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10 pages, 1602 KiB

Open AccessArticle

Time to Treatment Intensification to Reduce Diabetes-Related Complications: A Post Hoc Study

by Piranee Kaewbut, Natapong Kosachunhanun, Arintaya Phrommintikul, Dujrudee Chinwong, John J. Hall and Surarong Chinwong

Healthcare 2022, 10(9), 1673; https://doi.org/10.3390/healthcare10091673 - 01 Sep 2022

Cited by 3 | Viewed by 1580

Abstract

Patients with type 2 diabetes mellitus (T2DM) can be affected by clinical inertia, leading to abysmal results. Studies on a suitable timeframe for treatment intensification remain scarce—especially outside of developed countries. This study aimed to explore the association between time to treatment intensification [...] Read more.

Patients with type 2 diabetes mellitus (T2DM) can be affected by clinical inertia, leading to abysmal results. Studies on a suitable timeframe for treatment intensification remain scarce—especially outside of developed countries. This study aimed to explore the association between time to treatment intensification and diabetes-related complications. A database from a tertiary care hospital in Thailand was retrieved in order to conduct a retrospective cohort study for the years 2011–2017. This study comprised outpatients with T2DM presenting an HbA1c of ≥7.0%. Eligible patients were divided into three groups based on the time of treatment intensification: no delayed treatment intensification, treatment intensification within 6 months, and treatment intensification after 6 months. A Cox proportional hazards model was used to investigate the association between time to treatment intensification and diabetes-related complications. A total of 686 patients were included in the final analysis. During 6.5 years of median follow-up, the group with treatment intensification within 6 months was more strongly associated with diabetic nephropathy compared to the group with no delayed treatment intensification (adjusted HR 2.35; 95%CI 1.35–4.09). Our findings reveal that delaying treatment intensification by even 6 months can increase the likelihood of diabetic nephropathy compared to no delayed treatment intensification. We suggest that patients with T2DM whose blood glucose levels are outside the target range promptly receive treatment intensification. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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8 pages, 217 KiB

Open AccessArticle

The Socio-Economic Cost of Diabetes Mellitus in Korea Using National Health Insurance Claim Data, 2017

by Heesun Kim and Eun-Jung Kim

Healthcare 2022, 10(9), 1601; https://doi.org/10.3390/healthcare10091601 - 23 Aug 2022

Viewed by 1098

Abstract

(1) Purpose: As the economy develops and lifestyles become more westernized, diabetes is on the rise in Korea. This study tried to measure the socio-economic cost of diabetes by estimating the direct medical expenses and indirect costs used in Korea during the year [...] Read more.

(1) Purpose: As the economy develops and lifestyles become more westernized, diabetes is on the rise in Korea. This study tried to measure the socio-economic cost of diabetes by estimating the direct medical expenses and indirect costs used in Korea during the year due to diabetes mellitus. (2) Methods: This study extracted the insurance claim records from the Korea National Health Insurance claim database to determine the healthcare services provided to patients with diabetes mellitus in 2017. The total diabetes mellitus-related cost was the sum of the direct medical care costs: the costs paid by insurers and patients, the non-covered care costs and the prescribed pharmaceuticals costs, and also the direct non-medical care costs: the transportation costs for visits in outpatients and inpatients and the guardian’s cost for hospitalized patients, as well as the indirect cost: lost productivity. (3) Findings: The total socio-economic cost of diabetic patients in 2017 measured in this study was KRW 3.2 trillion, of which 48.3% was used for medical expenses, 10% was non-medical expenses, and 41.7% was estimated as indirect expenses. (4) Implications: Korea is considered to be aging significantly, and it is considered that more attention should be paid to reducing medical expenses through diabetes management. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

16 pages, 2426 KiB

Open AccessEditor’s ChoiceArticle

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

by Salvatore Corrao, Giuseppe Natoli, Alessandro Nobili, Pier Mannuccio Mannucci, Francesco Perticone, Vincenzo Arcoraci and Christiano Argano

Healthcare 2022, 10(8), 1459; https://doi.org/10.3390/healthcare10081459 - 03 Aug 2022

Cited by 4 | Viewed by 2511

Abstract

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing [...] Read more.

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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16 pages, 1998 KiB

Open AccessArticle

Clinical Parameters Affecting the Therapeutic Efficacy of SGLT-2—Comparative Effectiveness and Safety of Dapagliflozin and Empagliflozin in Patients with Type 2 Diabetes

by Irina Claudia Anton, Liliana Mititelu-Tartau, Eliza Gratiela Popa, Mihaela Poroch, Vladimir Poroch, Delia Reurean Pintilei and Gina Eosefina Botnariu

Healthcare 2022, 10(7), 1153; https://doi.org/10.3390/healthcare10071153 - 21 Jun 2022

Cited by 1 | Viewed by 2582

Abstract

(1) Background. We aimed to assess long-term efficacy and safety in inadequately controlled type 2 diabetes (T2DM) of two SGLT-2 inhibitors: empagliflozin (Empa) and dapagliflozin (Dapa), combined with metformin, other oral antidiabetics or insulin, according to the protocols in Romania. (2) Methods. The [...] Read more.

