scholarly journals High Prevalence of Depressive Symptoms in Patients With Type 1 and Type 2 Diabetes in Developing Countries: Results From the International Diabetes Management Practices Study

Diabetes Care ◽  
2021 ◽  
pp. dc202003
Author(s):  
Pablo Aschner ◽  
Juan José Gagliardino ◽  
Hasan Ilkova ◽  
Fernando Lavalle ◽  
Ambady Ramachandran ◽  
...  
2021 ◽  
Author(s):  
Pablo Aschner ◽  
Juan José Gagliardino ◽  
Hasan Ilkova ◽  
Fernando Lavalle ◽  
Ambady Ramachandran ◽  
...  

<b>Objective</b> <p>Depression is common in people with diabetes but data from developing countries are scarce. We evaluated the prevalence and risk factors for depressive symptoms in patients with diabetes using data from the International Diabetes Management Practices Study (IDMPS).</p> <p><b>Research Design and Methods</b></p> <p>IDMPS is an ongoing multinational, cross-sectional study investigating quality of care in patients with diabetes in real-world settings. Data from wave 5 (2011), including 21 countries, were analyzed using the Patient Health Questionnaire (PHQ)-9 to evaluate depressive symptoms. Logistic regression analyses were conducted to identify risk factors of depressive symptoms.</p> <p><b>Results</b></p> <p>Of 9865 patients eligible for analysis, 2280 had type 1 and 7585 had type 2 diabetes (treatment: oral glucose lowering drugs [OGLD] only, n=4729; OGLDs plus insulin, n=1892; insulin only, n=964). Depressive symptoms (PHQ-9 score ≥5) were reported in 30.7% of those with type 1 diabetes. In patients with type 2 diabetes, the respective figures were 29.0% for OGLDs only, 36.6% for OGLDs plus insulin, and 46.7% for insulin only subgroups. Moderate depressive symptoms (PHQ-9 score 10–19) were observed in 8–16% of patients with type 1 or type 2 diabetes. Female sex, complications, and low socioeconomic status were independently associated with depressive symptoms.<a> In type 1 and type 2 diabetes OGLDs only groups, depression was associated with poor glycemic control.</a></p> <p><b>Conclusions</b></p> <p>Depressive symptoms are common in patients with diabetes from developing countries calling for routine screening, especially in high-risk groups, to reduce the double burden of diabetes and depression and their negative interaction.</p>


2021 ◽  
Author(s):  
Pablo Aschner ◽  
Juan José Gagliardino ◽  
Hasan Ilkova ◽  
Fernando Lavalle ◽  
Ambady Ramachandran ◽  
...  

<b>Objective</b> <p>Depression is common in people with diabetes but data from developing countries are scarce. We evaluated the prevalence and risk factors for depressive symptoms in patients with diabetes using data from the International Diabetes Management Practices Study (IDMPS).</p> <p><b>Research Design and Methods</b></p> <p>IDMPS is an ongoing multinational, cross-sectional study investigating quality of care in patients with diabetes in real-world settings. Data from wave 5 (2011), including 21 countries, were analyzed using the Patient Health Questionnaire (PHQ)-9 to evaluate depressive symptoms. Logistic regression analyses were conducted to identify risk factors of depressive symptoms.</p> <p><b>Results</b></p> <p>Of 9865 patients eligible for analysis, 2280 had type 1 and 7585 had type 2 diabetes (treatment: oral glucose lowering drugs [OGLD] only, n=4729; OGLDs plus insulin, n=1892; insulin only, n=964). Depressive symptoms (PHQ-9 score ≥5) were reported in 30.7% of those with type 1 diabetes. In patients with type 2 diabetes, the respective figures were 29.0% for OGLDs only, 36.6% for OGLDs plus insulin, and 46.7% for insulin only subgroups. Moderate depressive symptoms (PHQ-9 score 10–19) were observed in 8–16% of patients with type 1 or type 2 diabetes. Female sex, complications, and low socioeconomic status were independently associated with depressive symptoms.<a> In type 1 and type 2 diabetes OGLDs only groups, depression was associated with poor glycemic control.</a></p> <p><b>Conclusions</b></p> <p>Depressive symptoms are common in patients with diabetes from developing countries calling for routine screening, especially in high-risk groups, to reduce the double burden of diabetes and depression and their negative interaction.</p>


Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1584-P
Author(s):  
JUAN J. GAGLIARDINO ◽  
PABLO ASCHNER ◽  
HASAN M. ILKOVA ◽  
FERNANDO J. LAVALLE-GONZALEZ ◽  
AMBADY RAMACHANDRAN ◽  
...  

