ORCID Profile
0000-0002-2398-4781
Current Organisations
University of Sydney
,
Université Officielle de Bukavu
,
Queensland Government
,
Royal Prince Alfred Hospital
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Health Economics | Rehabilitation Engineering | Preventive Medicine | Public Health and Health Services | Public Health And Health Services Not Elsewhere Classified | Biomedical Engineering | Intelligent Robotics | Care For Disabled
ANZSRC Socio-Economic Objective (SEO)
Preventive medicine | Medical instrumentation | Social structure and health | Health policy economic outcomes |
Related Links
Publications
Polygenic risk scores predict diabetic complications and their response to therapy
Publisher: Cold Spring Harbor Laboratory
Date: 02-11-2019
DOI: 10.1101/19010785
Abstract: Type 2 diabetes increases the risk of cardiovascular and renal complications, but early risk prediction can lead to timely intervention and better outcomes. Through summary statistics of meta-analyses of published genome-wide association studies performed in over 1.2 million of in iduals, we combined 9 PRS gathering genomic variants associated to cardiovascular and renal diseases and their key risk factors into one logistic regression model, to predict micro- and macrovascular endpoints of diabetes. Its clinical utility in predicting complications of diabetes was tested in 4098 participants with diabetes of the ADVANCE trial followed during a period of 10 years and replicated it in three independent non-trial cohorts. The prediction model adjusted for ethnicity, sex, age at onset and diabetes duration, identified the top 30% of ADVANCE participants at 3.1-fold increased risk of major micro- and macrovascular events (p=6.3×10 −21 and p=9.6×10 −31 , respectively) and at 4.4-fold (p=6.8×10 −33 ) increased risk of cardiovascular death compared to the remainder of T2D subjects. While in ADVANCE overall, combined intensive therapy of blood pressure and glycaemia decreased cardiovascular mortality by 24%, the prediction model identified a high-risk group in whom this therapy decreased mortality by 47%, and a low risk group in whom the therapy had no discernable effect. Patients with high PRS had the greatest absolute risk reduction with a number needed to treat of 12 to prevent one cardiovascular death over 5 years. This novel polygenic prediction model identified people with diabetes at low and high risk of complications and improved targeting those at greater benefit from intensive therapy while avoiding unnecessary intensification in low-risk subjects.
Prevention and management of chronic kidney disease in type 2 diabetes
Publisher: Wiley
Date: 04-2010
Cost to government and society of chronic kidney disease stage 1-5: A national cohort study
Publisher: Wiley
Date: 07-2015
DOI: 10.1111/IMJ.12797
Abstract: Costs associated with chronic kidney disease (CKD) are not well documented. Understanding such costs is important to inform economic evaluations of prevention strategies and treatment options. To estimate the costs associated with CKD in Australia. We used data from the 2004/2005 AusDiab study, a national longitudinal population-based study of non-institutionalised Australian adults aged ≥25 years. We included 6138 participants with CKD, diabetes and healthcare cost data. The annual age and sex-adjusted costs per person were estimated using a generalised linear model. Costs were inflated from 2005 to 2012 Australian dollars using best practice methods. Among 6138 study participants, there was a significant difference in the per-person annual direct healthcare costs by CKD status, increasing from $1829 (95% confidence interval (CI): $1740-1943) for those without CKD to $14 545 (95% CI: $5680-44 842) for those with stage 4 or 5 CKD (P < 0.01). Similarly, there was a significant difference in the per-person annual direct non-healthcare costs by CKD status from $524 (95% CI: $413-641) for those without CKD to $2349 (95% CI: $386-5156) for those with stage 4 or 5 CKD (P < 0.01). Diabetes is a common cause of CKD and is associated with increased health costs. Costs per person were higher for those with diabetes than those without diabetes in all CKD groups however, this was significant only for those without CKD and those with early stage (stage 1 or 2) CKD. In iduals with CKD incur 85% higher healthcare costs and 50% higher government subsidies than in iduals without CKD, and costs increase by CKD stage. Primary and secondary prevention strategies may reduce costs and warrant further consideration.
Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global B
Publisher: Elsevier BV
Date: 11-2018
Obesity, Type II diabetes and the Ala54Thr polymorphism of fatty acid binding protein 2 in the Tongan population
Publisher: Elsevier BV
Date: 07-2003
DOI: 10.1016/S1096-7192(03)00088-X
Abstract: Genetic variation of fatty acid binding protein 2 (FABP2) may contribute to the high prevalence of obesity and Type II diabetes in Tonga. To explore this we assessed the frequency of the FABP2 Ala54Thr polymorphism, obesity, and Type II diabetes in Tongans and possible inter-relationships. We investigated 1022 Tongan subjects, 433 men and 589 women aged 15-85 years, to identify possible associations between the FABP2 Ala54Thr polymorphism, obesity, Type II diabetes, BMI, glucose tolerance and standard lipid variables. The prevalence of the polymorphism was compared with that reported for other ethnic populations (studies from: Japanese, Finnish, African American, Native Canadian and Inuit, Swedish, Guadeloupe Indians, European males, and Caucasian populations). We found that 84% of the Tongan men and 93% of the Tongan women were overweight or obese (BMI> or =25kg/m2). The mean BMI+/-SD was not significantly different among those who were and were not carrying the Thr allele (males: Ala/Ala 30.4+/-5.4 and Thr carriers 29.8+/-5.1 females: Ala/Ala 33.8+/-6.4 and Thr carriers 33.6+/-5.1). The genotype frequencies were 76.2% Ala/Ala, 22.8% Ala/Thr, and 1.0% Thr/Thr. The Alal/Ala frequency is higher than the prevalences reported for all populations studied. The Thr allele was significantly associated with lower total cholesterol and LDL cholesterol in both sexes and in women also with lower HDL cholesterol. We conclude that there is a high prevalence of the FABP2 Ala54Thr polymorphism in Tongans. The polymorphism may be involved in lipid metabolism as the Thr allele is associated with low total and LDL cholesterol levels in this population.
Thermocline deepening boosts ecosystem metabolism: evidence from a large-scale lake enclosure experiment simulating a summer storm
Publisher: No publisher found
DOI: 10.1111/GCB.13512}
The Clinical Usefulness of 3a‐Androstanediol Glucuronide in Premenopausal Women with Hirsutism
Publisher: Wiley
Date: 05-1994
DOI: 10.1111/J.1479-828X.1994.TB02694.X
Abstract: A biochemical parameter correlating with the clinical assessment of the severity of hirsutism and changing appropriately with the clinical response to treatment would be extremely useful. Preliminary reports of androstanediol glucuronide indicated that it was a peripherally-derived androgen and had a high correlation with clinical gradings of hirsutism. More recent reports have cast doubts on this association. This paper presents an evaluation of the clinical usefulness of androstanediol in 121 consecutive premenopausal patients with hirsutism. Androstanediol had a positive correlation with the clinical grading of hirsutism (p < 0.02) and the BMI (p < 0.01) but a negative correlation with age (p < 0.01). After adjustment for the effects of age and BMI there was no significant association between the degree of hirsutism and the level of androstanediol.
Glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus—Practical implications
Publisher: Elsevier BV
Date: 09-2011
Algorithms to Improve the Prediction of Postprandial Insulinaemia in Response to Common Foods
Publisher: MDPI AG
Date: 08-04-2016
DOI: 10.3390/NU8040210
Cost effectiveness of dietitian‐led nutrition therapy for people with type 2 diabetes mellitus: a scoping review
Publisher: Wiley
Date: 14-10-2021
DOI: 10.1111/JHN.12821
Abstract: The management of diabetes costs in excess of $1.3 trillion per annum worldwide. Diet is central to the management of type 2 diabetes. It is not known whether dietetic intervention is cost effective. This scoping review aimed to map the existing literature concerning the cost effectiveness of medical nutrition therapy provided by dietitians for people with type 2 diabetes. Thirteen scientific databases, including MEDLINE, EMBASE and CINAHL, as well as multiple official websites, were searched to source peer-reviewed articles, reports, guidelines, dissertations and other grey literature published from 2008 to present. Eligible articles had to have assessed and reported the cost effectiveness of dietetic intervention for adults with type 2 diabetes in developed countries. Experimental, quasi-experimental, observational and qualitative studies were considered. Of 2387 abstracts assessed for eligibility, four studies combining 22 765 adults with type 2 diabetes were included. Dietetic intervention was shown to be cost-effective in terms of diabetes-related healthcare costs and hospital charges, at the same time as also reducing the risk of cumulative days at work lost to less than half and the risk of disability 'sick' days at work to less than one-seventh. The findings highlight the importance of advocacy for medical nutrition therapy for people with type 2 diabetes, with respect to alleviating the great global economic burden from this condition. Further studies are warranted to elucidate the factors that mediate and moderate cost effectiveness and to allow for the generalisation of the findings.
Conventional and Sprinkler Needle Injection of Magnesium Insulin
Publisher: Wiley
Date: 09-08-1992
DOI: 10.1111/J.1464-5491.1992.TB01856.X
Abstract: Currently available short-acting insulin preparations fail to mimic the postprandial insulin profile of non-diabetic in iduals. The activity of a novel insulin designed for faster absorption has been tested after subcutaneous injection. Magnesium insulin (50 U ml-1) given by sprinkler needle was compared with unmodified human insulin (100 U ml-1) given by conventional needle and unmodified human insulin (50 U ml-1) given by sprinkler needle in normal volunteers using a euglycaemic cl . Magnesium insulin had a significantly faster onset of action resulting in a higher exogenous insulin level by 15 min, peak level was reached after 60 min compared with 75 min for the unmodified insulins, and duration of action was significantly shorter than both unmodified insulins. No significant differences were observed between the unmodified insulins for the first 5 h after injection, indicating that the observed differences to magnesium insulin could not be attributed to the insulin concentration or the type of needle used for insulin administration. Injection of magnesium insulin prior to a test breakfast in people with Type 2 diabetes resulted in significantly lower total and 0 to 120 min areas under the glucose curve, an earlier rise in exogenous insulin levels and a higher area under the insulin curve from 0 to 120 min compared with unmodified 100 U ml-1 human insulin.
The metabolic syndrome: useful concept or clinical tool? Report of a WHO Expert Consultation
Publisher: Springer Science and Business Media LLC
Date: 11-12-2009
DOI: 10.1007/S00125-009-1620-4
Abstract: This article presents the conclusions of a WHO Expert Consultation that evaluated the utility of the 'metabolic syndrome' concept in relation to four key areas: pathophysiology, epidemiology, clinical work and public health. The metabolic syndrome is a concept that focuses attention on complex multifactorial health problems. While it may be considered useful as an educational concept, it has limited practical utility as a diagnostic or management tool. Further efforts to redefine it are inappropriate in the light of current knowledge and understanding, and there is limited utility in epidemiological studies in which different definitions of the metabolic syndrome are compared. Metabolic syndrome is a pre-morbid condition rather than a clinical diagnosis, and should thus exclude in iduals with established diabetes or known cardiovascular disease (CVD). Future research should focus on: (1) further elucidation of common metabolic pathways underlying the development of diabetes and CVD, including those clustering within the metabolic syndrome (2) early-life determinants of metabolic risk (3) developing and evaluating context-specific strategies for identifying and reducing CVD and diabetes risk, based on available resources and (4) developing and evaluating population-based prevention strategies.
Diabetes‐Related Risk Factors in Older People
Publisher: Wiley
Date: 16-04-2009
The Effect of Energy Labelling on Menus and a Social Marketing Campaign on Food-Purchasing Behaviours of University Students
Publisher: Springer Science and Business Media LLC
Date: 05-08-2016
Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: The treatment of cardiovascular risk using electronic decision support cluster-randomized trial
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
DOI: 10.1161/CIRCOUTCOMES.114.001235
Abstract: Despite effective treatments to reduce cardiovascular disease risk, their translation into practice is limited. Using a parallel arm cluster-randomized controlled trial in 60 Australian primary healthcare centers, we tested whether a multifaceted quality improvement intervention comprising computerized decision support, audit/feedback tools, and staff training improved (1) guideline-indicated risk factor measurements and (2) guideline-indicated medications for those at high cardiovascular disease risk. Centers had to use a compatible software system, and eligible patients were regular attendees (Aboriginal and Torres Strait Islander people aged ≥35 years and others aged ≥45 years). Patient-level analyses were conducted using generalized estimating equations to account for clustering. Median follow-up for 38 725 patients (mean age, 61.0 years 42% men) was 17.5 months. Mean monthly staff support was hour/site. For the coprimary outcomes, the intervention was associated with improved overall risk factor measurements (62.8% versus 53.4% risk ratio 1.25 95% confidence interval, 1.04–1.50 P =0.02), but there was no significant differences in recommended prescriptions for the high-risk cohort (n=10 308 56.8% versus 51.2% P =0.12). There were significant treatment escalations (new prescriptions or increased numbers of medicines) for antiplatelet (17.9% versus 2.7% P .001), lipid-lowering (19.2% versus 4.8% P .001), and blood pressure–lowering medications (23.3% versus 12.1% P =0.02). In Australian primary healthcare settings, a computer-guided quality improvement intervention, requiring minimal support, improved cardiovascular disease risk measurement but did not increase prescription rates in the high-risk group. Computerized quality improvement tools offer an important, albeit partial, solution to improving primary healthcare system capacity for cardiovascular disease risk management. URL: www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336630 . Australian New Zealand Clinical Trials Registry No. 12611000478910.
Higher-than-optimal body mass index and diabetes mortality in the Asia Pacific region
Publisher: Elsevier BV
Date: 12-2011
DOI: 10.1016/J.DIABRES.2011.10.002
Abstract: To estimate the population attributable fraction (PAF) of elevated body mass index (BMI) for diabetes mortality by country, sex and age group, for the Western Pacific and South-East Asia regions. Published data on nationally representative mean BMI (since year 2000) and age-specific hazard ratios for death due to diabetes for a unit increase in BMI were used to calculate PAFs using the methodology of the WHO Global Burden of Disease project, taking a BMI of 21 kg/m(2) as the ideal. Data were available for 15 countries in the Western Pacific and South East Asia regions. This included data from 330,374 in iduals. Age-standardized male PAFs ranged from 11% for India to 98% for American Samoa. Age-standardized female PAFs ranged from 9% in India to 95% in American Samoa. For males, several countries had PAFs at or below 30% - these were India, Indonesia and Japan whereas, India and Indonesia were the only two countries with PAFs below approximately 30% for females. Although this study is not a trial and thus not able to definitively state the proportions of diabetes deaths that could be averted by reducing mean BMI, this paper demonstrates that theoretically between 9% and 98% of deaths from diabetes could be prevented by tackling obesity in the Asia Pacific region. Preventing these deaths is likely to have an enormous positive social and economic impact, particularly in this region consisting of many low and middle-income countries.
Improving the Estimation of Mealtime Insulin Dose in Adults With Type 1 Diabetes
Publisher: American Diabetes Association
Date: 15-09-2011
DOI: 10.2337/DC11-0567
Abstract: Although carbohydrate counting is routine practice in type 1 diabetes, hyperglycemic episodes are common. A food insulin index (FII) has been developed and validated for predicting the normal insulin demand generated by mixed meals in healthy adults. We sought to compare a novel algorithm on the basis of the FII for estimating mealtime insulin dose with carbohydrate counting in adults with type 1 diabetes. A total of 28 patients using insulin pump therapy consumed two different breakfast meals of equal energy, glycemic index, fiber, and calculated insulin demand (both FII = 60) but approximately twofold difference in carbohydrate content, in random order on three consecutive mornings. On one occasion, a carbohydrate-counting algorithm was applied to meal A (75 g carbohydrate) for determining bolus insulin dose. On the other two occasions, carbohydrate counting (about half the insulin dose as meal A) and the FII algorithm (same dose as meal A) were applied to meal B (41 g carbohydrate). A real-time continuous glucose monitor was used to assess 3-h postprandial glycemia. Compared with carbohydrate counting, the FII algorithm significantly decreased glucose incremental area under the curve over 3 h (–52%, P = 0.013) and peak glucose excursion (–41%, P = 0.01) and improved the percentage of time within the normal blood glucose range (4–10 mmol/L) (31%, P = 0.001). There was no significant difference in the occurrence of hypoglycemia. An insulin algorithm based on physiological insulin demand evoked by foods in healthy subjects may be a useful tool for estimating mealtime insulin dose in patients with type 1 diabetes.
Evaluation of a Continuous Blood Glucose Monitor: A Novel and Non-Invasive Wearable Using Bioimpedance Technology
Publisher: SAGE Publications
Date: 29-10-2023
DOI: 10.1177/19322968211054110
Abstract: Frequent blood glucose level (BGL) monitoring is essential for effective diabetes management. Poor compliance is common due to the painful finger pricking or subcutaneous lancet implantation required from existing technologies. There are currently no commercially available non-invasive devices that can effectively measure BGL. In this real-world study, a prototype non-invasive continuous glucose monitoring system (NI-CGM) developed as a wearable ring was used to collect bioimpedance data. The aim was to develop a mathematical model that could use these bioimpedance data to estimate BGL in real time. The prototype NI-CGM was worn by 14 adult participants with type 2 diabetes for 14 days in an observational clinical study. Bioimpedance data were collected alongside paired BGL measurements taken with a Food and Drug Administration (FDA)-approved self-monitoring blood glucose (SMBG) meter and an FDA-approved CGM. The SMBG meter data were used to improve CGM accuracy, and CGM data to develop the mathematical model. A gradient boosted model was developed using a randomized 80-20 training-test split of data. The estimated BGL from the model had a Mean Absolute Relative Difference (MARD) of 17.9%, with the Parkes error grid (PEG) analysis showing 99% of values in clinically acceptable zones A and B. This study demonstrated the reliability of the prototype NI-CGM at collecting bioimpedance data in a real-world scenario. These data were used to train a model that could successfully estimate BGL with a promising MARD and clinically relevant PEG result. These results will enable continued development of the prototype NI-CGM as a wearable ring.
The cost of diabetes and obesity in Australia.
Publisher: Informa UK Limited
Date: 19-07-2018
DOI: 10.1080/13696998.2018.1497641
Abstract: To assess and compare the direct healthcare and non-healthcare costs and government subsidies by body weight and diabetes status. The Australian Diabetes, Obesity and Lifestyle study collected health service utilization and health-related expenditure data at the 2011-2012 follow-up surveys. Costing data were available for 4,409 participants. Unit costs for 2016-2017 were used where available or were otherwise inflated to 2016-2017 dollars. Age- and sex-adjusted costs per person were estimated using generalized linear models. The annual total direct cost ranged from $1,998 per person with normal weight to $2,501 per person with obesity in participants without diabetes. For those with diabetes, total direct costs were $2,353 per person with normal weight, $3,263 per person with overweight, and $3,131 per person with obesity. Additional expenditure as government subsidies ranged from $5,649 per person with normal weight and no diabetes to $8,085 per person with overweight and diabetes. In general, direct costs and government subsidies were higher for overweight and obesity compared to normal weight, regardless of diabetes status, but were more noticeable in the diabetes sub-group. The annual total excess cost compared with normal weight people without diabetes was 26% for obesity alone and 46% for those with obesity and diabetes. Participants included in this study represented a healthier cohort than the Australian population. The relatively small s le of people with both obesity and diabetes prevented a more detailed analysis by obesity class. Overweight and obesity are associated with increased costs, which are further increased in in iduals who also have diabetes. Interventions to prevent overweight and obesity or reduce weight in people who are overweight or obese, and prevent diabetes, should reduce the financial burden.
