNew YorkUSA
| | | | | | - Hanan Mohamed Farhan
- Clinical and Chemical Pathology DepartmentFaculty of Medicine, Beni Suef UniversityBeni SuefEgypt
| | | | - Riem M. Elmessiery
- Internal Medicine Department, Kasr Alainy Faculty of MedicineCairo UniversityCairoEgypt
| | - Mahmoud Farid Kamel
- Internal Medicine Department at Faculty of MedicineBeni Suef UniversityBeni SuefEgypt
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Quesada JA, Carratalá-Munuera C, Carbonell-Soliva A, Segura-Aparicio JC, González-Fernández J, Salazar-Sánchez L, Gil-Guillén VF, López-Pineda A, Nouni-García R, Orozco-Beltrán D. Trends in premature mortality from diabetes mellitus in Costa Rica in the period 2000-2020. Postgrad Med 2023; 135:128-140. [PMID: 36227619 DOI: 10.1080/00325481.2022.2135865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To analyze the temporal trends of premature mortality from diabetes in Costa Rica in the period 2000-2020, at a national level and by province, and the effect of the COVID-19 pandemic on diabetes mortality during the year 2020. METHODS We studied the temporal trends of mortality from diabetes in Costa Rica in the period between 2000 and 2020. Age-standardized mortality rates and corresponding 95% confidence intervals were calculated for each year, sex and province. RESULTS We analyzed the data of 17,968 deceased persons. The mean age was 72.5 years (range 1 to 109 years), and 51.5% of the population (n = 9253) was younger than 75 years. In both men and women, we observed a significant decrease in mortality from 2000 to 2014, followed by the opposite trend from 2014 to 2020, with average yearly increases of 13.9% in men and 11.6% in women. CONCLUSIONS Premature mortality from diabetes has been growing from 2014. The COVID-19 pandemic changed the mortality pattern, increasing premature diabetes deaths in Costa Rica in 2020.
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Affiliation(s)
- Jose A Quesada
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)
| | - Concepción Carratalá-Munuera
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)
| | - Alvaro Carbonell-Soliva
- Fisabio: Foundation for the Promotion of Health and Biomedical Research in the Valencian Community. San Juan de Alicante, Alicante
| | - Jean Carlo Segura-Aparicio
- Medical Integration Section. Faculty of Medicine, University of Costa Rica. Rodrigo Facio University City, San José, Costa Rica
| | | | - Lizbeth Salazar-Sánchez
- Faculty of Medicine, University of Costa Rica. Rodrigo Facio University City, San José, Costa Rica
| | - Vicente F Gil-Guillén
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS).,Fisabio: Foundation for the Promotion of Health and Biomedical Research in the Valencian Community. San Juan de Alicante, Alicante.,Isabial: Institute of Sanitary and Biomedical Research of Alicante, San José, Costa Rica
| | - Adriana López-Pineda
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS).,Fisabio: Foundation for the Promotion of Health and Biomedical Research in the Valencian Community. San Juan de Alicante, Alicante
| | - Rauf Nouni-García
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS).,Isabial: Institute of Sanitary and Biomedical Research of Alicante, San José, Costa Rica
| | - Domingo Orozco-Beltrán
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)
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Mendivil CO, Amaya-Montoya M, Hernández-Vargas JA, Ramírez-García N, Herrera-Parra LJ, Guatibonza-García V, Romero-Díaz C, Pérez-Londoño A, Acuña-Merchán L. Impact of metabolic control on all-cause mortality in a nationwide cohort of patients with diabetes from Colombia. Front Endocrinol (Lausanne) 2023; 14:1073833. [PMID: 36742410 PMCID: PMC9892640 DOI: 10.3389/fendo.2023.1073833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Objective The magnitude of the mortality benefit conferred by good integral metabolic control in diabetes in not sufficiently known, especially among Latin American patients. We prospectively studied the association between sustained control of blood glucose (HbA1c<7%), systolic blood pressure (SBP) (<130 mmHg) and LDL (LDLc, <100mg/dL) and non-HDL (non-HDLc, <130 mg/dL) cholesterol, and death from any cause among all adult patients with diagnosed diabetes in Colombia. Methods We retrospectively analyzed data from a nationwide, centralized, mandatory registry of all patients with diagnosed diabetes assisted by the Colombian health system between July 1, 2015, and June 30, 2019. We estimated the associations of sustained achievement of each goal, and of the joint triple goal (HbA1c + SBP + LDLc) with all-cause death. Associations were assessed after adjustment for sex, age, race, insurance type and BMI in multivariable logistic models. Results We studied 1 352 846 people with diabetes. Sustained SBP (OR 0.42 [0.41-0.43]), HbA1c (OR 0.25 [0.24-0.26]) and LDLc (OR 0.28 [0.27-0.29]) control had strong negative associations with death. Moreover, among the 5.4% of participants who achieved joint, sustained metabolic control, the OR for death was 0.19 (0.18-0.21). Importantly, the impact of sustained, joint metabolic control was significantly smaller for patients of black race compared to other races (OR 0.31 [0.23-0.43] versus 0.18 [0.17-0.20], p-value for interaction <0.001), mostly at the expense of a smaller impact of LDLc control. The results were similar across body-mass index categories. Conclusions Sustained and simultaneous metabolic control was associated with remarkably lower odds of death.
