|
1
|
Yarahmadi S, Nikkhoo B, Miraki P, Rahmani K. Investigating metabolic control and complications in type 2 diabetic patients with low income in northwest of Iran, 2023. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2025; 44:38. [PMID: 39940034 PMCID: PMC11823108 DOI: 10.1186/s41043-025-00742-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 01/06/2025] [Indexed: 02/14/2025]
Abstract
BACKGROUND AND AIM Socioeconomic factors are very important in non-communicable diseases (NCD) and their complications as a risk factor or as a barrier to receive effective health care. This study aimed to determine the prevalence of diabetes complications and factors related to glycemic control in type 2 diabetic patients with low income in Kurdistan Province, Iran. METHOD This cross-sectional study was conducted on 608 diabetic patients supported by the Imam Khomeini Relief Foundation in 2023 in the province of Kurdistan, northwest of Iran. In addition to collecting demographic data, major complications of diabetes were specified by clinical examination by specialist physicians and paraclinical data. Data analysis was performed in Stata version 16 using descriptive statistics and logistic regression modeling. RESULTS A total of 608, 76.6% female, with mean and standard deviation age 62.7 ± 9.7 years were investigated. Prevalence of retinopathy, nephropathy, neuropathy, and diabetic foot ulcers were 42.9%, 6.9%, 3.3% and 4.3%, respectively. HbA1C levels were favorable (≤ 7.5) in only 231 (38.0%) patients. Longer duration of diabetes was associated with worse glycemic control0.95 (OR = 0.95; 95%CI:0.90-0.96), whereas comorbidity of DM and hypertension (OR = 2.05; 1.36-3.10) was significantly associated with good glycemic control. CONCLUSION Based on the results obtained, the health care and glycemic control status of low-income diabetic patients is not favorable. Considering the vulnerability of this group due to their low-risk perception and low income, it is recommended to teach self-care behaviors and plan routine care to prevent disease complications and, if necessary, fully cover the cost of care for these patients by the national health system.
Collapse
Affiliation(s)
| | - Bahram Nikkhoo
- Department of Pathology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Parya Miraki
- Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Khaled Rahmani
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| |
Collapse
|
|
2
|
Eseadi C, Amedu AN, Ilechukwu LC, Ngwu MO, Ossai OV. Accessibility and utilization of healthcare services among diabetic patients: Is diabetes a poor man's ailment? World J Diabetes 2023; 14:1493-1501. [PMID: 37970126 PMCID: PMC10642413 DOI: 10.4239/wjd.v14.i10.1493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/03/2023] [Accepted: 09/06/2023] [Indexed: 10/09/2023] Open
Abstract
Diabetes is a non-communicable ailment that has adverse effects on the individual's overall well-being and productivity in society. The main objective of this study was to examine the empirical literature concerning the association between diabetes and poverty and the accessibility and utilization of medical care services among diabetic patients. The diabetes literature was explored using a literature review approach. This review revealed that diabetes is an ailment that affects all individuals irrespective of socioeconomic status; however, its pre-valence is high in low-income countries. Hence, despite the higher prevalence of diabetes in developing countries compared with developed countries, diabetes is not a poor man's ailment because it affects individuals of all incomes. While the number of diabetic patients that access and utilize diabetes medical care services has increased over the years, some personal and institutional factors still limit patients' access to the use of diabetes care. Also, there is a lacuna in the diabetes literature concerning the extent of utilization of available healthcare services by diabetic patients.
Collapse
Affiliation(s)
- Chiedu Eseadi
- Department of Educational Psychology, University of Johannesburg, Johannesburg 2006, Gauteng, South Africa
| | - Amos Nnaemeka Amedu
- Department of Educational Psychology, University of Johannesburg, Johannesburg 2006, Gauteng, South Africa
| | | | - Millicent O Ngwu
- Department of Sociology and Anthropology, University of Nigeria, Nsukka 41001, Enugu, Nigeria
| | - Osita Victor Ossai
- Department of Childhood Education, University of Johannesburg, Johannesburg 2006, Gauteng, South Africa
| |
Collapse
|
|
3
|
Krishnan R, Jain A, Nare S, Sankaranarayanan R, Bartlett J, Iyengar SK, Williams SM, Sundaram N. Patterns of risk for diabetic retinopathy in the Mumbai slums: The Aditya Jyot Diabetic Retinopathy in Urban Mumbai Slums Study (AJ-DRUMSS) Report 3. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000351. [PMID: 37043519 PMCID: PMC10096465 DOI: 10.1371/journal.pgph.0000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/20/2023] [Indexed: 04/13/2023]
Abstract
Diabetes onset precedes diabetic retinopathy (DR) by 5-10 years, but many people with diabetes remain free of this microvascular complication. Our aim was to identify risk factors for DR progression in a unique and diverse population, the slums of Mumbai. We performed a nested case-control study of 1163 diabetics over 40 years of age from slums in 18 wards of Mumbai. Data was collected on 33 variables and assessed for association with DR using both univariate and multivariate analyses. Stratified analyses were also performed on males and females, separately. Among hypertensive individuals we also assessed whether duration of hypertension associated with DR. Of 31 non-correlated variables analysed as risk factors for DR, 15 showed evidence of significant association. The most prominent included sex, where being a female associated with decreased odds of DR, while longer duration of diabetes and poor glycaemic control associated with increased odds. The duration of diabetes effect was partially, but significantly, mediated by age of diabetes diagnoses (8.6% of variance explained, p = 0.012). Obesity as measured by several measures, including body mass index (BMI) and measures of central obesity had a negative association with DR; increased measures of obesity consistently reduced odds of DR. As in most earlier studies, DR was associated with the duration of diabetes and glycaemic control. However, other factors, especially obesity related measures were associated with DR, in ways that contrast with most prior studies. These results indicated that the overall pattern of association in the Mumbai slums was novel. Thus, in previously uncharacterized populations, such as the slums that we examined, it is important to evaluate all risk factors de novo to appropriately assess patterns of association as the patterns of association with DR can be complex and population specific.
Collapse
Affiliation(s)
- Radhika Krishnan
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Astha Jain
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Siddhita Nare
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | | | - Jacquelaine Bartlett
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States of America
| | - Sudha K. Iyengar
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States of America
| | - Scott M. Williams
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States of America
| | - Natarajan Sundaram
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| |
Collapse
|
|
4
|
Misra R, Madhavan SS, Dhumal T, Sambamoorthi U. Prevalence and factors associated with diagnosed diabetes mellitus among Asian Indian adults in the United States. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001551. [PMID: 36963049 PMCID: PMC10021922 DOI: 10.1371/journal.pgph.0001551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023]
Abstract
Higher prevalence of diabetes mellitus (DM) has been documented among South Asians living in the United States. However, combining the south Asian subgroups into one category masks the heterogeneity in the diagnosed DM, after controlling for known protective and risk factors. We assessed the association of Asian Indian ethnicity to diagnosed DM using a nationally representative sample of 1,986 Asian Indian adults in the US compared to 109,072 Non-Hispanic Whites (NHWs) using disaggregated data from the National Health Interview Survey (2012-2016) (NHIS). 2010 US census figures were used for age-sex standardization. Age-sex adjusted prevalence of DM was 8.3% in Asian Indians as compared to 5.8% in NHW. In adjusted multivariable logistic regression models, Asian Indians had higher odds ratios of reporting diagnosed DM compared to NHWs (AOR = 1.39, 95% CI: 1.12, 1.71). This association remained strong and significant even after controlling for other risk factors in the model (AOR = 1.47, 95% CI: 1.16, 1.85). Results suggest a favorable socio-economic profile of Asian Indians was not protective on diagnosed DM. In addition, they were more likely to have diagnosed DM due to higher prevalence of obesity despite healthier behaviors of smoking and exercise.
Collapse
Affiliation(s)
- Ranjita Misra
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia, United States of America
| | - Suresh S Madhavan
- College of Pharmacy, University of North Texas System, Denton, Texas, United States of America
| | - Trupti Dhumal
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, United States of America
| | - Usha Sambamoorthi
- College of Pharmacy, University of North Texas System, Denton, Texas, United States of America
| |
Collapse
|
|
5
|
Brar AS, Sahoo J, Behera UC, Jonas JB, Sivaprasad S, Das T. Prevalence of diabetic retinopathy in urban and rural India: A systematic review and meta-analysis. Indian J Ophthalmol 2022; 70:1945-1955. [PMID: 35647959 PMCID: PMC9359280 DOI: 10.4103/ijo.ijo_2206_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A systematic review and meta-analysis were conducted to estimate the prevalence of diabetic retinopathy (DR) in India’s urban and rural areas. Medline, Scopus, and ScienceDirect databases were searched for population-based studies published in English between January 1990 and April 2021, wherein the prevalence of DR among Indian residents with type 2 diabetes mellitus (DM) was reported. A random-effects model was used to estimate the overall, rural, and urban prevalence. Data from 10 eligible studies were aggregated for meta-analysis. The prevalence of DR was 17.44% (95% confidence interval [CI], 14.33–20.55) in urban and 14.00% (95% CI: 9.13–18.86) in rural population (P = 0.24). The overall DR prevalence was 16.10% (95% CI: 13.16–24.32), and the population prevalence was 1.63% [95% CI: 0.94–2.32]. Prevalence of DR in people with diabetes was lower in the age group of 40–49 years [13.57% (95% CI: 7.16–19.98)] than in the age group of 50–59 years [16.72% (95% CI: 12.80–20.64)] and the age group of 60 years and above [16.55% (95% CI: 12.09–21.00)]. Variability in studies was high: urban (I2 = 88.90%); rural (I2 = 92.14%). Pooled estimates indicate a narrow difference in DR prevalence among people with diabetes in rural and urban India. The fast urbanization and increasing diabetes prevalence in rural areas underscore the need for providing equitable eye care at the bottom of the health pyramid.
Collapse
Affiliation(s)
- Anand Singh Brar
- Department of Retina and Vitreous, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Jyotiranjan Sahoo
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Umesh Chandra Behera
- Department of Retina and Vitreous, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Jost B Jonas
- Department of Ophthalmology, Institute of Molecular and Clinical Ophthalmology Basel, Switzerland
| | - Sobha Sivaprasad
- Department of Ophthalmology, NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK
| | - Taraprasad Das
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, L V Prasad Eye Institute (Kallam Anji Reddy Campus), Hyderabad, Telangana, India
| |
Collapse
|
|
6
|
Sharma PK, Rajpal N, Upadhyay S, Shaha D, Deo N. Status of diabetes control and knowledge about diabetes in patients. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2021; 68:716-727. [PMID: 34924160 DOI: 10.1016/j.endien.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE There are a number of studies in the literature which show that knowledge about the diabetes mellitus is related to socioeconomic status, education, duration of diabetes, age, sex, and family history. The above facts have prompted us to evaluate the status of knowledge of diabetes in our patients at the diabetic clinic Vivekananda Polyclinic and Institute of Medical Sciences (VPIMS), Lucknow, India. The main objective of this study is to evaluate the knowledge of diabetes among the suffering with people with type-2 diabetes mellitus and its correlation with diabetes control. METHODS The participants' knowledge about diabetes and their understanding about control and complications of diabetes were assessed by a standardized questionnaire. The data was collected at a single, routine visit of the patient to the diabetic clinic at VPIMS, Lucknow, India over a period of 1 year after detailed clinical examination and relevant investigations. RESULT Only 50% of the patients know what diabetes is, 46% know it is a hereditary disease, 68.8% know about its symptoms, 50% have complete knowledge about complications, 45.2%, know simple treatments of diabetes. Among educated graduate and professional category majority of subjects (62.5%) had good level of knowledge about diabetes which was statistically significant (p<0.001). Those having frequent/regular exercise, having higher education and shorter duration of diabetes had a better control over postprandial (PP) blood sugar as compared to those having occasional/no exercise and lower level of education (p<0.05). CONCLUSION The findings indicate a greater need for behavioral change to control diabetes and its associated threats.
