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Diabetes Prevalence and Its Relationship With Education, Wealth, and BMI in 29 Low- and Middle-Income Countries

OBJECTIVE

Diabetes is a rapidly growing health problem in low- and middle-income countries (LMICs), but empirical data on its prevalence and relationship to socioeconomic status are scarce. We estimated diabetes prevalence and the subset with undiagnosed diabetes in 29 LMICs and evaluated the relationship of education, household wealth, and BMI with diabetes risk.

RESEARCH DESIGN AND METHODS

We pooled individual-level data from 29 nationally representative surveys conducted between 2008 and 2016, totaling 588,574 participants aged ≥25 years. Diabetes prevalence and the subset with undiagnosed diabetes was calculated overall and by country, World Bank income group (WBIG), and geographic region. Multivariable Poisson regression models were used to estimate relative risk (RR).

RESULTS

Overall, prevalence of diabetes in 29 LMICs was 7.5% (95% CI 7.1–8.0) and of undiagnosed diabetes 4.9% (4.6–5.3). Diabetes prevalence increased with increasing WBIG: countries with low-income economies (LICs) 6.7% (5.5–8.1), lower-middle-income economies (LMIs) 7.1% (6.6–7.6), and upper-middle-income economies (UMIs) 8.2% (7.5–9.0). Compared with no formal education, greater educational attainment was associated with an increased risk of diabetes across WBIGs, after adjusting for BMI (LICs RR 1.47 [95% CI 1.22–1.78], LMIs 1.14 [1.06–1.23], and UMIs 1.28 [1.02–1.61]).

CONCLUSIONS

Among 29 LMICs, diabetes prevalence was substantial and increased with increasing WBIG. In contrast to the association seen in high-income countries, diabetes risk was highest among those with greater educational attainment, independent of BMI. LMICs included in this analysis may be at an advanced stage in the nutrition transition but with no reversal in the socioeconomic gradient of diabetes risk.




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Empagliflozin as Add-On to Metformin in Patients With Type 2 Diabetes: A 24-Week, Randomized, Double-Blind, Placebo-Controlled Trial

Hans-Ulrich Häring
Jun 1, 2014; 37:1650-1659
Emerging Technologies and Therapeutics




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Efficacy and Safety of Canagliflozin, a Sodium-Glucose Cotransporter 2 Inhibitor, as Add-on to Insulin in Patients With Type 1 Diabetes

Robert R. Henry
Dec 1, 2015; 38:2258-2265
Special Article Collection: Insulin




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Beneficial Effect of Low-Glycemic Index Diet in Overweight NIDDM Subjects

Thomas M S Wolever
Apr 1, 1992; 15:562-564
Short Report




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Undiagnosed NIDDM: Clinical and Public Health Issues

Maureen I Harris
Apr 1, 1993; 16:642-652
Kelly West Lecture 1992




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Policy Solutions to Address Crisis at Border Exist, But Require Will and Staying Power to Execute

Closing the U.S.-Mexico border and cutting off aid to Central America would only feed the crisis unfolding at key points along the U.S.-Mexico border. This commentary outlines a range of immediate and long-term policy responses that would more effectively address the complex mix of factors fueling rising Central American migration to the United States.




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Addressing caries through the lens of social justice, health equity, human rights

It’s a conviction that was published in the November issue of The Journal of the American Dental Association and the basis for the October 2019 forum that Dr. Francisco Ramos-Gomez fostered, where dentists, physicians, nurses and public health and public policy experts proposed, discussed and recommended solutions for preventing early childhood caries through the lens of social justice, health equity and human rights.




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PBHS adds mobile chairside patient education system to ADA TV

PBHS, Inc. announced in January the launch of Consult Mode, an addition to ADA TV that enables dental providers to demonstrate 3D procedural animations, videos and tutorials chairside via tablets, iPads and other hand-held devices.




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ADA adds frequently asked questions from dentists to coronavirus resources

With the coronavirus disease now deemed a pandemic by the World Health Organization, the American Dental Association updated its webpage on the disease March 11 to include a link to frequently asked questions from member dentists covering topics such as personal protective equipment and patient communications.