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Affiliation(s)
- Carlos O. Mendivil
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
- Endocrinology Section, Department of Internal Medicine, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | | | | | | | | | | | | | - Lizbeth Acuña-Merchán
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Bogotá, Colombia
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Mohammed NI, Alzubaidi ZF, Khudhair M. THE RELEVANCE OF RS6777038 AND RS6444082 OF IGF2BP2 GENE POLYMORPHISM AND TYPE 2 DIABETES MELLITUS: A CASE CONTROL STUDY. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2811-2816. [PMID: 36591772 DOI: 10.36740/wlek202211215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim: We investigate IGF2BP2 gene polymorphisms (rs6777038 and rs6444082) association with T2DM of Iraqi sample. PATIENTS AND METHODS Materials and methods: The study involves 800 participants that divided to a healthy control group (400) and T2DM patients (400). Fasting blood sugar (FBS), triglycerides (Tgs), high-density lipoprotein cholesterol (HDL-Ch), total cholesterol (T-Ch), low-density lipoprotein cholesterol (LDL-Ch), and fasting insulin measured for both participant groups. IGF2BP2 gene has been genotyped for polymorphisms, rs6777038 and rs6444082 using the PCR-RFLP technique. RESULTS Results: Logistic regression analysis testing for rs6777038 revealed that the genotype and allele frequency differ significantly (p=0.009) between T2DM and control group. In codominant model, TT genotype carriers had higher risks for diabetes than control also in the recessive model TT genotype significantly had higher risk for diabetes than control group. The other models of rs6777038 failed to reveal significant differences. The rs6777038 genotypes as codominant model showed significant differences with phenotypic characters of BMI, insulin and HOMA-IR. As well as, this SNP as dominant model showed significant differences with fasting insulin and HOMA-IR. However, rs6444082 genotypes only as dominant model reveal significant variation with HOMA-IR. CONCLUSION Conclusions: This study confirmed the variant rs6777038 of IGF2BP2 possibly associated with T2DM risks and some anthropometric parameters such as lower fasting insulin, HOMA-IR and BMI in Iraqi T2DM participants.
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Affiliation(s)
- Noaman Ibadi Mohammed
- DEPARTMENT OF PHYSIOLOGY, BIOCHEMISTRY AND PHARMACOLOGY, FACULTY OF VETERINARY MEDICINE, UNIVERSITY OF KUFA, NAJAF, IRAQ
| | - Zubaida Falih Alzubaidi
- DEPARTMENT OF CLINICAL AND LABORATORY SCIENCES, FACULTY OF PHARMACY, UNIVERSITY OF KUFA, NAJAF, IRAQ
| | - Muneer Khudhair
- DEPARTMENT OF LAB INVESTIGATIONS, FACULTY OF SCIENCES, UNIVERSITY OF KUFA, NAJAF, IRAQ
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12
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Bernabe-Ortiz A, Carrillo-Larco RM. The burden of diabetes in the Americas. Lancet Diabetes Endocrinol 2022; 10:613-614. [PMID: 35850130 DOI: 10.1016/s2213-8587(22)00196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Rodrigo M Carrillo-Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Cummings C, Seng K, Tweet R, Wagner J. Lifestyles Under Lockdown: A Scoping Review of International Studies on Type 2 Diabetes Self-Management Behaviors During COVID-19. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:830353. [PMID: 36992763 PMCID: PMC10012117 DOI: 10.3389/fcdhc.2022.830353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022]
Abstract
Background The effect of the COVID-19 pandemic on diabetes self-management behaviors is unclear. Objectives This paper is a scoping review of studies examining health behaviors among people with type 2 diabetes during the COVID-19 pandemic. Eligibility Criteria We searched articles available in English using the Search terms "COVID" and "diabetes", and, separately, each of the following terms: "lifestyle", "health behavior", "self-care", "self-management", "adherence", "compliance", "eating", "diet", "physical activity", "exercise", "sleep", "self-monitoring of blood glucose", or "continuous glucose monitoring". Sources of Evidence We searched PubMed, PsychInfo, and Google Scholar databases from December 2019 through August 2021. Charting Methods Data were extracted by 4 calibrated reviewers and study elements were charted. Results The search identified 1,710 articles. After screening for relevance and eligibility, 24 articles were included in this review. Findings show the strongest evidence for reduced physical activity and stable glucose monitoring and substance use. There was equivocal evidence for deleterious changes in sleep, diet, and medication intake. With one minor exception, there was no evidence for favorable changes in health behaviors. Limitations of the literature include small samples, predominantly cross-sectional study designs, reliance on retrospective self-reports, sampling through social media, and few standardized measures. Conclusions Early studies of health behaviors among people with type 2 diabetes during the COVID-19 pandemic suggest a need for novel interventions to support diabetes self-management, especially targeting physical activity. Future studies should go beyond documenting changes in health behaviors and examine predictors of change over time.
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Affiliation(s)
- Caroline Cummings
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States
| | - Kagnica Seng
- Department of Psychological Sciences, Central Connecticut State University, New Britain, CT, United States
| | - Ryan Tweet
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, School of Medicine, Portland, OR, United States
| | - Julie Wagner
- Division of Behavioral Sciences and Community Health, University of Connecticut School of Dental Medicine and Department of Psychiatry, School of Medicine, Farmington, CT, United States
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Guzman-Vilca WC, Carrillo-Larco RM. Mortality attributable to type 2 diabetes mellitus in Latin America and the Caribbean: a comparative risk assessment analysis. BMJ Open Diabetes Res Care 2022; 10:10/1/e002673. [PMID: 35185016 PMCID: PMC8860056 DOI: 10.1136/bmjdrc-2021-002673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/18/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION We quantified the proportion and the absolute number of deaths attributable to type 2 diabetes mellitus (T2DM) in Latin America and the Caribbean (LAC) using an estimation approach. RESEARCH DESIGN AND METHODS We combined T2DM prevalence estimates from the NCD Risk Factor Collaboration, relative risks between T2DM and all-cause mortality from a meta-analysis of cohorts in LAC, and death rates from the Global Burden of Disease Study 2019. We estimated population-attributable fractions (PAFs) and computed the absolute number of attributable deaths in 1990 and 2019 by multiplying the PAFs by the total deaths in each country, year, sex, and 5-year age group. RESULTS Between 1985 and 2014 in LAC, the proportion of all-cause mortality attributable to T2DM increased from 12.2% to 16.9% in men and from 14.5% to 19.3% in women. In 2019, the absolute number of deaths attributable to T2DM was 349 787 in men and 330 414 in women. The highest death rates (deaths per 100 000 people) in 2019 were in Saint Kitts and Nevis (325 in men, 229 in women), Guyana (313 in men, 272 in women), and Haiti (269 in men, 265 in women). CONCLUSIONS A substantial burden of all deaths is attributed to T2DM in LAC. To decrease the mortality attributable to T2DM in LAC, policies are needed to strengthen early diagnosis and management, along with the prevention of complications.