Collapse
Affiliation(s)
| | - Naresh Rajpal
- Vivekanand Polyclinic, Nirala Nagar, Lucknow 226020, India
| | - Shushil Upadhyay
- Vivekanand Polyclinic, Nirala Nagar, Lucknow 226020, India; Saha Hospital, Sector D, LDA Colony, Kanpur Road, Lucknow 226012, India
| | - Devashish Shaha
- Vivekanand Polyclinic, Nirala Nagar, Lucknow 226020, India; Hospital Nirala Nagar, Railway Crossing Road, Bans Mandi, Nirala Nagar, Lucknow 226020, India
| | | |
Collapse
|
|
7
|
Sujata, Thakur R. Unequal burden of equal risk factors of diabetes between different gender in India: a cross-sectional analysis. Sci Rep 2021; 11:22653. [PMID: 34811413 PMCID: PMC8608835 DOI: 10.1038/s41598-021-02012-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 10/27/2021] [Indexed: 02/08/2023] Open
Abstract
Many studies have supported that the burden of diabetes is shared differently by different genders due to various factors associated with it. This study aims at capturing whether women and men with a similar background, dietary and smoking habits, and biological conditions (blood pressure and body mass index (BMI)) are being affected equally or differently by diabetes. We have used cross-sectional data of NFHS-4 by covering the age group 15-49 years. Association between socio-economic background, dietary habits, biological conditions, and diabetes has been estimated using two separate multivariate logistic regression models. Results show that the overall prevalence of diabetes is higher among men (2.63%) than women (2.35%). Whereas, women belonging to urban areas (3.53%), Christian category (3.92%), richer section (3.22%), women with no schooling (2.51%), those reported never to consume pulses (2.66%) and green vegetables (2.40%) and daily consuming eggs (3.66%) and chicken or meat (3.54%) are more affected by diabetes than their men counterparts. Whereas men residing in rural areas (2.30%), belonging to the general category (3.12%), SCs (2.37%) and STs (1.72%) are more affected than their women counterparts. Results have also shown a higher prevalence of diabetes among obese men (11.46%), non-vegetarian (2.71%) and those who watch television almost every day (3.03%) as compared to their women counterparts. Regression analyses show that the richest, hypertensive, and obese women and men are significantly more likely to suffer from diabetes. This study concludes that women and men with similar socio-economic status, biological conditions, dietary and smoking habits are being affected differently by diabetes. Thus, there is a need for gender dimension in research to understand and validate the differences in the needed interventions for diabetes control in India.
Collapse
Affiliation(s)
- Sujata
- grid.462387.c0000 0004 1775 7851School of Humanities and Social Sciences, Indian Institute of Technology Mandi, Kamand, Himachal Pradesh 175075 India
| | - Ramna Thakur
- School of Humanities and Social Sciences, Indian Institute of Technology Mandi, Kamand, Himachal Pradesh, 175075, India.
| |
Collapse
|
|
8
|
Faraz A, Ashraf H, Ahmad J. Clinical Features, Biochemical Profile, and Response to Standard Treatment in Lean, Normal-Weight, and Overweight/Obese Indian Type 2 Diabetes Patients. Rev Diabet Stud 2021; 17:68-74. [PMID: 34852897 PMCID: PMC9380087 DOI: 10.1900/rds.2021.17.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND: Much evidence is available on the relationship between type 2 diabetes mellitus (T2D) and obesity, but less on T2D in lean individuals. AIM: This study was conducted in 12,069 T2D patients from northern India to find out which clinical and biochemical features are related to lean, normal weight, and overweight/obese T2D patients. METHODS: The study was conducted at two endocrine clinics in northern India as a retrospective cross-sectional study. The records of all patients who attended these clinics from January 2018 to December 2019 were screened. After screening 13,400 patients, 12,069 were labelled as type 2 diabetes mellitus according to the criteria of the American Diabetes Association, 2020, and were included in the study. The patients were subdivided into the three groups by their body mass index (BMI): lean (BMI < 18), normal weight (BMI = 18-22.9), overweight/obese (BMI ≥ 23). The study evaluated how the three subgroups responded to standard diabetes management, including antidiabetic medication and lifestyle interventions. RESULTS: Of a total of 12,069 patients 327 (2.7%) were lean, 1,841 (15.2%) of normal weight, and 9,906 (82.1%) overweight/obese. Lean patients were younger, but had more severe episodes of hyperglycemia. All three subgroups experienced significant improvements in glycemic control during follow-up; HbA1c values were significantly lowered in the overweight/obese group during follow-up compared with baseline. CONCLUSIONS: While overweight/obese patients could benefit from the improvements in glycemic control achieved by lowering HbA1c, lean and normal-weight patients had more severe and difficult-to-control hyperglycemia.
Collapse
Affiliation(s)
- Ahmad Faraz
- Department of Physiology, Jawahar Lal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Hamid Ashraf
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Jawahar Lal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Jamal Ahmad
- Former Professor of Endocrinology & Dean Faculty of Medicine, Ex-Director, Rajiv Gandhi Centre for Diabetes & Endocrinology, Aligarh Muslim University, Aligarh Diabetes & Endocrinology Super-Speciality Centre, Aligarh, India
| |
Collapse
|
|
9
|
Chatzipapas C, Karaglani M, Papanas N, Tilkeridis K, Drosos GI. Local Antibiotic Delivery Systems in Diabetic Foot Osteomyelitis: A Brief Review. Rev Diabet Stud 2021; 17:75-81. [PMID: 34852898 PMCID: PMC9380086 DOI: 10.1900/rds.2021.17.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Diabetic foot osteomyelitis (DFO) is a severe, difficult to treat infection. Local antibiotic delivery has been studied as a potential therapeutic adjunct following surgery for DFO. This review aims to summarize the evidence on local antibiotic delivery systems in DFO. PubMed database was searched up to March 2020. Overall, 16 studies were identified and included: 3 randomized controlled trials (RCTs), 3 retrospective studies (RSs), and 10 case series. In the RCTs, gentamicin-impregnated collagen sponges significantly improved clinical healing rates and slightly improved duration of hospitalization. In the RSs, antibiotic-impregnated calcium sulfate beads non-significantly improved all healing parameters, but did not reduce post-operative amputation rates or time of healing. The majority of case series used calcium sulfate beads, achieving adequate rates of healing and eradication of infection. In conclusion, evidence for add-on local antibiotic delivery in DFO is still limited; more data are needed to assess this therapeutic measure.
Collapse
Affiliation(s)
- Christos Chatzipapas
- Department of Orthopaedic Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Makrina Karaglani
- Department of Orthopaedic Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes Centre - Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Konstantinos Tilkeridis
- Department of Orthopaedic Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Georgios I Drosos
- Department of Orthopaedic Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| |
Collapse
|
|
10
|
Abstract
Socioeconomic status (SES) may influence the general health and the health-seeking behavior of an individual. Understanding the disease prevalence in different social strata may lead us to the important linkages that SES might have with diabetic retinopathy (DR). The knowledge on the prevalence of DR in the community based on their SES may help design strategies to provide affordable, last-mile care to the population most at risk of this blinding complication of diabetes mellitus. Our systematic search for population-based Indian studies found three studies in the past three decades that evaluated the effect of socioeconomic factors on the prevalence of diabetic retinopathy. The data on the prevalence in various socioeconomic strata was equivocal and the study settings were mostly urban. The parameters used to assess the SES differed among studies. This underscores the need for further research on SES-related diabetic retinopathy complications in India. Future studies should employ more robust socioeconomic scales to define the divide better.
Collapse
Affiliation(s)
- Umesh C Behera
- Department of Vitreo-Retina, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Anand S Brar
- Department of Vitreo-Retina, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| |
Collapse
|
|
11
|
Yap J, Anbalakan K, Tay WT, Ting D, Cheung CY, Sabanayagam C, Cheng CY, Wong TY, Yeo KK. Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population. BMJ Open Diabetes Res Care 2021; 9:e001413. [PMID: 34244217 PMCID: PMC8268896 DOI: 10.1136/bmjdrc-2020-001413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/17/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Diabetes mellitus is a growing public health epidemic in Asia. We examined the impact of type 2 diabetes, glycemic control and microvascular complications on mortality and cardiovascular outcomes in a multiethnic population-based cohort of Asians without prior cardiovascular disease. RESEARCH DESIGN AND METHODS This was a prospective population-based cohort study in Singapore comprising participants from the three major Asian ethnic groups: Chinese, Malays and Indians, with baseline examination in 2004-2011. Participants with type 1 diabetes and those with cardiovascular disease at baseline were excluded. Type 2 diabetes, Hemoglobin A1c (HbA1c) levels and presence of microvascular complications (diabetic retinopathy and nephropathy) were defined at baseline. The primary outcome was all-cause mortality and major adverse cardiovascular events (MACEs), defined as a composite of cardiovascular mortality, myocardial infarction, stroke and revascularization, collected using a national registry. RESULTS A total of 8541 subjects were included, of which 1890 had type 2 diabetes at baseline. Subjects were followed for a median of 6.4 (IQR 4.8-8.8) years. Diabetes was a significant predictor of mortality (adjusted HR 1.74, 95% CI 1.45 to 2.08, p<0.001) and MACE (adjusted HR 1.64, 95% CI 1.39 to 1.93, p<0.001). In those with diabetes, higher HbA1c levels were associated with increased MACE rates (adjusted HR (per 1% increase) 1.18, 95% CI 1.11 to 1.26, p<0.001) but not mortality (p=0.115). Subjects with two microvascular complications had significantly higher mortality and MACE compared with those with only either microvascular complication (adjusted p<0.05) and no microvascular complication (adjusted p<0.05). CONCLUSION Diabetes is a significant predictor of mortality and cardiovascular morbidity in Asian patients without prior cardiovascular disease. Among patients with type 2 diabetes, poorer glycemic control was associated with increased MACE but not mortality rates. Greater burden of microvascular complications identified a subset of patients with poorer outcomes.