(1) Background. We aimed to assess long-term efficacy and safety in inadequately controlled type 2 diabetes (T2DM) of two SGLT-2 inhibitors: empagliflozin (Empa) and dapagliflozin (Dapa), combined with metformin, other oral antidiabetics or insulin, according to the protocols in Romania. (2) Methods. The data of 100 patients treated for T2DM with associated dyslipidemia and/or cardiovascular diseases at the University Hospital and Consultmed Medical Center in Iasi were retrospectively reviewed (2017–2021). In total, 48 patients had received dapagliflozin (10 mg with oral antidiabetics or insulin) and 52 patients received empagliflozin (10 mg /25 mg with oral antidiabetics). (3) Results. In both groups, the lowering of BMI was significant: Dapa group (32.04 ± 4.49 vs. 31.40 ± 4.18 kg/m²; p = 0.006), and Empa group (34.16 ± 5.08 vs. 33.17 ± 4.99 kg/m²; p = 0.002). Blood sugar average levels decreased significantly (170 vs. 136 mg/dL; p = 0.001 for Dapa; 163 vs. 140 mg/dL; p = 0.002 for Empa) and also average levels of HbA1c (7.90% vs. 7.51%; p = 0,01 for Dapa; 7.72% vs. 7.35%; p = 0.004 for Empa). (4) Conclusions. Better results in all variables were observed in younger male patients with a shorter duration of diabetes and threshold BMI levels of 34.1, treated with SGLT2, and more significantly with Empa. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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7 pages, 564 KiB

Open AccessArticle

The Impact of COPD on Hospitalized Patients with Diabetes: A Propensity Score Matched Analysis on Discharge Records

by Giuseppe Di Martino, Pamela Di Giovanni, Fabrizio Cedrone, D’Addezio Michela, Francesca Meo, Piera Scampoli, Ferdinando Romano and Tommaso Staniscia

Healthcare 2022, 10(5), 885; https://doi.org/10.3390/healthcare10050885 - 11 May 2022

Cited by 1 | Viewed by 1094

Abstract

(1) Background: Type 2 diabetes is a common comorbidity of chronic obstructive pulmonary disease. Despite the lack of knowledge of the pathophysiological link between diabetes and chronic obstructive pulmonary disease, the presence of diabetes among those with chronic obstructive pulmonary disease is associated [...] Read more.

(1) Background: Type 2 diabetes is a common comorbidity of chronic obstructive pulmonary disease. Despite the lack of knowledge of the pathophysiological link between diabetes and chronic obstructive pulmonary disease, the presence of diabetes among those with chronic obstructive pulmonary disease is associated with worse outcomes, such as mortality and hospitalization. The aim of this study was to evaluate the impact of chronic obstructive pulmonary disease on in-hospital mortality and prolonged length of stay (PLOS) among patients with diabetes. (2) Methods: The study considered all hospital admissions of patients with diabetes aged over 65 years performed from 2006 to 2015 in Abruzzo, Italy. To compare outcomes between patients with and without chronic obstructive pulmonary disease, a propensity score matching procedure was performed. (3) Results: During the study period, 140,556 admissions of patients with diabetes were performed. After matching, 18,379 patients with chronic obstructive pulmonary disease and 18,379 controls were included in the analyses. Logistic regression analyses showed as chronic obstructive pulmonary disease was associated with in-hospital mortality (OR: 1.10; p = 0.036) and PLOS (OR: 1.18; p = 0.002). (4) Conclusions: In a cohort of Italian patients, diabetic patients with chronic obstructive pulmonary disease were associated with in-hospital mortality and PLOS. The definition of the causes of these differences aims to implement public health surveillance and policies. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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10 pages, 239 KiB

Open AccessArticle

Correlations between Diabetes Mellitus Self-Care Activities and Glycaemic Control in the Adult Population: A Cross-Sectional Study

by Mihaela Simona Popoviciu, Violeta Nicoleta Marin, Cosmin Mihai Vesa, Simona Diana Stefan, Roxana Adriana Stoica, Cristian Serafinceanu, Emanuele Maria Merlo, Ali A Rizvi, Manfredi Rizzo, Stefan Busnatu and Anca Pantea Stoian

Healthcare 2022, 10(1), 174; https://doi.org/10.3390/healthcare10010174 - 17 Jan 2022

Cited by 27 | Viewed by 2735

Abstract

Although it is well known that lifestyle changes can affect plasma glucose levels, there is little formal evidence for the sustained effectiveness of exercise and diet in diabetes mellitus (DM) management. Self-care in DM refers to the real-life application of the knowledge that [...] Read more.

Although it is well known that lifestyle changes can affect plasma glucose levels, there is little formal evidence for the sustained effectiveness of exercise and diet in diabetes mellitus (DM) management. Self-care in DM refers to the real-life application of the knowledge that the patient gained during the education programmes. The goals are to bring about changes in the patient’s behaviour, thus improving glycaemic control. We evaluated the influence of DM self-care activities (SCA) on glycaemic control in a total of 159 patients with DM. Plasma glycated haemoglobin (HbA1c) levels were used to monitor glycaemic control, while SCA were assessed using the standardised Diabetes Self-Management Questionnaire (DSMQ). In our study, 53% of the patients had a HbA1c ≥ 7%. In univariate linear regression models, a statistically significant inverse association was observed between the HbA1c (the dependent variable) and both the DSMQ Dietary Control Score (R2 = 0.037, p = 0.0145) and the DSMQ Sum Score (R2 = 0.06, p = 0.0014). The mean absolute change in the HbA1c% associated with one standard deviation (SD) change in the DSMQ Sum Score, independent of the other significant variables retained in the compacted multivariate regression model, was −0.419% (confidence interval: 95%: from −0.18 to −0.65). Although the impact of the DSMQ Score was modest when compared to the other independent variables in the multivariate model, the findings emphasise the importance of maintaining optimal lifestyle changes to avoid hyperglycaemia and its complications. In conclusion, enhanced self-management of DM is associated with improved glucose control. In patients with chronic diseases such as DM, the role of streamlining SCA encompassing physical activity and proper dietary choices is imperative because of a significantly reduced access to healthcare globally as a result of the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

