Poorer Attainment of Hemoglobin A1C, Blood Pressure and LDL-Cholesterol Goals among Younger Adults with Type 2 Diabetes

Concurrent attainment of glycated haemoglobin A1C, blood pressure, and LDL-cholesterol goals, or collectively known as the ‘ABC’ goals, help prevent cardiovascular complications in patients with type 2 diabetes (T2D). We aimed to determine the proportion of T2D patients who achieved all three ABC goals in Malaysia’s public health clinics. We also determined the association between age groups with the attainment of all the ABC goals. A cross-sectional analysis of the baseline findings from a retrospective open cohort study between 2013 and 2017 in Negeri Sembilan, Malaysia was conducted. The data was extracted from the National Diabetes Registry. The primary outcome was the proportion of patients who attained all three ABC goals. The exposure of interest was patients’ age groups, namely 18-44, 45-59 and ≥ 60 years. Multivariate logistic regression analysis was used to adjust demographics factors, comorbidities, complications and treatment profiles. Among 17,592 patients, the mean age was 59.1 years, with 56.3% females and 64.9% Malays. Overall, 4.5% (95% CI: 4.2-4.8) of the patients attained all the ABC goals. Compared to older adults aged ≥ 60 years, patients aged 18-44 and 45-59 years had adjusted odds ratios of 0.50 and 0.72, respectively, to achieve all the ABC goals. Ethnicity, body mass index, diabetes treatment modality, lipid-lowering agent and polypharmacy were independent factors associated with the outcome. In summary, achieving all the ABC goals in T2D patients is challenging, especially among younger adults. Our findings suggest that more targeted interventions should be directed towards this high-risk subpopulation.

The Association of Higher Composite Biomarker Score of Antioxidant Vitamins with Lower Cardiovascular Diseases Risk: A Cross-Sectional Study

Biomarkers for the dietary system, which includes a mixed fruit and vegetable (FV), are needed to understand the association of FV intake with a reduction in cardiovascular diseases risk. This is a cross-sectional study that aims to find the potential relationship between a high composite score comprised of antioxidant vitamins and a lower incidence of cardiovascular diseases (CVD). A total of 94 (42 males and 52 females) participants (mean age ± SD: 51.7 ± 9.4 years) completed a specific questionnaire including a quick food scan, which has designed by the American National Institutes of Health. The vitamins A, C, and E were determined using high-performance liquid chromatography (HPLC). An enzymatic colorimetric method was used to determine other biomarkers [fasting blood sugar (FBS), haemoglobin A1c (HbA1c), and lipid profile]. A Composite Biomarker Score (CBS) comprising of the plasma vitamins (A, C, and E) have been derived. The results showed that male participants demonstrated significantly higher atherosclerotic cardiovascular disease (ASCVD) risk than female participants. Female participants with greater ASCVD risk were associated with significantly higher age, total cholesterol, and triglyceride concentrations. Additionally, there is a significant relationship between the CBS with lower ASCVD risk. Consequently, it can be concluded that higher concentrations of serum antioxidant vitamins are related to a reduction in cardiovascular diseases risk.

Home monitoring of HbA1c in diabetes mellitus: A protocol for systematic review and narrative synthesis on reliability, accuracy, and patient acceptability

Introduction Worldwide there are an estimated 463 million people with diabetes. [1] In the UK people with diabetes are offered an annual review including monitoring of Haemoglobin A1c (HbA1c). [2] [3] This can identify people with diabetes who are not meeting their glycaemic targets, enabling early intervention. Those who do not attend these reviews often have higher HbA1c levels and poorer health outcomes. [4] During the Coronavirus disease of 2019 (COVID-19) pandemic, there was a 77% reduction in monitoring of HbA1c in the UK. [5] We hypothesise that people with diabetes could take finger-prick samples at home for the measurement of HbA1c. Method and Analysis We will perform a systematic review of current evidence for capillary blood collected at home for the measurement of HbA1c. We will examine the validity, reliability, safety, and patient acceptability of the use of capillary blood compared with the usual standard of care of venous blood. We will explore variables which affect validity of results. Using core terms of 'Diabetes', 'HbA1c' and 'Capillary sampling' we will search MEDLINE, Embase, CINAHL, Web of Science Core Collection, Google Scholar, Open Grey and other grey literature from database inception until 2021. Risk of bias will be assessed using the 'COSMIN risk of bias tool to assess the quality of studies on reliability and measurement error'. Database searches and data extraction for primary outcomes will be conducted in duplicate. We will produce a narrative synthesis exploring how variables of capillary blood collection impact on validity, as well as exploring the safety and acceptability of patient self-collection. Ethics and Dissemination This review will be submitted for publication in a peer-reviewed open-access journal. We will present our results at both national and international conferences. As a systematic review with no primary participant data or involvement, ethical approval is not applicable. PROSPERO registration number CRD42021225606