Collapse
Affiliation(s)
- Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | - Wan Ting Tay
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Daniel Ting
- Department of Ophthalmology, Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, Singapore
| | - Carol Yim Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Ching-Yu Cheng
- Department of Ophthalmology, Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, Singapore
| | - Tien-Yin Wong
- Department of Ophthalmology, Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| |
Collapse
|
|
12
|
Sharma PK, Rajpal N, Upadhyay S, Shaha D, Deo N. Status of diabetes control and knowledge about diabetes in patients. ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(21)00102-6. [PMID: 33985933 DOI: 10.1016/j.endinu.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE There are a number of studies in the literature which show that knowledge about the diabetes mellitus is related to socioeconomic status, education, duration of diabetes, age, sex, and family history. The above facts have prompted us to evaluate the status of knowledge of diabetes in our patients at the diabetic clinic Vivekananda Polyclinic and Institute of Medical Sciences (VPIMS), Lucknow, India. The main objective of this study is to evaluate the knowledge of diabetes among the suffering with people with type-2 diabetes mellitus and its correlation with diabetes control. METHODS The participants' knowledge about diabetes and their understanding about control and complications of diabetes were assessed by a standardized questionnaire. The data was collected at a single, routine visit of the patient to the diabetic clinic at VPIMS, Lucknow, India over a period of 1 year after detailed clinical examination and relevant investigations. RESULT Only 50% of the patients know what diabetes is, 46% know it is a hereditary disease, 68.8% know about its symptoms, 50% have complete knowledge about complications, 45.2%, know simple treatments of diabetes. Among educated graduate and professional category majority of subjects (62.5%) had good level of knowledge about diabetes which was statistically significant (p<0.001). Those having frequent/regular exercise, having higher education and shorter duration of diabetes had a better control over postprandial (PP) blood sugar as compared to those having occasional/no exercise and lower level of education (p<0.05). CONCLUSION The findings indicate a greater need for behavioral change to control diabetes and its associated threats.
Collapse
Affiliation(s)
| | - Naresh Rajpal
- Vivekanand Polyclinic, Nirala Nagar, Lucknow 226020, India
| | - Shushil Upadhyay
- Vivekanand Polyclinic, Nirala Nagar, Lucknow 226020, India; Saha Hospital, Sector D, LDA Colony, Kanpur Road, Lucknow 226012, India
| | - Devashish Shaha
- Vivekanand Polyclinic, Nirala Nagar, Lucknow 226020, India; Hospital Nirala Nagar, Railway Crossing Road, Bans Mandi, Nirala Nagar, Lucknow 226020, India
| | | |
Collapse
|
|
13
|
Sindal MD, Sathe T, Sengupta S, Yadav D. Proportion of diabetic retinopathy among diabetics presenting for the first time to a tertiary eye institute in South India. Int Ophthalmol 2021; 41:2789-2796. [PMID: 33813650 DOI: 10.1007/s10792-021-01835-9] [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: 11/11/2020] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To detect the proportion of diabetic retinopathy (DR) among diabetics visiting a tertiary eye care institute and correlate presenting symptoms to clinical diagnosis. METHODS The study recruited 1000 eyes of 1000 diabetics visiting a tertiary eye care institute in South India for the first time. Along with basic demographic data and systemic history, details of presenting complaints and clinical diagnosis were noted. RESULTS Data from 956 cases were analyzed. There were 29 (3%) newly diagnosed diabetics and 927 (97%) known diabetics. The commonest reason for the hospital visit was diminution of vision (66%) followed by "visiting for a routine checkup" (22.3%). Diabetic retinopathy was seen in 492 (51.5%), cataract in 161(17%) and refractive error in 240 patients (79.2%). Vision-threatening DR was present in 216 cases (22.59%) and clinically significant macular edema in 73 cases (7.63%) at first presentation itself. CONCLUSION The cohort from a tertiary eye care institute has higher proportion of diabetic retinopathy, with vision-threatening DR at presentation. These data emphasize the need for more robust screening for DR, along with population awareness programs.
Collapse
Affiliation(s)
- Manavi D Sindal
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Cuddalore Main Road, Pondicherry, 605007, India.
| | - Tejashree Sathe
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Cuddalore Main Road, Pondicherry, 605007, India
| | | | - Divya Yadav
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Cuddalore Main Road, Pondicherry, 605007, India
| |
Collapse
|
|
14
|
Jensen ET, Dabelea DA, Praveen PA, Anandakumar A, Hockett CW, Isom SP, Ong TC, Mohan V, D'Agostino R, Kahn MG, Hamman RF, Wadwa P, Dolan L, Lawrence JM, Madhu SV, Chhokar R, Goel K, Tandon N, Mayer-Davis E. Comparison of the incidence of diabetes in United States and Indian youth: An international harmonization of youth diabetes registries. Pediatr Diabetes 2021; 22:8-14. [PMID: 32196874 PMCID: PMC7748376 DOI: 10.1111/pedi.13009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/22/2020] [Accepted: 02/12/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Incidence of youth-onset diabetes in India has not been well described. Comparison of incidence, across diabetes registries, has the potential to inform hypotheses for risk factors. We sought to compare the incidence of diabetes in the U.S.-based registry of youth onset diabetes (SEARCH) to the Registry of Diabetes with Young Age at Onset (YDR-Chennai and New Delhi regions) in India. METHODS We harmonized data from both SEARCH and YDR to the Observational Medical Outcomes Partnership (OMOP) Common Data Model. Data were from youth registered with incident diabetes (2006-2012). Denominators were from census and membership data. We calculated diabetes incidence by averaging the total cases across the entire follow-up period and dividing this by the estimated census population corresponding to the source population for case ascertainment. Incidence was calculated for each of the registries and compared by type and within age and sex categories using a 2-sided, skew-corrected inverted score test. RESULTS Incidence of type 1 was higher in SEARCH (21.2 cases/100 000 [95% CI: 19.9, 22.5]) than YDR (4.9 cases/100 000 [95% CI: 4.3, 5.6]). Incidence of type 2 diabetes was also higher in SEARCH (5.9 cases/100 000 [95% CI: 5.3, 6.6] in SEARCH vs 0.5/cases/100 000 [95% CI: 0.3, 0.7] in YDR). The age distribution of incident type 1 diabetes cases was similar across registries, whereas type 2 diabetes incidence was higher at an earlier age in SEARCH. Sex differences existed in SEARCH only, with a higher rate of type 2 diabetes among females. CONCLUSION The incidence of youth-onset type 1 and 2 diabetes was significantly different between registries. Additional data are needed to elucidate whether the differences observed represent diagnostic delay, differences in genetic susceptibility, or differences in distribution of risk factors.
Collapse
Affiliation(s)
- Elizabeth T. Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Dana A. Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | | | | | - Christine W. Hockett
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Scott P. Isom
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Toan C. Ong
- Department of Pediatrics, University of Colorado, Aurora, CO
| | | | - Ralph D'Agostino
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael G. Kahn
- Department of Pediatrics, University of Colorado, Aurora, CO
| | - Richard F. Hamman
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Paul Wadwa
- Department of Pediatrics, University of Colorado, Aurora, CO
| | - Lawrence Dolan
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - SV Madhu
- University College of Medical Science, GTB Hospital, Delhi, India
| | - Reshmi Chhokar
- All India Institute of Medical Sciences, New Delhi, India
| | - Komal Goel
- All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Elizabeth Mayer-Davis
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
|
15
|
Ashraf H, Faraz A, Ahmad J. Achievement of guideline targets of glycemic and non-glycemic parameters in North Indian type 2 diabetes mellitus patients: A retrospective analysis. Diabetes Metab Syndr 2021; 15:425-431. [PMID: 33588199 DOI: 10.1016/j.dsx.2021.02.003] [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: 07/02/2020] [Revised: 11/26/2020] [Accepted: 02/02/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND AIMS Though, the prevalence of diabetes is increasing in the worldwide, achievement of glycemic and non-glycemic targets remain suboptimal. We conducted this retrospective cross-sectional study at two endocrine clinics of Aligarh (Uttar Pradesh) in north India. MATERIALS AND METHODS After screening the records of 13800 patients, 12140 patients of type 2 diabetes mellitus who were attending the clinic regularly every three to four months, were included in the final analysis. The data regarding patient's height, weight, body mass index, blood pressure, blood glucose, HbA1c, lipid profile and complications were obtained. RESULTS Mean age was 49.7 ± 11.3 years; males and females were almost equal in number. 2891 (23.8%) subjects were of age less than 40 years. 9614 (80%) patients had diabetes duration of less than 5 years. 3311 (27.3%) subjects were having an HbA1c of <7%, HbA1c 7-8% in 3711 (30.5%), HbA1c 8-9% in 2653 (21.9%) whereas HbA1c of >9% in 2465 (20.3%) subjects. The microvascular complications; diabetic nephropathy, diabetic neuropathy and diabetic retinopathy were present in 7.5%, 14.9% and 16.2% respectively. Hypertension was present in 25.8% and coronary artery disease was present in 15.5% of patients. Overall 27.3%, 41.7%, 44.1%, 45.3% and 67.7% of patients achieved their HbA1c, triglyceride, HDL, LDL and hypertension targets respectively, as per American Diabetes Association 2020 guidelines. CONCLUSION Despite availability of multiple drugs and guidelines, the attainment rates of glycemic and non-glycemic targets remain suboptimal. A more aggressive approach in the treatment of type 2 diabetes is required.
Collapse
Affiliation(s)
- Hamid Ashraf
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Aligarh Muslim University, Aligarh, UP, India.
| | - Ahmad Faraz
- Department of Physiology, Aligarh Muslim University, Aligarh, UP, India.
| | - Jamal Ahmad
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Aligarh Muslim University, Aligarh, UP, India
| |
Collapse
|
|
16
|
Matuszewski W, Baranowska-Jurkun A, Stefanowicz-Rutkowska MM, Modzelewski R, Pieczyński J, Bandurska-Stankiewicz E. Prevalence of Diabetic Retinopathy in Type 1 and Type 2 Diabetes Mellitus Patients in North-East Poland. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E164. [PMID: 32268561 PMCID: PMC7231267 DOI: 10.3390/medicina56040164] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/18/2020] [Accepted: 04/01/2020] [Indexed: 12/20/2022]
Abstract
Background and Objectives: The global epidemic of diabetes, especially type 2 (DM2), is related to lifestyle changes, obesity, and the process of population aging. Diabetic retinopathy (DR) is the most serious complication of the eye caused by diabetes. The aim of this research was to assess the prevalence of diabetic retinopathy in type 1 and type 2 diabetes mellitus patients in north-east Poland. Materials and Methods: The eye fundus was assessed on the basis of two-field 50 degrees color fundus photographs that showed the optic nerve and macula in the center after the pupil was dilated with 1% tropicamide. Results: The experimental group included 315 (26%) patients with type 1 diabetes mellitus (DM1) and 894 (74%) patients with DM2. DM1 patients were diagnosed with DR in 32.58% of cases, with non-proliferative diabetic retinopathy (NPDR) in 24.44% of cases, proliferative diabetic retinopathy (PDR) in 1.59% of cases, diabetic macular edema (DME) in 5.40% of cases, and PDR with DME in 0.95% of cases. DR was found in DM2 patients in 23.04% of cases, NPDR in 17.11% of cases, PDR in 1.01% of cases, DME in 4.81% of cases, and PDR with DME in 0.11% of cases. Conclusions: The presented study is the first Polish study on the prevalence of diabetic retinopathy presenting a large group of patients, and its results could be extrapolated to the whole country. Diabetic retinopathy was found in 25.48% of patients in the whole experimental group. The above results place Poland within the European average, indicating the quality of diabetic care offered in Poland, based on the number of observed complications.