9 pages, 638 KiB

Open AccessArticle

Exploring the Quality of Life Related to Health and Vision in a Group of Patients with Diabetic Retinopathy

by Ian Roberts-Martínez Aguirre, Paula Rodríguez-Fernández, Josefa González-Santos, Nerea Aguirre-Juaristi, Nuria Alonso-Santander, Juan Mielgo-Ayuso and Jerónimo J. González-Bernal

Healthcare 2022, 10(1), 142; https://doi.org/10.3390/healthcare10010142 - 12 Jan 2022

Cited by 9 | Viewed by 2318

Abstract

(1) Background: Visual impairment of people with diabetic retinopathy (DR) and its high impact on different dimensions of their lives can cause a significant deterioration in the quality of life. The aim of this study was to examine the association and relationship between [...] Read more.

(1) Background: Visual impairment of people with diabetic retinopathy (DR) and its high impact on different dimensions of their lives can cause a significant deterioration in the quality of life. The aim of this study was to examine the association and relationship between quality of life related to vision and the relevant clinical and sociodemographic variables in a group of patients with DR in Spain. (2) Methods: A descriptive cross-sectional study was conducted in all patients with DR over 18 years under follow-up in the Retina Service of the University Hospital of Burgos (HUBU), recruited during the months of January and February 2020. The main study variable was quality of life related to health and vision, obtained using the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25). (3) Results: In total 87 participants made up the sample, and significant differences were found in the NEI-VFQ-25 according to gender, type of diabetes, episodes of decompensated diabetes and high blood pressure (HBP) (p < 0.05). Best-corrected visual acuity (BCVA) was also correlated with the NEI-VFQ-25 (p < 0.05). (4) Conclusions: These data could facilitate the design of action protocols focused on the well-being of the patient, in addition to considering the clinical characteristics. Further studies are needed to help understand the causal relationship between variables and that includes a wider variety of factors. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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15 pages, 945 KiB

Open AccessArticle

Impact of Diabetes Mellitus and Its Comorbidities on Elderly Patients Hospitalized in Internal Medicine Wards: Data from the RePoSi Registry

by Christiano Argano, Giuseppe Natoli, Salvatore Mularo, Alessandro Nobili, Marika Lo Monaco, Pier Mannuccio Mannucci, Francesco Perticone, Antonello Pietrangelo and Salvatore Corrao

Healthcare 2022, 10(1), 86; https://doi.org/10.3390/healthcare10010086 - 03 Jan 2022

Cited by 10 | Viewed by 2675

Abstract

Background: Currently, diabetes represents the seventh leading cause of death worldwide, with a significant economic burden. The number and severity of comorbidities increase with age, and are identified as important determinants that influence the prognosis. We aimed to investigate comorbidities and outcomes in [...] Read more.

Background: Currently, diabetes represents the seventh leading cause of death worldwide, with a significant economic burden. The number and severity of comorbidities increase with age, and are identified as important determinants that influence the prognosis. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients affected by diabetes. Methods: In this observational study, we retrospectively analyzed data collected from the REgistro dei pazienti per lo studio delle POlipatologie e politerapie in reparti della rete Simi (RePoSi) registry. Socio-demographic, clinical characteristics, and laboratory findings were considered. The association between variables and in-hospital and 1-year follow-up were analyzed. Results: Among 4708 in-patients, 1378 (29.3%) had a diagnosis of diabetes. Patients with diabetes had more previous hospitalization, a clinically significant disability, and more need for a urinary catheter in comparison with subjects without diabetes. Patients affected by diabetes took more drugs, both at admission, at in-hospital stay, at discharge, and at 1-year follow-up. Thirty-five comorbidities were more frequent in patients with diabetes, and the first five were hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and chronic obstructive pulmonary disease (22.7%). Heart rate was an independent predictor of in-hospital mortality. At 1-year follow-up, cancer and male sex were strongly independently associated with mortality. Conclusions: Our findings showed the severity of the impact of diabetes and its comorbidities in the real life of internal medicine and geriatric wards, and provide data to be used for a better tailored management of elderly in-patients with diabetes. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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7 pages, 207 KiB

Open AccessArticle

Structural Factors and Quality of Diabetes Health Services in Hail, Saudi Arabia: A Cross-Sectional Study

by Ramaiah Itumalla, Rakesh Kumar, Mohamed Tharwat Elabbasy, Bilesha Perera and Mohammad R. Torabi

Healthcare 2021, 9(12), 1691; https://doi.org/10.3390/healthcare9121691 - 07 Dec 2021

Cited by 10 | Viewed by 2744

Abstract

The chronic disease burden in Saudi Arabia has created adverse health, social and economic consequences that require urgent attention from health and political authorities. Diabetes has become an epidemic in Saudi Arabia. Data on personal and structural factors associated with diabetes in the [...] Read more.