Thailand effective coverage of diabetes and hypertension: challenges and solutions

BackgroundIncreased Disability Adjusted Life Year (DALY) of diabetes and hypertension draws policy attention to improve effective coverage. This study assesses effective coverage of the two conditions in Thailand between 2016 and 2019.MethodWe estimated total diabetes and hypertension cases using age and sex specific prevalence rates for respective populations. Individual data from public insurance databases (2016-2019) were retrieved to estimate three indicators: detected need (diagnosed/total estimated cases), crude coverage (received health services/total estimated cases) and effective coverage (controlled/total estimated cases). Controlled diabetes was defined as Haemoglobin A1C (HbA1C) below 7% and controlled hypertension as blood pressure below 140/90 mmHg. In-depth interview of 85 multi-stakeholder key informants was conducted to identify challenges to better effective coverage.FindingsIn 2016-2019, among Universal Coverage Scheme members residing outside Bangkok, estimated cases were around 3.1-3.2 million for diabetes and 8.7-9.2 million for hypertension. For diabetes services, all three indicators have shown slow increase over the four years (67.4%, 69.9%, 71.9%, and 74.7% for detected need; 38.7%, 43.1%, 45.1%, 49.8% for crude coverage; and 8.1%, 10.5%, 11.8%, 11.7% for effective coverage). For hypertension services, the performance was poorer for detection (48.9%, 50.3%, 51.8%, 53.3%) and crude coverage (22.3%, 24.7%, 26.5%, 29.2%) but was better for effective coverage (11.3%, 13.2%, 15.1%, 15.7%) than diabetes service. For both diseases, the estimates were higher for the females and older age groups than their counterparts. Complex interplays between supply and demand side barriers were a key challenge. Database challenges remain which hamper regular assessment of effective coverage.RecommendationsGiven the increased diabetes and hypertension prevalence, strategic recommendations cover long term actions for primary prevention of known risk factors as unhealthy diet and sedentary behaviour. Short term actions aim to improve effective coverage through the application of Chronic Care Model, increase attention to non-pharmacological intervention and patient empowerment.

Hypoglycemic and Hepatoprotective Effects of Dried and Rice-Fried Psidium guajava Leaves in Diabetic Rats

Psidium guajava leaves (PGL) have been long used as an adjuvant therapy for diabetics. The present study evaluated the in vivo hypoglycemic and hepatoprotective effects of dried and the rice-fried PGL decoctions (PGLD and RPGLD). Our results indicated that both PGLD and RPGLD could significantly decrease the contents of fasting blood glucose (FBG) and haemoglobin A1c (HbA1c) in diabetic rats. Compared with the HFD/STZ (high-fat diet with streptozotocin) group, the PGLD and RPGLD-treated diabetic rats showed different degrees of recovery against the liver pathological changes. The upregulated expressions of glucokinase (GK), glucose transporter 2 (GLUT2), insulin growth factor-1 (IGF-1), insulin receptor substrate-1 (IRS-1), and insulin receptor substrate-2 (IRS-2) in PGLD and RPGLD-treated groups were observed. In general, RPGLD exhibited a much better antidiabetic effect than PGLD, which was further verified by the comprehensive evaluation with the TOPSIS method. Besides, HPLC (high-performance liquid chromatography) and UPLC-MS/MS (ultra-performance liquid chromatography-tandem mass spectrometry) analyses revealed that the contents of the primary constituents (ellagic acid, hyperoside, isoquercitroside, reynoutrin, guaijaverin, auicularin, and quercetin) in RPGLD increased obviously compared with PGLD. These results shed new light on the antidiabetic potential and mechanism of PGL, as well as the “higher efficacy” of the rice-fried processing method in traditional Chinese medicine.

Guided self-determination intervention versus attention control for people with type 2 diabetes in outpatient clinics: a protocol for a randomised clinical trial