Effectiveness and acceptability of a text message intervention (DTEXT) on HbA1c and self-management for people with type 2 diabetes. A randomized controlled trial
Publisher: Elsevier BV
Date: 07-2021
Factors influencing the cost of hospital care for people with diabetes in Australia
Publisher: Elsevier BV
Date: 11-2006
DOI: 10.1016/J.JDIACOMP.2005.08.004
Abstract: To estimate the incidence of disease and annual disease-specific hospital costs for people with and without diabetes. A comparison of costs of Australian hospital care (1996-1999) in 20,538 persons with diabetes over the age of 35 years, using matched controls. Odds ratios were used to compare the incidence of new episodes of disease in both groups and regression analyses using annual costs, and log-transformed annual costs were used to estimate disease-specific hospital costs. People with diabetes had a higher incidence of all vascular diseases and a range of nonvascular diseases with the greatest difference being for utation (odds ratio, 5.13 95% CI, 3.11-8.47). The overall average cost for people with diabetes was 3676 dollars (S.D., 7756) compared to 2670 dollars (S.D., 6045) for controls. Forty percent of the 1005 dollars(95% CI, 927-1084) excess hospital costs were due to higher disease-specific costs, reflecting greater intensity of treatment, with the remainder due to the higher frequency of hospitalization. It was found that although treatment costs for a new comorbidity peaked in the first year for both groups, these higher costs continued over subsequent years for people with diabetes. The majority of the excess costs is due to the increased frequency of disease requiring hospitalization rather than intensity of treatment. This additional cost is due to extra admissions, increased length of stay per admission, and greater ongoing treatment costs in subsequent years. There continues to be potential for cost containment through improved preventative care.
Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018
Publisher: Springer Science and Business Media LLC
Date: 03-06-2021
DOI: 10.1038/S41562-021-01108-6
Abstract: Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for ex le, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030.
Impact of gestational diabetes mellitus screening strategies on perinatal outcomes: A simulation study
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.DIABRES.2012.12.009
Abstract: To evaluate the impact on perinatal outcomes of universal gestational diabetes (GDM) screening based on 1999 WHO and IADPSG diagnostic criteria to assess the quality of the evidence (GRADE) to support GDM screening. Simulation of a hypothetical cohort of community-based pregnant women with 10% GDM prevalence (1999 WHO). Most parameters were obtained from recent systematic reviews. Compared to no screening, screening based on 1999 WHO criteria (followed by treatment) reduced the incidence of large for gestational age (LGA) neonates by 0.53% (95% CI 0.37-0.74% NNS=189) and of preecl sia by 0.27% (0.10-0.45% NNS=376). Screening based on IADPSG criteria reduced incidences by 0.85% (0.54-1.29% NNS=117) and by 0.39% (0.15-0.65% NNS=257), respectively. Compared to screening based on 1999 WHO criteria, screening with IADPSG criteria reduced the incidence of LGA by 0.32% (0.09-0.63% NNS=309) and of preecl sia by 0.12% (0.01-0.25 NNS=808). The quality of evidence for both screening approaches is very low. Universal screening for GDM has only a modest impact on pregnancy outcomes. The impact of screening based on IADPSG (vs. WHO, 1999) criteria is slightly larger. However, costs and resources should also be considered in local selection of a screening approach.
The cost of diabetes in adults in Australia
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.DIABRES.2012.12.002
Abstract: To assess and compare costs associated with diabetes and lesser degrees of glucose intolerance in Australia. The Australian Diabetes, Obesity and Lifestyle study collected data on the use of health services and health related expenditure in 2004-2005. Complications data were collected through physical examination and biochemical tests or questionnaire. Data were available on 6101 participants. Age- and sex-adjusted direct healthcare costs, direct non-healthcare costs and government subsidies were estimated according to glucose tolerance status. Annual direct per person costs were A$1898 for those with normal glucose tolerance to A$4390 for those with known diabetes. Costs were substantially higher in people with diabetes and both micro- and macrovascular complications. The total annual cost of diabetes in 2005 for Australians aged ≥30 years was A$10.6 billion (A$4.4 billion in direct costs A$6.2 billion in government subsidies) which equates to A$14.6 billion in 2010 dollars. Total annual excess cost associated with diabetes in 2005 was A$4.5 billion (A$2.2 billion in direct costs A$2.3 billion in government subsidies). The excess cost of diabetes to in iduals and government is substantial and is greater in those with complications. Costs could potentially be reduced by preventing the development of diabetes or its complications.
Reducing cardiovascular disease risk in diabetes
Publisher: AMPCo
Date: 06-2017
DOI: 10.5694/MJA16.00332
Abstract: To describe the management of cardiovascular disease (CVD) risk in Australian patients with diabetes to compare the effectiveness of a quality improvement initiative for people with and without diabetes. Subgroup analyses of patients with and without diabetes participating in a cluster randomised trial. Indigenous people (≥ 35 years old) and non-Indigenous people (≥ 45 years old) who had attended one of 60 Australian primary health care services at least three times during the preceding 24 months and at least once during the past 6 months. Quality improvement initiative comprising point-of-care electronic decision support with audit and feedback tools. Adherence to CVD risk screening and prescribing guidelines. Baseline rates of guideline-recommended screening were higher for 8829 patients with diabetes than for 44 335 without diabetes (62.0% v 39.5% P < 0.001). Baseline rates of guideline-recommended prescribing were greater for patients with diabetes than for other patients at high risk of CVD (55.5% v 39.6% P < 0.001). The proportions of patients with diabetes not attaining recommended treatment targets for blood pressure, low-density lipoprotein-cholesterol or HbA1c levels who were not prescribed the corresponding therapy at baseline were 28%, 44% and 24% respectively. The intervention was associated with improved screening rates, but the effect was smaller for patients with diabetes than for those without diabetes (rate ratio [RR], 1.14 v 1.28 P = 0.01). It was associated with improved guideline-recommended prescribing only for undertreated in iduals at high risk the effect size was similar for those with and without diabetes (RR, 1.63 v 1.53 P = 0.28). Adherence to CVD risk management guidelines was better for people with diabetes, but there is room for improvement. The intervention was modestly effective in people with diabetes, but further strategies are needed to close evidence-practice gaps.Australian and New Zealand Clinical Trials Registry number: ACTRN12611000478910.
Nutrition and Diet in Maternal Diabetes
Publisher: Springer International Publishing
Date: 2018
Prognostic Value of Variability in Systolic Blood Pressure Related to Vascular Events and Premature Death in Type 2 Diabetes Mellitus
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2017
DOI: 10.1161/HYPERTENSIONAHA.117.09359
Abstract: Visit-to-visit variability in systolic blood pressure (SBP) is a risk factor for cardiovascular events. However, whether it provides additional predictive information beyond traditional risk factors, including mean SBP, in the long term is unclear. The ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) was a randomized controlled trial in patients with type 2 diabetes mellitus ADVANCE-ON (ADVANCE-Observational) followed-up patients subsequently. In these analyses, 9114 patients without major macrovascular or renal events or death during the first 24 months were included. Data on SBP from 6 visits during the first 24 months after randomization were used to estimate visit-to-visit variability in several ways: the primary measure was the standard deviation. Events accrued during the following 7.6 years. The primary outcome was a composite of major macrovascular and renal events and all-cause mortality. Standard deviation of SBP was log-linearly associated with an increased risk of the primary outcome ( P .001) after adjustment for mean SBP and other cardiovascular risk factors. The hazard ratio (HR 95% confidence interval [CI]) in the highest, compared with the lowest, tenth of the standard deviation was 1.39 (1.15–1.69). Results were similar for major macrovascular events alone and all-cause mortality alone (both P .01). Addition of standard deviation of SBP significantly improved 8-year risk classification (continuous net reclassification improvement, 5.3%). Results were similar for other measures of visit-to-visit variability, except maximum SBP. Visit-to-visit variability in SBP is an independent predictor of vascular complications and death, which improves risk prediction beyond that provided by traditional risk factors, including mean SBP.
Comparison of clinical-metabolic monitoring and outcomes and coronary risk status in people with type 2 diabetes from Australia, France and Latin America
Publisher: Elsevier BV
Date: 04-2010
DOI: 10.1016/J.DIABRES.2009.12.024
Abstract: To compare clinical-metabolic monitoring and coronary risk status in people with type 2 diabetes from Australia, France and Latin America. Retrospective analysis of data collected at primary care (except ANDIAB--secondary care) [corrected] matched for age, gender and disease duration. Measurements included participants' characteristics, performance frequency of clinical-metabolic process indicators, and percentage of clinical-metabolic outcomes at recommended target values. The weighted mean of the percentage of process performance was within 68 to 81% that of outcomes at target dropped to 29 to 45%. Although statistically significant, differences among groups were far from those in healthcare budgets, and probably only of marginal clinical impact. The percentage of patients with low, slight or high coronary risk was similar in the three groups, with most people at high or very high risk. Despite the high difference in health per capita investment and system characteristics among countries, the study populations had striking similarities regarding the low percentage of participants who achieved cardiovascular risk factor and diabetes treatment goals. Therefore, differences in health budget and system characteristics would not be the main drivers in care quality. Diabetes education at every level and quality care registries would contribute to improve this situation and assess such improvement.
DTEXT – text messaging intervention to improve outcomes of people with type 2 diabetes: protocol for randomised controlled trial and cost-effectiveness analysis
Publisher: Springer Science and Business Media LLC
Date: 04-03-2019
The Quality of Self‐monitoring of Blood Glucose
Publisher: Wiley
Date: 11-1990
DOI: 10.1111/J.1464-5491.1990.TB01495.X
Abstract: The accuracy of self-monitoring of blood glucose (SBGM) was assessed by a quality control programme. Ninety diabetic patients who were routinely performing SBGM were supplied with a series of quality control solutions which they tested with their usual meter and reagent strip. The overall error rate (a result outside the range of the mean +/- 3SD for each quality control solution) was 39% for users of the Ames system and 33% in Boehringer Mannheim system users. The clinical relevance of these errors was determined by examining the effect on the clinical decision which would have been based on the erroneous result, either in taking inappropriate action or in failing to take appropriate action. In 30% of all patients, 25% or more of the errors were of such a degree as to be clinically misleading. The most common error was an underestimation of the result, which gave the impression of better than actual blood glucose control. The main reason for these errors was the failure of patients to take sufficient care in following the manufacturers' instructions when performing the test. Clinically relevant erroneous results are common among patients performing SBGM.
Diagnosis of GDM: A suggested consensus
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.BPOBGYN.2014.04.022
Abstract: Despite recent attempts at building consensus, an internationally consistent definition of gestational diabetes mellitus (GDM) remains elusive. Within and between countries, there is disagreement between obstetric, medical, and endocrine groups as to the diagnosis and management of GDM. The current article aims to discuss the background to the controversy of GDM diagnosis and to address issues related to the detection and treatment of GDM in low-, middle-, and high-resource settings. The criteria recommended by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG), the American Diabetes Association (ADA), and the World Health Organization (WHO) are endorsed. We also wish to put into perspective the importance of GDM, both during and after pregnancy, in terms of its relationship to overall women's health.
The metabolic syndrome as a tool for predicting future diabetes: the AusDiab study
Publisher: Wiley
Date: 10-07-2008
DOI: 10.1111/J.1365-2796.2008.01935.X
Abstract: To compare the ability of the metabolic syndrome (MetS), a diabetes prediction model (DPM), a noninvasive risk questionnaire and in idual glucose measurements to predict future diabetes. Five-year longitudinal cohort study. Tools tested included MetS definitions [World Health Organization, International Diabetes Federation, ATPIII and European Group for the study of Insulin Resistance (EGIR)], the FINnish Diabetes RIsk SCore risk questionnaire, the DPM, fasting and 2-h post load plasma glucose. Adult Australian population. A total of 5842 men and women without diabetes > or =25 years. Response 58%. A total of 224 incident cases of diabetes. In receiver operating characteristic curve analysis, the MetS was not a better predictor of incident diabetes than the DPM or measurement of glucose. The risk for diabetes among those with prediabetes but not MetS was almost triple that of those with MetS but not prediabetes (9.0% vs. 3.4%). Adjusted for component parts, the MetS was not a significant predictor of incident diabetes, except for EGIR in men [OR 2.1 (95% CI 1.2-3.7)]. A single fasting glucose measurement may be more effective and efficient than published definitions of the MetS or other risk constructs in predicting incident diabetes. Diagnosis of the MetS did not confer increased risk for incident diabetes independent of its in idual components, with an exception for EGIR in men. Given these results, debate surrounding the public health utility of a MetS diagnosis, at least for identification of incident diabetes, is required.
The value of early detection of type 2 diabetes
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2009
Cost effectiveness of primary care referral to a commercial provider for weight loss treatment, relative to standard care: a modelled lifetime analysis
Publisher: Springer Science and Business Media LLC
Date: 04-12-2013
DOI: 10.1038/IJO.2013.227
Diabetes Resistant to Subcutaneous Insulin: Effect of Aprotinin
Publisher: Massachusetts Medical Society
Date: 03-12-1981
Can a screening programme for diabetes be applied to another population?
Publisher: Wiley
Date: 15-08-2005
DOI: 10.1111/J.1464-5491.2005.01641.X
Abstract: To compare the performance of a Danish diabetes screening protocol in populations from Denmark and Australia. The populations used were the Inter99 population from Denmark and the AusDiab population from Australia. The Inter99 study included 6270 in iduals aged 30-60 years, randomly selected from Copenhagen County. The AusDiab study included 7079 in iduals also aged 30-60 years, randomly selected from throughout Australia. In both studies, all in iduals without known diabetes underwent an oral glucose tolerance test (OGTT). Screening using a Danish risk score as an initial step was followed by measurement of fasting plasma glucose (FPG). The characteristics of the study populations showed some differences in risk profile, with more in iduals in the AusDiab study being obese, whilst in the Danish cohort, mean blood pressure was higher, less people took anti-hypertensive medication and there was a higher prevalence of screen-detected diabetes. Comparing the Australian and Danish populations, overall performance of the screening protocol was similar-area under area receiver operator characteristic (ROC) curve 0.75 vs. 0.77, sensitivity 71 vs. 76% and positive predictive value (PPV) 6 vs. 9%. Small but statistically significant differences were observed in specificity (70 vs. 66% P < 0.001) and percentage of the population requiring further testing (31 vs. 36% P or = 6.1 mmol/l showed a similar pattern. Again, specificity was slightly but significantly higher in the Australian population (95 vs. 93% P < 0.001) and percentage of the population requiring further testing was lower (5 vs. 8% P < 0.001). The Danish risk score performed well when applied to a geographically different Caucasian population and is a suitable tool for detecting people at high risk of undiagnosed diabetes.
Trade and food policy: Case studies from three Pacific Island countries
Publisher: Elsevier BV
Date: 12-2010
The Framingham and UK Prospective Diabetes Study (UKPDS) risk equations do not reliably estimate the probability of cardiovascular events in a large ethnically diverse sample of patients with diabetes: the Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) Study.
Publisher: Springer Science and Business Media LLC
Date: 17-02-2010
DOI: 10.1007/S00125-010-1681-4
Abstract: Available multivariable equations for cardiovascular risk assessment in people with diabetes have been derived either from the general population or from populations with diabetes. Their utility and comparative performance in a contemporary group of patients with type 2 diabetes are not well established. The aim of this study was to evaluate the performance of the Framingham and UK Prospective Diabetes Study (UKPDS) risk equations in participants who took part in the Action in Diabetes and Vascular disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) trial. The 4-year risks of cardiovascular disease (CVD) and its constituents were estimated using two published Framingham and the UKPDS risk equations in 7,502 in iduals with type 2 diabetes without prior known CVD at their enrolment in the trial. The risk of major CVD was overestimated by 170% (95% CI 146-195%) and 202% (176-231%) using the two Framingham equations. The risk of major coronary heart disease was overestimated by 198% (162-238%) with the UKPDS, and by 146% (117-179%) and 289% (243-341%) with the two different Framingham equations, respectively. The risks of stroke events were also overestimated with the UKPDS and one of the Framingham equations. The ability of these equations to rank risk among ADVANCE participants was modest, with c-statistics ranging from 0.57 to 0.71. Results stratified by sex, treatment allocation and ethnicity were broadly similar. Application of the Framingham and UKPDS risk equations to a contemporary treated group of patients with established type 2 diabetes is likely to substantially overestimate cardiovascular risk.
Triple therapy combinations for the treatment of type 2 diabetes - A network meta-analysis
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.DIABRES.2016.04.037
Abstract: To estimate and compare the results from all randomised trials of triple combinations of anti-diabetes therapies that reported the reduction of glycated haemoglobin (HbA1c) and associated effects on body weight and hypoglycaemia. PubMed and the Cochrane Library were searched for trials with at least one study arm on triple therapy and which reported the differences in mean change in HbA1c between two study arms. These were included in a network meta-analysis. Altogether, 15,182 participants from 40 trials with treatment duration of 6-12months were included. Compared with none lacebo added to dual therapy, the addition of a drug therapy from six of eight drug classes to existing dual therapy resulted in significant additional mean reductions in HbA1c from -0.56% (-6.2mmol/mol dipeptidyl peptidase 4 inhibitors) to -0.94% (-10.3mmol/mol thiazolidinediones). Of the six drug classes, three were associated with less favourable weight change and two were associated with more favourable weight change when compared with none lacebo added to dual therapy. Furthermore, five drug classes were associated with greater odds of hypoglycaemia. Similar results were observed in analyses of studies with a 6month treatment duration and after excluding study arms that contained insulin. Overall triple therapy combinations were similar in improving diabetes control although there were some differences in adverse effects. By balancing the risks and benefits of each therapy, the estimates of pairwise comparisons of triple therapies for HbA1c, body weight and hypoglycaemia provided in this study may further inform evidence based practice.
The diagnosis and management of diabetes in Australia: Does the “Rule of Halves” apply?
Publisher: Elsevier BV
Date: 12-2020
The Answer to Diabetes Prevention: Science, Surgery, Service Delivery, or Social Policy?
Publisher: American Public Health Association
Date: 09-2006
Abstract: The diabetes and obesity epidemics are closely intertwined. International randomized controlled trials demonstrate that, in high-risk in iduals, type 2 diabetes can be prevented or at least delayed through lifestyle modification and, to a lesser degree, medication. We explored the relative roles of science, surgery, service delivery, and social policy in preventing diabetes. Although it is clear that there is a role for all, diabetes is a complex problem that demands commitment across a range of government and nongovernment agencies to be effectively controlled. Accordingly, we argue that social policy is the key to achieving and sustaining social and physical environments required to achieve widespread reductions in both the incidence and prevalence of diabetes.
Comparability of venous and capillary glucose measurements in blood
Publisher: Wiley
Date: 22-10-2003
DOI: 10.1046/J.1464-5491.2003.01048.X
Abstract: Diabetes and glucose intolerance are diagnosed by measurement of glucose in blood. Glucose is usually measured as venous plasma or capillary whole blood and diagnostic criteria frequently provide equivalence estimates for these two methods. This study examined the relationship between glucose measured in capillary and venous s les collected at random, fasting and 2 h after oral glucose. Simultaneous measurements of venous plasma and capillary blood glucose were performed on random s les in 609 people, fasting s les in 685 people, and 2 h after oral glucose s les in 463 people. Separate capillary and venous s les were collected each time. A variance component model was used to construct conversion algorithms between venous and capillary results. The relationship between venous and capillary glucose values varied, with venous plasma being higher than capillary blood for random and fasting s les but lower for s ling 2 h after oral glucose. Discrepancies were observed between measured capillary blood values and the published WHO capillary blood equivalence values for venous plasma values for all except a fasting venous value of 7.0 mmol/l. For ex le, for a fasting venous plasma glucose of 6.1 mmol/l the WHO equivalent value is 5.6 mmol/l, while the measured value was 5.2 mmol/l, and for a 2-h venous plasma glucose of 11.1 mmol/l the WHO value is 11.1 mmol/l, while the measured result was 11.7 mmol/l. These results highlight the difficulty in equating glucose levels from one s ling and measuring procedure to another, and raise uncertainties about current published equivalence values which could lead to misclassifications in glucose tolerance status.