Collapse
Affiliation(s)
- Wojciech Matuszewski
- Clinic of Endocrinology, Diabetology and Internal Medicine, Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn 10-561, Poland
| | - Angelika Baranowska-Jurkun
- Clinic of Endocrinology, Diabetology and Internal Medicine, Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn 10-561, Poland
| | - Magdalena M Stefanowicz-Rutkowska
- Clinic of Endocrinology, Diabetology and Internal Medicine, Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn 10-561, Poland
| | - Robert Modzelewski
- Clinic of Endocrinology, Diabetology and Internal Medicine, Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn 10-561, Poland
| | - Janusz Pieczyński
- Ophthalmology Clinic, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn 10-561, Poland
| | - Elżbieta Bandurska-Stankiewicz
- Clinic of Endocrinology, Diabetology and Internal Medicine, Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn 10-561, Poland
| |
Collapse
|
|
17
|
Sharma S, Jha J, Varshney A, Chauhan L. Awareness of various aspects of diabetes among people visiting tertiary eye care institute in north India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
|
18
|
Venugopal D, Lal B, Fernandes S, Gavde D. Awareness and knowledge of diabetic retinopathy and associated factors in Goa: A hospital-based cross-sectional study. Indian J Ophthalmol 2020; 68:383-390. [PMID: 31957734 PMCID: PMC7003591 DOI: 10.4103/ijo.ijo_1218_19] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/01/2019] [Accepted: 11/27/2019] [Indexed: 02/07/2023] Open
Abstract
Purpose To assess the awareness and knowledge about diabetic retinopathy (DR) and associated factors among patients visiting the tertiary health center in Goa. Methods A cross-sectional descriptive study was conducted using a standard predesigned and pretested closed-ended structured questionnaire to assess the awareness, knowledge, attitude and practice about DR among patients visiting a tertiary health center. Results Three hundred and fifty-eight subjects participated in the study. Only 125 (34.9% [95% CI: 30.0-40.1]) subjects were aware of DR and 122 (34.1% [95% CI: 29.2-39.2]) had adequate knowledge about DR. Awareness and knowledge of DR were significantly high among the subjects who completed college level of education (66.7%, OR = 2.78; 95% CI: 1.73-4.48, P < 0.001 and 55.9%, OR = 3.92; 95% CI: 2.41-6.38, P < 0.001) and who spoke English (52.5%, OR = 3.37; 95% CI: 2.14-5.30, P < 0.001 and 50.4%, OR = 3.26; 95% CI: 2.07-5.14, P < 0.001). Christians reported better knowledge about DR compared to other religions (48.8%, OR = 2.27; 95% CI: 1.38-3.75, P = 0.005). Negative association was noted between the knowledge of DR and presence of diabetes (29.4%, OR = 0.64; 95% CI: 0.41-0.99, P = 0.048). The practice pattern was strongly associated (OR = 7.47; 95% CI: 4.51-12.38, P < 0.001) with the knowledge of DR. Attitude was not influenced by any of the factors. Conclusion We found that awareness and knowledge about DR were unsatisfactory; literacy contributed significantly toward it. These findings also suggest that there is an immediate need to enhance the awareness and knowledge of diabetic eye diseases in order to reduce the burden of visual impairment.
Collapse
Affiliation(s)
- Dinesh Venugopal
- Optometry Division, Allied Health Science Course, Department of Ophthalmology, Goa Medical College and Hospital, Bambolim, Goa, India
| | - Barsha Lal
- Optometry Division, Allied Health Science Course, Department of Ophthalmology, Goa Medical College and Hospital, Bambolim, Goa, India
- School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Shawnicka Fernandes
- Optometry Division, Allied Health Science Course, Department of Ophthalmology, Goa Medical College and Hospital, Bambolim, Goa, India
| | - Deepali Gavde
- Optometry Division, Allied Health Science Course, Department of Ophthalmology, Goa Medical College and Hospital, Bambolim, Goa, India
| |
Collapse
|
|
19
|
Shah S, Abbas G, Hanif M, Anees-Ur-Rehman, Zaman M, Riaz N, Altaf A, Hassan SU, Saleem U, Shah A. Increased burden of disease and role of health economics: Asia-pacific region. Expert Rev Pharmacoecon Outcomes Res 2019; 19:517-528. [DOI: 10.1080/14737167.2019.1650643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Shahid Shah
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Ghulam Abbas
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Muhammad Hanif
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Anees-Ur-Rehman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Penang, Malaysia
| | - Muhammad Zaman
- Faculty of Pharmacy, University of Central Punjab, Lahore, Pakistan
| | - Nabeel Riaz
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Arslan Altaf
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Shams Ul Hassan
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Usman Saleem
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Abid Shah
- Pediatric Medicine Department, Mukhtar Ahmad Sheikh Hospital, Multan, Pakistan
| |
Collapse
|
|
20
|
Pradeepa R, Rajalakshmi R, Mohan V. Use of Telemedicine Technologies in Diabetes Prevention and Control in Resource-Constrained Settings: Lessons Learned from Emerging Economies. Diabetes Technol Ther 2019; 21:S29-S216. [PMID: 31169429 DOI: 10.1089/dia.2019.0038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Telemedicine is a promising strategy that utilizes telecommunication to provide health care in remote areas, facilitating beneficial interaction between the health care provider and people in rural areas and making affordable and accessible medical care available to remote, inaccessible areas of the world. This article provides an overview of some of the ways telemedicine is improving diabetes care outcomes at the community level. Telemedicine can play a number of roles in moving quality diabetes care forward. It is currently being used to create awareness among urban and rural population about the risk factors and prevention of diabetes; to facilitate patient monitoring; for remote diabetic retinopathy screening; and in diabetes prevention at the primary, secondary, and tertiary level. We also highlight the use of automated artificial intelligence software combined with telemedicine to conduct efficient real-time screening of complications such as diabetic retinopathy in remote areas where such facilities are currently unavailable.
Collapse
Affiliation(s)
- Rajendra Pradeepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Ramachandran Rajalakshmi
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| |
Collapse
|
|
21
|
Gillani AH, Aziz MM, Masood I, Saqib A, Yang C, Chang J, Mohamed Ibrahim MI, Fang Y. Direct and indirect cost of diabetes care among patients with type 2 diabetes in private clinics: a multicenter study in Punjab, Pakistan. Expert Rev Pharmacoecon Outcomes Res 2018; 18:647-653. [PMID: 30052085 DOI: 10.1080/14737167.2018.1503953] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) has a very high prevalence and poses a huge financial encumbrance on patients. This study aimed to evaluate the cost of diabetes care among patients with type 2 diabetes in private clinics of southern Punjab, Pakistan. RESEARCH DESIGN AND METHODS This was a descriptive, cross-sectional, prevalence-based, cost-of-illness (COI) study conducted in six private clinics of southern Punjab from July to September 2016, using a pretested questionnaire. Study participants were recruited using a random selection method. Continuous variables, including direct and indirect costs, were summarized using descriptive statistics. Inferential statistics were also used to analyze the correlation between the variables and cost. RESULTS The mean annual direct cost per patient with diabetes was estimated to be 332 USD. Medications accounted for the largest share (60.4%) of this cost. Age, locality, high socioeconomic status, and prolonged disease duration were significantly associated with the direct costs of illness (p < 0.05). Moreover, 19% of total earnings among very low-income patients were spent on diabetes care. CONCLUSIONS A substantial proportion of patients' income is spent on diabetes care in Punjab. Our findings support the substantial individual and societal burden caused by diabetes.
Collapse
Affiliation(s)
- Ali Hassan Gillani
- a Department of Pharmacy Administration and Clinical Pharmacy , School of pharmacy Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research , Xi'an Jiaotong University , Xi'an , China.,c The Global Health Institute , Xi'an Jiaotong University , Xi'an , China.,d Shaanxi Centre for Health Reform and Development Research , Xi'an , China
| | - Muhammad Majid Aziz
- a Department of Pharmacy Administration and Clinical Pharmacy , School of pharmacy Xi'an Jiaotong University , Xi'an , China
| | - Imran Masood
- e Department of Pharmacy , Islamia University of Bahawalpur , Punjab , Pakistan
| | - Anum Saqib
- e Department of Pharmacy , Islamia University of Bahawalpur , Punjab , Pakistan
| | - Caijun Yang
- a Department of Pharmacy Administration and Clinical Pharmacy , School of pharmacy Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research , Xi'an Jiaotong University , Xi'an , China.,c The Global Health Institute , Xi'an Jiaotong University , Xi'an , China.,d Shaanxi Centre for Health Reform and Development Research , Xi'an , China
| | - Jie Chang
- a Department of Pharmacy Administration and Clinical Pharmacy , School of pharmacy Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research , Xi'an Jiaotong University , Xi'an , China.,c The Global Health Institute , Xi'an Jiaotong University , Xi'an , China.,d Shaanxi Centre for Health Reform and Development Research , Xi'an , China
| | - Mohamed Izham Mohamed Ibrahim
- f Department of Social & Administrative Pharmacy, Clinical Pharmacy and Practice Section , College of Pharmacy Qatar University , Doha , Qatar
| | - Yu Fang
- a Department of Pharmacy Administration and Clinical Pharmacy , School of pharmacy Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research , Xi'an Jiaotong University , Xi'an , China.,c The Global Health Institute , Xi'an Jiaotong University , Xi'an , China.,d Shaanxi Centre for Health Reform and Development Research , Xi'an , China
| |
Collapse
|
|
22
|
Abstract
The article provides estimates of economic burden of diabetes among women. The study was based on primary data collected from Jalandhar. The article examines the direct, indirect and intangible cost of diabetes. The result indicates that mean cost of outpatient care of consultation, lab investigations, medicines, special diet and transport was ₹203.53, ₹535.50, ₹515.0, ₹258.80 and ₹120.30, respectively. While, mean cost of inpatient care of consultation, lab investigations, room charges, medicines, special diet and transport was ₹1157.00, ₹1468.75, ₹1354.50, ₹4175.50, ₹680.0 and ₹278.65, respectively. The analysis shows that the mean cost of inpatient care was higher than that of outpatient care. Intangible cost of diabetes involved reduced food consumption, borrowing from neighbours/relatives, decreased non-food consumption, decreased savings, decreased social obligations/functions, stopped purchase/expansion of house, sale of household assets, stopped medical treatment of other members in the family and stopped the purchase of consumer durables. These figures are compelling enough to stimulate government to take corrective actions to address the risk factors that contribute to diabetes. Immediate action is needed to stem the tide of diabetes and to introduce cost-effective treatment to reverse this trend. Healthcare policy planners must anticipate and respond to socio-economic implications, ideally through preventive as well as curative measures.
Collapse
Affiliation(s)
- Pooja Kansra
- Mittal School of Business, Lovely Professional University, Phagwara, Punjab, India
| |
Collapse
|
|
23
|
Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives. Surv Ophthalmol 2017; 63:406-436. [PMID: 29100897 DOI: 10.1016/j.survophthal.2017.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022]
Abstract
The association between socioeconomic position and morbidity and mortality has long been recognized. We evaluate the evidence for an association between multiple aspects of deprivation and ocular health in a global context. This is a systematic review of studies that evaluated deprivation in the adult population in the context of the major acquired causes of visual loss such as cataract, diabetic eye disease, glaucoma, age-related macular degeneration, and ocular trauma. The search strategy identified relevant studies reported between 1946 and August 2016, with randomized control trials, case-control, cohort, and cross-sectional study designs being selected for inclusion. The studies identified in this review from across the world demonstrate the extent to which the common themes such as low educational attainment and low income may be associated with increased incidence of various sight-threatening conditions and may adversely affect access to specialist assessment and delivery of treatment. Health inequality may always persist, but an increased recognition of the importance of the various impacts of deprivation may empower policy makers to target limited resources to the most vulnerable groups in order to deliver the greatest benefit.