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Affiliation(s)
- Wilmer Cristobal Guzman-Vilca
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina Cayetano Heredia (SOCEMCH), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rodrigo M Carrillo-Larco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Universidad Continental, Lima, Peru
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15
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Mohammed S, Juda T, Ali Z. Concept of biochemistry of food. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_87_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Impact of common cardio-metabolic risk factors on fatal and non-fatal cardiovascular disease in Latin America and the Caribbean: an individual-level pooled analysis of 31 cohort studies. LANCET REGIONAL HEALTH. AMERICAS 2021; 4:None. [PMID: 34957436 PMCID: PMC8669782 DOI: 10.1016/j.lana.2021.100068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/14/2021] [Accepted: 08/24/2021] [Indexed: 12/20/2022]
Abstract
Background Estimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains unknown. Methods We pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and non-HDL cholesterol on fatal (31 cohorts, n=168,287) and non-fatal (13 cohorts, n=27,554) cardiovascular diseases, adjusting for regression dilution bias. We used these RRs and national data on mean risk factor levels to estimate the number of cardiovascular deaths attributable to non-optimal levels of each risk factor. Results Our RRs for SBP, FPG and TC were like those observed in cohorts conducted in high-income countries; however, for BMI, our RRs were consistently smaller in people below 75 years of age. Across risk factors, we observed smaller RRs among older ages. Non-optimal SBP was responsible for the largest number of attributable cardiovascular deaths ranging from 38 per 100,000 women and 54 men in Peru, to 261 (Dominica, women) and 282 (Guyana, men). For non-HDL cholesterol, the lowest attributable rate was for women in Peru (21) and men in Guatemala (25), and the largest in men (158) and women (142) from Guyana. Interpretation RRs for BMI from studies conducted in high-income countries may overestimate disease burden metrics in LAC; conversely, RRs for SBP, FPG and TC from LAC cohorts are similar to those estimated from cohorts in high-income countries. Funding Wellcome Trust (214185/Z/18/Z).
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Xu JY, Yang LB, Han ZY, Wang K, Yin ZH, Wu T, Shao Y, Lu XL. Appropriate body mass index cutoffs for type 2 diabetes in Xinjiang population: defining the influence of liver aminotransferase. Oncotarget 2021; 12:1398-1405. [PMID: 34262650 PMCID: PMC8274728 DOI: 10.18632/oncotarget.28009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 06/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background/Purpose: Recent study suggested that type 2 diabetes (T2DM) attributed to body mass index (BMI) could be influenced by liver aminotransferase. We aim to ascertain the cut-off point of BMI associated with T2DM and the influence of both elevated aminotransferase (AST) and alanine aminotransferase (ALT). Materials and Methods: In our retrospective cohort study, T2DM was diagnosed when FBS ≥ 7.0 mmol/L, BMI of participants with baseline fasting (FBS) < 7.0 mmol/L was divided by percentiles and by aminotransferanse (ALT and AST ≥ 20 U/L, ALT or AST < 20 U/L). Hazard ratios and the turning point of BMI of high T2DM risk was estimated in totality and different aminotransferanse groups. Results: During an average follow-up time of 3.71 years of 33346 participants, 1486 developed T2DM, and the average baseline BMI of participants who developed T2DM was 26.22 kg/m2. Cumulative incidence of T2DM was more than 5% when ALT and AST ≥ 20U/L, age over 44, male sex or BMI over 25.39 kg/m2; The risk of T2DM incidence increased as the BMI grow. The turning point of BMI at high risk of T2DM was 25.0 kg/m2 in totality, 25.1 kg/m2 when ALT or AST < 20 U/L and 26.1 kg/m2 when ALT and AST ≥ 20U/L. Conclusions: BMI of 25.0 kg/m2 was the cutoff point for T2DM development, and there is greater association between BMI and T2DM when ALT or AST < 20 U/L.