The burden of cardiovascular disease associated with high body mass index in the Asia-Pacific region
Publisher: Wiley
Date: 27-04-2011
Efficacy and safety of the dipeptidyl peptidase‐4 inhibitor alogliptin in patients with type 2 diabetes inadequately controlled by glyburide monotherapy
Publisher: Wiley
Date: 29-12-2008
DOI: 10.1111/J.1463-1326.2008.01016.X
Abstract: To evaluate the efficacy and safety of alogliptin, a potent and highly selective dipeptidyl peptidase-4 (DPP-4) inhibitor, in combination with glyburide in patients with type 2 diabetes inadequately controlled by sulphonylurea monotherapy. After a 2-week screening period, adult patients 18-80 years of age entered a 4-week run-in/stabilization period in which they were switched from their own sulphonylurea medication to an equivalent dose of glyburide (open label) plus placebo (single blind). After the run-in period, patients were randomly assigned to double-blind treatment with alogliptin 12.5 mg (n = 203), alogliptin 25 mg (n = 198), or placebo (n = 99) for 26 weeks. The primary end-point was change from baseline to week 26 in glycosylated haemoglobin (HbA1c). Secondary end-points included clinical response rates and changes in fasting plasma glucose, beta-cell function (fasting proinsulin, insulin, proinsulin/insulin ratio, and C-peptide, and homeostasis model assessment beta-cell function), body weight, and safety end-points [adverse events (AEs), clinical laboratory tests, vital signs and electrocardiographic readings]. The study population had a mean age of 57 years and a mean disease duration of 8 years it was well balanced for gender (52% women) and was mainly white (71%). The mean baseline HbA1c was approximately 8.1% in each group. Significantly greater least squares (LS) mean reductions in HbA1c were seen at week 26 with alogliptin 12.5 mg (-0.38%) and 25 mg (-0.52%) vs. placebo (+0.01% p < 0.001), and more patients in the alogliptin 25-mg group had HbA1c levels or =0.5% from baseline compared with patients in the placebo group (26.3% p < 0.001). Minor improvements in in idual markers of beta-cell function were seen with alogliptin, but no significant treatment group differences were noted relative to placebo. Minor LS mean changes in body weight were noted across groups (placebo, -0.20 kg alogliptin 12.5 mg, +0.60 kg alogliptin 25 mg, +0.68 kg). AEs were reported for 63-64% of patients receiving alogliptin and 54% of patients receiving placebo. Few AEs were treatment limiting (2.0-2.5% across groups), and serious AEs (2.0-5.6%) were infrequent, similar across groups, and generally considered not related to treatment. The incidences of hypoglycaemia for placebo, alogliptin 12.5 mg and alogliptin 25 mg groups were 11.1, 15.8 and 9.6% respectively. In patients with type 2 diabetes inadequately controlled by glyburide monotherapy, the addition of alogliptin resulted in clinically significant reductions in HbA1c without increased incidence of hypoglycaemia.
Intensification of medication and glycaemic control among patients with type 2 diabetes - the ADVANCE trial.
Publisher: Wiley
Date: 16-12-2013
DOI: 10.1111/DOM.12238
Abstract: The aim of this study was to assess associations between patient characteristics, intensification of blood glucose-lowering treatment through oral glucose-lowering therapy and/or insulin and effective glycaemic control in type 2 diabetes. 11 140 patients from the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) trial who were randomized to intensive glucose control or standard glucose control and followed up for a median of 5 years were categorized into two groups: effective glycaemic control [haemoglobin A1c (HbA1c) ≤ 7.0% or a proportionate reduction in HbA1c over 10%] or ineffective glycaemic control (HbA1c > 7.0% and a proportionate reduction in HbA1c less than or equal to 10%). Therapeutic intensification was defined as addition of an oral glucose-lowering agent or commencement of insulin. Pooled logistic regression models examined the associations between patient factors, intensification and effective glycaemic control. A total of 7768 patients (69.7%), including 3198 in the standard treatment group achieved effective glycaemic control. Compared to patients with ineffective control, patients with effective glycaemic control had shorter duration of diabetes and lower HbA1c at baseline and at the time of treatment intensification. Treatment intensification with addition of an oral agent or commencement of insulin was associated with a 107% [odds ratio, OR: 2.07 (95% confidence interval, CI: 1.95-2.20)] and 152% [OR: 2.52 (95% CI: 2.30-2.77)] greater chance of achieving effective glycaemic control, respectively. These associations were robust after adjustment for several baseline characteristics and not modified by the number of oral medications taken at the time of treatment intensification. Effective glycaemic control was associated with treatment intensification at lower HbA1c levels at all stages of the disease course and in both arms of the ADVANCE trial.
It is Time to Make Policy for Healthier Food Environments in Australian Universities
Publisher: MDPI AG
Date: 04-12-2018
DOI: 10.3390/NU10121909
Abstract: The obesogenic food environment is likely driving excessive weight gain in young adults. Our study aimed to investigate the nutritional quality of current food and drink offerings in an Australian university. This cross-sectional study included baseline environmental audits of 30 food outlets and 62 vending machines across c us. A recent food and drink benchmark for health facilities by state government was used to classify the food and beverage offerings. It recommended food outlets and vending machines to offer at least 75% ‘Everyday’ (healthy) and less than 25% ‘Occasional’ (less healthy) foods and drinks. Sugary drinks and options with large portion sizes and unhealthy ingredients should be removed from sale. Only two beverage vending machines and none of the food outlets met the full recommendations. The overall proportions of Everyday and Occasional foods in food outlets were 35% and 22%, respectively with 43% falling into the category that should not be sold. Sugary drinks occupied a third of beverage varieties in outlets and 38% of beverage slots in vending machines. The current university food environment was poorly compliant with the existing benchmark. Specific food policy in the university setting may be needed to make healthier choices more accessible to young adults.
Can patients set their own educational priorities?
Publisher: Elsevier BV
Date: 11-1995
DOI: 10.1016/0168-8227(95)01160-9
Abstract: This study aimed to determine if patients can set their own educational priorities accurately and if the impact of diabetes education on knowledge differed between patients who did and did not set their own priorities. Forty patients referred for in idual education were randomly assigned to one of two groups. Prior to education with a diabetes specialist nurse (DSN) patients ranked 10 diabetes care topics in order of perceived importance and relevance to their needs and completed a knowledge questionnaire. Group 1 set their own priorities and the DSN directed education according to the patients stated priorities. In Group 2 the DSN set the educational priorities without seeing the patients priority list. The priority ranking by the two groups of the 10 topics and their pre-education knowledge score were not significantly different. Post-education knowledge scores improved equally and significantly in both groups (Group 1 from 23 to 87% Group 2 from 21 to 79%) P < 0.0001). In both groups, knowledge scores for the top three priorities were significantly higher than for the three lowest ranked topics. Knowledge is neither dependent on, nor a good discriminator of, patient-selected priorities. There may be reasons why it is important for patients to set their own priorities, but education directed solely at those priorities may leave knowledge deficits which could compromise diabetes care.
Health potential of a low glycaemic index diet
Publisher: BMJ
Date: 07-05-2015
DOI: 10.1136/BMJ.H2267
Creating a pandemic of prediabetes: the proposed new diagnostic criteria for impaired fasting glycaemia
Publisher: Springer Science and Business Media LLC
Date: 24-07-2004
DOI: 10.1007/S00125-004-1468-6
Abstract: In November 2003 the American Diabetes Association expert committee on the diagnosis and classification of diabetes mellitus suggested a revision of the diagnostic criteria for IFG, lowering the diagnostic threshold from 6.1 to 5.6 mmol/l. The aim of the present study was to evaluate the consequences of this change with respect to: (i) the prevalence of IFG in five different countries (ii) the concordance between IFG and IGT (classification of in iduals) and (iii) the cardiovascular risk profile of these groups. Finally we discuss the likelihood that intervention for cardiovascular risk and prevention strategies developed for in iduals with IGT are applicable to subjects with IFG. The first part of the study is based on the population-based Danish Inter99 study, where 6265 in iduals, aged 30 to 60 years and without previously diagnosed diabetes, underwent an oral glucose tolerance test. The second part is based on the DETECT-2 project, in which studies from China, India, France and USA were used to analyse the impact of the proposed revision of the diagnostic criteria in different ethnic groups. The proposed change in diagnostic criteria would increase the prevalence of IFG in Denmark from 11.8 to 37.6%. The proposed IFG category would identify 60.0% of all subjects with IGT compared to 29.2% with the old criteria, but among in iduals with the new IFG category only 18.5% would also have IGT. In iduals with isolated IFG had lower insulin levels and a lower cardiovascular risk profile with the proposed criteria compared with the current WHO criteria. Data from the DETECT-2 study confirmed the marked increase in the prevalence of IFG, and the estimated number of in iduals in the age range 40 to 64 years with IFG in urban India, urban China and the USA would increase by 78%, 135% and 193% respectively. The proposed revised diagnostic criteria will lead to a dramatic increase in the prevalence of IFG, but the concordance rate between IFG and IGT remains low. This new IFG group will have a more favourable cardiovascular risk profile than the current IFG group as defined by the WHO. This seriously questions whether the existing intervention strategies are applicable to the new category of in iduals with IFG.
Are Lower Fasting Plasma Glucose Levels at Diagnosis of Type 2 Diabetes Associated With Improved Outcomes?
Publisher: American Diabetes Association
Date: 08-2002
DOI: 10.2337/DIACARE.25.8.1410
Abstract: OBJECTIVE—Type 2 diabetes may be present for several years before diagnosis, by which time many patients have already developed diabetic complications. Earlier detection and treatment may reduce this burden, but evidence to support this approach is lacking. RESEARCH DESIGN AND METHODS—Glycemic control and clinical and surrogate outcomes were compared for 5,088 of 5,102 U.K. Diabetes Prospective Study participants according to whether they had low (& mg/dl [& .8 mmol/l]), intermediate (140 to & mg/dl [7.8 to & .0 mmol/l]), or high (≥180 mg/dl [≥10 mmol/l]) fasting plasma glucose (FPG) levels at diagnosis. In iduals who presented with and without diabetic symptoms were also compared. RESULTS—Fewer people with FPG in the lowest category had retinopathy, abnormal biothesiometer measurements, or reported erectile dysfunction. The rate of increase in FPG and HbA1c during the study was identical in all three groups, although absolute differences persisted. In iduals in the low FPG group had a significantly reduced risk for each predefined clinical outcome except stroke, whereas those in the intermediate group had significantly reduced risk for each outcome except stroke and myocardial infarction. The low and intermediate FPG groups had a significantly reduced risk for progression of retinopathy, reduction in vibration sensory threshold, or development of microalbuminuria. CONCLUSIONS—People presenting with type 2 diabetes with lower initial glycemia who may be earlier in the course of their disease had fewer adverse clinical outcomes despite similar glycemic progression. Since most such people are asymptomatic at diagnosis, active case detection programs would be required to identify them.
Explaining resistance to regulatory interventions to prevent obesity and improve nutrition: A case-study of a sugar-sweetened beverages tax in Australia
Publisher: Elsevier BV
Date: 05-2020
Screening for Diabetes Mellitus – the World Health Organization Perspective
Publisher: Wiley
Date: 07-01-2005
Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017
Publisher: American Medical Association (AMA)
Date: 12-2019
Glucose indices, health behaviors, and incidence of diabetes in Australia: The Australian diabetes, obesity and lifestyle study
Publisher: American Diabetes Association
Date: 02-2008
DOI: 10.2337/DC07-0912
Abstract: OBJECTIVE—This national, population-based study reports diabetes incidence based on oral glucose tolerance tests (OGTTs) and identifies risk factors for diabetes in Australians. RESEARCH DESIGN AND METHODS—The Australian Diabetes, Obesity and Lifestyle Study followed-up 5,842 participants over 5 years. Normal glycemia, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes were defined using World Health Organization criteria. RESULTS—Age-standardized annual incidence of diabetes for men and women was 0.8% (95% CI 0.6–0.9) and 0.7% (0.5–0.8), respectively. The annual incidence was 0.2% (0.2–0.3), 2.6% (1.8–3.4), and 3.5% (2.9–4.2) among those with normal glycemia, IFG, and IGT, respectively, at baseline. Among those with IFG, the incidence was significantly higher in women (4.0 vs. 2.0%), while among those with IGT, it was significantly higher in men (4.4 vs. 2.9%). Using multivariate logistic regression, hypertension (odds ratio 1.64 [95% CI 1.17–2.28]), hypertriglyceridemia (1.46 [1.05–2.02]), log fasting plasma glucose (odds ratio per 1 SD 5.25 [95% CI 3.98–6.92]), waist circumference (1.26 [1.08–1.48]), smoking (1.70 [96% CI 1.11–2.63]), physical inactivity (1.56 [1.12–2.16]), family history of diabetes (1.82 [1.30–2.52]), and low education level (1.85 [1.04–3.31]) were associated with incident diabetes. In age- and sex-adjusted models, A1C was a predictor of diabetes in the whole population, in those with normal glycemia, and in those with IGT or IFG. CONCLUSIONS—Diabetes incidence is 10–20 times greater in those with IGT or IFG than those with normal glycemia. Measures of glycemia, A1C, metabolic syndrome components, education level, smoking, and physical inactivity are risk factors for diabetes.
Author Correction: Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017
Publisher: Springer Science and Business Media LLC
Date: 02-07-2020
DOI: 10.1038/S41591-020-0972-7
Abstract: An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Sedimentary evolution and stratigraphy of the ~765–740 Ma Kansuki-Mwashya platform succession in the Tenke-Fungurume Mining District, Democratic Republic of the Congo
Publisher: Geologica Belgica
Date: 03-07-2020
DOI: 10.20341/GB.2020.022
Abstract: The origin of the Mwashya Conglomerate at the base of the Mwashya Subgroup in the Lufilian Belt is uncertain since it is considered as either a tectonic or as a sedimentary breccia. At Tenke Fungurume Mining District (TFMD) in the Democratic Republic of the Congo, the Mwashya Conglomerate is marked by an iron-bearing polymictic conglomerate embedded between the Kansuki and Kamoya formations. In this paper, the Kansuki-Mwashya platform succession at TFMD was investigated to shed light on the origin of this conglomerate, the depositional evolution and the tectonostratigraphic framework of the platform. Lithofacies analysis revealed that the Mwashya Conglomerate is a periglacial olistostrome, which was formed around ~765–745 Ma. A pre-Sturtian age for this conglomerate is supported by the Kamoya Formation, which is here interpreted as a post-glacial cap carbonate sequence. The Kansuki-Mwashya platform succession consists of a protected coastal lagoon adjacent to a tidal flat environment, both bordered by a barrier shoal. This paper concludes that the Kansuki-Mwashya platform succession was driven by rifting pulses, occurring gravity flows on instable slope, superimposed upon the ~750–717 Ma long-lasting Sturtian glacial period.
Optimal management of type 2 diabetes: the evidence
Publisher: Wiley
Date: 25-11-2011
DOI: 10.1111/J.1463-1326.2011.01506.X
Abstract: This paper reviews the evidence in relation to the optimal target for HbA1c and outlines a global treatment algorithm for people with type 2 diabetes. While most guidelines recommend a general HbA1c target of 7%, recent large scale intervention studies have examined the potential benefits of lower targets. These studies have generally shown that lower HbA1c targets provide no macrovascular benefits and limited effects on microvascular complications while increasing rates of hypoglycaemia. Overall these studies do not support a general HbA1c target lower than 7.0%. However an in idual's HbA1c target should be set and reviewed taking into account treatment benefits, safety, and tolerability. This may mean that an HbA1c target lower than 7% is appropriate for some when it can be easily and safely achieved but equally a higher HbA1c target may be appropriate in others. Clinicians and consumers are fortunate in having a wide range of pharmacological agents available to treat hyperglycaemia, however access to many of these options is limited in many middle and low income countries. Developing treatment algorithms is complex for several reasons. The major limitation is the limited evidence base for choosing particular treatment options or combinations of medications. However it is possible to derive a generic evidence-informed consensus algorithm which considers availability, access and cost of medications which can be adapted for local country use.
Body composition of Aboriginal Australian women: comparison with age-matched Caucasians
Publisher: Springer Science and Business Media LLC
Date: 10-2003
DOI: 10.1007/S00592-003-0096-9
Abstract: Although Aboriginal Australians (AA) exhibit an android fat deposition profile and suffer from a high incidence of type 2 diabetes, a comprehensive body composition assessment of AA has not yet been reported. The body composition of 16 non-diabetic AA women and 16 healthy age- and weight-matched Caucasian women (C) showed no significant ethnic differences in height, total body bone mineral density, total and appendicular skeletal muscle mass, and % fat. The abdominal fat-to-lean soft tissue ratio correlated more highly with age in AA ( r=0.79, p<0.001) than in C ( r=0.59, p<0.05) and with % fat in AA ( r=0.67, p<0.01) than in C ( r=0.54, p<0.05). However, analysis of variance showed that the difference between the two ethnic groups was not significant. Key findings are that dual-energy X-ray absorptiometry can accurately assess adiposity, and that hip girth should emerge as a valid predictor of central adiposity, in AA women.
Erratum
Publisher: American Diabetes Association
Date: 16-07-2011
DOI: 10.2337/DC11-ER08B
Effect of Ambient Temperature and Humidity on Performance of Blood Glucose Meters
Publisher: Wiley
Date: 04-1995
DOI: 10.1111/J.1464-5491.1995.TB00488.X
Abstract: The accuracy of four blood glucose meters (Accutrend, ExacTech Companion, Medisense Companion 2, and Glucometer III) was tested at temperatures ranging from 4 to 44 degrees C (control solutions) and 8 degrees C, 24 degrees C, and 36 degrees C (venous blood) and at humidities of 60% and 80%. Low and high temperatures resulted in a number of statistically significant changes in glucose readings with all meters. However, Accutrend, Medisense Companion 2, and Glucometer III were 100% clinically accurate at all temperatures. With the ExacTech Companion, only 70.8% of control solution and 55.6% of venous blood results were clinically accurate. The main errors were: (1) cold temperatures lowered the result so that euglycaemic levels erroneously read in the hypoglycaemic range and hyperglycaemic levels gave a better than actual result and (2) hot temperatures increased the result whereby hypoglycaemic levels falsely gave a euglycaemic result. Weather conditions at which blood glucose meters may be operated can affect results and potentially lead to errors in clinical decisions.
Lithostratigraphic position and petrographic characteristics of R.A.T. (“Roches Argilo-Talqueuses”) Subgroup, Neoproterozoic Katangan Belt (Congo)
Publisher: Elsevier BV
Date: 07-2005
Obstructive sleep apnoea—Another important diabetes-associated problem
Publisher: Elsevier BV
Date: 07-2008
Successful implementation of diabetes audits in Australia: the Australian National Diabetes Information Audit and Benchmarking (ANDIAB ) initiative
Publisher: Wiley
Date: 02-05-2018
DOI: 10.1111/DME.13635
Abstract: We developed and implemented a national audit and benchmarking programme to describe the clinical status of people with diabetes attending specialist diabetes services in Australia. The Australian National Diabetes Information Audit and Benchmarking (ANDIAB) initiative was established as a quality audit activity. De-identified data on demographic, clinical, biochemical and outcome items were collected from specialist diabetes services across Australia to provide cross-sectional data on people with diabetes attending specialist centres at least biennially during the years 1998 to 2011. In total, 38 155 sets of data were collected over the eight ANDIAB audits. Each ANDIAB audit achieved its primary objective to collect, collate, analyse, audit and report clinical diabetes data in Australia. Each audit resulted in the production of a pooled data report, as well as in idual site reports allowing comparison and benchmarking against other participating sites. The ANDIAB initiative resulted in the largest cross-sectional national de-identified dataset describing the clinical status of people with diabetes attending specialist diabetes services in Australia. ANDIAB showed that people treated by specialist services had a high burden of diabetes complications. This quality audit activity provided a framework to guide planning of healthcare services.
Diabetes in Indigenous Australians and Other Underserved Communities in Australia
Publisher: Springer International Publishing
Date: 23-11-2016
LAM-ICPMS U–Pb dating of kimberlitic perovskite: Eocene–Oligocene kimberlites from the Kundelungu Plateau, D.R. Congo
Publisher: Elsevier BV
Date: 03-2008
Screening for Type 2 Diabetes and Impaired Glucose Metabolism
Publisher: American Diabetes Association
Date: 02-2004
Abstract: OBJECTIVE—To assess the Australian protocol for identifying undiagnosed type 2 diabetes and impaired glucose metabolism. RESEARCH DESIGN AND METHODS—The Australian screening protocol recommends a stepped approach to detecting undiagnosed type 2 diabetes based on assessment of risk status, measurement of fasting plasma glucose (FPG) in in iduals at risk, and further testing according to FPG. The performance of and variations to this protocol were assessed in a population-based s le of 10,508 Australians. RESULTS—The protocol had a sensitivity of 79.9%, specificity of 79.9%, and a positive predictive value (PPV) of 13.7% for detecting undiagnosed type 2 diabetes and sensitivity of 51.9% and specificity of 86.7% for detecting impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). To achieve these diagnostic rates, 20.7% of the Australian adult population would require an oral glucose tolerance test (OGTT). Increasing the FPG cut point to 6.1 mmol/l (110 mg/dl) or using HbA1c instead of FPG to determine the need for an OGTT in people with risk factors reduced sensitivity, increased specificity and PPV, and reduced the proportion requiring an OGTT. However, each of these protocol variations substantially reduced the detection of IGT or IFG. CONCLUSIONS—The Australian screening protocol identified one new case of diabetes for every 32 people screened, with 4 of 10 people screened requiring FPG measurement and 1 in 5 requiring an OGTT. In addition, 1 in 11 people screened had IGT or IFG. Including HbA1c measurement substantially reduced both the number requiring an OGTT and the detection of IGT or IFG.