Collapse
|
|
24
|
Vengadesan N, Ahmad M, Sindal MD, Sengupta S. Delayed follow-up in patients with diabetic retinopathy in South India: Social factors and impact on disease progression. Indian J Ophthalmol 2017; 65:376-384. [PMID: 28573993 PMCID: PMC5565887 DOI: 10.4103/ijo.ijo_620_16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose: To identify social factors associated with delayed follow-up in South Indian patients with diabetic retinopathy (DR) and to study DR progression during the delayed follow-up period. Materials and Methods: In this cross-sectional study, 500 consecutive patients with DR returning after greater than twice the advised follow-up period were identified from a tertiary referral center in South India. A previously validated 19-item questionnaire was administered to study patients to assess causes for the follow-up delay. Patient demographics, DR status, and treatment plan were recorded at the study visit and the visit immediately before the delay. The eye with the most severe disease was included in the analysis. Results: Complete data were available for 491 (98.2%) patients. Among these, 248 (50.5%) cited “my eyes were okay at the time,” 201 (41.0%) cited “no attender to accompany me,” and 190 (38.6%) cited “financial cost” as causes of the follow-up delay. Those with vision-threatening DR (VTDR, n = 233) predominantly reported “financial cost” (47% vs. 32%, P = 0.001), whereas those with non-VTDR more frequently reported “my eyes were okay at the time” (58% vs. 42%, P = 0.001). Evidence of disease progression from non-VTDR to VTDR was seen in 67 (26%) patients. Almost 1/3rd (29%) of patients who were previously advised regular examination required additional intervention. Conclusion: Many patient-level factors affect poor compliance with follow-up in DR, and these factors vary by disease severity. Targeting these barriers to care through patient education and clinic procedures may promote timely follow-up and better outcomes in these patients.
Collapse
Affiliation(s)
| | - Meleha Ahmad
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Manavi D Sindal
- Department of VitreoRetina, Aravind Eye Hospital, Puducherry, India
| | | |
Collapse
|
|
25
|
Mahapatra T, Chakraborty K, Mahapatra S, Mahapatra U, Pandey N, Thomson PL, Musk AW, Mitra RN. Burden and Socio-Behavioral Correlates of Uncontrolled Abnormal Glucose Metabolism in an Urban Population of India. PLoS One 2016; 11:e0163891. [PMID: 27755543 PMCID: PMC5068776 DOI: 10.1371/journal.pone.0163891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 09/18/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Progressive burden of diabetes mellitus is a major concern in India. Data on the predictors of poor glycemic control among diabetics are scanty. A population-based cross-sectional study nested in an urban cohort was thus conducted in West Bengal, India to determine the burden and correlates of total and uncontrolled abnormalities in glucose metabolism (AGM) in a representative population. METHODS From 9046 adult cohort-members, 269 randomly selected consenting subjects (non-response = 7.24%) were interviewed, examined [blood pressure (BP), anthropometry], tested for fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1C). Those having pre-diagnosed diabetes or FPG ≥126 or HbA1c≥6.5 were defined as diabetic. Among non-diabetics, subjects with FPG (mg/dl) = 100-125 or HbA1C(%) = 5.7-6.4 were defined as pre-diabetic. Pre-diagnosed cases with current FPG ≥126 were defined as uncontrolled AGM. Descriptive and regression analyses were conducted using SAS-9.3.2. RESULTS Among participants, 28.62% [95% Confidence Interval (95%CI) = 23.19-34.06)] were overweight [body mass index(BMI) = (25-29.99)kg/meter2], 7.81% (4.58-11.03) were obese(BMI≥30kg/meter2), 20.82% (15.93-25.70) were current smokers, 12.64% (8.64-16.64) were current alcohol-drinkers and 46.32% of responders (39.16-53.47) had family history of diabetes. 17.84% (13.24-22.45) had stage-I [140≤average systolic BP (AvSBP in mm of mercury)<160 or 90≤average diastolic BP (AvDBP)<100] and 12.64% (8.64-16.64) had stage-II (AvSBP≥160 or AvDBP≥160) hypertension. Based on FPG and HbA1c, 10.41% (6.74-14.08) were diabetic and 27.88% (22.49-33.27) were pre-diabetic. Overall prevalence of diabetes was 15.61% (11.25-19.98). Among pre-diagnosed cases, 46.43% (26.74-66.12) had uncontrolled AGM. With one year increase in age [Odds Ratio(OR) = 1.05(1.03-1.07)], retired subjects [OR = 9.14(1.72-48.66)], overweight[OR = 2.78(1.37-5.64)], ex-drinkers [OR = 4.66(1.35-16.12)] and hypertensives [ORStage I = 3.75(1.42-9.94); ORStage II = 4.69(1.67-13.17)] had higher odds of diabetes. Relatively older subjects [OR = 1.06(1.02-1.10)], unemployed [OR = 19.68(18.64-20.78)], business-owners [OR = 25.53(24.91-16.18)], retired [OR = 46.53(45.38-47.72)], ex-smokers [OR = 4.75(1.09-20.78)], ex-drinkers [OR = 22.43(4.62-108.81)] and hypertensives [ORStage II = 13.17(1.29-134.03)] were more likely to have uncontrolled AGM. CONCLUSIONS Burden of uncontrolled AGM was high among participants. Efforts to curb the diabetes epidemic in urban India should include interventions targeting appropriate diabetic control among relatively older persons, unemployed, business-owners, retired, ex-smokers, ex-drinkers and hypertensives.
Collapse
Affiliation(s)
- Tanmay Mahapatra
- Barrackpore Population Health Research Foundation, Kolkata, 700123, India
- Mission Arogya Health and Information Technology Research Foundation, Kolkata, 700010, India
| | | | - Sanchita Mahapatra
- Mission Arogya Health and Information Technology Research Foundation, Kolkata, 700010, India
| | - Umakanta Mahapatra
- Department of Endocrinology and Metabolism, Institute of Post-Graduate Medical, Education and Research, Kolkata, 700020, India
| | - Naren Pandey
- Mediland Diagnostic Institute, Kolkata, Kolkata, 700014, India
| | - Peter L. Thomson
- Sir Charles Gairdner Hospital, University of Western Australia, Nedlands, 6009, Australia
| | - Arthur W. Musk
- Sir Charles Gairdner Hospital, University of Western Australia, Nedlands, 6009, Australia
- School of Population Health, University of Western Australia, Perth, 6009, Australia
| | - Ramendra N. Mitra
- Barrackpore Population Health Research Foundation, Kolkata, 700123, India
- Sir Charles Gairdner Hospital, University of Western Australia, Nedlands, 6009, Australia
| |
Collapse
|
|
26
|
Callander EJ, Schofield DJ. Type 2 diabetes mellitus and the risk of falling into poverty: an observational study. Diabetes Metab Res Rev 2016; 32:581-8. [PMID: 26663863 DOI: 10.1002/dmrr.2771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 11/11/2015] [Accepted: 11/24/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Diabetes is known to be associated with low income; however, no longitudinal studies have documented whether developing type 2 diabetes mellitus (T2DM) is a risk factor for later falling into poverty. This paper aims to determine whether Australians who are diagnosed with type 2 diabetes have an elevated risk of falling into income poverty or multidimensional poverty. METHODS Data from a nationally representative, longitudinal survey conducted annually since 2001 are utilized. It identifies adults aged 21 years and over who were diagnosed with type 2 diabetes between 2007 and 2009 and compares their risk of falling into income poverty and multidimensional poverty between 2007 and 2012 relative to those who had never been diagnosed with type 2 diabetes using survival analysis with Cox regression models. RESULTS After adjusting for confounding factors, for men who were diagnosed with T2DM, the hazard ratio for falling into income poverty was 1.89 (95% CI: 1.03-3.44) and 2.52 (95% CI: 1.24-5.12) for falling into multidimensional poverty, relative men who had never been diagnosed with T2DM. There was no significant difference in the hazard ratio for falling into income poverty (p = 0.6554) or multidimensional poverty (p = 0.9382) for women who were diagnosed with T2DM compared with women who had never been diagnosed with T2DM. CONCLUSION Being diagnosed with type 2 diabetes increases the risk of men falling into poverty. The risk is higher for multidimensional poverty than income poverty. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Emily J Callander
- Faculty of Pharmacy, University of Sydney, Sydney, Australia
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | | |
Collapse
|
|
27
|
Kannuri NK, Anchala R, Murthy GVS, Gilbert CE. Strengthening diabetes retinopathy services in India: Qualitative insights into providers' perspectives: The India 11-city 9-state study. Indian J Endocrinol Metab 2016; 20:S59-S66. [PMID: 27144138 PMCID: PMC4847451 DOI: 10.4103/2230-8210.179775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
CONTEXT There is a lack of evidence on the subjective aspects of the provider perspective regarding diabetes and its complications in India. OBJECTIVES The study was undertaken to understand the providers' perspective on the delivery of health services for diabetes and its complications, specifically the eye complications in India. SETTINGS AND DESIGN Hospitals providing diabetic services in government and private sectors were selected in 11 of the largest cities in India, based on geographical distribution and size. METHODS Fifty-nine semi-structured interviews conducted with physicians providing diabetes care were analyzed all interviews were recorded, transcribed, and translated. Nvivo 10 software was used to code the transcripts. Thematic analysis was conducted to analyze the data. RESULTS The results are presented as key themes: "Challenges in managing diabetes patients," "Current patient management practices," and "Strengthening diabetic retinopathy (DR) services at the health systems level." Diabetes affects people early across the social classes. Self-management was identified as an important prerequisite in controlling diabetes and its complications. Awareness level of hospital staff on DR was low. Advances in medical technology have an important role in effective management of DR. A team approach is required to provide comprehensive diabetic care. CONCLUSIONS Sight-threatening DR is an impending public health challenge that needs a concerted effort to tackle it. A streamlined, multi-dimensional approach where all the stakeholders cooperate is important to strengthening services dealing with DR in the existing health care setup.
Collapse
Affiliation(s)
- Nanda Kishore Kannuri
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Hyderabad, Telangana, India
| | - Raghupathy Anchala
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Hyderabad, Telangana, India
| | - Gudlavalleti V. S. Murthy
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Hyderabad, Telangana, India
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare E. Gilbert
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
|
28
|
Yang GR, Yuan SY, Fu HJ, Wan G, Zhu LX, Yuan MX, Lv YJ, Zhang JD, Du XP, Li YL, Ji Y, Zhou L, Li Y. Influence of educational attainments on long term glucose control and morbid events in patients with type 2 diabetes receiving integrated care from 15 China urban communities: The Beijing Community Diabetes Study 11. Prim Care Diabetes 2015; 9:473-481. [PMID: 25865852 DOI: 10.1016/j.pcd.2015.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 02/06/2015] [Accepted: 03/13/2015] [Indexed: 01/22/2023]
Abstract
AIM To investigate the effects of educational attainment on glucose control and morbid events in patients with type 2 diabetes in Beijing communities. METHODS In this prospective multi-center study, 2866 type 2 diabetes patients receiving integrated care from 15 Beijing urban communities were investigated. Educational attainment was categorized into three levels: low, medium, and high. After a 42-month management, glucose control parameters and morbid events were analyzed. RESULTS At baseline, the percentages of patients with good glucose control (HbA1c ≤ 7.0%) in the low, medium and high educational groups were 49.09%, 54.82% and 62.59%, respectively (P<0.001). After the 42-month management, fasting plasma glucose and HbA1c values were the highest in the low educational group (7.51 ± 2.05 mmol/l and 7.20 ± 1.27%, respectively). Percentages of patients with good glucose control in the three groups were 49.6%, 55.83% and 67.23%, respectively, and the incidences of combined morbid events were 4.5%, 2.4% and 1.5%, respectively. Cox regression analysis showed that educational level was related to the incidence of combined morbid events (medium level, HR=0.572; high level, HR=0.351; P<0.05). CONCLUSIONS Educational level was associated with long-term glucose control, and seemed to be related to the incidence of combined morbid events in people with type 2 diabetes.