The chronic disease burden in Saudi Arabia has created adverse health, social and economic consequences that require urgent attention from health and political authorities. Diabetes has become an epidemic in Saudi Arabia. Data on personal and structural factors associated with diabetes in the Hail region are scarce. Such data are imperative to develop effective strategies to control the epidemic in the region. A cross-sectional study of diabetes patients attending diabetes health care facilities in Hail was conducted using a sample of 392 patients. An interviewer-administered questionnaire was used. A slightly higher proportion of female participants (54.1%) were included in the sample. Most of the participants were from rural areas (73.9%), and 70.9% of the participants were from the middle-age (30–50 years) category. A close proximity to the diabetes clinic (OR = 1.98; 95% CI: 1.08–3.44), good transport facilities (OR = 1.67; 95% CI: 1.11–2.78) and feeling contented with supportive services (OR = 2.03; 95% CI: 1.12–4.04) were associated with patients’ satisfaction with the overall quality of the diabetes clinic services. The presence of good-quality health care professionals working in these treatment centers also seemed to contribute to patients’ satisfaction with the services they received. These structural factors associated with patients’ satisfaction with the services they received from diabetes clinics must be considered in diabetes control programs in the region. The minimization of structural barriers will eventually assist the national strategic plan, Vision 2030, which aims to improve the quality of life of the Saudi people by 2030. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

24 pages, 1563 KiB

Open AccessArticle

Clustering Inflammatory Markers with Sociodemographic and Clinical Characteristics of Patients with Diabetes Type 2 Can Support Family Physicians’ Clinical Reasoning by Reducing Patients’ Complexity

by Zvonimir Bosnic, Pinar Yildirim, František Babič, Ines Šahinović, Thomas Wittlinger, Ivo Martinović and Ljiljana Trtica Majnaric

Healthcare 2021, 9(12), 1687; https://doi.org/10.3390/healthcare9121687 - 06 Dec 2021

Cited by 6 | Viewed by 2460

Abstract

Diabetes mellitus type 2 (DM2) is a complex disease associated with chronic inflammation, end-organ damage, and multiple comorbidities. Initiatives are emerging for a more personalized approach in managing DM2 patients. We hypothesized that by clustering inflammatory markers with variables indicating the sociodemographic and [...] Read more.

Diabetes mellitus type 2 (DM2) is a complex disease associated with chronic inflammation, end-organ damage, and multiple comorbidities. Initiatives are emerging for a more personalized approach in managing DM2 patients. We hypothesized that by clustering inflammatory markers with variables indicating the sociodemographic and clinical contexts of patients with DM2, we could gain insights into the hidden phenotypes and the underlying pathophysiological backgrounds thereof. We applied the k-means algorithm and a total of 30 variables in a group of 174 primary care (PC) patients with DM2 aged 50 years and above and of both genders. We included some emerging markers of inflammation, specifically, neutrophil-to-lymphocyte ratio (NLR) and the cytokines IL-17A and IL-37. Multiple regression models were used to assess associations of inflammatory markers with other variables. Overall, we observed that the cytokines were more variable than the marker NLR. The set of inflammatory markers was needed to indicate the capacity of patients in the clusters for inflammatory cell recruitment from the circulation to the tissues, and subsequently for the progression of end-organ damage and vascular complications. The hypothalamus–pituitary–thyroid hormonal axis, in addition to the cytokine IL-37, may have a suppressive, inflammation-regulatory role. These results can help PC physicians with their clinical reasoning by reducing the complexity of diabetic patients. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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10 pages, 632 KiB

Open AccessArticle

Social Support, Self-Care Behaviour and Self-Efficacy in Patients with Type 2 Diabetes during the COVID-19 Pandemic: A Cross-Sectional Study

by Premalatha Paulsamy, Rizwan Ashraf, Shadia Hamoud Alshahrani, Kalaiselvi Periannan, Absar Ahmed Qureshi, Krishnaraju Venkatesan, Vani Manoharan, Natarajan Govindasamy, Kousalya Prabahar, Tamilselvi Arumugam, Kumar Venkatesan, Kumarappan Chidambaram, Geetha Kandasamy, Rajalakshimi Vasudevan and Kalpana Krishnaraju

Healthcare 2021, 9(11), 1607; https://doi.org/10.3390/healthcare9111607 - 22 Nov 2021

Cited by 7 | Viewed by 3235

Abstract

Diabetes mellitus is a major public health issue that considerably impacts mortality, morbidity, and healthcare costs worldwide. The COVID-19 pandemic has created havoc in diabetes management, too, like other spectrums of life. A descriptive, cross-sectional study was adopted to determine the effect of [...] Read more.

Diabetes mellitus is a major public health issue that considerably impacts mortality, morbidity, and healthcare costs worldwide. The COVID-19 pandemic has created havoc in diabetes management, too, like other spectrums of life. A descriptive, cross-sectional study was adopted to determine the effect of Social Support, Self-Care Behaviour and Self-Efficacy in Type 2 Diabetes Mellitus (T2D) during this COVID-19 pandemic. Two hundred T2D patients who satisfied the inclusion criteria were chosen using a convenient sampling procedure. The tool consists of four sections, including socio-demographic characteristics, Multidimensional Scale of Perceived Social Support (MSPSS), revised Summary of Diabetes Self-Care Activities (SDSCA) Scale and modified Diabetes Management Self-Efficacy Scale (DMS). Descriptive and inferential statistics were used to analyze the obtained data. The mean and SD of diabetic management self-efficacy is 5.74 (1.95) and 4.37 (1.4), respectively, for patients with HbA1c < 6.5% and HbA1c ≥ 6.5%. The self-care activities of the patients who had good glycemic control were 4.31 (2.06) compared to 3.50 (1.73) who did not. The social support received by the patients was 6.13 (2.13) vs. 5.31 (1.67) among patients with glycemic control vs. no control. The results show that social support (p = 0.04), self-efficacy (p =0.01) and self-care activities (p = 0.001) were significantly related to the level of glycemic control of the T2D patients. A significant relationship was also identified between gender (p = 0.036), age (p = 0.001) and education status (p = 0.000) with HbA1c control of the participants. This study demonstrates a significant relationship between social support, self-care behaviours, self-efficacy and glycemic management in T2D patients. During this COVID-19 pandemic, interventions to enhance the self-care activities like exercise and social support to boost their self-efficacy; for better diabetes management, reducing diabetes complications or prolonging their onset are the need of the hour. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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11 pages, 800 KiB