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ADA begins to address coding, billing procedures during COVID-19 outbreak

The ADA is releasing a guide intended to help dental offices navigate issues related to coding and billing for virtual check-ins in the midst of the COVID-19 outbreak.




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ADA, recovery task force seek to address PPE shortages

Association staff and members of the ADA Advisory Task Force on Dental Practice Recovery are aware and working diligently in addressing members’ concerns over the limited availability of certain personal protective equipment items.




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Two new dental benefit guides address common hurdles anticipated when reopening practices

In the face of economic challenges, the ADA has released two online guides relating to third-party payment programs available at ADA.org/virus that are intended to help smooth the path of reopening practices: Handling Contract Negotiations and Handling Eligibility Verification




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Sleep Duration Patterns in Early to Middle Adulthood and Subsequent Risk of Type 2 Diabetes in Women

OBJECTIVE

To identify sleep duration trajectories from early to middle adulthood and their associations with incident type 2 diabetes.

RESEARCH DESIGN AND METHODS

Using a group-based modeling approach, we identified sleep duration trajectories based on sleep duration in ages 20–25, 26–35, 36–45, and 46+ years, which were retrospectively assessed in 2009 among 60,068 women from the Nurses’ Health Study II (median age 54.9 years) who were free of diabetes, cardiovascular disease, and cancer. We investigated the prospective associations between sleep duration trajectories and diabetes risk (2009–2017) using multivariable Cox proportional hazards models.

RESULTS

We documented 1,797 incident diabetes cases over a median follow-up of 7.8 years (442,437 person-years). Six sleep duration trajectories were identified: persistent 5-, 6-, 7-, or 8-h sleep duration and increased or decreased sleep duration. After multivariable adjustment for diabetes risk factors, compared with the persistent 7-h sleep duration group, the hazard ratio was 1.43 (95% CI 1.10, 1.84) for the 5-h group, 1.17 (1.04, 1.33) for the 6-h group, 0.96 (0.84, 1.10) for the 8-h group, 1.33 (1.09, 1.61) for the increased sleep duration group, and 1.32 (1.10, 1.59) for the decreased sleep duration group. Additional adjustment for time-updated comorbidities and BMI attenuated these associations, although a significantly higher risk remained in the decreased sleep duration group (1.24 [1.03, 1.50]).

CONCLUSIONS

Persistent short sleep duration or changes in sleep duration from early to middle adulthood were associated with higher risk of type 2 diabetes in later life. These associations were weaker after obesity and metabolic comorbidities were accounted for.




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Combination Therapy With Canagliflozin Plus Liraglutide Exerts Additive Effect on Weight Loss, but Not on HbA1c, in Patients With Type 2 Diabetes

OBJECTIVE

To examine the effect of combination therapy with canagliflozin plus liraglutide on HbA1c, endogenous glucose production (EGP), and body weight versus each therapy alone.

RESEARCH DESIGN AND METHODS

Forty-five patients with poorly controlled (HbA1c 7–11%) type 2 diabetes mellitus (T2DM) on metformin with or without sulfonylurea received a 9-h measurement of EGP with [3-3H]glucose infusion, after which they were randomized to receive 1) liraglutide 1.2 mg/day (LIRA); 2) canagliflozin 100 mg/day (CANA); or 3) liraglutide 1.2 mg plus canagliflozin 100 mg (CANA/LIRA) for 16 weeks. At 16 weeks, the EGP measurement was repeated.

RESULTS

The mean decrease from baseline to 16 weeks in HbA1c was –1.67 ± 0.29% (P = 0.0001), –0.89 ± 0.24% (P = 0.002), and –1.44 ± 0.39% (P = 0.004) in patients receiving CANA/LIRA, CANA, and LIRA, respectively. The decrease in body weight was –6.0 ± 0.8 kg (P < 0.0001), –3.5 ± 0.5 kg (P < 0.0001), and –1.9 ± 0.8 kg (P = 0.03), respectively. CANA monotherapy caused a 9% increase in basal rate of EGP (P < 0.05), which was accompanied by a 50% increase (P < 0.05) in plasma glucagon-to-insulin ratio. LIRA monotherapy reduced plasma glucagon concentration and inhibited EGP. In CANA/LIRA-treated patients, EGP increased by 15% (P < 0.05), even though the plasma insulin response was maintained at baseline and the CANA-induced rise in plasma glucagon concentration was blocked.