Collapse
Affiliation(s)
- Guang-Ran Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shen-Yuan Yuan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Han-Jing Fu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Gang Wan
- Department of Medical Records and Statistics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Liang-Xiang Zhu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ming-Xia Yuan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yu-Jie Lv
- Cuigezhuang Community Health Service Center, Beijing, China
| | | | - Xue-Ping Du
- Yuetan Community Health Service Center of Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yu-Ling Li
- Xinjiekou Community Health Service Center, Beijing, China
| | - Yu Ji
- Department of Endocrinology, Beijing Aerospace General Hospital, Beijing, China
| | - Li Zhou
- School Hospital of Central University for Nationalities, Beijing, China
| | - Yue Li
- Aerospace Central Hospital, Beijing, China
| |
Collapse
|
|
29
|
Sharma N, Sharma SK, Maheshwari VD, Sharma KK, Gupta R. Association of low educational status with microvascular complications in type 2 diabetes: Jaipur diabetes registry. Indian J Endocrinol Metab 2015; 19:775-780. [PMID: 26693427 PMCID: PMC4673805 DOI: 10.4103/2230-8210.167552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To determine the association of educational status (ES), as marker of socioeconomic status, with the prevalence of microvascular complications in diabetes. METHODS Successive patients (n = 1214) presenting to our center were evaluated for sociodemographic, anthropometric, clinical, and therapeutic variables. Subjects were classified according to ES into Group 1 (illiterate, 216); Group 2 (≤ primary, 537), Group 3 (≤ higher secondary, 312), and Group 4 (any college, 149). Descriptive statistics is reported. RESULTS Mean age of patients was 52 ± 10 years, duration of diabetes 7 ± 7 years and 55% were men. Prevalence of various risk factors was smoking/tobacco 25.5%, obesity body mass index ≥25 kg/m(2) 64.0%, abdominal obesity 63.4%, hypertension 67.5%, high fat diet 14.5%, low fruits/vegetables 31.8%, low fiber intake 60.0%, high salt diet 16.9%, physical inactivity 27.5%, coronary or cerebrovascular disease 3.0%, and microvascular disease (peripheral, ocular or renal) in 20.7%. Microvascular disease was significantly greater in illiterate (25.9%) and low (23.6%) compared to middle (15.0%) and high (14.7%) ES groups (P < 0.05). Age- and sex-adjusted logistic regression analysis revealed that in illiterate and low ES groups respectively, prevalence of smoking/tobacco use (odds ratio 3.84, confidence interval: 09-7.05 and 2.15, 1.36-3.41); low fruit/vegetable (2.51, 1.53-4.14 and 1.99, 1.30-3.04) and low fiber intake (4.02, 2.50-6.45 and 1.78, 1.23-2.59) was greater compared to high ES. Poor diabetes control (HbA1c >.0%) was significantly greater in illiterate (38.0%), low (46.0%), and middle (41.0%) compared to high (31.5%) ES subjects (P < 0.05). CONCLUSIONS There is a greater prevalence of the microvascular disease in illiterate and low ES diabetes patients in India. This is associated with the higher prevalence of smoking/tobacco use, poor quality diet, and sub-optimal diabetes control.
Collapse
Affiliation(s)
- Niharikaa Sharma
- Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | | | - Vitthal D. Maheshwari
- Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | | | - Rajeev Gupta
- Department of Medicine, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| |
Collapse
|
|
30
|
Spratt SE, Feinglos MN, Willis JM. Barriers to care for patients with diabetes in Durham, North Carolina, why are we withholding life-sustaining medications from the patients who need them the most? Expert Rev Endocrinol Metab 2015; 10:459-461. [PMID: 30298767 DOI: 10.1586/17446651.2015.1069704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The diabetes epidemic and its complications disproportionately affect minorities and the poor. Medical treatments that can prevent or delay diabetes complications are widely available but poverty underlies much of why there are disparities in diabetes care and outcomes. Lack of access to care, food insecurity and inability to pay for medications prevents adherence to a medication and lifestyle regimen that can be life-sustaining. At the very least, US policies should be changed to provide life-sustaining medications that prevent costly complications to patients who cannot afford them. Adopting value-based insurance design would benefit patients with diabetes who cannot afford to pay for medications but would also reduce healthcare costs in the long run.
Collapse
Affiliation(s)
- Susan E Spratt
- a 1 Department of Medicine, Division of Endocrinology, Metabolism and Nutrition, Durham, NC 27710, USA
| | - Mark N Feinglos
- a 1 Department of Medicine, Division of Endocrinology, Metabolism and Nutrition, Durham, NC 27710, USA
| | - Janese M Willis
- b 2 Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710, USA
| |
Collapse
|
|
31
|
Sharma N, Sharma SK, Maheshwari VD, Sharma KK, Gupta R. Association of low educational status with microvascular complications in type 2 diabetes: Jaipur diabetes registry-1. Indian J Endocrinol Metab 2015; 19:667-672. [PMID: 26425480 PMCID: PMC4566351 DOI: 10.4103/2230-8210.163206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the association of educational status (ES), as a marker of socioeconomic status, with the prevalence of microvascular complications in diabetes. METHODS Successive patients (n = 1214) presenting to our centre were evaluated for sociodemographic, anthropometric, clinical, and therapeutic variables. Subjects were classified according to ES into Group 1 (illiterate, 216); Group 2 (<primary, 537), Group 3 (<higher secondary, 312), and Group 4 (any college, 149). Descriptive statistics are reported. RESULTS Mean age of patients was 52 ± 10 years, duration of diabetes 7 ± 7 years, and 55% were men. Prevalence of various risk factors was smoking/tobacco 25.5%, obesity body mass index ≥25 kg/m(2) 64.0%, abdominal obesity 63.4%, hypertension 67.5%, high fat diet 14.5%, low fruits/vegetables 31.8%, low fibre intake 60.0%, high salt diet 16.9%, physical inactivity 27.5%, coronary, or cerebrovascular disease 3.0%, and microvascular disease (peripheral, ocular or renal) in 20.7%. Microvascular disease was significantly greater in illiterate (25.9%) and low (23.6%) compared to middle (15.0%) and high (14.7%) ES groups (P < 0.05). Age- and sex-adjusted logistic regression analysis revealed that in illiterate and low ES groups respectively, prevalence of smoking/tobacco use (odds ratio 3.84, confidence intervals 2.09-7.05 and 2.15, 1.36-3.41); low fruit/vegetable (2.51, 1.53-4.14 and 1.99, 1.30-3.04) and low fibre intake (4.02, 2.50-6.45 and 1.78, 1.23-2.59) was greater compared to high ES. Poor diabetes control (HbA1c >8.0%) was significantly greater in illiterate (38.0%), low (46.0%) and middle (41.0%) compared to high (31.5%) ES subjects (P < 0.05). CONCLUSIONS There is a greater prevalence of the microvascular disease in illiterate and low ES diabetes patients in India. This is associated with the higher prevalence of smoking/tobacco use, poor quality diet and sub-optimal diabetes control.
Collapse
Affiliation(s)
- Niharikaa Sharma
- Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | | | - Vitthal D. Maheshwari
- Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | | | - Rajeev Gupta
- Department of Medicine, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| |
Collapse
|
|
32
|
Jagannathan A, Narayanan VV, Kulkarni I, Jogdand SP, Pailoor S, Nagarathna R. Prevalence of type 2 diabetes among Yoga practitioners: A pilot cross-sectional study in two districts in India. Int J Yoga 2015; 8:148-53. [PMID: 26170597 PMCID: PMC4479895 DOI: 10.4103/0973-6131.158485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Diabetes is one of the major health diseases in the world today. The efficacy of Yoga in the management of type 2 diabetes is well-established. The aim of this study was to assess the prevalence of type 2 diabetes among Yoga practitioners in two districts of India (one each in West and South of India). Methodology: In this cross-sectional field study, 155 Yoga practitioners from Pune and 192 from Ernakulam districts were assessed using the diabetes risk test and fasting blood sugar. The data collected were entered in a statistics software package and analyzed using the Pearson's correlation analysis, t-test, univariate ANOVA, and linear regression to understand the predictors of risk for diabetes. Results: The overall prevalence of diabetes among Yoga practitioners in Central Pune was 3.6% (95% confidence interval [CI]: [0.01–0.04]). 18.9% of participants (95% CI: [0.16–0.19]) were diagnosed to be “at risk” for diabetes. In Ernakulam, the overall prevalence of diabetes among practitioners was 26% (95% CI: [0.05-0.06]) with 12% of practitioners (95% CI: [0.05-0.06]) diagnosed to be “at risk” for diabetes (prediabetic). Higher age and lesser duration of Yoga practice were significant predictors of diabetes. Conclusion: It is essential for every person above the age of 40 to undergo regular health check-ups and screening for diabetes and involve oneself in lifestyle modification programs such as Yoga for significantly long duration of time on a daily basis, to better manage diabetes.
Collapse
Affiliation(s)
- Aarti Jagannathan
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India
| | - V V Narayanan
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India
| | - Isha Kulkarni
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India
| | - Sonali P Jogdand
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India
| | - Subramanya Pailoor
- Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India
| | - R Nagarathna
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India
| |
Collapse
|
|
33
|
Abstract
Diabetes mellitus is becoming a global health issue with more than 80% diabetics living in developing countries. India accounts for 62.4 million diabetics (2011). Indian Council of Medical Research India Diabetes Study (ICMR-INDIAB) study showed highest weighted prevalence rate in the north India among all studied regions. Diabetes in north India has many peculiarities in all aspects from risk factors to control programmers. North Indians are becoming more prone for diabetes and dyslipidemia because rapid westernization of living style and diet due rapid migration to metropolitan cities for employment. North Indian diabetes is plagued with gender bias against females, poor quality of health services, myths, and lack of disease awareness compounded with small number of prevention and awareness programmers that too are immature to counteract the growing pandemic.