Open AccessArticle

Serum Uric Acid Levels and Risk of Rapid Decline of Estimated Glomerular Filtration Rate in Patients with Type 2 Diabetes: Findings from a 5-Year Prospective Cohort Study

by Hoa Tuyet Le, Tung Thanh Le, Nguyet Minh Thi Tran, Thuy Thanh Thi Nguyen, Ni Chanh Su Minh, Quyen Thi Le, Tuyet Anh Thi Tram, Thang Duc Tran, Tung Xuan Doan, Mai Huynh Thi Duong and Truc Thanh Thai

Healthcare 2021, 9(10), 1341; https://doi.org/10.3390/healthcare9101341 - 09 Oct 2021

Cited by 5 | Viewed by 1548

Abstract

This study investigated the association between serum uric acid (SUA) levels with rapid decline of the estimated glomerular filtration rate (eGFR) in type 2 diabetes (T2 DM) patients. A prospective cohort study was conducted in a community-based hospital in Vietnam. We followed 405 [...] Read more.

This study investigated the association between serum uric acid (SUA) levels with rapid decline of the estimated glomerular filtration rate (eGFR) in type 2 diabetes (T2 DM) patients. A prospective cohort study was conducted in a community-based hospital in Vietnam. We followed 405 T2DM patients with normal kidney function for five years. Rapid progression of kidney function was defined as an average annual decrease of eGFR of at least 4 mL/min/1.73 m² and was found in 16.0% of patients. Patients in the SUA high tertile ( ≥6 mg/dL) had higher BMI (p = 0.004), lower HbA1c (p = 0.001), lower eGFR (p < 0.001) and higher rate of hypertension than low and middle tertile. After adjusting for age and sex, rapid progression of renal function was significantly associated with SUA level (OR = 1.22, 95% CI 1.02–1.45, p = 0.026). This association was marginally significant when more covariates were included in the model (OR = 1.20, 95% CI 0.99–1.46, p = 0.065). However, the association between tertiles of SUA and rapid decline of eGFR was not statistically significant. This study demonstrates neither a strong significant association between SUA and rapid decline of eGFR nor evidence to refuse the role of SUA levels in the increased risk of renal function decline in in T2DM patients. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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9 pages, 228 KiB

Open AccessArticle

The Correlation between Clinical and Demographic Parameters and Sickness Absence in Diabetic Employees

by Oren Zack, Irena Golob, Gabriel Chodick, Idan Perluk, Rachel Raanan and Shlomo Moshe

Healthcare 2021, 9(10), 1309; https://doi.org/10.3390/healthcare9101309 - 30 Sep 2021

Viewed by 1253

Abstract

Objectives: Diabetes mellitus is one of the most significant and prevalent chronic diseases. Individuals with diabetes can still encounter substantial difficulties in finding and keeping their job because of their condition. The purpose of this study was to examine the scope of diabetes-related [...] Read more.

Objectives: Diabetes mellitus is one of the most significant and prevalent chronic diseases. Individuals with diabetes can still encounter substantial difficulties in finding and keeping their job because of their condition. The purpose of this study was to examine the scope of diabetes-related absence from work and its relationship with variables such as type of employer, workload, the severity of illness, and type of treatment. Materials and Methods: We conducted a case-control study, including 220 diabetic patients and 230 controls. Information regarding absence from work was obtained by reviewing medical records, and general patient information was retrieved by conducting telephone interviews. Results: Patients with diabetes had, annually, more days of absence than non-diabetic patients (8.5 vs. 2.7, respectively p and lt; 0.001). Among diabetic patients, public-sector employees were absent more than private-sector employees (9.0 vs. 7.2 days, respectively, p and lt; 0.05). A positive correlation was found between workload (measured by stamina) and absence (Pearson correlation = 0.098, p = 0.04). Concerning the clinical variables, we found that employees suffering from diabetic complications exhibited higher absence rates (15.5 vs. 5.7 days, respectively, p and lt; 0.003). Parameters like HbA1c levels, patient age, disease duration, and type of treatment did not differ significantly amongst the groups with regards to absence rates. Conclusions: The main variables affecting absence from work were not medical but rather sociodemographic: education, workload, and type of employer. The results of this study reinforce the perception that well-controlled diabetic employees can be combined in most types of occupations without fear of increased absence from work. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

8 pages, 235 KiB

Open AccessArticle

Development and Validation of an Undiagnosed Diabetes Screening Tool: Based on the Korean National Health and Nutrition Examination Survey (2010–2016)

by Eunhee Cho, Deulle Min and Hye Sun Lee

Healthcare 2021, 9(9), 1138; https://doi.org/10.3390/healthcare9091138 - 31 Aug 2021

Cited by 2 | Viewed by 1431

Abstract

Approximately half of the population worldwide suffers from under/undiagnosed diabetes. In South Korea, 27.7% of people aged over 30 years have type 2 diabetes and are unaware of their condition because they have not been diagnosed. Optimal tools for identifying risk factors of [...] Read more.