IntroductionIn the management of type 2 diabetes, autonomy-supporting interventions may be a prerequisite to achieving more long-term improvement. Preliminary evidence has shown that the guided self-determination (GSD) method might have an effect on haemoglobin A1c and diabetes distress in people with type 1 diabetes. Previous trials were at risk of uncertainty. Thus, the objective is to investigate the benefits and harms of a GSD intervention versus an attention control group intervention in adults with type 2 diabetes.Methods and analysisThis trial protocol is guided by the The Standard Protocol Items: Recommendations for International Trials Statement. We describe the protocol for a pragmatic randomised, dual-centre, parallel-group, superiority clinical trial testing a GSD intervention versus an attention control for people with type 2 diabetes in outpatient clinics. The participants (n=224) will be recruited from two diverse regions of Denmark. The experimental stepped-care intervention will consist of three to five GSD sessions lasting up to 1 hour with a trained GSD facilitator. The sessions will be conducted face to face, by video conference or over the telephone. The attention controls will receive three to five sessions lasting up to an hour with a communication-trained healthcare professional provided face to-face, by video conference, or over the telephone. Participants will be included if they have type 2 diabetes,>18 years old, are not pregnant. Participants will be assessed before randomisation, at 5-month, and 12-month follow-up, the latter being the primary. The primary outcome is diabetes distress. Secondary outcomes are quality of life, depressive symptoms and non-serious adverse events. Exploratory outcomes are haemoglobin A1c, motivation and serious adverse events. Data will be collected using REDCap and analysed using Stata V.16.Ethics and disseminationThe trial will be conducted in compliance with the protocol, the Helsinki Declaration in its latest form, International Harmonisation of Good Clinical Practice guidelines and the applicable regulatory requirement(s). The trial has been approved by the Danish Data Protection Agency (P-2020-864). The Ethics Committee of the Capital Region of Denmark reviewed the trial protocol, but exempted the trial protocol from full review (H-20003638). The results of the trial will be presented at the outpatient clinics treating people with type 2 diabetes, at national and international conferences as well as to associations for people with diabetes and their relatives.Trial registration numberClinicalTrials.gov identifier: NCT04601311.

Associations between diabetes duration and self-stigma development in Japanese people with type 2 diabetes: a secondary analysis of cross-sectional data

ObjectivesTo examine the associations between self-stigma and diabetes duration in a sample of Japanese people with type 2 diabetes.DesignA secondary analysis of a cross-sectional study.SettingTwo university hospitals, one general hospital and one clinic in Tokyo, Japan.ParticipantsOutpatients with type 2 diabetes aged 20–74 years and receiving treatment from diabetes specialist physicians (n=209) completed a self-administered questionnaire.Primary and secondary outcome measuresSelf-stigma was measured as the primary outcome. Patient Activation Measure, body mass index and haemoglobin A1c were measured as secondary outcomes.ResultsOne-way analysis of covariance showed significant differences in self-stigma levels between the five groups of diabetes duration (≤5 years, 6–10 years, 11–15 years, 16–21 years and 22 years or more) after controlling for age, gender, education, marital status, diabetes treatment (insulin use) and diabetes-related complications, F(4,198)=2.83, p=0.026. Multiple comparisons using Bonferroni correction showed statistically significant differences in self-stigma levels between the groups with ≤5 years (95% CI 59.63 to 69.73) and 11–15 years with diabetes (95% CI 71.12 to 80.82; p=0.020). The highest mean level of self-stigma was observed in the group having diabetes for 11–15 years.ConclusionsSelf-stigma was associated with diabetes duration and was lowest after diagnosis and gradually increased, with its highest levels being observed in those having diabetes for 11–15 years. Self-stigma takes time to develop and gradually increases in individuals as it is learnt through direct experiences of diabetes-related stigma after self-administering treatment in everyday social situations.

Eight-Year Retrospective Study of Young Adults in a Diabetes Transition Clinic

The transition of people from paediatric to adult diabetes services is associated with worsening glycaemia and increased diabetes-related hospitalisation. This study compared the clinical characteristics of those with and without mental health conditions among attenders at a diabetes young adult clinic diabetes before and after changes in service delivery. Retrospective audit of 200 people with diabetes attending a Sydney public hospital over eight years corresponding to the period before (2012–2016) and after (2017–2018) restructuring of a clinic for young adults aged 16–25 years. Characteristics of those with and without mental health conditions (depression, anxiety, diabetes related distress, eating disorders), were compared. Among clinic attenders (type 1 diabetes n = 184, 83.2%), 40.5% (n = 89) had a mental health condition particularly, depression (n = 57, 64%), which was higher among Indigenous than non-Indigenous people (5.6% vs. 0.8%, p = 0.031) but similar between diabetes type. Over eight years, those with, compared with those without a mental health condition had higher haemoglobin A1c (HbA1c) at the last visit (9.4% (79 mmol/mol) vs. 8.7% (71 mmol/mol), p = 0.027), the proportion with diabetic ketoacidosis (DKA 60.7% vs. 42.7%, p = 0.009), smoking (38.4 vs. 13.6%, p = 0.009), retinopathy (9.0 vs. 2.3%, p = 0.025), multiple DKAs (28.4 vs. 16.0%, p = 0.031) were significantly higher. Having a mental health condition was associated with 2.02 (95% confidence intervals 1.1–3.7) fold increased risk of HbA1c ≥9.0% (75 mmol/mol). Changes to the clinic were not associated with improvements in mental health condition (39.0% vs. 32.4%, p = 0.096). In conclusion, we found that mental health conditions, particularly depression, are common in this population and are associated with diabetes complications. Diabetes type and clinic changes did not affect the reported mental health conditions. Additional strategies including having an in-house psychologist are required to reduce complication risks among those with mental health conditions.