Collapse
Affiliation(s)
- Manish Gutch
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Meerut, Uttar Pradesh, India
| | - Syed Mohd Razi
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Meerut, Uttar Pradesh, India
| | - Sukriti Kumar
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
| | - Keshav Kumar Gupta
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Meerut, Uttar Pradesh, India
| |
Collapse
|
|
34
|
M. R. N, Baghel RK, Siddalingappa H. Prevalence and factors influencing type 2 diabetes mellitus in rural Mysore. Int J Diabetes Dev Ctries 2014. [DOI: 10.1007/s13410-014-0202-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
|
|
35
|
|
|
36
|
Skar M, Villumsen AB, Christensen DL, Petersen JH, Deepa M, Anjana RM, Pradeepa R, Mohan V. Increased risk of type 2 diabetes with ascending social class in urban South Indians is explained by obesity: The Chennai urban rural epidemiology study (CURES-116). Indian J Endocrinol Metab 2013; 17:1084-1089. [PMID: 24381889 PMCID: PMC3872690 DOI: 10.4103/2230-8210.122632] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AIM The aim of this study is to determine the factors responsible for differences in the prevalence of diabetes mellitus (DM) in subjects of different social class in an urban South Indian population. MATERIALS AND METHODS Analyses were based on the cross-sectional data from the Chennai Urban Rural Epidemiology Study of 1989 individuals, aged ≥20 years. Entered in the analyses were information obtained by self-report on (1) household income; (2) family history of diabetes; (3) physical activity; (4) smoking status; (5) alcohol consumption. Biochemical, clinical and anthropometrical measurements were performed and included in the analyses. Social class was classified based on income as low (Rs. <2000) intermediate (Rs. 2000-5000`) and high (Rs. 5000-20000). RESULTS The prevalence rates of DM were 12.0%, 18.4% and 21.7% in low, intermediate and high social class, respectively (P < 0.001). A significant increase in the risk of diabetes was found with ascending social class (Intermediate class: Odds ratio [OR], 1.7 [confidence interval [CI], 1.2-2.3]; High class: OR, 2.0 [CI-1.4-2.9]). The multivariable adjusted logistic regression analysis revealed that the effect of social class on the risk of diabetes remained significant (P = 0.016) when age, family history of diabetes and blood pressure were included. However, with the inclusion of abdominal obesity in the model, the significant effect of social class disappeared (P = 0.087). CONCLUSION An increased prevalence of DM was found in the higher social class in this urban South Indian population, which is explained by obesity.
Collapse
Affiliation(s)
- Mette Skar
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Dirk Lund Christensen
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | | | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention and Control, International Diabetes Federation Centre of Education, Gopalapuram, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Department of Epidemiology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention and Control, International Diabetes Federation Centre of Education, Gopalapuram, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Department of Epidemiology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention and Control, International Diabetes Federation Centre of Education, Gopalapuram, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Department of Epidemiology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention and Control, International Diabetes Federation Centre of Education, Gopalapuram, Chennai, Tamil Nadu, India
| |
Collapse
|
|
37
|
Chakrabarti R, Chatterjee T. Tip of the Iceberg: The Need for Diabetic Retinopathy Screening in Developing Countries. Lessons From Vietnam. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2013; 2:76-8. [PMID: 26108042 DOI: 10.1097/apo.0b013e3182897e70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Noncommunicable diseases such as diabetes are emerging particularly in low-income countries. Diabetic retinopathy (DR) is a major complication that threatens vision among people with diabetes. Research has demonstrated that blindness from diabetes is preventable with early diagnosis, optimization of risk factors, and timely photocoagulation. Experiences from neighboring Southeast Asian countries such as Vietnam highlight the health system's challenges in managing DR in low-resourced countries. Insight can be gained from successful interventions in India and Latin America. A systematic approach to manage DR is required to achieve Vision2020 goals. This must identify people at risk and engage with key stakeholders at all levels of the health system to ensure that systems for treatment and follow-up are available.
Collapse
Affiliation(s)
- Rahul Chakrabarti
- From the *Centre for Eye Research Australia, The University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia; and †Department of Internal Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | | |
Collapse
|
|
38
|
Abstract
Diabetic retinopathy (DR), a major microvascular complication of diabetes, has a significant impact on the world's health systems. Globally, the number of people with DR will grow from 126.6 million in 2010 to 191.0 million by 2030, and we estimate that the number with vision-threatening diabetic retinopathy (VTDR) will increase from 37.3 million to 56.3 million, if prompt action is not taken. Despite growing evidence documenting the effectiveness of routine DR screening and early treatment, DR frequently leads to poor visual functioning and represents the leading cause of blindness in working-age populations. DR has been neglected in health-care research and planning in many low-income countries, where access to trained eye-care professionals and tertiary eye-care services may be inadequate. Demand for, as well as, supply of services may be a problem. Rates of compliance with diabetes medications and annual eye examinations may be low, the reasons for which are multifactorial. Innovative and comprehensive approaches are needed to reduce the risk of vision loss by prompt diagnosis and early treatment of VTDR.
Collapse
Affiliation(s)
- Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | | | | |
Collapse
|
|
39
|
Mohan V, Deepa M, Pradeepa R, Prathiba V, Datta M, Sethuraman R, Rakesh H, Sucharita Y, Webster P, Allender S, Kapur A, Anjana RM. Prevention of diabetes in rural India with a telemedicine intervention. J Diabetes Sci Technol 2012; 6:1355-64. [PMID: 23294780 PMCID: PMC3570875 DOI: 10.1177/193229681200600614] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Diabetes care is not presently available, accessible, or affordable to people living in rural areas in developing countries, such as India. The Chunampet Rural Diabetes Prevention Project (CRDPP) was conceived with the aim of implementing comprehensive diabetes screening, prevention, and treatment using a combination of telemedicine and personalized care in rural India. METHODS This project was undertaken in a cluster of 42 villages in and around the Chunampet village in the state of Tamil Nadu in southern India. A telemedicine van was used to screen for diabetes and its complications using retinal photography, Doppler imaging, biothesiometry, and electrocardiography using standardized techniques. A rural diabetes center was set up to provide basic diabetes care. RESULTS Of the total 27,014 adult population living in 42 villages, 23,380 (86.5%) were screened for diabetes, of which 1138 (4.9%) had diabetes and 3410 (14.6%) had prediabetes. A total of 1001 diabetes subjects were screened for complications (response rate of 88.0%). Diabetic retinopathy was detected in 18.2%, neuropathy in 30.9%, microalbuminuria in 24.3%, peripheral vascular disease in 7.3%, and coronary artery disease in 10.8%. The mean hemoglobin A1c levels among the diabetes subjects in the whole community decreased from 9.3 ± 2.6% to 8.5 ± 2.4% within 1 year. Less than 5% of patients needed referral for further management to the tertiary diabetes hospital in Chennai. CONCLUSIONS The Chunampet Rural Diabetes Prevention Project is a successful model for screening and for delivery of diabetes health care and prevention to underserved rural areas in developing countries such as India.
Collapse
Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention & Control, IDF Centre for Education, Gopalapuram, Chennai, India.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
40
|
Vaz NC, Ferreira A, Kulkarni M, Vaz FS, Pinto N. Prevalence of diabetic complications in rural goa, India. Indian J Community Med 2012; 36:283-6. [PMID: 22279258 PMCID: PMC3263148 DOI: 10.4103/0970-0218.91330] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 09/20/2011] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determine the prevalence of diabetes mellitus (DM) and its associated diabetic complications in rural Goa, India. MATERIALS AND METHODS A community-based study was carried out in a rural setting in Goa, India. About 1,266 participants were selected by systematic random sampling. The participants were interviewed using a semi-structured questionnaire and were subjected to anthropometric, clinical evaluation and biochemical investigations. American Diabetes Association criteria were used to determine the prevalence of diabetes and standard operational definitions were used to define the diabetic complications. Data was analyzed using SPSS version 14.0 while chi-square and chi-square for trend were the tests used. RESULTS Among the total 1,266 study participants about 130 (10.3%) were diabetics. The prevalence of the associated diabetic complications were as follows viz. neuropathy (60%), CHD (32.3%) and cataract (20%), retinopathy (15.4%), peripheral vascular disease (11.5%) and cerebrovascular accidents (CVAs) (6.9%). A significant rising trend in the prevalence of all diabetic complications was observed with advancing duration of diabetes. CONCLUSION The prevalence of DM and its associated complications was higher among the diabetic individuals in the rural setting of Goa, India. All the associated diabetic complications observed need to be addressed with appropriate prevention and control strategies.
Collapse
Affiliation(s)
- Nafisa C Vaz
- Department of Preventive and Social Medicine, Goa Medical College, Bambolim, Goa, India
| | | | | | | | | |
Collapse
|
|
41
|
Sivaprasad S, Gupta B, Crosby-Nwaobi R, Evans J. Prevalence of diabetic retinopathy in various ethnic groups: a worldwide perspective. Surv Ophthalmol 2012; 57:347-70. [PMID: 22542913 DOI: 10.1016/j.survophthal.2012.01.004] [Citation(s) in RCA: 242] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 01/17/2012] [Accepted: 01/18/2012] [Indexed: 01/10/2023]
Abstract
The alarming rise in diabetes prevalence is a global public health and economic problem. Diabetic retinopathy is the most common complication of diabetes and the leading cause of blindness among working-age populations in the Western world. Screening and prompt treatment of diabetic retinopathy are not top priorities in many regions of the world, because the impacts of other causes of preventable blindness remain an issue. Ethnicity is a complex, independent risk factor for diabetic retinopathy. Observations from white populations cannot be extrapolated fully to other ethnic groups. The prevalence of diabetic retinopathy, sight-threatening diabetic retinopathy, and clinically significant macular edema are higher in people of South Asian, African, Latin American, and indigenous tribal descent compared to the white population. Although all ethnic groups are susceptible to the established risk factors of diabetic retinopathy-such as length of exposure and severity of hyperglycemia, hypertension, and hyperlipidemia-ethnic-specific risk factors also may influence these rates. Such risk factors may include differential susceptibility to conventional risk factors, insulin resistance, differences in anthropometric measurements, truncal obesity, urbanization, variations in access to healthcare systems, genetic susceptibility, and epigenetics. The rates of nonproliferative diabetic retinopathy appear to be declining in the United States, supporting the observation that better medical management of diabetes and prompt treatment of sight-threatening diabetic retinopathy substantially improve the long-term diabetic retinopathy incidence; studies from other parts of the world are limited and do not mirror this finding, however. We examine the ethnicity and region-based prevalence of diabetic retinopathy around the world and highlight the need to reinforce ethnicity-based screening and treatment thresholds in diabetic retinopathy.
Collapse
Affiliation(s)
- Sobha Sivaprasad
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
| | | | | | | |
Collapse
|
|
42
|
Vashitha A, Agarwal BK, Gupta S. Hospital Based Study: Prevalence and Predictors of type 2 diabetes mellitus in Rural Population of Haryana. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2012. [DOI: 10.1016/s2222-1808(12)60147-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
|
43
|
Corsi DJ, Subramanian SV. Association between socioeconomic status and self-reported diabetes in India: a cross-sectional multilevel analysis. BMJ Open 2012; 2:bmjopen-2012-000895. [PMID: 22815470 PMCID: PMC3401832 DOI: 10.1136/bmjopen-2012-000895] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To quantify the association between socioeconomic status (SES) and type 2 diabetes in India. DESIGN Nationally representative cross-sectional household survey. SETTING Urban and rural areas across 29 states in India. PARTICIPANTS 168 135 survey respondents aged 18-49 years (women) and 18-54 years (men). PRIMARY OUTCOME MEASURE Self-reported diabetes status. RESULTS Markers of SES were social caste, household wealth and education. The overall prevalence of self-reported diabetes was 1.5%; this increased to 1.9% and 2.5% for those with the highest levels of education and household wealth, respectively. In multilevel logistic regression models (adjusted for age, gender, religion, marital status and place of residence), education (OR 1.87 for higher education vs no education) and household wealth (OR 4.04 for richest quintile vs poorest) were positively related to self-reported diabetes (p<0.0001). In a fully adjusted model including all socioeconomic variables and body mass index, household wealth emerged as positive and statistically significant with an OR for self-reported diabetes of 2.58 (95% credible interval (CrI): 1.99 to 3.40) for the richest quintile of household wealth versus the poorest. Nationally in India, a one-quintile increase in household wealth was associated with an OR of 1.31 (95% CrI 1.20 to 1.42) for self-reported diabetes. This association was consistent across states with the relationship found to be positive in 97% of states (28 of 29) and statistically significant in 69% (20 of 29 states). CONCLUSIONS The authors found that the highest SES groups in India appear to be at greatest risk for type 2 diabetes. This raises important policy implications for addressing the disease burdens among the poor versus those among the non-poor in the context of India, where >40% of the population is living in poverty.