Approximately half of the population worldwide suffers from under/undiagnosed diabetes. In South Korea, 27.7% of people aged over 30 years have type 2 diabetes and are unaware of their condition because they have not been diagnosed. Optimal tools for identifying risk factors of undiagnosed diabetes, which is associated with multiple complications, are currently lacking. Secondary data analysis was conducted using the 2010–2016 Korean National Health and Nutrition Examination Survey. This study aimed to identify the risk factors in individuals not diagnosed with type 2 diabetes, using glycated hemoglobin as the diagnostic standard. Furthermore, we aimed to develop an accurate screening tool for diabetes using HbA1c values by analyzing the data of 12,843 adults (aged ≥20 years) not diagnosed with type 2 diabetes. Age, gender, family history of diabetes, hypertension diagnosis, waist-to-height ratio, smoking, and health check-ups were identified as significant risk factors for undiagnosed type 2 diabetes. A screening tool with total and cutoff scores of 13 and 7 points was developed, and it had a sensitivity of 82.7% and specificity of 58.2%. The developed screening tool appears to be a simple and cost-effective method for detecting undiagnosed type 2 diabetes. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

16 pages, 525 KiB

Open AccessArticle

Factors Associated with Depressive Symptoms in Korean Adults with Diabetes Mellitus: A Cross-Sectional Study

by Mihyun Jeong

Healthcare 2021, 9(8), 1049; https://doi.org/10.3390/healthcare9081049 - 16 Aug 2021

Cited by 3 | Viewed by 1899

Abstract

Depressive symptoms in adults with diabetes are influenced by sociodemographic status, health-related behaviors, and comorbid diseases. This study aimed to examine the factors related to depressive symptoms in Korean adults with diabetes, using data from the Korea National Health and Nutrition Examination Surveys [...] Read more.

Depressive symptoms in adults with diabetes are influenced by sociodemographic status, health-related behaviors, and comorbid diseases. This study aimed to examine the factors related to depressive symptoms in Korean adults with diabetes, using data from the Korea National Health and Nutrition Examination Surveys for 2014, 2016, and 2018. A total of 1529 Korean adults with diabetes were selected as subjects for the analysis. The age group of the participants was 19–80 years, with a mean age of 63.34 ± 0.68 years. The depressive symptoms and severity were assessed using the Korean version of the Patient Health Questionnaire-9. Descriptive statistics, chi-squared tests, and univariate and multivariable logistic regression analyses were used by applying a complex sample analysis method. The findings showed that 9.6% of Korean adults with diabetes exhibited moderate to severe depressive symptoms, which gradually decreased during 2014–2018. The most significant independent factors of depressive symptoms were living without a spouse, unemployment, low household income, fair or poor subjective health conditions, high perceived stress, a diabetes duration of over 20 years, and stroke. In females, living without a spouse, low household income, poor subjective health condition, high perceived stress, stroke, and coronary heart disease were significantly associated with depressive symptoms. In males, living without a spouse, unemployment, poor subjective health condition, high perceived stress, and hypertension were significantly associated with depressive symptoms. These findings highlight the importance of regular screening for depressive symptoms in patients with diabetes as the prevalence of depressive symptoms in people with diabetes may be higher than those in the general population. Future studies should also examine the development and effectiveness of psychosocial intervention programs to decrease depressive symptoms in patients with diabetes, considering cost-effective and time-saving approaches. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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9 pages, 1077 KiB

Open AccessArticle

The Burden of Diabetes-Related Preventable Hospitalization: 11-Year Trend and Associated Factors in a Region of Southern Italy

by Giuseppe Di Martino, Pamela Di Giovanni, Fabrizio Cedrone, Michela D’Addezio, Francesca Meo, Piera Scampoli, Ferdinando Romano and Tommaso Staniscia

Healthcare 2021, 9(8), 997; https://doi.org/10.3390/healthcare9080997 - 04 Aug 2021

Cited by 9 | Viewed by 1872

Abstract

(1) Introduction: Diabetes care is complex and delivered by different care providers in different settings across the healthcare system. Better coordination through all levels of care can lead to better outcomes and fewer hospitalizations. Prevention quality indicators (PQIs) for diabetes allow us to [...] Read more.

(1) Introduction: Diabetes care is complex and delivered by different care providers in different settings across the healthcare system. Better coordination through all levels of care can lead to better outcomes and fewer hospitalizations. Prevention quality indicators (PQIs) for diabetes allow us to monitor diabetes-related avoidable admissions. The aim of this research is to assess the trend of diabetes-related preventable hospitalizations and associated risk factors in a southern Italian region. (2) Methods: The study considered all hospital admissions performed from 2008 to 2018 in the Abruzzo region, Southern Italy. Data were collected from hospital discharge records. Four different indicators were evaluated as follows: short-term complications (PQI-01), long-term complications (PQI-03), uncontrolled diabetes (PQI-14) and lower-extremity amputations (PQI-16). Joinpoint models were used to evaluate the time trends of standardized rates and the average annual percent change (AAPC). (3) Results: During study period, 8660 DRPH were performed: 1298 among PQI-01, 3217 among PQI-03, 1975 among PQI-14 and 2170 among PQI-16. During the study period, PQI-01and PQI-04 showed decreasing trends. An increasing trend was showed by PQI-16. (4) Conclusions: During an 11-year period, admissions for short-term diabetes complications and for uncontrolled diabetes significantly decreased. The use of standardized tools as PQIs can help the evaluation of healthcare providers in developing preventive strategy. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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15 pages, 697 KiB

Open AccessArticle

Factors Influencing Healthcare Experience of Patients with Self-Declared Diabetes: A Cross-Sectional Population-Based Study in the Basque Country

by Roberto Nuño-Solínis, Sara Ponce, Maider Urtaran-Laresgoiti, Esther Lázaro and María Errea Rodríguez

Healthcare 2021, 9(5), 509; https://doi.org/10.3390/healthcare9050509 - 28 Apr 2021

Cited by 1 | Viewed by 1827

Abstract

Background: Diabetes affects more than 400 million people around the world. Few published studies incorporate questionnaires that comprehensively cover every aspect of a patient’s experience of healthcare. This study analyzes potential differences in the healthcare experience for patients with diabetes based on their [...] Read more.