The metabolic syndrome identifies a heterogeneous group of metabolic component combinations in the Asia-Pacific region
Publisher: Elsevier BV
Date: 09-2008
DOI: 10.1016/J.DIABRES.2008.05.011
Abstract: To compare the prevalence of metabolic syndrome (MetS) by combinations of MetS components derived from the National Cholesterol Education Program Adult Treatment Panel III (ATPIII) and International Diabetes Federation (IDF) definitions. Four studies with ethnically distinct populations from the Asia-Pacific region were selected from the DETECT-2 study database. The prevalences of combinations of MetS components using the modified ATPIII (modATPIII) and IDF MetS definitions were compared between sexes and across populations. A total of 22,952 participants from Australia, Japan, Korea and Samoa were included. The age-adjusted prevalence of modATPIII MetS varied from 9.4 to 35.8% in men and 10.3 to 57.2% in women results for IDF were generally higher. Prevalences of the 16 possible MetS component combinations from the modATPIII definition that result in a diagnosis of MetS ranged from 0 to 12.7%. Of those with IDF-defined abdominal obesity, the prevalences of the 11 IDF-defined MetS component combinations ranged from 0.2 to 18.3%. The large variation in the prevalence of possible MetS component combinations to diagnose MetS may explain the different risk of cardiovascular outcomes associated with MetS in different populations, especially since particular combinations of MetS components are associated with different risk of cardiovascular disease.
Time to move to a glycated haemoglobin‐based algorithm for diabetes screening and diagnosis?
Publisher: AMPCo
Date: 07-2015
DOI: 10.5694/MJA15.00558
It is Time to Make Policy for Healthier Food Environments in Australian Universities
Publisher: MDPI AG
Date: 04-12-2018
DOI: 10.3390/NU10121909
Abstract: The obesogenic food environment is likely driving excessive weight gain in young adults. Our study aimed to investigate the nutritional quality of current food and drink offerings in an Australian university. This cross-sectional study included baseline environmental audits of 30 food outlets and 62 vending machines across c us. A recent food and drink benchmark for health facilities by state government was used to classify the food and beverage offerings. It recommended food outlets and vending machines to offer at least 75% ‘Everyday’ (healthy) and less than 25% ‘Occasional’ (less healthy) foods and drinks. Sugary drinks and options with large portion sizes and unhealthy ingredients should be removed from sale. Only two beverage vending machines and none of the food outlets met the full recommendations. The overall proportions of Everyday and Occasional foods in food outlets were 35% and 22%, respectively with 43% falling into the category that should not be sold. Sugary drinks occupied a third of beverage varieties in outlets and 38% of beverage slots in vending machines. The current university food environment was poorly compliant with the existing benchmark. Specific food policy in the university setting may be needed to make healthier choices more accessible to young adults.
Estimating insulin demand for protein-containing foods using the food insulin index
Publisher: Springer Science and Business Media LLC
Date: 09-07-2014
Abstract: The Food Insulin Index (FII) is a novel algorithm for ranking foods on the basis of insulin responses in healthy subjects relative to an isoenergetic reference food. Our aim was to compare postprandial glycemic responses in adults with type 1 diabetes who used both carbohydrate counting and the FII algorithm to estimate the insulin dosage for a variety of protein-containing foods. A total of 11 adults on insulin pump therapy consumed six in idual foods (steak, battered fish, poached eggs, low-fat yoghurt, baked beans and peanuts) on two occasions in random order, with the insulin dose determined once by the FII algorithm and once with carbohydrate counting. Postprandial glycemia was measured in capillary blood glucose s les at 15-30 min intervals over 3 h. Researchers and participants were blinded to treatment. Compared with carbohydrate counting, the FII algorithm significantly reduced the mean blood glucose level (5.7±0.2 vs 6.5±0.2 mmol/l, P=0.003) and the mean change in blood glucose level (-0.7±0.2 vs 0.1±0.2 mmol/l, P=0.001). Peak blood glucose was reached earlier using the FII algorithm than using carbohydrate counting (34±5 vs 56±7 min, P=0.007). The risk of hypoglycemia was similar in both treatments (48% vs 33% for FII vs carbohydrate counting, respectively, P=0.155). In adults with type 1 diabetes, compared with carbohydrate counting, the novel FII algorithm improved postprandial hyperglycemia after consumption of protein-containing foods.
Factors influencing participant enrolment in a diabetes prevention program in general practice
Publisher: Springer Science and Business Media LLC
Date: 24-09-2012
The ‘carnivore connection’—evolutionary aspects of insulin resistance
Publisher: Springer Science and Business Media LLC
Date: 03-2002
Abstract: Insulin resistance is common and is determined by physiological (aging, physical fitness), pathological (obesity) and genetic factors. The metabolic compensatory response to insulin resistance is hyperinsulinaemia, the primary purpose of which is to maintain normal glucose tolerance. The 'carnivore connection' postulates a critical role for the quantity of dietary protein and carbohydrate and the change in the glycaemic index of dietary carbohydrate in the evolution of insulin resistance and hyperinsulinaemia. Insulin resistance offered survival and reproductive advantages during the Ice Ages which dominated human evolution, during which a high-protein low-carbohydrate diet was consumed. Following the end of the last Ice Age and the advent of agriculture, dietary carbohydrate increased. Although this resulted in a sharp increase in the quantity of carbohydrate consumed, these traditional carbohydrate foods had a low glycaemic index and produced only modest increases in plasma insulin. The industrial revolution changed the quality of dietary carbohydrate. The milling of cereals made starch more digestible and postprandial glycaemic and insulin responses increased 2-3 fold compared with coarsely ground flour or whole grains. This combination of insulin resistance and hyperinsulinaemia is a common feature of many modern day diseases. Over the last 50 y the explosion of convenience and takeaway 'fast foods' has exposed most populations to caloric intakes far in excess of daily energy requirements and the resulting obesity has been a major factor in increasing the prevalence of insulin resistance.
The use of orthotic devices to correct plantar callus in people with diabetes
Publisher: Elsevier BV
Date: 04-1995
DOI: 10.1016/0168-8227(95)01050-N
Abstract: Foot problems are a major cause of morbidity in people with diabetes. Plantar callus is common and is a sign of abnormal foot pressures. Shear stresses at these areas of high foot pressures may ultimately result in ulcer formation. This study compared the effect on plantar callus of the use of rigid orthotic devices and conventional podiatric care. Twenty diabetic subjects participated in the study and were randomly allocated to conventional treatment (n = 11) or orthotic device treatment (n = 9). After 12 months the patients in the orthotic group showed a significant reduction in callus grade, whereas the conventionally treated group showed no significant change. There were no adverse effects from wearing the orthotic device. Rigid orthoses have a beneficial effect on plantar callus presumably through the lowering and redistribution of abnormal foot pressures.
Race/ethnicity and challenges for optimal insulin therapy
Publisher: Elsevier BV
Date: 05-2021
Petrography and perovskite U-Pb age of the Katuba kimberlite, Kundelungu Plateau (D.R. Congo): Implications for regional tectonism and mineralisation
Publisher: Elsevier BV
Date: 08-2019
Efficacy of carbohydrate counting in type 1 diabetes: a systematic review and meta-analysis
Publisher: Elsevier BV
Date: 02-2014
Grand challenges in chronic non-communicable diseases
Publisher: Springer Science and Business Media LLC
Date: 11-2007
DOI: 10.1038/450494A
Comparing different definitions of prediabetes with subsequent risk of diabetes: an individual participant data meta-analysis involving 76 513 individuals and 8208 cases of incident diabetes
Publisher: BMJ
Date: 12-2019
DOI: 10.1136/BMJDRC-2019-000794
Abstract: There are currently five widely used definition of prediabetes. We compared the ability of these to predict 5-year conversion to diabetes and investigated whether there were other cut-points identifying risk of progression to diabetes that may be more useful. We conducted an in idual participant meta-analysis using longitudinal data included in the Obesity, Diabetes and Cardiovascular Disease Collaboration. Cox regression models were used to obtain study-specific HRs for incident diabetes associated with each prediabetes definition. Harrell’s C-statistics were used to estimate how well each prediabetes definition discriminated 5-year risk of diabetes. Spline and receiver operating characteristic curve (ROC) analyses were used to identify alternative cut-points. Sixteen studies, with 76 513 participants and 8208 incident diabetes cases, were available. Compared with normoglycemia, current prediabetes definitions were associated with four to eight times higher diabetes risk (HRs (95% CIs): 3.78 (3.11 to 4.60) to 8.36 (4.88 to 14.33)) and all definitions discriminated 5-year diabetes risk with good accuracy (C-statistics 0.79–0.81). Cut-points identified through spline analysis were fasting plasma glucose (FPG) 5.1 mmol/L and glycated hemoglobin (HbA1c) 5.0% (31 mmol/mol) and cut-points identified through ROC analysis were FPG 5.6 mmol/L, 2-hour postload glucose 7.0 mmol/L and HbA1c 5.6% (38 mmol/mol). In terms of identifying in iduals at greatest risk of developing diabetes within 5 years, using prediabetes definitions that have lower values produced non-significant gain. Therefore, deciding which definition to use will ultimately depend on the goal for identifying in iduals at risk of diabetes.
Improvement in glycated haemoglobin evaluated by baseline body mass index: a meta‐analysis of the liraglutide phase III clinical trial programme
Publisher: Wiley
Date: 02-02-2016
DOI: 10.1111/DOM.12617
International Diabetes Federation guideline for management of postmeal glucose: a review of recommendations
Publisher: Wiley
Date: 10-2008
Priority actions for the non-communicable disease crisis
Publisher: Elsevier BV
Date: 04-2011
Primary analysis of the Mandarin-speaking sub-study within the Sydney diabetes prevention program
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.DIABRES.2017.07.032
Abstract: There is strong and consistent evidence from large scale randomised controlled trials that type 2 diabetes can be prevented or delayed through lifestyle modification which improves diet quality, increases physical activity and achieves weight loss in people at risk. Worldwide, the prevalence of type 2 diabetes is increasing in in iduals of Chinese descent. Culturally tailored programs are required to address the risk in the Chinese population. This paper analyses effectiveness of a culturally tailored community-based lifestyle modification program (Sydney Diabetes Prevention Program (SDPP)) targeting Mandarin speakers. The SDPP was a 12 month translational study aiming to promote increased physical activity and dietary changes. Effectiveness was assessed through the improvement of anthropometric, metabolic, physical activity and dietary outcomes and number of goals met. Seventy-eight Mandarin-speaking participants at a high risk (Australian Diabetes Risk, AUSDRISK≥15) of developing diabetes were recruited for this study. In this cohort, waist circumference, total cholesterol and fat intake significantly improved at the 12-month review. In comparison to the English-speaking stream, the Mandarin-speaking stream achieved fewer improvements in outcomes and goals. The SDPP was not effective in reducing the risk factors associated with developing type 2 diabetes in this cohort of high risk Mandarin-speaking in iduals living in Sydney.
Glycemic Index and Glycemic Load of Carbohydrates in the Diabetes Diet
Publisher: Springer Science and Business Media LLC
Date: 11-01-2011
DOI: 10.1007/S11892-010-0173-8
Abstract: Medical nutrition therapy is the first line of treatment for the prevention and management of type 2 diabetes and plays an essential part in the management of type 1 diabetes. Although traditionally advice was focused on carbohydrate quantification, it is now clear that both the amount and type of carbohydrate are important in predicting an in idual's glycemic response to a meal. Diets based on carbohydrate foods that are more slowly digested, absorbed, and metabolized (i.e., low glycemic index [GI] diets) have been associated with a reduced risk of type 2 diabetes and cardiovascular disease, whereas intervention studies have shown improvements in insulin sensitivity and glycated hemoglobin concentrations in people with diabetes following a low GI diet. Research also suggests that low GI diets may assist with weight management through effects on satiety and fuel partitioning. These findings, together with the fact that there are no demonstrated negative effects of a low GI diet, suggest that the GI should be an important consideration in the dietary management and prevention of diabetes.
Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.DIABRES.2019.107843
Abstract: To provide global estimates of diabetes prevalence for 2019 and projections for 2030 and 2045. A total of 255 high-quality data sources, published between 1990 and 2018 and representing 138 countries were identified. For countries without high quality in-country data, estimates were extrapolated from similar countries matched by economy, ethnicity, geography and language. Logistic regression was used to generate smoothed age-specific diabetes prevalence estimates (including previously undiagnosed diabetes) in adults aged 20-79 years. The global diabetes prevalence in 2019 is estimated to be 9.3% (463 million people), rising to 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045. The prevalence is higher in urban (10.8%) than rural (7.2%) areas, and in high-income (10.4%) than low-income countries (4.0%). One in two (50.1%) people living with diabetes do not know that they have diabetes. The global prevalence of impaired glucose tolerance is estimated to be 7.5% (374 million) in 2019 and projected to reach 8.0% (454 million) by 2030 and 8.6% (548 million) by 2045. Just under half a billion people are living with diabetes worldwide and the number is projected to increase by 25% in 2030 and 51% in 2045.
Liraglutide, a once‐daily human GLP‐1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in su
Publisher: Wiley
Date: 03-2009
Trade and the nutrition transition: Strengthening policy for health in the pacific
Publisher: Informa UK Limited
Date: 10-01-2011
DOI: 10.1080/03670244.2010.524104
Abstract: This article describes pathways through which trade policy change in two Pacific Island countries has contributed to changes in the food supply, and thereby to the nutrition transition. The effect of various trade policies from 1960 to 2005 on trends in food imports and availability is described, and case studies are presented for four foods associated with the nutrition transition and chronic disease in the Pacific. Trade policies (including liberalization, export promotion, protection of the domestic meat industry and support for foreign direct investment) have contributed to a reduced availability of traditional staples, and increased availability of foods associated with the nutrition transition, including refined cereals (particularly polished rice and white flour), meat, fats and oils, and processed food products. This study suggests that promoting healthier imports and increasing production of healthier traditional foods, in both of which trade policy has an important effect, has the potential to improve diets and health, in conjunction with other public health intervention.
Changes in Albuminuria and the Risk of Major Clinical Outcomes in Diabetes: Results From ADVANCE-ON.
Publisher: American Diabetes Association
Date: 27-10-2018
DOI: 10.2337/DC17-1467
Abstract: To assess the association between 2-year changes in urine albumin-to-creatinine ratio (UACR) and the risk of clinical outcomes in type 2 diabetes. We analyzed data from 8,766 participants in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation Post-Trial Observational Study (ADVANCE-ON). Change in UACR was calculated from UACR measurements 2 years apart, classified into three groups: decrease in UACR of ≥30%, minor change, and increase in UACR of ≥30%. By analyzing changes from baseline UACR groups, categorized into thirds, we repeated these analyses accounting for regression to the mean (RtM). The primary outcome was the composite of major macrovascular events, renal events, and all-cause mortality secondary outcomes were these components. Cox regression models were used to estimate hazard ratios (HRs). Over a median follow-up of 7.7 years, 2,191 primary outcomes were observed. Increases in UACR over 2 years independently predicted a greater risk of the primary outcome (HR for ≥30% UACR increase vs. minor change: 1.26 95% CI 1.13-1.41), whereas a decrease in UACR was not significantly associated with lower risk (HR 0.93 95% CI 0.83-1.04). However, after allowing for RtM, the effect of "real" decrease in UACR on the primary outcome was found to be significant (HR 0.84 95% CI 0.75-0.94), whereas the estimated effect on an increase was unchanged. Changes in UACR predicted changes in the risk of major clinical outcomes and mortality in type 2 diabetes, supporting the prognostic utility of monitoring albuminuria change over time.
Polygenic risk scores predict diabetes complications and their response to intensive blood pressure and glucose control
Publisher: Springer Science and Business Media LLC
Date: 06-07-2021
DOI: 10.1007/S00125-021-05491-7
Abstract: Type 2 diabetes increases the risk of cardiovascular and renal complications, but early risk prediction could lead to timely intervention and better outcomes. Genetic information can be used to enable early detection of risk. We developed a multi-polygenic risk score (multiPRS) that combines ten weighted PRSs (10 wPRS) composed of 598 SNPs associated with main risk factors and outcomes of type 2 diabetes, derived from summary statistics data of genome-wide association studies. The 10 wPRS, first principal component of ethnicity, sex, age at onset and diabetes duration were included into one logistic regression model to predict micro- and macrovascular outcomes in 4098 participants in the ADVANCE study and 17,604 in iduals with type 2 diabetes in the UK Biobank study. The model showed a similar predictive performance for cardiovascular and renal complications in different cohorts. It identified the top 30% of ADVANCE participants with a mean of 3.1-fold increased risk of major micro- and macrovascular events ( p = 6.3 × 10 −21 and p = 9.6 × 10 −31 , respectively) and a 4.4-fold ( p = 6.8 × 10 −33 ) higher risk of cardiovascular death. While in ADVANCE overall, combined intensive blood pressure and glucose control decreased cardiovascular death by 24%, the model identified a high-risk group in whom it decreased the mortality rate by 47%, and a low-risk group in whom it had no discernible effect. High-risk in iduals had the greatest absolute risk reduction with a number needed to treat of 12 to prevent one cardiovascular death over 5 years. This novel multiPRS model stratified in iduals with type 2 diabetes according to risk of complications and helped to target earlier those who would receive greater benefit from intensive therapy.
Lithostratigraphy, basin development, base metal deposits, and regional correlations of the Neoproterozoic Nguba and Kundelungu rock successions, central African Copperbelt
Publisher: Elsevier BV
Date: 04-2007
An approach to implementing international diabetes guidelines
Publisher: Mark Allen Group
Date: 09-2009
DOI: 10.12968/IJTR.2009.16.9.43764
Abstract: Diabetes is a common, costly and ever-increasing health problem, with chronic complications that result in a heavy socioeconomic burden for people with the disease, the health care system and society (Ringborg et al, 2009). Chronic complications, the major cause of morbidity, premature mortality and costs of diabetes, can be significantly reduced by control of blood glucose and associated cardiovascular risk factors (Ray et al, 2009). The cost of these treatments is within the range of currently accepted preventative interventions (Gæde et al, 2008). Despite the available evidence, prevention strategies have not been widely incorporated into clinical practice and the care received by many people with diabetes is less than optimal worldwide (Chan et al, 2009).
Chronic kidney disease and measurement of albuminuria or proteinuria: a position statement
Publisher: Wiley
Date: 08-2012
DOI: 10.5694/MJA11.11468
Abstract: Optimal detection and subsequent risk stratification of people with chronic kidney disease (CKD) requires simultaneous consideration of both kidney function (glomerular filtration rate [GFR]) and kidney damage (as indicated by albuminuria or proteinuria). Measurement of urinary albuminuria and proteinuria is hindered by a lack of standardisation regarding requesting, s le collection, reporting and interpretation of tests. A multidisciplinary working group was convened with the goal of developing and promoting recommendations that achieve consensus on these issues. The working group recommended that the preferred method for assessment of albuminuria in both diabetic and non-diabetic patients is urinary albumin-to-creatinine ratio (UACR) measurement in a first-void spot urine specimen. Where a first-void specimen is not possible or practical, a random spot urine specimen for UACR is acceptable. The working group recommended that adults with one or more risk factors for CKD should be assessed using UACR and estimated GFR every 1-2 years, depending on their risk-factor profile. Recommended testing algorithms and sex-specific cut-points for microalbuminuria and macroalbuminuria are provided. The working group recommended that all pathology laboratories in Australia should implement the relevant recommendations as a vital component of an integrated national approach to detection of CKD.