CONCLUSIONS

These results demonstrate that liraglutide failed to block the increase in EGP caused by canagliflozin despite blocking the rise in plasma glucagon and preventing the decrease in plasma insulin concentration caused by canagliflozin. The failure of liraglutide to prevent the increase in EGP caused by canagliflozin explains the lack of additive effect of these two agents on HbA1c.




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Metabolic Factors, Lifestyle Habits, and Possible Polyneuropathy in Early Type 2 Diabetes: A Nationwide Study of 5,249 Patients in the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) Cohort

OBJECTIVE

To investigate the association of metabolic and lifestyle factors with possible diabetic polyneuropathy (DPN) and neuropathic pain in patients with early type 2 diabetes.

RESEARCH DESIGN AND METHODS

We thoroughly characterized 6,726 patients with recently diagnosed diabetes. After a median of 2.8 years, we sent a detailed questionnaire on neuropathy, including the Michigan Neuropathy Screening Instrument questionnaire (MNSIq), to identify possible DPN (score ≥4) and the Douleur Neuropathique en 4 Questions (DN4) questionnaire for possible associated neuropathic pain (MNSIq ≥4 + pain in both feet + DN4 score ≥3).

RESULTS

Among 5,249 patients with data on both DPN and pain, 17.9% (n = 938) had possible DPN, including 7.4% (n = 386) with possible neuropathic pain. In regression analyses, central obesity (waist circumference, waist-to-hip ratio, and waist-to-height ratio) was markedly associated with DPN. Other important metabolic factors associated with DPN included hypertriglyceridemia ≥1.7 mmol/L, adjusted prevalence ratio (aPR) 1.36 (95% CI 1.17; 1.59); decreased HDL cholesterol <1.0/1.2 mmol/L (male/female), aPR 1.35 (95% CI 1.12; 1.62); hs-CRP ≥3.0 mg/L, aPR 1.66 (95% CI 1.42; 1.94); C-peptide ≥1,550 pmol/L, aPR 1.72 (95% CI 1.43; 2.07); HbA1c ≥78 mmol/mol, aPR 1.42 (95% CI 1.06; 1.88); and antihypertensive drug use, aPR 1.34 (95% CI 1.16; 1.55). Smoking, aPR 1.50 (95% CI 1.24; 1.81), and lack of physical activity (0 vs. ≥3 days/week), aPR 1.61 (95% CI 1.39; 1.85), were also associated with DPN. Smoking, high alcohol intake, and failure to increase activity after diabetes diagnosis associated with neuropathic pain.

CONCLUSIONS

Possible DPN was associated with metabolic syndrome factors, insulin resistance, inflammation, and modifiable lifestyle habits in early type 2 diabetes.




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Securing the Border: Defining the Current Population Living in the Shadows and Addressing Future Flows

Testimony of Marc Rosenblum before the Senate Committee on Homeland Security and Governmental Affairs for the March 26, 2015 hearing on the characteristics of unauthorized immigrants in the United States and how to address future flows.




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Watch: Tinsley Mortimer, Scott Kluth planning 'small' wedding

"Real Housewives of New York" star Tinsley Mortimer gave an update on her wedding plans amid the coronavirus pandemic.




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[ Add-ons ] Open Question : Finding a way to backup with external harddrive?

I'm trying to make a backup to an external harddrive, but when I go to update & security and then to back up, I don't find the option to 'add a drive'. It's completely empty, even though my computer is detecting the external harddrive.  Where do I find the option to backup files? I'm using windows 10 




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[ Politics ] Open Question : Trump supporters: Do you watch Disney and Pixar movies even though they carry hidden liberal agendas?

Do you let your kids watch Disney and Pixar movies? They're all created by liberals.