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Affiliation(s)
- Jing-Yuan Xu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China.,Department of Gastroenterology, Shanghai Pudong Hospital of Fudan University, Shanghai 201399, China.,These authors contributed equally to this work
| | - Long-Bao Yang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China.,These authors contributed equally to this work
| | - Zhi-Yi Han
- Karamay Central Hospital of Xinjiang, Karamay 834099, China
| | - Kai Wang
- Department of Gastroenterology, Shanghai Pudong Hospital of Fudan University, Shanghai 201399, China
| | - Zhen-Hua Yin
- Department of Gastroenterology, Shanghai Pudong Hospital of Fudan University, Shanghai 201399, China
| | - Ting Wu
- Community Health Service Center of Jinxi Town, Kunshan 215300, China
| | - Yong Shao
- Community Health Service Center of Jinxi Town, Kunshan 215300, China
| | - Xiao-Lan Lu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China.,Department of Gastroenterology, Shanghai Pudong Hospital of Fudan University, Shanghai 201399, China
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Chen-Ku CH, Grimaldo de Sucre P, Vinocour M, Ramírez-Zamora LC, Andrés-Jiménez F, Slon-Hitti C, Cob A, Rodríguez G. Diabetes Second-Line Medication Prescription Patterns in Costa Rica and Panama: Evidence From the DISCOVER Registry. Cureus 2021; 13:e16060. [PMID: 34354876 PMCID: PMC8328805 DOI: 10.7759/cureus.16060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/05/2022] Open
Abstract
AIM This study aimed to describe the prescription patterns of second-line medications for patients with diabetes from selected centers in Costa Rica and Panama. METHODS DISCOVER is a registry of patients with type 2 diabetes switching from first- to second-line medications. We analyzed medication choice and the reasons to switch for each country. Results: A total of 219 patients were included during 2014-2016, 127 in Costa Rica and 92 in Panama. The most frequently prescribed first-line medication was metformin, followed by sulphonylureas in Panama, and a combination of metformin and dipeptidyl peptidase-4 inhibitor (iDPP4) in Costa Rica. DPP4 inhibitors plus metformin was the most commonly prescribed second-line medication, followed by metformin combined with sodium-glucose transport protein-2 inhibitor (iSGLT2) in Costa Rica and iDPP4 in monotherapy in Panama. The main reason to switch being efficacy. When choosing the second-line medication, the main reasons behind the switch were efficacy, weight loss, and hypoglycemia risk in both countries (tolerability being also common in Panama). CONCLUSIONS According to the DISCOVER registry, in Costa Rica and Panama, efficacy is the most common reason to switch to second-line medication. Metformin plus iDPP4 was the most commonly prescribed agent.
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Jiménez-Montero JG, Villegas-Barakat M. Changes in diabetes mortality rate in Costa Rica 2007-2017. Diabetes Res Clin Pract 2021; 174:108749. [PMID: 33713723 DOI: 10.1016/j.diabres.2021.108749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/23/2021] [Accepted: 03/03/2021] [Indexed: 11/19/2022]
Abstract
AIM Diabetes mellitus is a major health problem in Costa Rica. Its prevalence is increasing and represents a significant burden. OBJECTIVES To determine specific diabetes mortality rates (SDMR) in Costa Rica from 2007 to 2017 and explore it's potential causes. METHODS Death certificates (classification CIE-10) were obtained from the Instituto Nacional de Estadística y Censos. All-cause mortality, SDMR, ischemic heart disease (IHD), cerebrovascular disease (CVD), and peripheral vascular disease mortality were assessed per year, sex, age and province. We evaluated relationships between SDMR and Index of Human Development (IHUD), performed a multivariate regression negative binomial model analysis and compared SDMR with goals of metabolic control in the primary care setting. RESULTS All-cause mortality and SDMR increased while IHD and CVD mortality rates remained invariable. SDMR was higher in females and in provinces with predominant rural areas. The years of observation, sex, age and province were significant predictors of death at a 5% level in people with diabetes. Reports from primary care setting showed inadequeate public health care coverage and insuficient metabolic control. CONCLUSIONS SDMR increased in elderly patients with specific complications. Age, place of residence and sex predicted SDMR. Unsatisfactory diabetes medical coverage and poorly diabetes management likely explain our findings.
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Affiliation(s)
- José G Jiménez-Montero
- Department of Endocrinology Hospital CIMA, San José, Costa Rica; School of Medicine, Universidad de Ciencias Médicas San José, Costa Rica.
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Baiocchi CDAF, Rocha de Sá DA. Impact of Metabolic Surgery on Type-2 Diabetes Remission. Curr Diabetes Rev 2021; 17:e121420189129. [PMID: 33319676 DOI: 10.2174/1573399817999201214224920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/02/2020] [Accepted: 09/25/2020] [Indexed: 11/22/2022]
Abstract
Diabetes Mellitus is characterized by numerous metabolic disorders, which have in common the serum elevation of glucose, caused for a pancreatic malfunction in insulin secretion and / or its action. It is a non-communicable disease, considered major public health problems and generalized growth worldwide, being a chronic disease, which can generate a high treatment cost. Metabolic surgery is a safe treatment, regulated by the Federal Council of Medicine and useful in treating people with BMI over 30 years of age, who are unable to control pathologies associated with obesity, primarily type 2 diabetes. The general objective of this study is to understand through a literature review the main impacts of metabolic surgery about the remission of DM 2. This present study it is an exploratory and descriptive study carried out through a literature review. Data were collected through research in virtual health databases, at the Virtual Health Library - VHL, Latin American and Caribbean Health Sciences Information System, LILACS, National Library of Medicine - MEDLINE, Scielo, USP database, PUBMED theses and books. Metabolic surgery proof be a good and effective treatment for having and maintaining good weight loss, as well as a significant clinical and metabolic improvement that extends beyond weight loss. Metabolic surgery is a satisfactory way of achieving long-term weight reduction in obese individuals, increasing survival for these patients. Obese patients with DM2 have a long-term remission of DM2 after bariatric / metabolic surgery. Therefore, it concludes that such procedure is effective in the treatment of the disease and other diseases associated with obesity.