Epidemiology of Prediabetes
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1016/J.MCNA.2010.11.003
Abstract: Identifying in iduals at increased risk of developing diabetes has assumed increasing importance with the expansion of the evidence from clinical trials on the prevention or delay of type 2 diabetes using lifestyle modification and medication. The epidemiology of prediabetes depends on the diagnostic method used. Glucose measures defining impaired glucose tolerance and impaired fasting glucose levels identify about 10% of the adults to have prediabetes, whereas glycated hemoglobin-based criteria identify a significantly lower proportion of the population. Increasingly, multifactorial risk tools are being used and cut-points set to identify approximately 15% of the population as being at high risk.
Comparison of two methods for assessing diabetes risk in a pharmacy setting in Australia
Publisher: Springer Science and Business Media LLC
Date: 27-11-2014
Human insulin and hypoglycaemia
Publisher: Elsevier BV
Date: 08-1992
Adherence to eye examination guidelines among individuals with diabetes: An analysis of linked health data
Publisher: Wiley
Date: 20-08-2020
DOI: 10.1111/CEO.13830
A global study of the unmet need for glycemic control and predictor factors among patients with type 2 diabetes mellitus who have achieved optimal fasting plasma glucose control on basal insulin
Publisher: Wiley
Date: 13-10-2016
DOI: 10.1002/DMRR.2858
People With Type 2 Diabetes Report Dietitians, Social Support, and Health Literacy Facilitate Their Dietary Change
Publisher: Elsevier BV
Date: 2020
Government action on diabetes prevention: Time to try something new
Publisher: AMPCo
Date: 06-2015
DOI: 10.5694/MJA14.01611
Abstract: Type 2 diabetes mellitus, driven by overweight and obesity linked to unhealthy diets, is the fastest-growing non-communicable disease in Australia. Halting the rise of diabetes will require a paradigm shift from personal to shared responsibility, with greater accountability from Australian governments and the food industry. It will also require governments to try something different to the prevailing approaches emphasising education and the provision of information. We propose four priority areas where government regulation could strengthen Australia's response. Those areas relate to mandatory front-of-pack food labelling, regulating junk food advertising, better oversight of food reformulation and taxing sugar-sweetened beverages.
The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe
Publisher: Oxford University Press (OUP)
Date: 11-2004
Using the transtheoretical model’s stages of change to predict medication adherence in patients with type 2 diabetes mellitus in a primary health care setting
Publisher: Springer Science and Business Media LLC
Date: 07-02-2019
GROWTH HORMONE and DIABETIC RETINOPATHY
Publisher: Wiley
Date: 12-1977
Definition and Classification of Diabetes and Prediabetes and Emerging Data on Phenotypes
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.1016/J.ECL.2021.06.004
Abstract: Diabetes diagnosis has important implications for in iduals. Diagnostic criteria for fasting and 2-hour plasma glucose and HbA1c are universally agreed. Intermediate hyperglycemia rediabetes is a risk factor for diabetes and cardiovascular disease. Because risk is a continuum, determining cut-point is problematic and reflected in significant differences in recommended fasting glucose and HbA1c criteria. Many types of diabetes are recognized. Diabetes classification systems are limited by a lack of understanding of etiopathogenetic pathways leading to diminished β-cell function. The World Health Organization classification system is designed to assist clinical care decisions. Newly recognized phenotypic clusters of diabetes might inform future classification systems.
Comparisons of Metabolic Syndrome Definitions in Four Populations of the Asia-Pacific Region
Publisher: Mary Ann Liebert Inc
Date: 03-1100
Abstract: To compare the prevalence of metabolic syndrome (MetS) by four MetS definitions in four Asia-Pacific populations, and to compare the prevalence of in idual metabolic components. Population-based cross-sectional studies from Australia, Japan, Korea, and Samoa were used to assess the World Health Organization (WHO), European Group for the Study of Insulin Resistance (EGIR), modified National Cholesterol Education Program Adult Treatment Panel III (modATPIII), and International Diabetes Federation (IDF) MetS definitions. Age-adjusted MetS prevalences were compared within and between countries and kappa statistics were used to determine the agreement between IDF and the other three definitions. Japanese people had the lowest prevalence of MetS regardless of definition, and Samoans generally the highest prevalence. Age-adjusted prevalences for the four definitions ranged from 16% to 42% in Australia, 3% to 11% in Japan, 7% to 29% in Korea and 17% to 60% in Samoa. With the exceptions of Korean and Japanese males, the highest prevalence of MetS was obtained with the IDF definition. The best overall agreement with IDF MetS definition was for modATPIII, and the worst for EGIR. There were marked differences in the prevalence of MetS between the sexes, with no systematic pattern, and between the prevalences of in idual metabolic components. Differences in the prevalence of MetS and its components, using the various definitions, both within and between populations, indicate that caution is required when comparing studies from different countries. Determining the clinical significance of these differences will require prospective outcome studies.
Health Policy in Ageing Populations: Economic Modeling of Chronic Disease Policy Options in Australia
Publisher: BENTHAM SCIENCE PUBLISHERS
Date: 09-12-2013
The management of Type 2 diabetes: A survey of Australian general practitioners
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.DIABRES.2011.11.004
Abstract: To explore how clinical and demographic variables impact on the management of diabetes mellitus in general practice. A structured vignette survey was conducted in Australia. This included nine vignettes chosen at random from 128 developed around seven clinical variables. Respondents were asked to recommend a change in treatment and make specific recommendations. A random s le of general practitioners (GPs) were recruited. Two diabetologists involved in the development of national guidelines also participated. 125 (13.8%) GPs participated. Statistical analyses were used to generate outcome measures. GPs recommended a change in treatment for most (81.1%) cases were less likely to prescribe a statin (68.5% GPs vs. 76.3% diabetologists), less likely to treat hypertension (66.7% vs.89%) and less likely to refer for lifestyle modification (82.3% vs. 96.5%). Significant disagreement occurred around prescribing or changing oral hypoglycaemics. No GP characteristics showed significant impact. The proportion of GPs who agreed with diabetiologists on dose and choice of drugs was 35.7% for statins, 49.6% for antihypertensives and 39.6% for oral hypoglycaemics. There were significant differences between diabetologists and GPs on the management of diabetes. The survey suggests significant under-dosing by GPs. These findings warrant further investigation.
The Carnivore Connection
Publisher: Elsevier
Date: 2010
Systematic review and meta-analysis of the efficacy and hypoglycemic safety of gliclazide versus other insulinotropic agents
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.DIABRES.2015.07.002
Abstract: Sulfonylureas are well positioned in treating type 2 diabetes, after lifestyle modification and metformin. The sulfonylurea gliclazide was given preference over glibenclamide in older people with type 2 diabetes in the World Health Organization model list of essential medicines. Consequently, a systematic review and meta-analysis of randomized controlled trials of the efficacy and safety of gliclazide versus other oral insulinotropic agents (sulfonylureas, dipeptidyl peptidase-4 inhibitors, and glinides) was performed. Two reviewers searched MEDLINE for studies of ≥12 weeks duration in adults with type 2 diabetes. The key search word was "gliclazide", filtered with "randomized controlled trial", "human" and "19+ years". Differences were explored in mean change in glycated hemoglobin (HbA(1c)) from baseline (primary outcome) and risk of hypoglycemia (secondary outcome) between gliclazide and other oral insulinotropic agents and other sulfonylureas. Nine out of 181 references reported primary outcomes, of which 7 reported secondary outcomes. Gliclazide lowered HbA1c more than other oral insulinotropic agents, with a weighted mean difference of -0.11% (95%, CI -0.19 to -0.03%, P=0.008, I(2)=60%), though not more than other sulfonylureas (-0.12% 95%, CI -0.25 to 0.01%, P=0.07, I(2)=77%). Risk of hypoglycemia with gliclazide was not different to other insulinotropic agents (RR 0.85 95%, CI 0.66 to 1.09, P=0.20, I(2)=61%) but significantly lower than other sulfonylureas (RR 0.47 95%, CI 0.27 to 0.79, P=0.004, I(2)=0%). Compared with other oral insulinotropic agents, gliclazide significantly reduced HbA1c with no difference regarding hypoglycemia risk. Compared with other sulfonylureas, HbA1c reduction with gliclazide was not significantly different, but hypoglycemia risk was significantly lower.
Long-Term Glycemic Variability and Vascular Complications in Type 2 Diabetes: Post Hoc Analysis of the FIELD Study
Publisher: The Endocrine Society
Date: 07-08-2020
Abstract: To investigate whether long-term glycemic variability (GV) is associated with vascular complication development in type 2 diabetes. In a post hoc FIELD trial analysis, GV was calculated as the standard deviation and coefficient of variation (CV) of glycated hemoglobin A1c (HbA1c) and fasting plasma glucose. Baseline variables were compared across quartiles of on-study variability by chi square and ANOVA. Prospective associations between baseline to 2-year GV and subsequent vascular and mortality outcomes were analyzed using landmark logistic and Cox proportional hazards regression. Baseline factors associated with higher on-study GV included younger age, male gender, longer diabetes duration, and higher pharmacological therapies usage. Both HbA1c and fasting glucose CV were associated with increased risk of microvascular complications (HR 1.02 [95% CI, 1.01-1.03] P & 0.01 and HR 1.01 [95% CI, 1.00-1.01] P & 0.001, respectively). HbA1c and fasting glucose CV were associated with increased cardiovascular disease (HR 1.02 [95% CI, 1.00-1.04] and HR 1.01 [95% CI, 1.00-1.02], both P & 0.05). HbA1c CV associated with increased stroke (HR 1.03 [95% CI, 1.01-1.06) P & 0.01). Glucose CV associated with increased coronary events (HR 1.01 [95% CI, 1.00-1.02] P & 0.05). Both HbA1c and glucose CV associated with increased total mortality (HR 1.04 [95% CI, 1.02-1.06] and HR 1.01 [95% CI, 1.01-1.02], both P & 0.001) and noncardiovascular mortality (HR 1.05 [95% CI, (1.03-1.07] and HR 1.02 [95% CI, 1.01-1.03], both P & 0.001). HbA1c CV associated with coronary mortality (HR 1.04 [95% CI, 1.01-1.07] P & 0.05). Long-term GV was associated with increased risk of vascular outcomes in type 2 diabetes.
Effectiveness of dietetic intervention for people with type 2 diabetes: A meta-analysis
Publisher: Elsevier BV
Date: 05-2021
DOI: 10.1016/J.CLNU.2020.12.009
Abstract: Diet is central to treatment of type 2 diabetes. This review aimed to compare the effectiveness of nutrition therapy delivered by dietitians to nutrition advice delivered by other healthcare professionals in adults with type 2 diabetes on metabolic parameters. Cochrane CENTRAL, CINAHL, EMBASE, MEDLINE and PsychINFO were searched for randomised controlled trials of three months duration or longer, published from 1st January 2008 to 18th June 2019. Relevant data were extracted from studies with additional author information. Random-effects meta-analysis assessed mean changes in HbA1c and other clinical parameters. PROSPERO registration number: CRD42019130528. Of 2477 records identified, fourteen studies, involving 3338 participants, were eligible for qualitative synthesis and meta-analysis. The mean changes [95% CI] at follow-up in HbA1c, BMI, weight, LDL cholesterol, systolic and diastolic blood pressure were -0·47 [-0·92, -0·02] %, -0·38 [-0·63, -0·13] kg/m Nutrition therapy provided by dietitians was associated with better clinical parameters of type 2 diabetes, including clinically significant improved glycaemic control, across erse multiethnic patient groups from all six inhabited continents. This conclusion should be reflected in clinical guidelines.
Contemporary model for cardiovascular risk prediction in people with type 2 diabetes.
Publisher: Oxford University Press (OUP)
Date: 28-02-2011
Abstract: Existing cardiovascular risk prediction equations perform non-optimally in different populations with diabetes. Thus, there is a continuing need to develop new equations that will reliably estimate cardiovascular disease (CVD) risk and offer flexibility for adaptation in various settings. This report presents a contemporary model for predicting cardiovascular risk in people with type 2 diabetes mellitus. A 4.5-year follow-up of the Action in Diabetes and Vascular disease: preterax and diamicron-MR controlled evaluation (ADVANCE) cohort was used to estimate coefficients for significant predictors of CVD using Cox models. Similar Cox models were used to fit the 4-year risk of CVD in 7168 participants without previous CVD. The model's applicability was tested on the same s le and another dataset. A total of 473 major cardiovascular events were recorded during follow-up. Age at diagnosis, known duration of diabetes, sex, pulse pressure, treated hypertension, atrial fibrillation, retinopathy, HbA1c, urinary albumin/creatinine ratio and non-HDL cholesterol at baseline were significant predictors of cardiovascular events. The model developed using these predictors displayed an acceptable discrimination (c-statistic: 0.70) and good calibration during internal validation. The external applicability of the model was tested on an independent cohort of in iduals with type 2 diabetes, where similar discrimination was demonstrated (c-statistic: 0.69). Major cardiovascular events in contemporary populations with type 2 diabetes can be predicted on the basis of routinely measured clinical and biological variables. The model presented here can be used to quantify risk and guide the intensity of treatment in people with diabetes.
Dietitians' experiences and perspectives regarding access to and delivery of dietetic services for people with type 2 diabetes mellitus
Publisher: Elsevier BV
Date: 02-2020
Diabetes Simulation: An Effective Method for Teaching Diabetes to Medical Students
Publisher: SAGE Publications
Date: 04-1994
DOI: 10.1177/014572179402000211
Abstract: Developmental dysplasia of the hip (DDH) is a complicated skeletal disease ranging from subluxation to complete dislocation of the hip as a result of insufficient development of the acetabulum and femur. To date, numerous genes such as C-X3-C motif chemokine receptor 1 ( Overall, 168 subjects (68 participants in the patient group, 100 participants in the control group) were investigated. The participants with following evidence and symptoms were excluded from the two groups: any systemic syndrome, another congenital anomaly, hereditary diseases, breech presentation, history of oligohydramnios, swaddling and high birth weight (> 4000 g). 3 single-nucleotide polymorphisms (SNP) were examined by qRT-PCR method. For Our work is the first study to investigate DDH and genetic polymorphisms in Turkish population where DDH is observed quite frequently. It is also the first study to investigate the relationship between
Lithospheric mantle structure and the diamond potential of kimberlites in southern D.R. Congo
Publisher: Elsevier BV
Date: 11-2009
A new blood glucose management algorithm for type 2 diabetes: a position statement of the Australian Diabetes Society
Publisher: AMPCo
Date: 12-2014
DOI: 10.5694/MJA14.01187
Abstract: Lowering blood glucose levels in people with type 2 diabetes has clear benefits for preventing microvascular complications and potential benefits for reducing macrovascular complications and death. Treatment needs to be in idualised for each person with diabetes. This should start with selecting appropriate glucose and glycated haemoglobin targets, taking into account life expectancy and the patient's wishes. For most people, early use of glucose-lowering therapies is warranted. A range of recently available therapies has added to the options for lowering glucose levels, but this has made the clinical pathway for treating diabetes more complicated. This position statement from the Australian Diabetes Society outlines the risks, benefits and costs of the available therapies and suggests a treatment algorithm incorporating the older and newer agents.
Obesity, Type II diabetes and the β2 adrenoceptor gene Gln27Glu polymorphism in the Tongan population
Publisher: Portland Press Ltd.
Date: 03-2003
DOI: 10.1042/CS20020242
International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes
Publisher: American Diabetes Association
Date: 07-2009
DOI: 10.2337/DC09-9033
IS TRANSTHEORETICAL MODEL’S STAGES OF CHANGE A GOOD PREDICTOR OF MEDICATION ADHERENCE IN PATIENTS WITH TYPE 2 DIABETES?
Publisher: Elsevier BV
Date: 10-2017
Self-Monitoring of Blood Glucose in Type 2 Diabetes
Publisher: American Diabetes Association
Date: 10-2007
DOI: 10.2337/DC07-0951
A globally applicable screening model for detecting individuals with undiagnosed diabetes
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.DIABRES.2011.11.011
Abstract: Current risk scores for undiagnosed diabetes are additive in structure. We sought to derive a globally applicable screening model based on established non-invasive risk factors for diabetes but with a more flexible structure. Data from the DETECT-2 study were used, including 102,058 participants from 38 studies covering 8 geographical regions worldwide. A global screening model for undiagnosed diabetes was identified through tree-structured regression analysis. The performance of the global screening model was evaluated in each of the geographical regions by receiver operating characteristic (ROC) analysis. The global screening model included age, height, body mass index, waist circumference and systolic- and diastolic blood pressure. Area under the ROC curve ranged between 0.64 in North America and 0.76 in Australia and New Zealand. Overall, to identify 75% of the undiagnosed diabetes cases, 49% required further diagnostic testing. We identified a globally applicable screening model to detect in iduals at high risk of undiagnosed diabetes. The model performed well in most geographical regions, is simple and requires no calculations. This global screening model may be particularly helpful in developing countries with no population based data with which to develop own screening models.
Global and regional burden of cancer in 2016 arising from occupational exposure to selected carcinogens: a systematic analysis for the Global Burden of Disease Study 2016
Publisher: BMJ
Date: 13-02-2020
DOI: 10.1136/OEMED-2019-106012
Abstract: This study provides a detailed analysis of the global and regional burden of cancer due to occupational carcinogens from the Global Burden of Disease 2016 study. The burden of cancer due to 14 International Agency for Research on Cancer Group 1 occupational carcinogens was estimated using the population attributable fraction, based on past population exposure prevalence and relative risks from the literature. The results were used to calculate attributable deaths and disability-adjusted life years (DALYs). There were an estimated 349 000 (95% Uncertainty Interval 269 000 to 427 000) deaths and 7.2 (5.8 to 8.6) million DALYs in 2016 due to exposure to the included occupational carcinogens—3.9% (3.2% to 4.6%) of all cancer deaths and 3.4% (2.7% to 4.0%) of all cancer DALYs 79% of deaths were of males and 88% were of people aged 55 –79 years. Lung cancer accounted for 86% of the deaths, mesothelioma for 7.9% and laryngeal cancer for 2.1%. Asbestos was responsible for the largest number of deaths due to occupational carcinogens (63%) other important risk factors were secondhand smoke (14%), silica (14%) and diesel engine exhaust (5%). The highest mortality rates were in high-income regions, largely due to asbestos-related cancers, whereas in other regions cancer deaths from secondhand smoke, silica and diesel engine exhaust were more prominent. From 1990 to 2016, there was a decrease in the rate for deaths (−10%) and DALYs (−15%) due to exposure to occupational carcinogens. Work-related carcinogens are responsible for considerable disease burden worldwide. The results provide guidance for prevention and control initiatives.
An audit of food and beverage advertising on the Sydney metropolitan train network: regulation and policy implications
Publisher: Springer Science and Business Media LLC
Date: 22-05-2017
Effectiveness of gestational diabetes treatment: A systematic review with quality of evidence assessment
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.DIABRES.2012.09.002
Abstract: To evaluate the effectiveness of gestational diabetes (GDM) treatment compared to usual antenatal care, in the prevention of adverse pregnancy outcomes. Additionally, to assess the quality of the evidence to support GDM treatment according to GRADE guidelines. Fourteen electronic databases and reference lists of relevant literature were searched for articles published from inception to February, 2012. Controlled clinical trials comparing GDM treatment to usual antenatal care were included. Independent extraction of articles was done by two authors using predefined data fields. Seven trials involving 3157 women were included. We found high quality evidence that treatment of GDM reduces macrosomia (RR=0.47 95% CI, 0.34-0.65 NNT=11.4) and large for gestational age birth (RR=0.57 95% CI, 0.47-0.71 NNT=12.2) moderate quality evidence that treatment reduces preecl sia (RR=0.61 95% CI, 0.46-0.81 NNT=21.0) and hypertensive disorders in pregnancy (RR=0.64 95% CI, 0.51-0.81 NNT=18.1) and low quality evidence that treatment reduces shoulder dystocia (RR=0.41 95% CI, 0.22-0.76 NNT=48.8). No statistically significant reduction was seen for caesarean section. No increase in small for gestational age or preterm birth was found. Treatment of GDM is effective in reducing macrosomia (high quality evidence), preecl sia and shoulder dystocia.