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The Multicultural Dilemma: Amid Rising Diversity and Unsettled Equity Issues, New Zealand Seeks to Address Its Past and Present

New Zealand drew global attention for its unity and support for the Muslim community targeted during the horrific Christchurch attacks. Yet the country's road to inclusion has been far from straightforward, and amid rising diversity it is grappling with the best way to achieve inclusion for its multiethnic population, including indigenous Māori peoples and migrants. This article outlines the opportunities and challenges to fostering multiculturalism against a backdrop of bicultural policies.




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Legal Migration Pathways to Europe for Low- and Middle-Skilled Migrants

This event hosted by MPI Europe and the Research Unit of the Expert Council of German Foundations on Integration and Migration featured a discussion of research into legal migration pathways for work and training for low- and middle-skilled migrants.




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Turning the Tide: Addressing the Long-Term Challenges of EU Mobility for Sending Countries

Amid ongoing debates about the costs and benefits of free movement, this MPI Europe webchat examines big-picture trends of East-West migration; considers possible policy responses at regional, national, and EU levels to alleviate some of the challenges; and reflects on realistic actions that could be taken under the incoming European Commission.




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Addressing Trauma in Young Children in Immigrant and Refugee Families through Early Childhood Programs

During this webinar, speakers discuss a MPI policy brief that explores the intersection of trauma and early childhood development, exploring how migration-related trauma and stressors can influence the wellbeing of young children of immigrants, and points to key opportunities for states to support, through early childhood and other programs.




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Expansion of legal migration opportunities for third-country nationals, particularly in middle- and low-skill sectors, holds potential but should not be oversold as migration management tool, new study cautions

BRUSSELS — While the European Union has called on Member States to expand channels for foreign workers as a way to meet labour market needs and potentially tackle spontaneous migration, they have struggled to deliver on this pledge. To date, policies have focused more on attracting high-skilled workers, but less attention has been paid to admission of low- or middle-skilled nationals. Policymakers would do well not to overestimate the potential of legal channels to reduce irregular migration.




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Phillippa's Christmas Pudding

This recipe was featured on Foodie Tuesday, a weekly segment with Raf Epstein on Drive, 774 ABC Melbourne, 3:30 PM, courtesy of Phillippa Grogan. Her new book is 'Phillippa's Home Baking.'




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Muhallabiya (citris pudding)

This recipe was featured on Foodie Tuesday, a weekly segment with Richelle Hunt on Drive, 774 ABC Melbourne, 3:30 PM, courtesy of Hana Assafiri. Hana's new book is called "Moroccan Soup Bar: Recipes of a Spoken Menu."




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Flinders island lamb saddle, crushed peppered turnip, fried salt bush

This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, courtesy of David Hall of Pure South Dining




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Lemony myrtle delicious pudding

Sometimes these old desserts are just the ticket on a winter's night. We have used a little lemon myrtle powder to add that native home growing touch to this gorgeous pudding.




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Vanilla-scented Baked Rice Pudding

This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, shared by the Dinner Ladies (Katherine Westwood & Sophie Gilliatt)




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Rich and warm teff pudding

Here's a healthy, rich and super tasty teff pudding for a stylish breakfast, brunch or anytime snack.




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Legal Migration Pathways to Europe for Low- and Middle-Skilled Migrants

This event hosted by MPI Europe and the Research Unit of the Expert Council of German Foundations on Integration and Migration featured a discussion on research into legal migration pathways for work and training for low- and middle-skilled migrants.




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Turning the Tide: Addressing the Long-Term Challenges of EU Mobility for Sending Countries

Amid ongoing debates about the costs and benefits of free movement, this MPI webinar examines evidence from the EU-funded REMINDER project on different types of East-West mobility. Speakers examine big-picture trends of East-West migration; consider possible policy responses at regional, national, and EU levels to alleviate some of the challenges; and reflect on realistic actions that could be taken under a new European Commission.




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Addressing Trauma in Young Children in Immigrant and Refugee Families through Early Childhood Programs

During this webinar, speakers provide an overview of an MPI policy brief that seeks to raise awareness of the intersection of trauma and early childhood development, and how U.S. early childhood programs could more effectively address this trauma in young children in refugee and immigrant households. The participants discuss efforts to integrate trauma-informed approaches into early childhood systems and how home visiting services can effectively address trauma and mental health through a two-generation approach.