Background: Diabetes affects more than 400 million people around the world. Few published studies incorporate questionnaires that comprehensively cover every aspect of a patient’s experience of healthcare. This study analyzes potential differences in the healthcare experience for patients with diabetes based on their sociodemographic, economic, and health-related characteristics from a comprehensive viewpoint in an integrated delivery system. Methods: We used data from the 2018 Basque Health Survey, which includes a questionnaire for the measurement of the experiences of patients with chronic problems. We present descriptive and regression analyses to explore differences by sociodemographic, economic, and health-related characteristics of patients’ experiences with different healthcare services. Results: Having diabetes plus other comorbidities significantly decreases the quality of the experience with all healthcare services and decreases the global healthcare experience score. When comorbidities are present, the elderly seem to report better experiences than younger patients. Some differences in experience can be explained by sociodemographic and economic factors. No differences exist between conditions co-occurring with diabetes. Conclusion: Patients with diabetes who also suffer from other conditions report worse experiences than individuals who suffer from diabetes only. No specific conditions explain the differences in care experience. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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6 pages, 231 KiB

Open AccessEditor’s ChoiceArticle

Hospitalization for Short-Term Diabetes-Related Complications: Focus on Patients Aged over 85 Years

by Giuseppe Di Martino, Pamela Di Giovanni, Fabrizio Cedrone, Francesca Meo, Piera Scampoli, Ferdinando Romano and Tommaso Staniscia

Healthcare 2021, 9(4), 460; https://doi.org/10.3390/healthcare9040460 - 14 Apr 2021

Cited by 7 | Viewed by 2003

Abstract

(1) Background: The prevalence of diabetes in elderly people is frequently high. When occurring in the elderly, diabetes is often accompanied by complications and comorbidities, at least one in 60% and four or more in 40% of older people with diabetes. As [...] Read more.

(1) Background: The prevalence of diabetes in elderly people is frequently high. When occurring in the elderly, diabetes is often accompanied by complications and comorbidities, at least one in 60% and four or more in 40% of older people with diabetes. As far as short-term complications among the elderly are concerned, hypoglycemia and hyperglycemic crises prove to be frequent. The aim of this study was to investigate the difference in hospitalization for short-term diabetes complications in patients below and over 85 years of age. (2) Methods: Data were collected from hospital discharge records (HDRs) of all hospital admissions that occurred in Abruzzo Region, Italy, from 2006 to 2015. Only diabetic patients aged over 65 years were included. Outcomes included were diabetic ketoacidosis, hyperosmolar coma, hypoglycemic shock, iatrogenic hypoglycemic coma, and other diabetic comas. (3) Results: During the study period, 144,376 admissions were collected, 116,305 (80.56%) of which referred to patients below 85 years. Those aged over 85 years were significantly associated to all short-term diabetes-related complications with the exception of ketoacidosis. (4) Conclusions: In older diabetic patients, the avoidance of short-term diabetes complications are a greater concern than in younger patients. Diabetes management among very elderly patients should be tailored accordingly to patient characteristics. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

11 pages, 254 KiB

Open AccessArticle

Factors Associated with Poor Glycemic Control Amongst Rural Residents with Diabetes in Korea

by Junhee Ahn and Youngran Yang

Healthcare 2021, 9(4), 391; https://doi.org/10.3390/healthcare9040391 - 01 Apr 2021

Cited by 6 | Viewed by 1711

Abstract

(1) Background: Glycemic control is an effective way to reduce the cardiovascular complications of diabetes. The purpose of this study was to identify the factors associated with poor glycemic control amongst rural residents with diabetes in Korea. (2) Methods: This cross-sectional analysis was [...] Read more.

(1) Background: Glycemic control is an effective way to reduce the cardiovascular complications of diabetes. The purpose of this study was to identify the factors associated with poor glycemic control amongst rural residents with diabetes in Korea. (2) Methods: This cross-sectional analysis was conducted amongst a total of 522 participants who had completed baseline health examinations for the Korean Genome and Epidemiology Study (KoGES) Rural Cohort from 2005 to 2011. The subjects were divided into two groups: the good glycemic control group (GCG) (glycosylated hemoglobin (HbA1C) < 7%) and the poor GCG (HbA1C ≥ 7%). Logistic regression was used to examine the role of sociodemographics, health-related behavior, comorbidity and diabetes-related and clinical factors in poor glycemic control amongst rural residents with diabetes. (3) Results: In total, 48.1% of participants were in the poor GCG. Poor GCG was significantly associated with drinking (odds ratio (OR) = 0.42, 95% CI = 0.24–0.71), lack of regular physical activity (OR = 1.68, 95% CI = 1.03–2.76), fasting blood glucose (FBG) > 130 mg/dL (OR = 7.80, 95% CI = 4.35–13.98), diabetes for > 7 years (OR = 1.79, 95% CI = 1.08–2.98), cholesterol ≥ 200 mg/dL (OR = 1.73, 95% CI = 1.05–2.84) and positive urine glucose (OR = 6.24, 95% CI = 1.32–29.44). (4) Conclusion: Intensive glucose control interventions should target individuals amongst rural residents with diabetes who do not engage in regular physical activity, have been diagnosed with diabetes for more than seven years and who have high fasting-blood glucose, high cholesterol levels and glucose-positive urine. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

9 pages, 234 KiB

Open AccessArticle

Depressive Symptoms among Patients with Diabetes in Qatar: Frequency and Potential Determinants

by Hiba Bawadi, Alanood Al-Shahwani, Dana Arafeh, Daniah Al-Asmar, Joyce Moawad, Zumin Shi and Suhad Daher-Nashif

Healthcare 2021, 9(3), 302; https://doi.org/10.3390/healthcare9030302 - 09 Mar 2021

Cited by 4 | Viewed by 1870

Abstract

Background: Diabetes is a highly prevalent chronic disease that is associated with major complications. Findings regarding risk of depression among patients with diabetes are controversial. This study aimed to determine the prevalence and determinants of depressive symptoms among Qatari patients with type 2 [...] Read more.