The carnivore connection: dietary carbohydrate in the evolution of NIDDM
Publisher: Springer Science and Business Media LLC
Date: 12-1994
DOI: 10.1007/BF00399803
Diagnosing diabetes—time for a change?
Publisher: Springer Science and Business Media LLC
Date: 08-09-2009
Combination of Changes in Estimated GFR and Albuminuria and the Risk of Major Clinical Outcomes
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2019
DOI: 10.2215/CJN.13391118
Abstract: Whether combining changes in eGFR and urine albumin-to-creatinine ratio (UACR) is more strongly associated with outcomes compared with either change alone is unknown. We analyzed 8766 patients with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation Observational (ADVANCE-ON) study. Changes in eGFR and UACR (baseline to 2 years) were defined as ≥40% decrease, minor change, and ≥40% increase. The primary outcome was the composite of major macrovascular (nonfatal or fatal myocardial infarction, nonfatal or fatal stroke, or cardiovascular death), major kidney events (requirement for kidney replacement therapy or kidney death), and all-cause mortality. Over a median of 7.7 years of follow-up, 2191 primary outcomes were recorded. Strong linear associations between eGFR and UACR changes and subsequent risk of the outcome were observed. For eGFR, the hazard ratios were 1.58 (95% confidence interval [95% CI], 1.27 to 1.95) for a decrease ≥40% and 0.82 for an increase ≥40% (95% CI, 0.64 to 1.04) compared with minor change. For UACR, the hazard ratios were 0.96 (95% CI, 0.85 to 1.07) for a decrease ≥40% and 1.32 (95% CI, 1.19 to 1.46) for ≥40% increase compared with minor change. Compared with dual minor changes, both an eGFR decrease ≥40% and a UACR increase ≥40% had 2.31 (95% CI, 1.67 to 3.18) times the risk of the outcome, with evidence of interaction between the two markers. Clinically meaningful decreases in eGFR and increases in UACR over 2 years, independently and in combination, were significantly associated with higher risk of major clinical outcomes.
Association of HbA1c levels with vascular complications and death in patients with type 2 diabetes: evidence of glycaemic thresholds.
Publisher: Springer Science and Business Media LLC
Date: 21-12-2011
DOI: 10.1007/S00125-011-2404-1
Abstract: There is conflicting evidence regarding appropriate glycaemic targets for patients with type 2 diabetes. Here, we investigate the relationship between HbA(1c) and the risks of vascular complications and death in such patients. Eleven thousand one hundred and forty patients were randomised to intensive or standard glucose control in the Action in Diabetes and Vascular disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Glycaemic exposure was assessed as the mean of HbA(1c) measurements during follow-up and prior to the first event. Adjusted risks for each HbA(1c) decile were estimated using Cox models. Possible differences in the association between HbA(1c) and risks at different levels of HbA(1c) were explored using linear spline models. There was a non-linear relationship between mean HbA(1c) during follow-up and the risks of macrovascular events, microvascular events and death. Within the range of HbA(1c) studied (5.5-10.5%), there was evidence of 'thresholds', such that below HbA(1c) levels of 7.0% for macrovascular events and death, and 6.5% for microvascular events, there was no significant change in risks (all p > 0.8). Above these thresholds, the risks increased significantly: every 1% higher HbA(1c) level was associated with a 38% higher risk of a macrovascular event, a 40% higher risk of a microvascular event and a 38% higher risk of death (all p < 0.0001). In patients with type 2 diabetes, HbA(1c) levels were associated with lower risks of macrovascular events and death down to a threshold of 7.0% and microvascular events down to a threshold of 6.5%. There was no evidence of lower risks below these levels but neither was there clear evidence of harm.
There really is an epidemic of type 2 diabetes
Publisher: Springer Science and Business Media LLC
Date: 09-07-2005
Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.DIABRES.2018.02.026
Abstract: Nutrition therapy is considered a key component of diabetes management, yet evidence around the ideal macronutrient composition of the diet remains inconclusive. A systematic review and meta-analysis was performed to assess the effects of carbohydrate-restricted diets (≤45% of total energy) compared to high carbohydrate diets (>45% of total energy) on glycemic control in adults with diabetes mellitus. Six databases were searched for articles published between January 1980 and August 2016. Primary outcome was between-group difference in HbA1c change. In idual effect sizes were standardized, and a meta-analysis performed to calculate pooled effect size using random effects. 25 RCTs involving 2412 participants were included. Carbohydrate-restricted diets, in particular those that restrict carbohydrate to <26% of total energy, produced greater reductions in HbA1c at 3 months (WMD -0.47%, 95% CI: -0.71, -0.23) and 6 months (WMD -0.36%, 95% CI: -0.62, -0.09), with no significant difference at 12 or 24 months. There was no difference between moderately restricted (26-45% of total energy) and high carbohydrate diets at any time point. Although there are issues with the quality of the evidence, this review suggests that carbohydrate-restricted diets could be offered to people living with diabetes as part of an in idualised management plan.
Effect of repaglinide addition to metformin monotherapy on glycemic control in patients with type 2 diabetes.
Publisher: American Diabetes Association
Date: 1999
Abstract: OBJECTIVE: To compare the effect of repaglinide in combination with metformin with monotherapy of each drug on glycemic control in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 83 patients with type 2 diabetes who had inadequate glycemic control (HbA1c & 7.1%) when receiving the antidiabetic agent metformin were enrolled in this multicenter, double-blind trial. Subjects were randomized to continue with their prestudy dose of metformin (n = 27), to continue with their prestudy dose of metformin with the addition of repaglinide (n = 27), or to receive repaglinide alone (n = 29). For patients receiving repaglinide, the optimal dose was determined during a 4- to 8-week titration and continued for a 3-month maintenance period. RESULTS: In subjects receiving combined therapy, HbA1c was reduced by 1.4 +/- 0.2%, from 8.3 to 6.9% (P = 0.0016) and fasting plasma glucose by 2.2 mmol/l (P = 0.0003). No significant changes were observed in subjects treated with either repaglinide or metformin monotherapy in HbA1c (0.4 and 0.3% decrease, respectively) or fasting plasma glucose (0.5 mmol/l increase and 0.3 mmol/l decrease respectively). Subjects receiving repaglinide either alone or in combination with metformin, had an increase in fasting levels of insulin between baseline and the end of the trial of 4.04 +/- 1.56 and 4.23 +/- 1.50 mU/l, respectively (P & 0.02). Gastrointestinal adverse events were common in the metformin group. An increase in body weight occurred in the repaglinide and combined therapy groups (2.4 +/- 0.5 and 3.0 +/- 0.5 kg, respectively P & 0.05). CONCLUSIONS: Combined metformin and repaglinide therapy resulted in superior glycemic control compared with repaglinide or metformin monotherapy in patients with type 2 diabetes whose glycemia had not been well controlled on metformin alone. Repaglinide monotherapy was as effective as metformin monotherapy.
Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018
Publisher: Springer Science and Business Media LLC
Date: 10-2021
DOI: 10.1038/S41591-021-01498-0
Abstract: Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations.
Sensori‐motor Function in Older Persons with Diabetes
Publisher: Wiley
Date: 09-08-1993
DOI: 10.1111/J.1464-5491.1993.TB00133.X
Abstract: Twenty-five persons with diabetes (aged 55-83 years) who were living independently in the community, and 40 age- and sex-matched non-diabetic controls were assessed for tactile sensitivity, vibration sense, proprioception, quadriceps strength and body sway. In both men and women, those with diabetes performed significantly worse in tests of body sway on firm and compliant surfaces compared with the control subjects after controlling for weight and body mass index. The female diabetic subjects also performed significantly worse in tests of peripheral sensation and strength compared with controls. Age-related declines in sensori-motor function were greater in the diabetic group (r = 0.55-0.75) than in the controls (r < 0.44), while within the diabetic group, duration of diabetes and vibration sense were significantly correlated with sway on a compliant (foam rubber) surface with the eyes open (partial r = 0.52, p < 0.01 and r = 0.55, p < 0.01, respectively). The study findings provide evidence that older people with diabetes have problems with stability and related sensori-motor factors which may place them at increased risk of falls.
Guideline for management of postmeal glucose
Publisher: Elsevier BV
Date: 05-2008
DOI: 10.1016/J.NUMECD.2008.01.012
Abstract: An estimated 246 million people worldwide have diabetes. Diabetes is a leading cause of death in most developed countries, and is reaching epidemic proportions in many developing and newly industrialized nations. Poorly controlled diabetes is associated with the development of renal failure, vision loss, macrovascular diseases and utations. Large controlled clinical trials have demonstrated that intensive treatment of diabetes can significantly decrease the development and/or progression of microvascular complications of diabetes. There appears to be no glycaemic threshold for reduction of diabetes complications the lower the glycated haemoglobin (HbA1c), the lower the risk. The progressive relationship between plasma glucose levels and cardiovascular risk extends well below the diabetic threshold. Until recently, the predominant focus of therapy has been on lowering HbA1c levels, with a strong emphasis on fasting plasma glucose. Although control of fasting hyperglycaemia is necessary, it is usually insufficient to obtain optimal glycaemic control. A growing body of evidence suggests that reducing postmeal plasma glucose excursions is as important, or perhaps more important for achieving HbA1c goals. This guideline reviews the evidence on the harmful effects of elevated postmeal glucose and makes recommendations on its treatment, assessment and targets.
Department of Error
Publisher: Elsevier BV
Date: 06-2019
SGLT2 inhibitors: New medicines for addressing unmet needs in type 2 diabetes
Publisher: OMICS Publishing Group
Date: 31-10-2014
Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17
Publisher: Elsevier BV
Date: 08-2020
Erratum to “Comparison of clinical-metabolic monitoring and outcomes and coronary risk status in people with type 2 diabetes from Australia, France and Latin America” [Diabetes Research and Clinical P
Publisher: Elsevier BV
Date: 10-2010
Failing to address access to insulin in its centenary year would be a catastrophic moral failure
Publisher: Elsevier BV
Date: 04-2021
Economic model system of chronic diseases in Australia: a novel approach initially focusing on diabetes and cardiovascular disease
Publisher: Inderscience Publishers
Date: 2010
HbA1c, fasting and 2 h plasma glucose in current, ex- and never-smokers: a meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 25-09-2013
Lipid-lowering therapy in people with type 2 diabetes
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2002
DOI: 10.1097/00041433-200212000-00004
Abstract: The risk of cardiovascular disease is markedly increased in people with type 2 diabetes. There is abundant epidemiological and clinical trial evidence that lipid abnormalities play a major role in the pathogenesis of atherosclerotic vascular disease in diabetes. Although the benefits of lipid-lowering therapy are well established in people without diabetes, the evidence in people with diabetes is not as well established. Recent population studies of lipid-lowering therapy and cardiovascular disease outcomes that included people with diabetes and performed a separate subgroup analysis were reviewed. Lipid lowering with statins and fibrates is effective in improving cardiovascular disease outcomes in diabetes, and their effectiveness is similar to that in the non-diabetic population. This effect is well established in secondary prevention and is accumulating for primary prevention. In iduals with diabetes require aggressive management of dyslipidaemia as part of an overall management strategy to reduce the risk of cardiovascular disease. In iduals with a previous cardiovascular disease event should be on lipid-lowering therapy, whereas in those who have not had a previous cardiovascular disease event, the decision to use lipid-lowering therapy should be based on lipid levels and the overall risk of a future event. The results of large studies that are currently in progress specifically in people with diabetes should resolve outstanding questions in relation to lipid-lowering therapy in diabetes.
Consensus Report: The Current Role of Self-Monitoring of Blood Glucose in Non-Insulin-Treated Type 2 Diabetes
Publisher: SAGE Publications
Date: 11-2011
The Sydney Diabetes Prevention Program: A community-based translational study
Publisher: Springer Science and Business Media LLC
Date: 10-06-2010
Mismatch between diabetes diagnosis in primary care and recommended diagnostic criteria
Publisher: Elsevier BV
Date: 03-2011
Inner retinal change in a novel rd1-FTL mouse model of retinal degeneration.
Publisher: Frontiers Media SA
Date: 29-07-2015
The Evaluation of Screening and Early Detection Strategies for Type 2 Diabetes and Impaired Glucose Tolerance (DETECT-2) update of the Finnish diabetes risk score for prediction of incident type 2 dia
Publisher: Springer Science and Business Media LLC
Date: 12-12-2010
DOI: 10.1007/S00125-010-1990-7
Abstract: The Finnish diabetes risk questionnaire is a widely used, simple tool for identification of those at risk for drug-treated type 2 diabetes. We updated the risk questionnaire by using clinically diagnosed and screen-detected type 2 diabetes instead of drug-treated diabetes as an endpoint and by considering additional predictors. Data from 18,301 participants in studies of the Evaluation of Screening and Early Detection Strategies for Type 2 Diabetes and Impaired Glucose Tolerance (DETECT-2) project with baseline and follow-up information on oral glucose tolerance status were included. Incidence of type 2 diabetes within 5 years was used as the outcome variable. Improvement in discrimination and classification of the logistic regression model was assessed by the area under the receiver-operating characteristic (ROC) curve and by the net reclassification improvement. Internal validation was by bootstrapping techniques. Of the 18,301 participants, 844 developed type 2 diabetes in a period of 5 years (4.6%). The Finnish risk score had an area under the ROC curve of 0.742 (95% CI 0.726-0.758). Re-estimation of the regression coefficients improved the area under the ROC curve to 0.766 (95% CI 0.750-0.783). Additional items such as male sex, smoking and family history of diabetes (parent, sibling or both) improved the area under the ROC curve and net reclassification. Bootstrapping showed good internal validity. The predictive value of the original Finnish risk questionnaire could be improved by adding information on sex, smoking and family history of diabetes. The DETECT-2 update of the Finnish diabetes risk questionnaire is an adequate and robust predictor for future screen-detected and clinically diagnosed type 2 diabetes in Europid populations.
Petrology and geochemistry of the Neoproterozoic Nguba and Kundelungu Groups, Katangan Supergroup, southeast Congo: Implications for provenance, paleoweathering and geotectonic setting
Publisher: Elsevier BV
Date: 2006
Lithology, petrography and Cu occurrence of the Neoproterozoic glacial Mwale Formation at the Shanika syncline (Tenke Fungurume, Congo Copperbelt; Democratic Republic of Congo)
Publisher: Elsevier BV
Date: 05-2017
Using An Economic Model Of Diabetes To Evaluate Prevention And Care Strategies In Australia
Publisher: Health Affairs (Project Hope)
Date: 2008
Abstract: The health benefits and costs of a national diabetes screening and prevention scenario are estimated among Australians ages 45-74. The Australian Diabetes Cost-Benefit Model is used to compare baseline and scenario outcomes from 2000 to 2010. Those newly diagnosed in 2000 receive intensive care, resulting in lower complication rates. People "at high risk" of developing diabetes are offered lifestyle intervention, reducing the numbers developing diabetes. A total of 115,000 people became "newly diagnosed." Among those deemed at high risk, 53,000 avoided developing diabetes by 2010. Average yearly intervention and incremental treatment cost was AU$179 million, with a cost per disability-adjusted life-year of AU$50,000.
A within-trial cost-effectiveness analysis of primary care referral to a commercial provider for weight loss treatment, relative to standard care—an international randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 28-08-2012
DOI: 10.1038/IJO.2012.139
Gestational Diabetes Mellitus: Squaring the Circle
Publisher: American Diabetes Association
Date: 10-05-2014
DOI: 10.2337/DC14-0344
High-level stratigraphic scheme for New Zealand rocks
Publisher: Informa UK Limited
Date: 02-10-2014
Diabetes Prevention in Australia: The Challenges of Scaling-up and Rolling-out Programs
Publisher: WORLD SCIENTIFIC
Date: 21-07-2014
Detecting the hidden burden of pre-diabetes and diabetes in Western Sydney
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.DIABRES.2019.04.019
Abstract: Examining pre-diabetes and diabetes rates using glycated haemoglobin (HbA Epidemiological study of HbA1c measurements in in iduals ≥18 years receiving a blood test (1) in the hospital setting of the ED at Blacktown/Mt Druitt hospital (1/06/2016 to 31/05/2018) and (2) in primary care involving Bridgeview Medical Practice (BVMP) (1/03/2017 to 01/02/2018) as well as other general practices (June 2018 only). Totals of 55,568 in iduals from ED and 5911 in iduals from GP. The prevalence of diabetes in tested in iduals was 17.3% (n = 9704) in ED and 17.4% (n = 1027) in GP. The prevalence of pre-diabetes in ED was 30.2% (n = 16,854) and 26.6% (n = 1576) in GP. Regression controlling for age, season, and gender revealed a weekly increase of 1.1% in odds for diabetes and 1.5% for pre-diabetes (p < 0.001), in line with the yearly absolute increase of 1% in rate for both tested and coded hospital patients. In BVMP the rate of diabetes rose by 22% during the testing period from 8.9% to 11%. There exists a high burden of diabetes both in hospitals and general practice. Testing in ED and general practice revealed similarly high burdens of diabetes across different areas of the healthcare system. In the appropriate hospital and primary care setting, HbA1c can be used to identify in iduals with diabetes that may benefit from targeted intervention.
Public support for regulations to prevent overweight and obesity in Australia.
Publisher: Springer Science and Business Media LLC
Date: 18-04-2018
The association of periodontal disease with the complications of diabetes mellitus. A systematic review
Publisher: Elsevier BV
Date: 07-2020
Follow-up of Blood-Pressure Lowering and Glucose Control in Type 2 Diabetes
Publisher: Massachusetts Medical Society
Date: 09-10-2014
Screening for diabetes prevention with diabetes risk scores - A balancing act.
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.DIABRES.2017.11.009
Abstract: To compare the diabetes prevention impact and cost of several screening scenarios for diabetes prevention programs with the scenario which included an oral glucose tolerance test (OGTT). We included 4864 participants of the Australian Diabetes, Obesity and Lifestyle study who were aged ≥40 years, did not have known diabetes at baseline, and attended the five year follow-up. The proportions of participants eligible or ineligible for diabetes prevention program were estimated for each scenario. The costs of screening and diabetes prevention programs were also estimated. Screening with OGTT alone identified 21% of participants as eligible for diabetes prevention. While 3.1% of the cohort were identified as high risk and developed diabetes after five years, 1.0% of the cohort were identified as low risk and developed diabetes. The population prevention potential (i.e. sensitivity) for OGTT alone was 76.5%. Screening all Australian adults aged ≥40 years in 2015 by OGTT would have cost a total of AU$2025 million (AU$1031 million on screening and AU$994 million on prevention programs). The total costs of screening and prevention were substantially lower when AUSDRISK was used alone or in combination with a blood test. However, the population prevention potentials were also lower (ranged from 20.1% to 50.7%). A blood test post non-invasive risk assessment is a worthwhile step in the process of enrolling participants in a diabetes prevention program. Nevertheless, there will be ineligible in iduals who proceed to diabetes.