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What's So Tough About Taking Insulin? Addressing the Problem of Psychological Insulin Resistance in Type 2 Diabetes

William H. Polonsky
Jul 1, 2004; 22:147-150
Practical Pointers




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Cuddling: The Amazing Effect On Your Brain

For the study, 10 couples spent 45 minutes inside a brain scanner together in close physical contact.

Support PsyBlog for just $5 per month. Enables access to articles marked (M) and removes ads.

→ Explore PsyBlog's ebooks, all written by Dr Jeremy Dean:




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Is Addiction Hereditary?

Addiction is a major health problem, both mentally and physically. In fact, it is probably one of the most complicated illnesses to deal with because it is has to be dealt with on both a physical and psychological level. Approximately one in eight adults struggle with drug and alcohol addiction at the same time and […]




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Hidden Segregation Within Schools Is Tracked in New Study

When schools reduce racial segregation between schools, racial isolation within the classes inside those schools goes up, according to an analysis of 20 years of North Carolina data.




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Staff Email Addresses Removed From District Websites to Improve Cybersecurity

Some district technology leaders say having staff email addresses publicly available opens the door for phishing scams and potential hacks.




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Texas Directed to Take Additional Actions to Remedy Special Education Violations

Thousands of Texas children are believed to have been kept from special education services because of a now-prohibited special education enrollment target of 8.5 percent, which is well below the national average.




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Eight States Add Citizenship Test as Graduation Requirement

Advocates have plans to push more state legislatures to pass laws requiring high schoolers to pass a citizenship test in order to graduate in coming years.




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Lessons From a 'Hidden Gem' in Alabama

A rural Southern school with a predominantly Native American population engages the whole community in its continued quest for improvement.




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New Jersey Solicits Community Input on Later Middle, High School Start Times

State education officials are responding to a state law passed last year requiring them to solicit feedback from the community on the impact of implementing later school start times for middle and high school students.




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Called to the islands / Alison Todd.

The memoirs of Alison Todd MBE, a retired minister who, as a young woman, went to the New Hebrides (later Vanuatu) as a missionary nurse. She spent nearly twenty years there, establishing a successful clinic on the island of Paama, and helping medical services on Tanna prepare for independence.




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Just a girl from Crewe / Janice Madden.




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Carly Tarkari Dodd : shackled excellence : 1 October - 10 December 2019 / curated by Adele Sliuzas ; photography by Morgon Sette.

Carly Dodd is a KaurnaNarungga and Ngarrindjeri artist. Carly mixes traditional and contemporary techniques, to produce works that are conceptually and culturally driven. Jack Buckskin is a Kaurna, Narungga and Wirangu man, born in the Adelaide Plains region, who has dedicated himself to learning and sharing the Kaurna language and culture.




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The Book of Lost Addresses.




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Modelling carp biomass : estimates for the year 2023 / Charles R. Todd, John D. Koehn, Tim R. Brown, Ben Fanson, Shane Brooks and Ivor Stuart.




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Ecological anxiety / Jeremy Gadd.




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Portfolio additional estimates statements 2018-19 : explanations of additional estimates 2018-19 : Prime Minister and Cabinet Portfolio / Department of the Prime Minister and Cabinet.




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Stigma & Resilience Framework : (National strategic framework to address HIV stigma and build resilience capacity for people living with HIV) / written and edited by Brent Allan and Kirsten Machon.

"The HIV resilience framework will be of relevance to a wide range of people involved at all levels of the HIV response. We hope it provides encouragement for government decision makers and policy developers to pursue consistent and enabling policy and legislative environments and work cooperatively between jurisdictions and across departments to achieve best practice. Our consultation suggests that consistent legislation with the goal of supporting strong health outcomes, making disclosure safe, and eliminating stigmatising laws is crucial to creating environments in which people with HIV feel safe to access testing, treatment, and care. The HIV resilience framework also contains valuable insights for those who have responsibility for HIV health program management and service delivery, providing guidance to help ensure that programs, services, interventions or strategies supporting people living with HIV are developed and delivered in a way that is mindful of the interlinked twin goals of building personal resilience and eliminating stigma and discrimination." --President's message (page 6).