Background: Diabetes is a highly prevalent chronic disease that is associated with major complications. Findings regarding risk of depression among patients with diabetes are controversial. This study aimed to determine the prevalence and determinants of depressive symptoms among Qatari patients with type 2 diabetes. Methods: This cross-sectional study was based on Qatar Biobank (QBB) data of 2448 Qatari adults with diabetes aged 21–60 years old. Data regarding age, gender, education, income, body mass index (BMI), medication use, glycated hemoglobin (HbA1c) were retrieved. Patients’ responses to the Patient Health Questionnaire-9 (PHQ-9) were also obtained. Data analyses was performed using STATA 16, and statistical significance was considered at a p-value of <0.05. Results: Of the 2448 participants, 15.4% (n = 378) had self-reported depressive symptoms. Depressive symptoms were frequent among females (69.6%), smokers (15.9%), and participants with a higher level of education (47.1%). Average age of participants who reported depressive symptoms was significantly less that among participants without depressive symptoms (44.8 vs. 52.9 years). Qatari women with diabetes seem to be at higher risk of depression when compared to men (OR = 1.819, 95% CI: 1.42–2.33); The odds of reporting depressive symptoms were 35% higher among patients with more advanced educational qualifications (OR = 1.351, 95% CI: 1.00, 1.82). Smokers were twice as likely to report depressive symptoms as their non-smoking counterparts. There was no significant relationship between depression and poor glycemic control, physical activity, BMI, or insulin use. Conclusions: In summary, the study results suggest that several sociodemographic factors, such as age, gender, and level of education were associated with the risk of depressive symptoms among Qataris with diabetes. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

Review

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10 pages, 1184 KiB

Open AccessReview

Diabetic Retinopathy Screening and Registration in Europe—Narrative Review

by Elitsa Hristova, Darina Koseva, Zornitsa Zlatarova and Klara Dokova

Healthcare 2021, 9(6), 745; https://doi.org/10.3390/healthcare9060745 - 17 Jun 2021

Cited by 8 | Viewed by 3228

Abstract

Diabetic retinopathy (DR) is a leading cause of preventable vision impairment and blindness in the European Region. Despite the fact that almost all European countries have some kind of prophylactic eye examination for people with diabetes, the examinations are not properly arranged and [...] Read more.

Diabetic retinopathy (DR) is a leading cause of preventable vision impairment and blindness in the European Region. Despite the fact that almost all European countries have some kind of prophylactic eye examination for people with diabetes, the examinations are not properly arranged and are not organized according to the principles of screening in medicine. In 2021, the current COVID-19 pandemic moved telemedicine to the forefront healthcare services. Due to that, a lot more patients could benefit from comfortable and faster access to ophthalmology specialist care. This study aimed to conduct a narrative literature review on current DR screening programs and registries in the European Union for the last 20 years. With the implementation of telemedicine in daily medical practice, performing screening programs became much more attainable. Remote assessment of retinal pictures simultaneously saves countries time, money, and other resources. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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Other

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11 pages, 1205 KiB

Open AccessProtocol

Defining Potentially Inappropriate Prescriptions for Hypoglycaemic Agents to Improve Computerised Decision Support: A Study Protocol

by Paul Quindroit, Nicolas Baclet, Erwin Gerard, Laurine Robert, Madleen Lemaitre, Sophie Gautier, Chloé Delannoy-Rousselière, Bertrand Décaudin, Anne Vambergue and Jean-Baptiste Beuscart

Healthcare 2021, 9(11), 1539; https://doi.org/10.3390/healthcare9111539 - 11 Nov 2021

Cited by 3 | Viewed by 1737

Abstract

In France, around 5% of the general population are taking drug treatments for diabetes mellitus (mainly type 2 diabetes mellitus, T2DM). Although the management of T2DM has become more complex, most of these patients are managed by their general practitioner and not a [...] Read more.

In France, around 5% of the general population are taking drug treatments for diabetes mellitus (mainly type 2 diabetes mellitus, T2DM). Although the management of T2DM has become more complex, most of these patients are managed by their general practitioner and not a diabetologist for their antidiabetics treatments; this increases the risk of potentially inappropriate prescriptions (PIPs) of hypoglycaemic agents (HAs). Inappropriate prescribing can be assessed by approaches that are implicit (expert judgement based) or explicit (criterion based). In a mixed, multistep process, we first systematically reviewed the published definitions of PIPs for HAs in patients with T2DM. The results will be used to create the first list of explicit definitions. Next, we will complete the definitions identified in the systematic review by conducting a qualitative study with two focus groups of experts in the prescription of HAs. Lastly, a Delphi survey will then be used to build consensus among participants; the results will be validated in consensus meetings. We developed a method for determining explicit definitions of PIPs for HAs in patients with T2DM. The resulting explicit definitions could be easily integrated into computerised decision support tools for the automated detection of PIPs. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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