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Alvarado-Vasquez N. Could a family history of type 2 diabetes be a risk factor to the endothelial damage in the patient with COVID-19? Med Hypotheses 2020; 146:110378. [PMID: 33189452 PMCID: PMC7644429 DOI: 10.1016/j.mehy.2020.110378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
In December 2019, in China, a disease derived from a new beta coronavirus (SARS-CoV-2) was reported, which was termed coronavirus disease 2019 (COVID-19). Currently, it is known that endothelial cell dysfunction is a critical event in the infection by this virus. However, in a representative percentage of patients with COVID-19, neither cardiovascular disease nor diabetes mellitus, which could be linked with endothelial dysfunction, has been reported. Previous evidence has shown the presence of early endothelial dysfunction in healthy subjects but with a family history of type 2 diabetes (FH-DM2), where glucose metabolism, the synthesis of nitric oxide (NO), reactive oxygen species (ROS), as well as expression of genes involved with their synthesis are impaired. Besides, in subjects with an FH-DM2, the presence of hyperinsulinemia and high glucose levels are common events that could favor the infection of endothelial cells by the coronavirus. Interestingly, both events have been reported in patients with COVID-19, in whom hyperinsulinemia increases the surface expression of ACE2 through a diminution of ADAMTS17 activity; whereas hyperglycemia induces higher expression of ACE2 in different tissues, including microvascular endothelial cells from the pancreatic islets, favoring chronic hyperglycemia and affecting the release of insulin. Therefore, we hypothesized that an FH-DM2 should be considered an important risk factor, since the individuals with this background develop an early endothelial dysfunction, which would increase the susceptibility and severity of infection and damage to the endothelium, in the patient infected with the SARS-CoV-2.
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Affiliation(s)
- Noé Alvarado-Vasquez
- Department of Biochemistry, National Institute of Respiratory Diseases, Mexico City 14080, Mexico.
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22
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Albitres-Flores L, Bernabe-Ortiz A. Diagnostic accuracy of ADA 2020 criteria for undiagnosed diabetes in a Peruvian population. Diabetes Res Clin Pract 2020; 169:108475. [PMID: 33002547 DOI: 10.1016/j.diabres.2020.108475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/26/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
AIMS To assess the prevalence of undiagnosed diabetes (UDD) and the diagnostic accuracy of the American Diabetes Association (ADA) criteria to detect UDD cases in a Peruvian population. METHODS Population-based cross-sectional study. UDD was defined using fasting plasma glucose (FPG), 2-hour post-prandial plasma glucose (2 h-PPG), and glycated hemoglobin (HbA1c) traditional cut-offs. Diagnostic accuracy was estimated using areas under the receiver-operating characteristic (ROC) curve, compared with the combination of oral glucose tolerance test (FPG plus 2 h-PPG) plus HbA1c as gold standard. RESULTS 1609 subjects were evaluated; mean age 48.2 (SD: 10.6) years, 50.3% were women. A total of 179 (11.3%) subjects were classified as having diabetes, 41.3% of them had UDD. Area under the curve for FPG, 2 h-PPG and HbA1c was 86.5% (95% CI: 81.4-91.6%); 87.2% (95% CI: 82.2-92.2%) and 80.4% (95% CI: 74.8-86.0%), respectively. FPG sensitivity was 73.0%, whereas this value was 74.3% for 2 h-PPG and 60.8% for HbA1c. Of 74 UDD cases, 45 were positive for HbA1c, 54 for FPG and 55 for 2 h-PPG. CONCLUSIONS 41.3% of people with diabetes do not know their diagnosis. Diagnostic accuracy of FPG and 2 h-PPG was higher than HbA1c. The most sensitive combination of two tests to detect UDD cases was FPG plus 2 h-PPG.
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Affiliation(s)
- Leonardo Albitres-Flores
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Peru. https://orcid.org/0000-0002-0077-3615
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Universidad Científica del Sur, Lima, Peru. https://orcid.org/0000-0002-6834-1376
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Avilés-Santa ML, Monroig-Rivera A, Soto-Soto A, Lindberg NM. Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent. Curr Diab Rep 2020; 20:62. [PMID: 33037442 PMCID: PMC7546937 DOI: 10.1007/s11892-020-01341-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. RECENT FINDINGS The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.
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Affiliation(s)
- M Larissa Avilés-Santa
- Division of Extramural Scientific Programs, Clinical and Health Services Research at the National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
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Linkeviciute-Ulinskiene D, Kaceniene A, Dulskas A, Patasius A, Zabuliene L, Smailyte G. Increased Mortality Risk in People with Type 2 Diabetes Mellitus in Lithuania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6870. [PMID: 32962295 PMCID: PMC7559991 DOI: 10.3390/ijerph17186870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 12/15/2022]
Abstract
This retrospective cohort study aimed to analyze overall and cause-specific mortality risk in people with type 2 diabetes mellitus (T2DM) in Lithuania. Information on the diagnosis of T2DM and glucose-lowering medication was obtained from the National Health Insurance Fund database, causes of death-from death certificates. Sex, age, and calendar period-standardized mortality ratios (SMRs) were calculated. In addition, 89,512 patients were followed-up between 2010 and 2017, contributing to the observation period of 592,321 person-years. Overall mortality risk was increased for both sexes (overall SMR = 1.35, 95% confidence interval (CI) 1.34-1.37). Greatest mortality risk was in the age group of 40-49 years at diabetes diagnosis (SMR = 1.68, 95% CI 1.60-1.76) and among those who had died before the age of 50 (SMR = 22.04, 95% CI 18.82-25.81). Patients treated with insulin only had the highest SMR (2.43, 95% CI 2.32-2.55). Mortality risk increased with increasing diabetes duration and was higher in women in all these groups. The highest cause-specific SMRs were infection-related causes (SMR = 1.44), particularly septicemia (SMR = 1.78), diseases of the circulatory system (SMR = 1.42), especially ischemic heart (SMR = 1.46) and cerebrovascular diseases (SMR = 1.38), as well as diseases of the digestive system (SMR = 1.35). Cancer mortality risk was elevated for women (SMR = 1.13), but not for men (SMR = 0.93). In conclusion, people with T2DM had an excess mortality risk, which was higher in women compared to men, younger people, in those who were diagnosed with T2DM at a younger age, had longer diabetes duration, and who required treatment with insulin.