Crustal evolution in the central Congo-Kasai Craton, Luebo, D.R. Congo: Insights from zircon U–Pb ages, Hf-isotope and trace-element data
Publisher: Elsevier BV
Date: 04-2009
The Prevalence of Diabetes in the Kingdom of Tonga
Publisher: American Diabetes Association
Date: 08-2002
DOI: 10.2337/DIACARE.25.8.1378
Abstract: OBJECTIVE—To determine the prevalence of diabetes, impaired glucose metabolism, and related risk factors in Tonga. RESEARCH DESIGN AND METHODS—A randomly selected representative national s le of 1,024 people aged & years was surveyed. Each participant had fasting blood glucose and HbA1c measured. Subjects with a fasting blood glucose & .0 mmol/l (90 mg/dl) and & .1 mmol/l (200 mg/dl) or a fasting blood glucose ≤5.0 mmol/l and an HbA1c & .0% and every fifth subject with a fasting blood glucose ≤5.0 mmol/l and a normal HbA1c had a 75-g oral glucose tolerance test (OGTT). A total of 472 in iduals had an OGTT based on these criteria. Subjects with a fasting blood glucose ≥11.1 mmol/l and an elevated HbA1c were diagnosed as having diabetes. RESULTS—The mean age was 41.3 years, and the mean BMI was 32.3 kg/m2. The age-standardized prevalence of diabetes was 15.1% (CI 12.5–17.6), 12.2% (8.7–15.8) in men and 17.6% (14.0–21.1) in women (NS), of which only 2.1% was previously diagnosed. A total of 75% of people with newly diagnosed diabetes had a fasting plasma glucose ≥7.0 mmol/l (126 mg/dl). The prevalence of impaired glucose tolerance was 9.4% (7.3–11.5) and of impaired fasting glycemia 1.6% (0.7–2.6). Undiagnosed diabetes was significantly associated with increasing age, obesity, hypertension, and a family history of diabetes. CONCLUSIONS—The current prevalence of diabetes in Tonga is 15.1%, of which 80% is undiagnosed. A similar survey in 1973 reported a 7.5% diabetes prevalence, indicating a doubling of diabetes over the past 25 years. In addition, lesser degrees of glucose intolerance are common, and much of the community is overweight
Strategies for implementing the WHO diagnostic criteria and classification of hyperglycaemia first detected in pregnancy
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.DIABRES.2014.02.012
Abstract: The World Health Organization (WHO) has recently released updated recommendations on Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy which are likely to increase the prevalence of gestational diabetes mellitus (GDM). Any increase in the number of women with GDM has implications for health services since these women will require treatment and regular surveillance during the pregnancy. Some health services throughout the world may have difficulty meeting these demands since country resources for addressing the diabetes burden are finite and resource allocation must be prioritised by balancing the need to improve care of people with diabetes and finding those with undiagnosed diabetes, including GDM. Consequently each health service will need to assess their burden of hyperglycaemia in pregnancy and decide if and how it will implement programmes to test for and treat such women. This paper discusses some considerations and options to assist countries, health services and health professionals in these deliberations.
Diabetes prevention and care: we know what to do, so why aren't we doing it?
Publisher: AMPCo
Date: 11-2014
DOI: 10.5694/MJA14.01307
Epidemiology of Prediabetes
Publisher: WORLD SCIENTIFIC
Date: 21-07-2014
Bimodal Distribution of Glucose Is Not Universally Useful for Diagnosing Diabetes
Publisher: American Diabetes Association
Date: 03-2009
DOI: 10.2337/DC08-0867
Abstract: OBJECTIVE—Bimodality in the distribution of glucose has been used to define the cut point for the diagnosis of diabetes. Previous studies on bimodality have primarily been in populations with a high prevalence of type 2 diabetes, including one study in a white Caucasian population. All studies included participants with known diabetes. The aim of this study was to assess whether a bimodal structure is a general phenomenon in fasting plasma glucose (FPG) and 2-h plasma glucose that is useful for deriving a common cut point for diabetes in populations of different origin, both including and excluding known diabetes. RESEARCH DESIGN AND METHODS—The Evaluation of Screening and Early Detection Strategies for Type 2 Diabetes and Impaired Glucose Tolerance (DETECT-2) project is an international collaboration pooling surveys from all continents. These studies include surveys in which plasma glucose was measured during an oral glucose tolerance test in total, 43 studies (135,383 participants) from 27 countries were included. A mixture of two normal distributions was fitted to plasma glucose levels, and a cut point for normal glycemia was estimated as their intersection. In populations with a biologically meaningful cut point, bimodality was tested for significance. RESULTS—Distributions of FPG and 2-h plasma glucose did not, in general, produce bimodal structures useful for deriving cut points for diabetes. When present, the cut points produced were inconsistent over geographical regions. CONCLUSIONS—Deriving cut points for normal glycemia from distributions of FPG and 2-h plasma glucose does not appear to be suitable for defining diagnostic cut points for diabetes.
Low–Glycemic Index Diets in the Management of Diabetes
Publisher: American Diabetes Association
Date: 08-2003
DOI: 10.2337/DIACARE.26.8.2261
Abstract: OBJECTIVE—The use of diets with low glycemic index (GI) in the management of diabetes is controversial, with contrasting recommendations around the world. We performed a meta-analysis of randomized controlled trials to determine whether low-GI diets, compared with conventional or high-GI diets, improved overall glycemic control in in iduals with diabetes, as assessed by reduced HbA1c or fructosamine levels. RESEARCH DESIGN AND METHODS—Literature searches identified 14 studies, comprising 356 subjects, that met strict inclusion criteria. All were randomized crossover or parallel experimental design of 12 days’ to 12 months’ duration (mean 10 weeks) with modification of at least two meals per day. Only 10 studies documented differences in postprandial glycemia on the two types of diet. RESULTS—Low-GI diets reduced HbA1c by 0.43% points (CI 0.72–0.13) over and above that produced by high-GI diets. Taking both HbA1c and fructosamine data together and adjusting for baseline differences, glycated proteins were reduced 7.4% (8.8–6.0) more on the low-GI diet than on the high-GI diet. This result was stable and changed little if the data were unadjusted for baseline levels or excluded studies of short duration. Systematically taking out each study from the meta-analysis did not change the CIs. CONCLUSIONS—Choosing low-GI foods in place of conventional or high-GI foods has a small but clinically useful effect on medium-term glycemic control in patients with diabetes. The incremental benefit is similar to that offered by pharmacological agents that also target postprandial hyperglycemia.
The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019
Publisher: Elsevier BV
Date: 2022
Insulin intensification for people with type 2 diabetes: a practical approach
Publisher: OMICS Publishing Group
Date: 12-2010
DOI: 10.4066/AMJ.2010.466
U–Pb and Hf-isotope analyses of zircon from the Kundelungu Kimberlites, D.R. Congo: Implications for crustal evolution
Publisher: Elsevier BV
Date: 06-2007
Insulin sensitivity predicts glycemia after a protein load
Publisher: Elsevier BV
Date: 2000
DOI: 10.1016/S0026-0495(00)90488-8
Abstract: Protein ingestion results in small but distinct changes in plasma glucose and insulin. We hypothesized that the glycemic and/or insulin response to protein might be related to the degree of insulin sensitivity. Our aim was to determine the relationships between insulin sensitivity (assessed by euglycemic-hyperinsulinemic cl ) and postprandial glucose, insulin, C-peptide, and glucagon responses to a 75-g protein meal and a 75-g glucose load. Sixteen lean healthy Caucasian subjects (mean +/- SD age, 25 +/- 6 years body mass index [BMI], 23.1 +/- 1.7 kg/m2) participated in the study. After the protein meal, the mean plasma glucose declined gradually below fasting levels to a nadir of -0.36 +/- 0.46 mmol/L from 60 to 120 minutes, showing wide intrain idual variation. Insulin sensitivity (M value) was 1.1 to 3.9 mmol/L/m2 min in the subjects and correlated inversely with the plasma glucose response to the protein meal (r = -.58, P = .03), ie, the most insulin-sensitive subjects showed the greatest decline in plasma glucose. In contrast, there was no correlation between insulin sensitivity and the insulin or glucagon response to the protein load, or between the M value and the metabolic responses (glucose, insulin, C-peptide, and glucagon) to the glucose load. Our study suggests that the net effect of insulin and glucagon secretion on postprandial glucose levels after a protein meal might depend on the in idual's degree of insulin sensitivity. Gluconeogenesis in the liver may be less susceptible to inhibition by insulin in the more highly resistant subjects, thereby counteracting a decline in plasma glucose.
Trends in overweight and obesity over 22 years in a large adult population: the HUNT Study, Norway.
Publisher: Wiley
Date: 02-2013
DOI: 10.1111/COB.12009
Risk scores for predicting type 2 diabetes: using the optimal tool
Publisher: Springer Science and Business Media LLC
Date: 10-06-2011
The rationale for combining GLP-1 receptor agonists with basal insulin.
Publisher: AMPCo
Date: 08-2013
DOI: 10.5694/MJA12.11856
Abstract: • Type 2 diabetes mellitus (T2DM) is progressive the more intensively it is treated, the greater is the risk of hypoglycaemia and weight gain. Achieving treatment intensification while mitigating these risks presents a challenge to patient management. • Basal insulins provide control of fasting glucose however, their utility in the control of postprandial glucose excursions is limited. • Glucagon-like peptide-1 (GLP-1) receptor agonists stimulate glucose-medicated insulin secretion, suppress glucagon secretion, delay gastric emptying and decrease appetite. Use of GLP-1 receptor agonists in combination therapy with basal insulin offers an alternative approach to intensification of insulin therapy. • Prospective interventional trials demonstrate that GLP-1 receptor agonists added to basal insulin decrease postprandial glucose levels, lower HbA1c levels, decrease weight and lower basal insulin requirements without increasing the risk of major hypoglycaemic events. • The current clinical data are limited by the lack of any data on the long-term effects of GLP-1 receptor agonists over additional prandial regimens they may be beneficial or deleterious. • Although cost, gastrointestinal side effects and long-term safety should be taken into account when considering this combination, it appears to be growing in popularity and is likely to be an important therapeutic option for T2DM in the future.
Glycemic thresholds for diabetes-specific retinopathy: Implications for diagnostic criteria for diabetes
Publisher: American Diabetes Association
Date: 26-10-2008
DOI: 10.2337/DC10-1206
Abstract: To re-evaluate the relationship between glycemia and diabetic retinopathy. We conducted a data-pooling analysis of nine studies from five countries with 44,623 participants aged 20–79 years with gradable retinal photographs. The relationship between diabetes-specific retinopathy (defined as moderate or more severe retinopathy) and three glycemic measures (fasting plasma glucose [FPG n = 41,411], 2-h post oral glucose load plasma glucose [2-h PG n = 21,334], and A1C [n = 28,010]) was examined. When diabetes-specific retinopathy was plotted against continuous glycemic measures, a curvilinear relationship was observed for FPG and A1C. Diabetes-specific retinopathy prevalence was low for FPG & .0 mmol/l and A1C & .0% but increased above these levels. Based on vigintile (20 groups with equal numbers) distributions, glycemic thresholds for diabetes-specific retinopathy were observed over the range of 6.4–6.8 mmol/l for FPG, 9.8–10.6 mmol/l for 2-h PG, and 6.3–6.7% for A1C. Thresholds for diabetes-specific retinopathy from receiver-operating characteristic curve analyses were 6.6 mmol/l for FPG, 13.0 mmol/l for 2-h PG, and 6.4% for A1C. This study broadens the evidence based on diabetes diagnostic criteria. A narrow threshold range for diabetes-specific retinopathy was identified for FPG and A1C but not for 2-h PG. The combined analyses suggest that the current diabetes diagnostic level for FPG could be lowered to 6.5 mmol/l and that an A1C of 6.5% is a suitable alternative diagnostic criterion.
The Australian Primary Care Collaboratives Program: improving diabetes care
Publisher: BMJ
Date: 16-06-2012
DOI: 10.1136/BMJQS-2011-000460
Abstract: Diabetes is a major, growing health problem often managed in primary care but with suboptimal control of risk factors. A large-scale quality improvement collaborative implemented in seven waves. General practices and Aboriginal medical services across Australia. Percentage of patients in each health service with haemoglobin A1C (HbA1C), total cholesterol and blood pressure at target. Health services attended three 2-day workshops, separated by 3-month activity periods and followed by 12 months of further improvement work. Local collaborative program managers supported teams to report measures and plan/do/study/act (PDSA) cycles monthly. Health services received feedback about changes in their measures in comparison with their wave. 743 health services participated in seven waves between 2004 and 2009 serving approximately 150,000 people with diabetes. Mean numbers of patients at target HbA1c levels improved by 50% from 25% at baseline to 38% at month 18. Lipid and blood pressure measures showed similar improvement. Engagement in the Program and results demonstrated that the collaborative methodology is transferable to Australian primary care. The results may reflect improved data recording and disease coding, and changes in clinical care. Internal evaluation should be built into improvement projects from the start to facilitate improvements and reporting. Enthusing, training and resourcing practice teams appeared to be the key to rapid change. Local support of practice teams was instrumental in improvement. Early investment to facilitate automatic measure collection ensured good data reporting.
The cost of screening for diabetes and intermediate hyperglycaemia
Publisher: Elsevier BV
Date: 09-2012
The treatment of cardiovascular risk in primary care using electronic decision support (TORPEDO) study
Publisher: BMJ
Date: 2012
The Rising Prevalence of Diabetes and Impaired Glucose Tolerance
Publisher: American Diabetes Association
Date: 05-2002
Abstract: OBJECTIVE—To determine the population-based prevalence of diabetes and other categories of glucose intolerance (impaired glucose tolerance [IGT] and impaired fasting glucose [IFG]) in Australia and to compare the prevalence with previous Australian data. RESEARCH DESIGN AND METHODS—A national s le involving 11,247 participants aged ≥25 years living in 42 randomly selected areas from the six states and the Northern Territory were examined in a cross-sectional survey using the 75-g oral glucose tolerance test to assess fasting and 2-h plasma glucose concentrations. The World Health Organization diagnostic criteria were used to determine the prevalence of abnormal glucose tolerance. RESULTS—The prevalence of diabetes in Australia was 8.0% in men and 6.8% in women, and an additional 17.4% of men and 15.4% of women had IGT or IFG. Even in the youngest age group (25–34 years), 5.7% of subjects had abnormal glucose tolerance. The overall diabetes prevalence in Australia was 7.4%, and an additional 16.4% had IGT or IFG. Diabetes prevalence has more than doubled since 1981, and this is only partially explained by changes in age profile and obesity. CONCLUSIONS—Australia has a rapidly rising prevalence of diabetes and other categories of abnormal glucose tolerance. The prevalence of abnormal glucose tolerance in Australia is one of the highest yet reported from a developed nation with a predominantly Europid background.
Risk scores for diabetes prediction: The International Diabetes Federation PREDICT-2 project
Publisher: Elsevier BV
Date: 05-2013
Meta-Analysis of Low–Glycemic Index Diets in the Management of Diabetes
Publisher: American Diabetes Association
Date: 12-2003
Diabetes research and clinical practice: Developing a leading medium for diabetes care, prevention and cure
Publisher: Elsevier BV
Date: 05-2008
Guideline for management of postmeal glucose in diabetes
Publisher: Elsevier BV
Date: 02-2014
Assessment of kidney function in type 2 diabetes
Publisher: Wiley
Date: 04-2010
Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000–17
Publisher: Elsevier BV
Date: 09-2020
Clinical Application of the Food Insulin Index for Mealtime Insulin Dosing in Adults with Type 1 Diabetes: A Randomized Controlled Trial
Publisher: Mary Ann Liebert Inc
Date: 04-2016
Abstract: The Food Insulin Index (FII) is a novel algorithm for ranking foods based on their insulin demand relative to an isoenergetic reference food. We compared the effect of carbohydrate counting (CC) versus the FII algorithm for estimating insulin dosage on glycemic control in type 1 diabetes. In a randomized, controlled trial, adults (n = 26) using insulin pump therapy were assigned to using either traditional CC or the novel Food Insulin Demand (FID) counting for 12 weeks. Subjects participated in group education and in idual sessions. At baseline and on completion of the trial, glycated hemoglobin A1c (HbA1c), day-long glycemia (6-day continuous glucose monitoring), fasting lipids, and C-reactive protein were determined. Changes in HbA1c from baseline to 12 weeks were small and not significant in both groups (mean ± SEM FII vs. CC, -0.1 ± 0.1% vs. -0.3 ± 0.2% P = 0.855). The incremental area under the curve following breakfast declined significantly among the FID counters with no change in the CC group (FID vs. CC, -93 ± 41 mmol/L/min [P = 0.043] vs. 4 ± 50 mmol/L/min [P = 0.938] between groups, P = 0.143). The mean litude of the glycemic excursion (MAGE) was significantly reduced among the FID counters (FID vs. CC, -6.1 ± 1.0 vs. -1.3 ± 1.0 mmol/L P = 0.003), and only the FID counters experienced a trend (-44% vs. +11% P = 0.057) to reduced hypoglycemia. In a 12-week pilot study, MAGE and postprandial glycemia following breakfast were significantly improved with FII counting versus CC, despite no significant differences in HbA1c.
Efficacy and safety of the dipeptidyl peptidase‐4 inhibitor, sitagliptin, compared with the sulfonylurea, glipizide, in patients with type 2 diabetes inadequately controlled on metformin alone: a rand
Publisher: Wiley
Date: 26-01-2007
DOI: 10.1111/J.1463-1326.2006.00704.X
Abstract: To compare the efficacy and safety of sitagliptin vs. glipizide in patients with type 2 diabetes and inadequate glycaemic control [haemoglobin A(1c) (HbA(1c)) > or = 6.5 and or = 1500 mg/day), 1172 patients were randomized to the addition of sitagliptin 100 mg q.d. (N = 588) or glipizide 5 mg/day (uptitrated to a potential maximum 20 mg/day) (N = 584) for 52 weeks. The primary analysis assessed whether sitagliptin was non-inferior to glipizide regarding HbA(1c) changes from baseline at Week 52 using a per-protocol approach. From a mean baseline of 7.5%, HbA(1c) changes from baseline were -0.67% at Week 52 in both groups, confirming non-inferiority. The proportions achieving an HbA(1c) < 7% were 63% (sitagliptin) and 59% (glipizide). Fasting plasma glucose changes from baseline were -0.56 mmol/l (-10.0 mg/dl) and -0.42 mmol/l (-7.5 mg/dl) for sitagliptin and glipizide, respectively. The proportion of patients experiencing hypoglycaemia episodes was significantly (p < 0.001) higher with glipizide (32%) than with sitagliptin (5%), with 657 events in glipizide-treated patients compared with 50 events in sitagliptin-treated patients. Sitagliptin led to weight loss (change from baseline =-1.5 kg) compared with weight gain (+1.1 kg) with glipizide [between-treatment difference (95% confidence interval) =-2.5 kg (-3.1, -2.0) p < 0.001]. In this study, the addition of sitagliptin compared with glipizide provided similar HbA(1c)-lowering efficacy over 52 weeks in patients on ongoing metformin therapy. Sitagliptin was generally well tolerated, with a lower risk of hypoglycaemia relative to glipizide and with weight loss compared with weight gain with glipizide.
Cost-effectiveness and socioeconomic implications of prevention and management of chronic kidney disease in type 2 diabetes
Publisher: Wiley
Date: 04-2010
Correction to: Polygenic risk scores predict diabetes complications and their response to intensive blood pressure and glucose control
Publisher: Springer Science and Business Media LLC
Date: 27-08-2021
The Epidemiology of Diabetes in Pacific Island Populations
Publisher: Wiley
Date: 11-09-2008
Double-blind crossover comparison of human and porcine insulins in patients reporting lack of hypoglycaemia awareness
Publisher: Elsevier BV
Date: 06-1992
DOI: 10.1016/0140-6736(92)92028-E
Abstract: There has been much debate about reports that some insulin-treated diabetic patients lose awareness of hypoglycaemic symptoms on changing from porcine to human insulin. In a double-blind, crossover study, we sought differences between porcine and human insulin in the frequency and characteristics of hypoglycaemic episodes among patients who reported a reduction of awareness of hypoglycaemia after changing treatment. We studied 50 patients referred by their physicians because of complaints of lack of awareness of hypoglycaemia on human insulin. They had had diabetes for a mean of 20 (SD 12) years and 70% had good or acceptable glycaemic control. Each patient was treated in a double-blind manner for four 1-month periods, two with human and two with porcine insulin, in random order. Only 2 patients correctly identified the sequence of insulin treatments used 8 or 9 would have been expected to do so by chance alone. The mean percentage of hypoglycaemic episodes associated with reduced or absent awareness was 64% (SD 30%) for human insulin and 69% (31%) for porcine insulin. We could find no statistically significant differences between the insulin species with respect to glycaemic control or the frequency, timing, severity, or awareness of hypoglycaemia. Reduced hypoglycaemia awareness is common with both human and porcine insulins.
Back to the future—Do IGT and IFG have value as clinical entities?