Diabetologia ◽  
2020 ◽  
Vol 63 (4) ◽  
pp. 711-721 ◽  
Author(s):  
Pablo Aschner ◽  
Juan J. Gagliardino ◽  
Hasan Ilkova ◽  
Fernando Lavalle ◽  
Ambady Ramachandran ◽  
...  

Abstract Aims/hypothesis We evaluated the secular trend of glycaemic control in individuals with type 2 diabetes in developing countries, where data are limited. Methods The International Diabetes Management Practices Study provides real-world evidence of patient profiles and diabetes care practices in developing countries in seven cross-sectional waves (2005–2017). At each wave, each physician collected data from ten consecutive participants with type 2 diabetes during a 2 week period. The primary objective of this analysis was to evaluate trends of glycaemic control over time. Results A total of 66,088 individuals with type 2 diabetes were recruited by 6099 physicians from 49 countries. The proportion of participants with HbA1c <53 mmol/mol (<7%) decreased from 36% in wave 1 (2005) to 30.1% in wave 7 (2017) (p < 0.0001). Compared with wave 1, the adjusted ORs of attaining HbA1c ≤64 mmol/mol (≤8%) decreased significantly in waves 2, 5, 6 and 7 (p < 0.05). Over 80% of participants received oral glucose-lowering drugs, with declining use of sulfonylureas. Insulin use increased from 32.8% (wave 1) to 41.2% (wave 7) (p < 0.0001). The corresponding time to insulin initiation (mean ± SD) changed from 8.4 ± 6.9 in wave 1 to 8.3 ± 6.6 years in wave 7, while daily insulin dosage ranged from 0.39 ± 0.21 U/kg (wave 1) to 0.33 ± 0.19 U/kg (wave 7) for basal regimen and 0.70 ± 0.34 U/kg (wave 1) to 0.77 ± 0.33 (wave 7) U/kg for basal–bolus regimen. An increasing proportion of participants had ≥2 HbA1c measurements within 12 months of enrolment (from 61.8% to 92.9%), and the proportion of participants receiving diabetes education (mainly delivered by physicians) also increased from 59.0% to 78.3%. Conclusions In developing countries, glycaemic control in individuals with type 2 diabetes remained suboptimal over a 12 year period, indicating a need for system changes and better organisation of care to improve self-management and attainment of treatment goals.


Diabetologia ◽  
2021 ◽  
Author(s):  
Jean Claude Mbanya ◽  
Pablo Aschner ◽  
Juan J. Gagliardino ◽  
Hasan İlkova ◽  
Fernando Lavalle ◽  
...  

Abstract Aims/hypothesis Diabetes is the leading cause of kidney disease worldwide. There is limited information on screening, treatment and control of kidney disease in patients with diabetes in low-to-middle-income countries (LMICs). Methods The International Diabetes Management Practices Study is an ongoing, non-interventional study of clinical profiles and practices among patients receiving outpatient care mainly by internal medicine physicians and endocrinologists in LMICs. We examined screening, prevalence, treatment and control of kidney disease across seven waves (W) of data collection between 2005 and 2017. Results Among 15,079 patients with type 1 and 66,088 patients with type 2 diabetes, screening for kidney disease increased between W2 and W3 followed by a plateau (type 1 diabetes: W2, 73.7%; W3, 84.1%; W7, 83.4%; type 2 diabetes: W2, 65.1%; W3, 82.6%; W7, 86.2%). There were also decreasing proportions of patients with microalbuminuria (type 1 diabetes: W1, 27.1%; W3, 14.7%; W7, 13.8%; type 2 diabetes: W1, 24.5%; W3, 12.6%; W7, 11.9%) and proteinuria (type 1 diabetes: W1, 14.2%; W3, 8.7%; W7, 8.2%; type 2 diabetes: W1, 15.6%; W3, 9.3%; W7, 7.6%). Fewer patients were reported as receiving dialysis for both type 1 diabetes (W2, 1.4%; W7, 0.3%) and type 2 diabetes (W2, 0.9%; W7, 0.2%) over time. While there was no change in mean HbA1c or prevalence of diagnosed hypertension (type 1 diabetes: W1, 22.7%; W7, 19.9%; type 2 diabetes: W1, 60.9%; W7, 66.2%), the use of statins had increased among patients diagnosed with dyslipidaemia (type 1 diabetes: W1, 77.7%; W7, 90.7%; type 2 diabetes: W1, 78.6%; W7, 94.7%). Angiotensin II receptor blockers (type 1 diabetes: W1, 18.0%; W7, 30.6%; type 2 diabetes: W1, 24.2%; W7, 43.6%) were increasingly used over ACE inhibitors after W1 (type 1 diabetes: W1, 65.0%; W7, 55.9%; type 2 diabetes: W1, 55.7%, W7, 41.1%) among patients diagnosed with hypertension. Conclusions/interpretation In LMICs, real-world data suggest improvement in screening and treatment for kidney disease in patients with type 1 and type 2 diabetes attending non-nephrology clinics. This was accompanied by decreasing proportions of patients with microalbuminuria and proteinuria, with fewer patients who reported receiving dialysis over a 12-year period. Graphical abstract