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Affiliation(s)
- Donata Linkeviciute-Ulinskiene
- Institute of Biomedical Sciences, Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Ciurlionio g. 21, 03101 Vilnius, Lithuania
| | - Auguste Kaceniene
- Laboratory of Cancer Epidemiology, National Cancer Institute, P. Baublio g. 3b, 08406 Vilnius, Lithuania; (A.K.); (A.D.); (A.P.); (G.S.)
| | - Audrius Dulskas
- Laboratory of Cancer Epidemiology, National Cancer Institute, P. Baublio g. 3b, 08406 Vilnius, Lithuania; (A.K.); (A.D.); (A.P.); (G.S.)
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, Santariskiu g. 1, 08406 Vilnius, Lithuania
| | - Ausvydas Patasius
- Laboratory of Cancer Epidemiology, National Cancer Institute, P. Baublio g. 3b, 08406 Vilnius, Lithuania; (A.K.); (A.D.); (A.P.); (G.S.)
- Institute of Health Sciences, Faculty of Medicine, Vilnius University, Ciurlionio g. 21, 03101 Vilnius, Lithuania
| | - Lina Zabuliene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu g. 2, 08406 Vilnius, Lithuania;
| | - Giedre Smailyte
- Laboratory of Cancer Epidemiology, National Cancer Institute, P. Baublio g. 3b, 08406 Vilnius, Lithuania; (A.K.); (A.D.); (A.P.); (G.S.)
- Institute of Health Sciences, Faculty of Medicine, Vilnius University, Ciurlionio g. 21, 03101 Vilnius, Lithuania
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Lazo‐Porras M, Ruiz‐Alejos A, Miranda JJ, Carrillo‐Larco RM, Gilman RH, Smeeth L, Bernabé‐Ortiz A. Intermediate hyperglycaemia and 10-year mortality in resource-constrained settings: the PERU MIGRANT Study. Diabet Med 2020; 37:1519-1527. [PMID: 32181918 PMCID: PMC7649719 DOI: 10.1111/dme.14298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2020] [Indexed: 12/13/2022]
Abstract
AIM To determine whether intermediate hyperglycaemia, defined by fasting plasma glucose and HbA1c criteria, is associated with mortality in a 10-year cohort of people in a Latin American country. METHODS Analysis of the PERU MIGRANT Study was conducted in three different population groups (rural, rural-to-urban migrant, and urban). The baseline assessment was conducted in 2007/2008, with follow-up assessment in 2018. The outcome was all-cause mortality, and the exposure was intermediate hyperglycaemia, using three definitions: (1) impaired fasting glucose, defined according to American Diabetes Association criteria [fasting plasma glucose 5.6-6.9 mmol/l (100-125 mg/dl)]; (2) intermediate hyperglycaemia defined according to American Diabetes Association criteria [HbA1c levels 39-46 mmol/mol (5.7-6.4%)]; and (3) intermediate hyperglycaemia defined according to the International Expert Committee criteria [HbA1c levels 42-46 mmol/mol (6.0-6.4%)]. Crude and adjusted hazard ratios and 95% CIs were estimated using Cox proportional hazard models. RESULTS At baseline, the mean (sd) age of the study population was 47.8 (11.9) years and 52.5% of the cohort were women. The study cohort was divided into population groups as follows: 207 people (20.0%) in the rural population group, 583 (59.7%) in the rural-to-urban migrant group and 198 (20.3%) in the urban population group. The prevalence of intermediate hyperglycaemia was: 6%, 12.9% and 38.5% according to the American Diabetes Association impaired fasting glucose definition, the International Expert Committee HbA1c -based definition and the American Diabetes Association HbA1c -based definition, respectively, and the mortality rate after 10 years was 63/976 (7%). Intermediate hyperglycaemia was associated with all-cause mortality using the HbA1c -based definitions in the crude models [hazard ratios 2.82 (95% CI 1.59-4.99) according to the American Diabetes Association and 2.92 (95% CI 1.62-5.28) according to the International Expert Committee], whereas American Diabetes Association-defined impaired fasting glucose was not [hazard ratio 0.84 (95% CI 0.26-2.68)]. In the adjusted model, however, only the American Diabetes Association HbA1c -based definition was associated with all-cause mortality [hazard ratio 1.91 (95% CI 1.03-3.53)], whereas the International Expert Committee HbA1c -based and American Diabetes Association impaired fasting glucose-based definitions were not [hazard ratios 1.42 (95% CI 0.75-2.68) and 1.09 (95% CI 0.33-3.63), respectively]. CONCLUSIONS Intermediate hyperglycaemia defined using the American Diabetes Association HbA1c criteria was associated with an elevated mortality rate after 10 years in a cohort from Peru. HbA1c appears to be a factor associated with mortality in this Peruvian population.