Publisher: Elsevier BV
Date: 08-2008
Metabolic syndrome and early death [5]
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2007
Chronic diseases and multi-morbidity - a conceptual modification to the WHO ICCC model for countries in health transition
Publisher: Springer Science and Business Media LLC
Date: 09-06-2014
Individual patient education for people with type 2 diabetes mellitus
Publisher: Wiley
Date: 21-01-2009
What Do We Know About Recruitment and Retention in Diabetes Prevention Programs? An Australian Perspective
Publisher: Wiley
Date: 10-07-2013
Translating research for evidence-based public health: Key concepts and future directions
Publisher: BMJ
Date: 08-05-2012
Abstract: Applying research to guide evidence-based practice is an ongoing and significant challenge for public health. Developments in the emerging field of 'translation' have focused on different aspects of the problem, resulting in competing frameworks and terminology. In this paper the scope of 'translation' in public health is defined, and four related but conceptually different 'translation processes' that support evidence-based practice are outlined: (1) reviewing the transferability of evidence to new settings, (2) translation research, (3) knowledge translation, and (4) knowledge translation research. Finally, an integrated framework is presented to illustrate the relationship between these domains, and priority areas for further development and empirical research are identified.
The role of HbA1c in the diagnosis of diabetes mellitus in Australia
Publisher: AMPCo
Date: 08-2012
DOI: 10.5694/MJA12.10988
Abstract: For many years, the diagnosis of diabetes has been made through the laboratory-based measurement of fasting or random blood glucose levels, or using the oral glucose tolerance test. A glycated haemoglobin (HbA(1c)) level ≥ 6.5% (48 mmol/mol) is now also acceptable for diagnosing diabetes. Caution is needed in interpreting HbA(1c) test results in the presence of conditions affecting red blood cells or their survival time, such as haemoglobinopathies or anaemia.
Effectiveness and costs of strategies to recruit Australian adults with type 2 diabetes into a text message intervention (DTEXT) study
Publisher: The Sax Institute
Date: 2022
Department of Error
Publisher: Elsevier BV
Date: 06-2020
Oral Disease in Relation to Future Risk of Dementia and Cognitive Decline: Prospective Cohort Study Based on the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Contro
Publisher: Cambridge University Press (CUP)
Date: 02-10-2011
DOI: 10.1016/J.EURPSY.2011.07.005
Abstract: Examine the association of oral disease with future dementia/cognitive decline in a cohort of people with type 2 diabetes. A total of 11,140 men and women aged 55–88 years at study induction with type 2 diabetes participated in a baseline medical examination when they reported the number of natural teeth and days of bleeding gums. Dementia and cognitive decline were ascertained periodically during a 5-year follow-up. Relative to the group with the greatest number of teeth (more than or equal to 22), having no teeth was associated with the highest risk of both dementia (hazard ratio 95% confidence interval: 1.48 1.24, 1.78) and cognitive decline (1.39 1.21, 1.59). Number of days of bleeding gums was unrelated to these outcomes. Tooth loss was associated with an increased risk of both dementia and cognitive decline.
The Carnivore Connection Hypothesis: Revisited
Publisher: Hindawi Limited
Date: 2012
DOI: 10.1155/2012/258624
Abstract: The “Carnivore Connection” hypothesizes that, during human evolution, a scarcity of dietary carbohydrate in diets with low plant : animal subsistence ratios led to insulin resistance providing a survival and reproductive advantage with selection of genes for insulin resistance. The selection pressure was relaxed at the beginning of the Agricultural Revolution when large quantities of cereals first entered human diets. The “Carnivore Connection” explains the high prevalence of intrinsic insulin resistance and type 2 diabetes in populations that transition rapidly from traditional diets with a low-glycemic load, to high-carbohydrate, high-glycemic index diets that characterize modern diets. Selection pressure has been relaxed longest in European populations, explaining a lower prevalence of insulin resistance and type 2 diabetes, despite recent exposure to famine and food scarcity. Increasing obesity and habitual consumption of high-glycemic-load diets worsens insulin resistance and increases the risk of type 2 diabetes in all populations.
Global Guideline for Type 2 Diabetes
Publisher: Elsevier BV
Date: 04-2014
Estimating the cost of complications of diabetes in Australia using administrative health-care data
Publisher: Elsevier BV
Date: 03-2008
DOI: 10.1111/J.1524-4733.2007.00228.X
Abstract: To estimate Australian health-care costs in the year of first occurrence and subsequent years for major diabetes-related complications using administrative health-care data. The costs were estimated using administrative information on hospital services and primary health-care services financed through Australia's national health insurance system Medicare. Data were available for 70,340 patients with diabetes in Western Australia (mean duration of 4.5 years of follow-up). Multiple regression analysis was used to estimate inpatient and primary care costs. For a man aged 60 years, the average costs in the year the event first occurred were: utation $20,416 (95% CI 18,670-22,411) nonfatal myocardial infarction (MI) $11,660 (10,931-12,450) nonfatal stroke $14,012 (12,849-15,183) ischaemic heart disease $12,577 (12,026-13,123) heart failure $15,530 (13,965-17,009) renal failure $28,661 (22,989-34,202) and chronic leg ulcer $15,413 (13,089-18,123). The costs in subsequent years for a man aged 60 years range from 14% for nonfatal MI to 106% for renal failure, of event costs. Estimates of the health-care costs associated with diabetes-related complications can be used in modeling the long-term costs of diabetes and in evaluating the cost-effectiveness of improving care.
Emplacement ages and sources of kimberlites and related rocks in southern Africa: U–Pb ages and Sr–Nd isotopes of groundmass perovskite
Publisher: Springer Science and Business Media LLC
Date: 07-2014
Hypoglycaemia with insulin aspart: a double‐blind, randomised, crossover trial in subjects with Type 1 diabetes
Publisher: Wiley
Date: 13-04-2004
A novel fuzzy neural network estimator for predicting hypoglycaemia in insulin-induced subjects
Publisher: IEEE
Date: 2001
Effectiveness and acceptability of a text message intervention (DTEXT) on diabetes control and self-management for people with type 2 diabetes: A randomized controlled trial.
Publisher: Research Square Platform LLC
Date: 05-06-2020
DOI: 10.21203/RS.3.RS-33162/V1
Abstract: Background Mobile phone text message interventions have the potential to improve the health of people with type 2 diabetes at a population level. This study aimed to determine the effectiveness and acceptability of a mobile phone text message intervention (DTEXT) on diabetes control and self-management behaviours for Australian adults with type 2 diabetes. Methods A two-armed parallel non-blinded randomised control trial was conducted with 395 community dwelling adults with type 2 diabetes and HbA1c ≥7.0% (53 mmol/mol). Block randomisation occurred after completion of baseline measures. The control group received usual care, the intervention group received usual care and the automated six month text message intervention (daily messages for months 1-3, four messages per week for months 4-6). Pathology measures and self-report telephone surveys were assessed using intention to treat analysis. Generalised estimating equations determined between group changes in HbA1c at 3 and 6 months. Secondary outcomes included change in nutrition, physical activity, blood lipid profile, body mass index, quality of life, self-efficacy, medication adherence and program acceptability. Results No significant difference was observed between the intervention (n=197) or control group (n=198) for HbA1c at 3 months (-0.11% CI -0.28, 0.07 d= -0.05, p=0.23) or 6 months (-0.13% CI -0.33, 0.08 d= -0.05, p=0.22). A significant improvement in nutrition was seen with consumption of vegetables at 3 months (0.74 serves/day 95%CI 0.34, 1.12 d =0.31, p .01) and 6 months (0.42 serves/day 95% CI 0.03, 0.82 d =0.18, p=0.04) fruit at 3 months (0.21 serves/day 95% CI 0.00, 0.41 d =0.09, p .05) and discretionary sweet foods at 3 months (-1.10 times/week 95% CI -2.03, -0.16 d =-0.47, p=0.02). No other significant effects were seen at 3 months and 6 months. The intervention demonstrated high rates of acceptability (94.0%) and minimal withdrawal (1.5%). Conclusions A mobile phone text message intervention can improve some nutritional behaviours in people with type 2 diabetes, but does not significantly improve HbA1c or other health outcomes. DTEXT provides a highly accepted and potentially scalable form of self-management support that can complement existing diabetes care. Trial Registration Australian New Zealand Clinical Trials Registry, Trial ID: ACTRN12617000416392. Registered: 23 March 2017.
Comparative effects of microvascular and macrovascular disease on the risk of major outcomes in patients with type 2 diabetes
Publisher: Springer Science and Business Media LLC
Date: 27-07-2017
New IDF Guideline for managing type 2 diabetes in older people
Publisher: Elsevier BV
Date: 03-2014
Type 2 diabetes prevention in the community: 12-Month outcomes from the Sydney Diabetes Prevention Program
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.DIABRES.2015.11.010
Abstract: The Sydney Diabetes Prevention Program (SDPP) was a community-based type 2 diabetes prevention translational research study with screening and recruitment in the primary health care setting. We aimed to investigate the program's effectiveness in reducing risk factors for diabetes as well as the program's reach, adoption and implementation. 1238 participants aged 50-65 years at high-risk of developing type 2 diabetes were recruited by primary care physicians in the greater Sydney region. The intervention, delivered by trained allied health professionals, included an initial consultation, three group sessions/in idual sessions, three follow-up phone calls, and a final review at 12 months. Biomarkers and behavioural goals were compared between baseline and 12 months. At baseline, the mean age of those who entered the program was 58.8 ± 4.4 years, 63% female, and the mean body mass index was 31.6 ± 5.2 kg/m(2). There was a significant weight reduction of 2 ± 4.3 kg (p<0.02) in the 850 participants who completed the 12-month follow-up accompanied by improvements in diet (total fat, saturated fat, and fibre intake) and physical activity. There were also significant reductions in waist circumference 2.6 ± 4.7 cm (p<0.001) and total cholesterol -0.2 ± 0.8 mmol/L (p<0.001) but not blood glucose. The diabetes risk reduction was estimated to be 30%, consistent with similar trials. This study demonstrates that a community-based lifestyle modification program is effective in reducing important risk factors for diabetes in in iduals at high-risk of developing type 2 diabetes.
Soft sediment deformation structures in the Neoproterozoic Kansuki formation (Katanga Supergroup, Democratic Republic of the Congo): Evidence for deposition in a tectonically active carbonate platform
Publisher: Elsevier BV
Date: 02-2019
Validation of the food insulin index in lean, young, healthy individuals, and type 2 diabetes in the context of mixed meals: an acute randomized crossover trial
Publisher: Elsevier BV
Date: 10-2015
Abstract: The Food Insulin Index (FII) is a novel classification of single foods based on insulin responses in healthy subjects relative to an isoenergetic reference food. Our aim was to compare day-long responses to 2 nutrient-matched diets predicted to have either high or low insulin demand in healthy controls and in iduals with type 2 diabetes (T2DM). Twenty adults (10 healthy adults and 10 adults with T2DM) were recruited. On separate mornings, subjects consumed either a high- or low-FII diet in random order. Diets consisted of 3 consecutive meals (breakfast, morning tea, and lunch), matched for macronutrients, fiber, and glycemic index (GI), but with 2-fold difference in insulin demand as predicted by the FII of the component foods. Postprandial glycemia and insulinemia were measured in capillary plasma at regular intervals over 8 h. As predicted by their GI, there were no differences in glycemic responses between the 2 diets in either group (mean ± SEM healthy: 6.2 ± 0.2 compared with 6.1 ± 0.1 mmol/L · min, P = 0.429 T2DM: 9.9 ± 1.3 compared with 10.3 ± 1.6 mmol/L · min, P = 0.485). Compared with the high-FII diet, mean postprandial insulin response over 8 h was 53% lower with the low-FII diet in healthy subjects (mean ± SEM incremental AUCinsulin 31,900 ± 4100 pmol/L · min compared with 68,100 ± 11,400 pmol/L · min, P = 0.003) and 41% lower in subjects with T2DM (mean ± SEM incremental AUCinsulin 11,000 ± 1800 pmol/L · min compared with 18,700 ± 3100 pmol/L · min, P = 0.018). Incremental AUCinsulin was statistically significantly different between diets when groups were combined (P = 0.001). The FII algorithm may be a useful tool for reducing postprandial hyperinsulinemia in T2DM, thereby potentially improving insulin resistance and β-cell function. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12611000654954.
Quality Assurance of Individual Diabetes Patient Education
Publisher: SAGE Publications
Date: 12-1994
DOI: 10.1177/014572179402000610
Abstract: In idual patient education is the most common means of communicating diabetes information and teaching self-care skills. Despite a considerable amount of literature regarding the outcome of group patient education, there is limited reference to the outcome of in idual diabetes patient education or to quality assurance of the health messages delivered during this type of education. This study was designed to develop standardized educational messages for in idual patient education delivered by diabetes nurse educators, test the immediate impact of these educational messages on patient knowledge, and identify any differences between diabetes nurse educators in their ability to influence patient knowledge. Overall, subjects demonstrated a significant improvement in knowledge immediately following an in idual education session. The topic with the least improvement was diet. Significant differences in the patients' posteducation knowledge scores were observed between the three nurse educators in this study. No apparent patient factors accounted for this difference.
Association of a functional inducible nitric oxide synthase promoter variant with complications in type 2 diabetes
Publisher: Springer Science and Business Media LLC
Date: 02-2002
DOI: 10.1007/S00109-001-0287-1
Abstract: Complications of diabetes have a genetic influence. Since increased inducible nitric oxide synthase (iNOS) gene ( NOS2A) expression can contribute to tissue damage, NOS2A is a worthy candidate for such a role. We therefore tested a 4-bp insertion/deletion (+/-) polymorphism 0.7 kb upstream of NOS2A for association with complications in type 2 diabetes patients, and also performed transient transfection experiments to examine the effect of this variant on promoter activity in kidney cells in culture. We investigated 379 Caucasian type 2 diabetes patients of British/European descent, 93 of whom had microalbuminuria, 26 overt nephropathy, 46 retinopathy, and 73 clinical neuropathy. Genotyping for the variant was carried out by PCR and automated Genescan analysis. Transient transfection studies involved the renal HEK 293 cell line and luciferase reporter gene constructs containing 1.1 kb of 5'-flanking DNA from '+' or '-' allele homozygotes. We found that the '+' allele frequency in patients without microalbuminuria was 12%, but was 23% in those with microalbuminuria ( P=0.0005), and was 26% in those with nephropathy ( P=0.0007), 22% in those with retinopathy ( P=0.037), and 23% in those with neuropathy ( P=0.045). The odds ratios for homozygote +/+ to have microalbuminuria or nephropathy were 2.4 (95% CI 1.4-4.2, P=0.0023) and 5.4 (95% CI 1.8-16, P=0.0009), respectively. Luciferase reporter gene constructs containing 1 kb of NOS2A promoter DNA for each allele were made and sequence analysis confirmed that the +/- variation was the only sequence difference present. Transient transfection of these into HEK 293 cells revealed 25 times higher reporter gene activity for the '+' allele compared with the '-' allele. Gel shift analysis with 30mer oligonucleotides corresponding to each allele showed specific binding to nuclear extracts, being greater for the '+' allele. Thus the '+' allele of the NOS2A promoter variant may confer higher iNOS expression, and could contribute to complications of type 2 diabetes, especially in the approximately 5% of patients homozygous for this variant.
Mapping disparities in education across low- and middle-income countries
Publisher: Springer Science and Business Media LLC
Date: 25-12-2019
DOI: 10.1038/S41586-019-1872-1
Abstract: Educational attainment is an important social determinant of maternal, newborn, and child health 1–3 . As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting 4–6 . The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness 7,8 however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health 9–11 . Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of in iduals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but—to our knowledge—no analysis has examined the subnational proportions of in iduals who completed specific levels of education across all low- and middle-income countries 12–14 . By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations.
Incorporating fatty liver disease in multidisciplinary care and novel clinical trial designs for patients with metabolic diseases
Publisher: Elsevier BV
Date: 09-2021
Glucose, Lipid, and Blood Pressure Control in Australian Adults With Type 2 Diabetes
Publisher: American Diabetes Association
Date: 06-2005
Diabesity: therapeutic options
Publisher: Wiley
Date: 20-04-2010
DOI: 10.1111/J.1463-1326.2009.01182.X
Abstract: A pathogenic relationship exists between type 2 diabetes and obesity. Over the last decade, the escalation in diabetes cases has paralleled the rapid increase in obesity rates, constituting a global health crisis. Environmental risk factors attributed to the global increase in obesity include the consumption of high-calorie, high-fat foods and inadequate physical activity. Obese in iduals may also have a genetic predisposition for obesity. Both diabetes and obesity confer an elevated risk of developing a range of complications and comorbidities, including cardiovascular disease, hypertension and stroke, which can complicate disease management. This review examines the aetiology of the linkages between diabetes and obesity and the range of available therapies. Recent clinical evidence substantiating the efficacy and safety of incretin-based antidiabetic therapies is analysed, in addition to data on antiobesity therapeutic strategies, such as antiobesity agents, behaviour modification and bariatric surgery. Glucose control is often accompanied by weight-neutral or modest weight reduction effects with DPP-4 inhibitor treatment (sitagliptin, vildagliptin, saxagliptin) and weight loss with GLP-1 receptor agonist therapy (exenatide, liraglutide). Studies of antiobesity agents including orlistat, sibutramine and rimonabant have shown attrition rates of 30-40%, and the long-term effects of these agents remain unknown. Bariatric surgical procedures commonly performed are laparoscopic adjustable banding of the stomach and the Roux-en-Y gastric bypass, and have produced type 2 diabetes remission rates of up to 73%. Therapeutic strategies that integrate glycaemic control and weight loss will assume greater importance as the prevalence of diabetes and obesity increase.
Early prevention of diabetes microvascular complications in people with hyperglycaemia in Europe. ePREDICE randomized trial. Study protocol, recruitment and selected baseline data
Publisher: Public Library of Science (PLoS)
Date: 13-04-2020
Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study
Publisher: Springer Science and Business Media LLC
Date: 02-09-2016
Derivation and validation of diabetes risk score for urban Asian Indians
Publisher: Elsevier BV
Date: 10-2005
DOI: 10.1016/J.DIABRES.2005.02.016
Abstract: Simple risk scores for identifying people with undiagnosed diabetes have been developed, mostly in Caucasian groups. This may not be suitable for Asian Indians, therefore this study was undertaken to develop and validate a simple diabetes risk score in an urban Asian Indian population with a high prevalence of diabetes. We also tested whether this score was applicable to South Asian migrants living in a different cultural context. A population based Cohort of 10,003 participants aged >or=20 years was ided into two equal halves (Cohorts 1 and 2), after excluding people with known diabetes. Cohort 1 (n=4993) was used to derive the risk score. Validation of the score was performed in the other half of the survey population (Cohort 2) (n=5010). The validation was also done in a separate survey population in Chennai, India (Cohort 3) (n=2002) (diagnosis of diabetes was based on OGTT) and in the South Asian Cohort of the 1999 Health Survey for England (n=676) (fasting glucose value>or=7 mmol/l and HbA1c>or=6.5% were used for diagnosis). A logistic regression model was used to compute the beta coefficients for risk factors. The risk score value was derived from a receiver operating characteristic curve. The significant risk factors included in the risk score were age, BMI, waist circumference, family history of diabetes and sedentary physical activity. A risk score value of >21 gave a sensitivity, specificity, positive predictive value and negative predictive value of 76.6%, 59.9%, 9.4% and 97.9% in Cohort 1, 72.4%, 59%, 8.3% and 97.6% in Cohort 2 and 73.7%, 61.0%, 12.2% and 96.9% in Cohort 3, respectively. The higher distribution of risk factors in the UK Cohort means that at the same cut point the score was much more sensitive but also less specific. (sensitivity 92.2%, specificity 25.7%, positive predictive value of 21.6% and negative predictive value of 93.7%). A diabetes risk score involving simple non-biochemical measurements was developed and validated in a native Asian Indian population. This easily applicable simple score could play an important role as the first step in the process of identifying in iduals with an increased likelihood of having prevalent but undiagnosed diabetes. The different distribution of risk factors with the migrant Asian Indians living in England and the different relationship between sensitivity and specificity for the same score demonstrate that risk scores and cut-points developed and tested even within one ethnic group cannot be generalized to in iduals of the same ethnic group living in a different cultural setting where the distribution of risk factors for diabetes is different.
Related Organisations
Université Officielle De Bukavu
Location: Congo, Democratic Republic of the
Related Funding Activities
Discovery Projects - Grant ID: DP0559650
Start Date: 2005
End Date: 12-2011
Amount: $524,500.00
Funder: Australian Research Council
View Funded ActivityLinkage Projects - Grant ID: LP0561214
Start Date: 2005
End Date: 12-2008
Amount: $240,000.00
Funder: Australian Research Council
View Funded Activity