2021 ◽  
Vol 32 (Sup3) ◽  
pp. S10-S13
Author(s):  
Martha Stewart

In this article Martha Stewart discusses how illness affects diabetes management and outlines the ‘sick-day advice’ that should be shared with people living with type 1 and type 2 diabetes Intercurrent illness can cause glucose levels to rise in people with diabetes mellitus. These illnesses include the common cold, diarrhoea and vomiting, urinary tract infections and COVID-19. If diabetes is not managed well during illness it can escalate and result in more serious conditions, such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS), which would require emergency hospital admission. This article discusses how illness affects diabetes management and outlines the ‘sick-day advice’ that should be shared with people living with type 1 and type 2 diabetes.


2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Zoe Pafili ◽  
Sophia Samara ◽  
Charilaos Dimosthenopoulos ◽  
Olga Gkortzi

AbstractIntroductionAccording to diabetes care standards nutrition therapy should be an integral part of diabetes management, and all individuals with diabetes should be referred to a registered dietitian for nutrition therapy at—or soon after—diagnosis and for ongoing follow-up. There is limited international data that indicate that a large percentage of people with diabetes have not received structured diabetes education and have not visited a dietitian. The aim of this study was to assess the involvement of dietitians in diabetes care in Greece.Materials and MethodsAll adult diabetic patients admitted to a secondary care general hospital in Greece during 30 consecutive days were included in the study. Patients admitted in the ICU, CICU, day clinics and hemodialysis patients were excluded. Data were obtained by personal interviews using a 40 item questionnaire which included 10 questions regarding number of visits to dietitians for diabetes management, whether patients were referred by their doctors or sought dietary advice by their own, reasons for visiting a dietitian, goal achievement and patient satisfaction.ResultsIn total 124 patients (68 males and 56 females) with diabetes were admitted to the hospital during the study period (4 type 1, 114 type 2 and 6 pregnancy diabetes). Data were obtained from 3 (22.8 ± 6 yrs, 26.1 ± 5.7kg/m2,8.3 ± 5.9 yrs with diabetes),105 (76.6 ± 11.3 yrs, 28.0 ± 5.3 kg/m2, 12.8 ± 9.3 yrs with diabetes), and 5 (32.6 ± 4.4 yrs, 28.5 ± 4.0 kg/m2) patients with type 1, type 2 and pregnancy diabetes respectively. Two out of 3 type 1 diabetes and 1 out of 5 patients with pregnancy diabetes interviewed reported to have been referred to a dietitian by their doctor. Only 5.7% (6 patients) of type 2 diabetes patients reported to have been referred to a dietitian by their doctor and another 5.7% have visited a dietitian on their own initiative. Five out of 6 referrals were at diabetes diagnosis. The number of encounters with a dietitian ranged from 1 to 24 with patients seeking to loose weight having the greater number of encounters. Of type 2 diabetes patients 94.3% did not receive lifestyle advice before commencing diabetes medication whereas 25% did not receive any dietary advice by any health professional even after starting medication.ConclusionsIn our cohort the majority of diabetes patients had not received dietary counseling by a dietitian, whereas about one fourth of type 2 diabetes patients had not received any dietary advice.


2001 ◽  
Vol 73 (3) ◽  
pp. 582-585 ◽  
Author(s):  
Gian Franco Meloni ◽  
Carla Colombo ◽  
Carlo La Vecchia ◽  
Adolfo Pacifico ◽  
Paolo Tomasi ◽  
...  

1999 ◽  
Vol 1 (2) ◽  
pp. 44-57 ◽  
Author(s):  
Frank Varon ◽  
Lynn Mack-Shipman

Abstract Diabetes mellitus, specifically type 2 diabetes, is one of the major public health issues facing the world in the 21st Century. This article summarizes the rapid changes in the management of diabetes and its impact on dental practice. The reader will find many “hyperlinks” to other diabetes information on the Internet throughout this article as these links provide greater detail. The incidence of type 1 diabetes has increased slowly, while that of type 2 diabetes has increased explosively. The worldwide incidence of type 2 is likely to double by the year 2010 due in large part to changing lifestyles, longer life expectancy, and rapid growth of ethnic and racial populations that have high prevalence rates. There are 15.7 million people or 5.9% of the population in the United States who have diabetes. While an estimated 10.3 million have been diagnosed, it is unfortunate that 5.4 million people are not aware they have the disease. Diabetic dental patient management strategies are presented. Dental professionals are urged to remain current in their knowledge of this disease in order to provide proper care for their patients.


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