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Affiliation(s)
- M. Lazo‐Porras
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Division of Tropical and Humanitarian MedicineGeneva University Hospitals and University of GenevaGenevaSwitzerland
| | - A. Ruiz‐Alejos
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Autonomic Dysfunction CentreDepartment of MedicineVanderbilt University Medical CentreTNUSA
| | - J. J. Miranda
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- School of MedicineUniversidad Peruana Cayetano HerediaLimaPeru
| | - R. M. Carrillo‐Larco
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
| | - R. H. Gilman
- Department of International HealthBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | - L. Smeeth
- Faculty of Epidemiology and Population HealthLondon School of Hygienel and Tropical MedicineLondonUK
| | - A. Bernabé‐Ortiz
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
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Oliveira H, Fernandes A, F. Brás N, Mateus N, de Freitas V, Fernandes I. Anthocyanins as Antidiabetic Agents-In Vitro and In Silico Approaches of Preventive and Therapeutic Effects. Molecules 2020; 25:E3813. [PMID: 32825758 PMCID: PMC7504281 DOI: 10.3390/molecules25173813] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
Many efforts have been made in the past two decades into the search for novel natural and less-toxic anti-diabetic agents. Some clinical trials have assigned this ability to anthocyanins, although different factors like the food source, the amount ingested, the matrix effect and the time of consumption (before or after a meal) seem to result in contradictory conclusions. The possible mechanisms involved in these preventive or therapeutic effects will be discussed-giving emphasis to the latest in vitro and in silico approaches. Therapeutic strategies to counteract metabolic alterations related to hyperglycemia and Type 2 Diabetes Mellitus (T2DM) may include: (a) Inhibition of carbohydrate-metabolizing enzymes; (b) reduction of glucose transporters expression or activity; (c) inhibition of glycogenolysis and (d) modulation of gut microbiota by anthocyanin breakdown products. These strategies may be achieved through administration of individual anthocyanins or by functional foods containing complexes of anthocyanin:carbohydrate:protein.
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Affiliation(s)
| | | | | | | | | | - Iva Fernandes
- LAQV, REQUIMTE, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, Rua do Campo Alegre s/n, 4169-007 Porto, Portugal; (H.O.); (A.F.); (N.F.B.); (N.M.); (V.d.F.)
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Zenil-Vega M, Cerón E, López-Bello G, Moreno J, Juárez-Cruz E, Castillejos-López M, Bernal-Alcántara D, Sommer B, Alvarado-Vasquez N. An association between glycine and insulin levels is observed in patients with pulmonary tuberculosis and type 2 diabetes. Clin Nutr 2020; 39:3019-3023. [PMID: 32093879 DOI: 10.1016/j.clnu.2020.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Adequate nutrition from which amino acids are part gives us protection against infectious or metabolic diseases. In particular, glycine has immunomodulatory properties and is a secretagogue of insulin. However, its absorption rate or plasma levels are impaired in bacterial infection or high glucose levels. The aim of this study was to evaluate the association between glycine and insulin plasma levels in patients with pulmonary tuberculosis (PTB) and type 2 diabetes mellitus (DM2). METHODS Plasma levels of insulin and glycine were determined in four groups: 1) patients with PTB; 2) patients with PTB-DM2; 3) household contacts with DM2 (C-DM2), and 4) healthy household contacts (H-C). Likewise, we analyzed the plasma levels of glucose, serine, arginine, lysine, taurine, and glutamic acid. RESULTS We observed significant differences in the glycine levels between PTB and PTB-DM2 vs C-DM2 and H-C groups (P < 0.05). We observed also important differences in insulin and glucose levels after comparisons between PTB, PTB-DM2, and C-DM2 vs. H-C groups (P < 0.05). A correlation between glycine and insulin levels in the PTB (r = 0.326) and PTB-DM2 (r = 0.318) groups was found. CONCLUSION Our results showed a significant association between glycine and insulin plasma levels in patients with PTB and PTB-DM2, which suggests that the determination of glycine levels could be used as a reference test to evaluate both pathologic conditions. An additional support to the above is that significant changes in the glucose levels in these groups were observed, too.
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Affiliation(s)
- Mariela Zenil-Vega
- Department of Biochemistry, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico
| | - Eduarda Cerón
- Department of Biochemistry, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico
| | - Guadalupe López-Bello
- National Institute of Psychiatry "Ramón de La Fuente Muñiz", Mexico City, 14370, Mexico
| | - Julia Moreno
- National Institute of Psychiatry "Ramón de La Fuente Muñiz", Mexico City, 14370, Mexico
| | - Eliuth Juárez-Cruz
- National Institute of Psychiatry "Ramón de La Fuente Muñiz", Mexico City, 14370, Mexico
| | - Manuel Castillejos-López
- Epidemiological Surveillance Unit, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico
| | - Demetrio Bernal-Alcántara
- Department of Biochemistry, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico
| | - Bettina Sommer
- Department of Hyperresponsiveness Research, National Institute of Respiratory Diseases "Ismael Cosío Villegas", 14080, Mexico City, Mexico
| | - Noé Alvarado-Vasquez
- Department of Biochemistry, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico.
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Carrillo-Larco RM, Pearson-Stuttard J, Bernabe-Ortiz A, Gregg EW. The Andean Latin-American burden of diabetes attributable to high body mass index: A comparative risk assessment. Diabetes Res Clin Pract 2020; 160:107978. [PMID: 31838121 PMCID: PMC7042885 DOI: 10.1016/j.diabres.2019.107978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Body mass index (BMI) has increased in Latin-America, but the implications for the diabetes burden have not been quantified. We estimated the proportion and absolute number of diabetes cases attributable to high BMI in Bolivia, Ecuador and Peru (Andean Latin-America), with estimation of region-level indicators in Peru. METHODS We estimated the population attributable fraction (PAF) of BMI on diabetes (regardless of type 1 or 2) from 1980 to 2014, including the number of cases attributable to overweight (BMI 25-<30), class I (30-<35), class II (BMI 35-<40) and class III (BMI ≥ 40) obesity. We used age- and sex-specific prevalence estimates of diabetes and BMI categories (NCD-RisC and Peru's DHS survey) combined with relative risks from population-based cohorts in Peru. FINDINGS Across Andean Latin-America in 2014, there were 1,258,313 diabetes cases attributable to high BMI: 209,855 in Bolivia, 367,440 in Ecuador and 681,018 in Peru. Between 1980 and 2010, the absolute proportion of diabetes cases attributable to class I obesity increased the most (from 12.9% to 27.2%) across the region. The second greatest increase was for class II obesity (from 3.6% to 16.5%). There was heterogeneity in the fraction of diabetes cases attributable to high BMI by region in Peru, as coastal regions had the largest fractions, and so did high-income regions. INTERPRETATION Over one million diabetes cases are attributable to high BMI in Andean Latin-America. Public health efforts should focus on implementing population-based interventions to reduce high BMI and to develop focused interventions targeted at those at highest risk of diabetes.
