New IDF clinical practice recommendations for managing type 2 diabetes in primary care.
TL;DR: Globally, appropriate diabetes care is particularly important at the primary care level, where most people with type 2 diabetes are treated and therefore, where a healthcare team trained on best practice for T2D is vital for success.
About: This article is published in Diabetes Research and Clinical Practice.The article was published on 2017-10-01. It has received 169 citations till now. The article focuses on the topics: MEDLINE & Type 2 diabetes.
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653 citations
TL;DR: Evidence on the variations in prevalence by state, age group, and rural vs urban location is critical to effectively target diabetes and hypertension prevention, screening, and treatment programs to those most in need.
Abstract: Importance Understanding how diabetes and hypertension prevalence varies within a country as large as India is essential for targeting of prevention, screening, and treatment services. However, to our knowledge there has been no prior nationally representative study of these conditions to guide the design of effective policies. Objective To determine the prevalence of diabetes and hypertension in India, and its variation by state, rural vs urban location, and individual-level sociodemographic characteristics. Design, Setting, and Participants This was a cross-sectional, nationally representative, population-based study carried out between 2012 and 2014. A total of 1 320 555 adults 18 years or older with plasma glucose (PG) and blood pressure (BP) measurements were included in the analysis. Exposures State, rural vs urban location, age, sex, household wealth quintile, education, and marital status. Main Outcomes and Measures Diabetes (PG level ≥126 mg/dL if the participant had fasted or ≥200 mg/dL if the participant had not fasted) and hypertension (systolic BP≥140 mm Hg or diastolic BP≥90 mm Hg). Results Of the 1 320 555 adults, 701 408 (53.1%) were women. The crude prevalence of diabetes and hypertension was 7.5% (95% CI, 7.3%-7.7%) and 25.3% (95% CI, 25.0%-25.6%), respectively. Notably, hypertension was common even among younger age groups (eg, 18-25 years: 12.1%; 95% CI, 11.8%-12.5%). Being in the richest household wealth quintile compared with being in the poorest quintile was associated with only a modestly higher probability of diabetes (rural: 2.81 percentage points; 95% CI, 2.53-3.08 and urban: 3.47 percentage points; 95% CI, 3.03-3.91) and hypertension (rural: 4.15 percentage points; 95% CI, 3.68-4.61 and urban: 3.01 percentage points; 95% CI, 2.38-3.65). The differences in the probability of both conditions by educational category were generally small (≤2 percentage points). Among states, the crude prevalence of diabetes and hypertension varied from 3.2% (95% CI, 2.7%-3.7%) to 19.9% (95% CI, 17.6%-22.3%), and 18.0% (95% CI, 16.6%-19.5%) to 41.6% (95% CI, 37.8%-45.5%), respectively. Conclusions and Relevance Diabetes and hypertension prevalence is high in middle and old age across all geographical areas and sociodemographic groups in India, and hypertension prevalence among young adults is higher than previously thought. Evidence on the variations in prevalence by state, age group, and rural vs urban location is critical to effectively target diabetes and hypertension prevention, screening, and treatment programs to those most in need.
226 citations
The Chinese University of Hong Kong1, University of Cambridge2, Baker IDI Heart and Diabetes Institute3, University of Pittsburgh4, Centers for Disease Control and Prevention5, Sahlgrenska University Hospital6, Imperial College London7, Royal Prince Alfred Hospital8, University of Cape Town9, Shanghai Jiao Tong University10, Universidade Federal do Rio Grande do Sul11, University of Sydney12, University of Oxford13, National Institutes of Health14, University of Melbourne15, National University of La Plata16, National Health and Medical Research Council17, University of Leicester18
214 citations
09 May 2019
TL;DR: This short review compares and contrasts the diagnostic criteria for screening of prediabetes, the impact of various glycaemic measures on prevalence estimates, and discusses current and future trends in the global prevalence estimates ofprediabetes.
Abstract: Prediabetes is defined as an intermediate state of hyperglycaemia with glucose levels above the normal state but below the diagnostic levels of diabetes. It is increasingly recognised as an important metabolic state, as individuals with prediabetes are at high risk of developing overt diabetes and its associated complications. A better understanding of prediabetes could help with earlier identification, thereby allowing earlier intervention, potentially lowering the number of individuals who go on to develop diabetes. The definitions and screening criteria for prediabetes differ between guidelines published by different organisations, resulting in estimations of prevalence that can vary widely from one another. Despite these differences, these estimates suggest that the number of individuals affected by prediabetes is increasing rapidly in all areas of the world. This short review compares and contrasts the diagnostic criteria for screening of prediabetes, the impact of various glycaemic measures on prevalence estimates, and discusses current and future trends in the global prevalence estimates of prediabetes.
173 citations
University of Eastern Finland1, St. Michael's Hospital2, University of Toronto3, Physicians Committee for Responsible Medicine4, University of Naples Federico II5, Aarhus University Hospital6, Charité7, National and Kapodistrian University of Athens8, Rovira i Virgili University9, Carlos III Health Institute10
TL;DR: It is concluded that T2D is preventable by changing lifestyle and the risk reduction is sustained for many years after the active intervention (high certainty of evidence).
Abstract: Prevention of type 2 diabetes (T2D) is a great challenge worldwide. The aim of this evidence synthesis was to summarize the available evidence in order to update the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy. We conducted a systematic review and, where appropriate, meta-analyses of randomized controlled trials (RCTs) carried out in people with impaired glucose tolerance (IGT) (six studies) or dysmetabolism (one study) to answer the following questions: What is the evidence that T2D is preventable by lifestyle changes? What is the optimal diet (with a particular focus on diet quality) for prevention, and does the prevention of T2D result in a lower risk of late complications of T2D? The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to assess the certainty of the trial evidence. Altogether seven RCTs (N = 4090) fulfilled the eligibility criteria and were included in the meta-analysis. The diagnosis of incident diabetes was based on an oral glucose tolerance test (OGTT). The overall risk reduction of T2D by the lifestyle interventions was 0.53 (95% CI 0.41; 0.67). Most of the trials aimed to reduce weight, increase physical activity, and apply a diet relatively low in saturated fat and high in fiber. The PREDIMED trial that did not meet eligibility criteria for inclusion in the meta-analysis was used in the final assessment of diet quality. We conclude that T2D is preventable by changing lifestyle and the risk reduction is sustained for many years after the active intervention (high certainty of evidence). Healthy dietary changes based on the current recommendations and the Mediterranean dietary pattern can be recommended for the long-term prevention of diabetes. There is limited or insufficient data to show that prevention of T2D by lifestyle changes results in a lower risk of cardiovascular and microvascular complications.
157 citations
Cites background from "New IDF clinical practice recommend..."
...Furthermore, based on the evidence coming from observational studies on T2D risk factors [2,63] and the remarkable beneficial effects of weight reduction on glucose metabolism [51,64–66], weight reduction has been considered as a cornerstone in the prevention of T2D; with larger weight reductions associated with a lower risk of T2D....
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13 Mar 2017
106 citations
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...Diabetes Res Clin Pract 2014;103(3):538-40 83 56 33 81 65 58 62%...
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