Collapse
Affiliation(s)
- Daniel J Corsi
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - S V Subramanian
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
|
44
|
Weil EJ, Curtis JM, Hanson RL, Knowler WC, Nelson RG. The impact of disadvantage on the development and progression of diabetic kidney disease. Clin Nephrol 2010; 74 Suppl 1:S32-8. [PMID: 20979961 PMCID: PMC3472657 DOI: 10.5414/cnp74s032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Disadvantaged people include those experiencing economic, social or educational deprivation and, in some cases, those undergoing rapid transition from subsistence to industrial economies. Disadvantaged people worldwide are affected disproportionately by the global epidemic of diabetes. They are also at increased risk of kidney disease attributable to diabetes, and for many, the cost of managing their kidney disease far exceeds their available resources. METHODS We review factors associated with disadvantage that may increase the risk of diabetic kidney disease, and the barriers to care that hinder attempts to provide an adequate therapeutic response. RESULTS AND CONCLUSIONS A rapidly rising prevalence and magnitude of obesity among children and adults, increasing frequency of intrauterine exposure to diabetes, and inadequate access to healthcare are responsible, in part, for a surge in the frequency of diabetes and, in turn, diabetic kidney disease among disadvantaged people. These factors may also predispose to an earlier onset of diabetes and kidney disease, thereby perpetuating the disadvantage by reducing the earning potential of those affected through illness and disability.
Collapse
Affiliation(s)
- E J Weil
- Diabetes Epidemiology and Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | | | | | | | | |
Collapse
|
|
45
|
Cunningham J. Socio-economic gradients in self-reported diabetes for Indigenous and non-Indigenous Australians aged 18-64. Aust N Z J Public Health 2010; 34 Suppl 1:S18-24. [PMID: 20618286 DOI: 10.1111/j.1753-6405.2010.00547.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine and compare socio-economic gradients in diabetes among Indigenous and non-Indigenous Australians. METHODS I analysed weighted data on self-reported diabetes and a range of socio-economic status (SES) measures for 5,417 Indigenous and 15,432 non-Indigenous adults aged 18-64 years from two nationally representative surveys conducted in parallel by the Australian Bureau of Statistics in 2004-05. RESULTS After adjusting for age, diabetes prevalence was significantly higher among those of lower SES in both Indigenous and non-Indigenous populations. The age- and sex-adjusted odds ratios (OR) for diabetes for the lowest versus the highest SES group were similar for the two populations on many variables. For example, the OR for the lowest quintile of equivalised household income (compared with quintiles 3-5 combined) was 2.3 (95% CI 1.6-3.4) for the Indigenous population and 2.0 (95% CI 1.5-2.8) for the non-Indigenous population. However, Indigenous people of high SES had greater diabetes prevalence than low SES non-Indigenous people on every SES measure examined. CONCLUSION Socio-economic status explains some but not all of the difference in diabetes prevalence between Indigenous and non-Indigenous Australians. Other factors that may operate across the socio-economic spectrum, such as racism, stress, loss and grief, may also be relevant and warrant further examination. IMPLICATIONS Indigenous Australians do not constitute a homogeneous group with respect to socio-economic status or diabetes prevalence, and this diversity must be recognised in developing measures to redress Indigenous health disadvantage.
Collapse
Affiliation(s)
- Joan Cunningham
- Menzies School of Health Research and Institute of Advanced Studies, Charles Darwin University, Northern Territory.
| |
Collapse
|
|
46
|
Abstract
Prevalence of type 2 diabetes has rapidly increased in native and migrant Asian populations. Diabetes develops at a younger age in Asian populations than in white populations, hence the morbidity and mortality associated with the disease and its complications are also common in young Asian people. The young age of these populations and the high rates of cardiovascular risk factors seen in Asian people substantially increase lifetime risk of cardiovascular disease. Several distinctive features are apparent in pathogenetic factors for diabetes and their thresholds in Asian populations. The economic burden due to diabetes at personal, societal, and national levels is huge. National strategies to raise public awareness about the disease and to improve standard of care and implementation of programmes for primary prevention are urgently needed.
Collapse
Affiliation(s)
- Ambady Ramachandran
- India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India.
| | | | | |
Collapse
|
|
47
|
Goldhaber-Fiebert JD, Li H, Ratanawijitrasin S, Vidyasagar S, Wang XY, Aljunid S, Shah N, Wang Z, Hirunrassamee S, Bairy KL, Wang J, Saperi S, Nur AM, Eggleston K. Inpatient treatment of diabetic patients in Asia: evidence from India, China, Thailand and Malaysia. Diabet Med 2010; 27:101-8. [PMID: 20121896 DOI: 10.1111/j.1464-5491.2009.02874.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS The prevalence of Type 2 diabetes mellitus (DM) has grown rapidly, but little is known about the drivers of inpatient spending in low- and middle-income countries. This study aims to compare the clinical presentation and expenditure on hospital admission for inpatients with a primary diagnosis of Type 2 DM in India, China, Thailand and Malaysia. METHODS We analysed data on adult, Type 2 DM patients admitted between 2005 and 2008 to five tertiary hospitals in the four countries, reporting expenditures relative to income per capita in 2007. RESULTS Hospital admission spending for diabetic inpatients with no complications ranged from 11 to 75% of per-capita income. Spending for patients with complications ranged from 6% to over 300% more than spending for patients without complications treated at the same hospital. Glycated haemoglobin was significantly higher for the uninsured patients, compared with insured patients, in India (8.6 vs. 8.1%), Hangzhou, China (9.0 vs. 8.1%), and Shandong, China (10.9 vs. 9.9%). When the hospital admission expenditures of the insured and uninsured patients were statistically different in India and China, the uninsured always spent less than the insured patients. CONCLUSIONS With the rising prevalence of DM, households and health systems in these countries will face greater economic burdens. The returns to investment in preventing diabetic complications appear substantial. Countries with large out-of-pocket financing burdens such as India and China are associated with the widest gaps in resource use between insured and uninsured patients. This probably reflects both overuse by the insured and underuse by the uninsured.
Collapse
Affiliation(s)
- J D Goldhaber-Fiebert
- Centers for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
48
|
Ali MK, Narayan KMV, Mohan V. Innovative research for equitable diabetes care in India. Diabetes Res Clin Pract 2009; 86:155-67. [PMID: 19796835 DOI: 10.1016/j.diabres.2009.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 06/05/2009] [Accepted: 09/07/2009] [Indexed: 11/26/2022]
Abstract
The emergence of non-communicable diseases (NCD) in South Asia and other low- and middle-income countries presents a growing and costly public health challenge. The surreptitious and rapid escalation of these chronic conditions will soon surpass attempts to quantify and appropriately respond to these overwhelming health threats. Given the elevated risk of cardio-metabolic diseases (diabetes, cardiovascular disease, and kidney disease) and projected morbidity and mortality burdens in the Asian Indian population group, the lack of representative data to support national response strategies will likely result in crippling health and socioeconomic losses. We describe how systematic research may help to reconcile India's data deficits and may be applied towards prioritizing resource allocation and addressing shortfalls in disease prevention and control efforts. Expanding the scope of and contextualizing NCD health research in India may also have tremendous benefits for resource allocation and planning in other developing countries.
Collapse
Affiliation(s)
- Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | | | | |
Collapse
|
|
49
|
Abstract
India, a country experiencing rapid socioeconomic progress and urbanization, carries a considerable share of the global diabetes burden. Studies in different parts of India have demonstrated an escalating prevalence of diabetes not only in urban populations, but also in rural populations as a result of the urbanization of lifestyle parameters. The prevalence of prediabetes is also high. Recent studies have shown a rapid conversion of impaired glucose tolerance to diabetes in the southern states of India, where the prevalence of diabetes among adults has reached approximately 20% in urban populations and approximately 10% in rural populations. Because of the considerable disparity in the availability and affordability of diabetes care, as well as low awareness of the disease, the glycemic outcome in treated patients is far from ideal. Lower age at onset and a lack of good glycemic control are likely to increase the occurrence of vascular complications. The economic burden of treating diabetes and its complications is considerable. It is appropriate that the Indian Government has initiated a national program for the management and prevention of diabetes and related metabolic disorders. Lifestyle modification is an effective tool for the primary prevention of diabetes in Asian Indians. The primary prevention of diabetes is urgently needed in India to curb the rising burden of diabetes.
Collapse
Affiliation(s)
- Ambady Ramachandran
- India Diabetes Research Foundation and Dr A. Ramachandran's Diabetes Hospitals, Chennai, India.
| | | |
Collapse
|
|
50
|
Raman R, Rani PK, Reddi Rachepalle S, Gnanamoorthy P, Uthra S, Kumaramanickavel G, Sharma T. Prevalence of diabetic retinopathy in India: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study report 2. Ophthalmology 2008; 116:311-8. [PMID: 19084275 DOI: 10.1016/j.ophtha.2008.09.010] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 08/26/2008] [Accepted: 09/04/2008] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of the study was to estimate the prevalence of diabetic retinopathy in an urban Indian population older than 40 years. DESIGN A population-based cross-sectional study. PARTICIPANTS Five thousand nine hundred ninety-nine subjects residing in Chennai, India, were enumerated. METHODS A multistage random sampling, based on socioeconomic criteria, was followed. Identified subjects with diabetes mellitus (based on the World Health Organization criteria) underwent detailed examination at the base hospital. The fundi of all patients were photographed using 45 degrees , 4-field stereoscopic digital photography. The diagnosis of diabetic retinopathy was based on Klein's classification of the Early Treatment Diabetic Retinopathy Study scale. MAIN OUTCOME MEASURES These included age- and gender-adjusted prevalence of diabetes and diabetic retinopathy, and correlation of prevalence with history-based risk factors. RESULTS The age- and gender-adjusted prevalence rate of diabetes in an urban Chennai population was 28.2% (95% confidence interval [CI], 27.0-29.3), and the prevalence of diabetic retinopathy in general population was 3.5% (95% CI, 3.49-3.54). The prevalence of diabetic retinopathy in the population with diabetes mellitus was 18.0% (95% CI, 16.0-20.1). History-based variables that were significantly associated with increased risk of diabetic retinopathy included gender (men at greater risk; odds ratio [OR], 1.41; 95% CI, 1.04-1.91); use of insulin (OR, 3.52; 95% CI, 2.05-6.02); longer duration of diabetes (>15 years; OR, 6.43; 95% CI, 3.18-12.90); and subjects with known diabetes mellitus (OR, 2.98; 95% CI, 1.72-5.17). Differences in the socioeconomic status did not influence the occurrence of diabetic retinopathy. CONCLUSIONS The prevalence of diabetic retinopathy was 18% in an urban population with diabetes mellitus in India. The duration of diabetes is the strongest predictor for diabetic retinopathy. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Collapse
Affiliation(s)
- Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India
| | | | | | | | | | | | | |
Collapse
|