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Affiliation(s)
- Rodrigo M Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Universidad Científica del Sur, Lima, Peru
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Carrillo‐Larco RM, Aparcana‐Granda DJ, Mejia JR, Barengo NC, Bernabe‐Ortiz A. Risk scores for type 2 diabetes mellitus in Latin America: a systematic review of population-based studies. Diabet Med 2019; 36:1573-1584. [PMID: 31441090 PMCID: PMC6900051 DOI: 10.1111/dme.14114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 12/18/2022]
Abstract
AIM To summarize the evidence on diabetes risk scores for Latin American populations. METHODS A systematic review was conducted (CRD42019122306) looking for diagnostic and prognostic models for type 2 diabetes mellitus among randomly selected adults in Latin America. Five databases (LILACS, Scopus, MEDLINE, Embase and Global Health) were searched. type 2 diabetes mellitus was defined using at least one blood biomarker and the reports needed to include information on the development and/or validation of a multivariable regression model. Risk of bias was assessed using the PROBAST guidelines. RESULTS Of the 1500 reports identified, 11 were studied in detail and five were included in the qualitative analysis. Two reports were from Mexico, two from Peru and one from Brazil. The number of diabetes cases varied from 48 to 207 in the derivations models, and between 29 and 582 in the validation models. The most common predictors were age, waist circumference and family history of diabetes, and only one study used oral glucose tolerance test as the outcome. The discrimination performance across studies was ~ 70% (range: 66-72%) as per the area under the receiving-operator curve, the highest metric was always the negative predictive value. Sensitivity was always higher than specificity. CONCLUSION There is no evidence to support the use of one risk score throughout Latin America. The development, validation and implementation of risk scores should be a research and public health priority in Latin America to improve type 2 diabetes mellitus screening and prevention.
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Affiliation(s)
- R. M. Carrillo‐Larco
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPerú
- Centro de Estudios de PoblacionUniversidad Catolica los Ángeles de Chimbote (ULADECHCatolica)ChimbotePerú
| | - D. J. Aparcana‐Granda
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPerú
| | - J. R. Mejia
- Facultad de Medicina HumanaUniversidad Nacional del Centro del PerúHuancayoPerú
| | - N. C. Barengo
- Department of Medical and Population Health Sciences ResearchHerbert Wertheim College of MedicineFlorida International UniversityMiamiFLUSA
- Department of Public HealthFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Faculty of MedicineRiga Stradins UniversityRigaLatvia
| | - A. Bernabe‐Ortiz
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPerú
- Universidad Científica del SurLimaPerú
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Carrillo-Larco RM, Altez-Fernandez C, Pacheco-Barrios N, Bambs C, Irazola V, Miranda JJ, Danaei G, Perel P. Cardiovascular Disease Prognostic Models in Latin America and the Caribbean: A Systematic Review. Glob Heart 2019; 14:81-93. [PMID: 31036306 PMCID: PMC6499414 DOI: 10.1016/j.gheart.2019.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/05/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cardiovascular prognostic models guide treatment allocation and support clinical decisions. Whether there are valid models for Latin American and Caribbean (LAC) populations is unknown. OBJECTIVE This study sought to identify and critically appraise cardiovascular prognostic models developed, tested, or recalibrated in LAC populations. METHODS The systematic review followed the CHARMS (CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies) framework (PROSPERO [International Prospective Register of Systemic Reviews]: CRD42018096553). Reports were included if they followed a prospective design and presented a multivariable prognostic model; reports were excluded if they studied symptomatic individuals or patients. The following search engines were used: EMBASE, MEDLINE, Scopus, SciELO, and LILACS. Risk of bias assessment was conducted with PROBAST (Prediction model Risk Of Bias ASsessment Tool). No quantitative summary was conducted due to large heterogeneity. RESULTS From 2,506 search results, 8 studies (N = 130,482 participants) were included for qualitative synthesis. We could not identify any cardiovascular prognostic model developed for LAC populations; reviewed reports evaluated available models or conducted a recalibration analysis. Only 1 study included a Caribbean population (Puerto Rico); 3 studies were retrieved from Chile; 2 from Argentina, Brazil, Colombia, and Uruguay; and 1 from Mexico. Four studies included population-based samples, and the other 4 included people affiliated to a health facility (e.g., prevention clinics). Most studied participants were older than 50 years, and there were more women in 5 reports. The Framingham model was assessed 6 times, and the American College of Cardiology/American Heart Association pooled equation was assessed twice. Across the prognostic models assessed, calibration varied widely from one population to another, showing great overestimation particularly in some subgroups (e.g., highest risk). Discrimination (e.g., C-statistic) was acceptable for most models; for Framingham it ranged from 0.66 to 0.76. The American College of Cardiology/American Heart Association pooled equation showed the best discrimination (0.78). That there were few outcome events was the most important methodological limitation of the identified studies. CONCLUSIONS No cardiovascular prognostic models have been developed in LAC, hampering key evidence to inform public health and clinical practice. Validation studies need to improve methodological issues.
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Affiliation(s)
- Rodrigo M Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Carlos Altez-Fernandez
- Facultad de Medicina "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Niels Pacheco-Barrios
- Facultad de Medicina "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Claudia Bambs
- Department of Public Health and Advanced Center for Chronic Diseases (ACCDiS), Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Facultad de Medicina "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
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