RESEARCH DESIGN AND METHODS: The prevalence of diabetes, defined as self-reported or fasting glycemia ≥7 mmol/L, was documented in 119,666 adults from three high-income (HIC), seven upper-middle-income (UMIC), four lower-middle-income (LMIC), and four low-income (LIC) countries. Relationships between diabetes and its risk factors within these country groupings were assessed using multivariable analyses.
RESULTS: Age- and sex-adjusted diabetes prevalences were highest in the poorer countries and lowest in the wealthiest countries (LIC 12.3%, UMIC 11.1%, LMIC 8.7%, and HIC 6.6%; P < 0.0001). In the overall population, diabetes risk was higher with a 5-year increase in age (odds ratio 1.29 [95% CI 1.28-1.31]), male sex (1.19 [1.13-1.25]), urban residency (1.24 [1.11-1.38]), low versus high education level (1.10 [1.02-1.19]), low versus high physical activity (1.28 [1.20-1.38]), family history of diabetes (3.15 [3.00-3.31]), higher waist-to-hip ratio (highest vs. lowest quartile; 3.63 [3.33-3.96]), and BMI (≥35 vs. <25 kg/m(2); 2.76 [2.52-3.03]). The relationship between diabetes prevalence and both BMI and family history of diabetes differed in higher- versus lower-income country groups (P for interaction < 0.0001). After adjustment for all risk factors and ethnicity, diabetes prevalences continued to show a gradient (LIC 14.0%, LMIC 10.1%, UMIC 10.9%, and HIC 5.6%).
CONCLUSIONS: Conventional risk factors do not fully account for the higher prevalence of diabetes in LIC countries. These findings suggest that other factors are responsible for the higher prevalence of diabetes in LIC countries.
METHODS: This qualitative study used individual in-depth interviews to capture the views and experiences of non-pregnant diabetic women of reproductive age in four public health clinics in a southwestern state of peninsular Malaysia from May 2016 to February 2017. The participants were purposively sampled according to ethnicity and were interviewed using a semi-structured topic guide. Interviews were audio-recorded, and transcripts were analysed using thematic analysis.
RESULTS: From the 33 interviews that were analysed, four important factors influencing participants' decisions regarding pregnancy planning were identified. Participants' perception of poor pregnancy outcomes due to advanced age and medical condition was found to have an impact. However, despite these fears and negative relationships with doctors, personal, family and cultural influences supported by religious 'up to God' beliefs took centre stage in the pregnancy intention of some participants. Participants demonstrated a variety of understandings of pregnancy planning. They outlined some activities for pregnancy preparation, although many also reported limited engagement with pre-pregnancy care.
CONCLUSIONS: This study emphasised the known dilemma experienced by diabetic women considering their desire for an ideal family structure against their perceived pregnancy risks, heterogeneous religious beliefs and the impact of cultural demands on pregnancy intention. This study urges healthcare providers to increase their engagement with the women in pregnancy planning in a more personalised approach.
RESEARCH DESIGN AND METHODS: The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults aged 35-70 years from 4 high-income countries (HIC), 12 middle-income countries (MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 ± 3.0 years.
RESULTS: Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 person-years, P < 0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1,000 person-years, P < 0.001), and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1,000 person-years, P < 0.001) were considerably higher in LIC compared with MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, and high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioral risk factors and treatments (hazard ratio [95% CI] 1.89 [1.58-2.27] to 1.78 [1.36-2.34]).
CONCLUSIONS: CVD rates, all-cause mortality, and CV mortality were markedly higher among those with diabetes in LIC compared with MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society.
METHODS: REDISCOVER, a prospective study, enrolled 11,288 adults where sociodemographic data, anthropometric and blood pressure measurements, fasting lipid profile and glucose, and history of diabetes, hypertension, and smoking were obtained. The cross-sectional analytic sample presented in this article comprised 10,482 participants from baseline recruitment. The data was analysed by descriptive statistics and multivariable logistic regression.
RESULTS: The overall prevalence of elevated TC, elevated LDL-c, elevated TG, low HDL-c, and elevated non-HDL-c were 64.0% (95% CI 63.0-65.0), 56.7% (CI 55.7-57.7), 37.4% (CI 36.5-38.4), 36.2% (CI 35.2-37.1), and 56.2% (CI 55.3-57.2), respectively. Overweight, obesity, and central obesity were highly prevalent and significantly associated with elevated TC and all dyslipidaemia subtypes. Older age was associated with elevated TC, elevated LDL-c and elevated non-HDL-c. Hypertension was associated with elevated TC, elevated TG, and elevated non-HDL-c, while diabetes was associated with elevated TG and low HDL-c.
CONCLUSIONS: Elevated TC and all dyslipidaemia subtypes are highly prevalent in Malaysia where increased body mass seems the main driver. Differences in the prevalence and associated personal and clinical attributes may facilitate specific preventive and management strategies.
METHODS: A total of 110 hospitalized geriatric patients aged 60 years and older were selected using convenience sampling method in a cross-sectional study. Sociodemographic data and medical history were obtained from the medical records. Questionnaires were used during the in-person semistructured interviews, which were conducted in the wards. Linear regression analyses were used to determine the predictors of each domain of quality of life.
RESULTS: Multiple regression analysis showed that activities of daily living, depression, and appetite were the determinants of physical health domain of quality of life (R(2)=0.633, F(3, 67)=38.462; P<0.001), whereas depression and instrumental activities of daily living contributed to 55.8% of the variability in psychological domain (R(2)=0.558, F(2, 68)=42.953; P<0.001). Social support and cognitive status were the determinants of social relationship (R(2)=0.539, F(2, 68)=39.763; P<0.001) and also for the environmental domain of the quality of life (R(2)=0.496, F(2, 68)=33.403; P<0.001).
CONCLUSION: The findings indicated different predictors for each domain in the quality of life among hospitalized geriatric patients with diabetes mellitus. Nutritional, functional, and psychological aspects should be incorporated into rehabilitation support programs prior to discharge in order to improve patients' quality of life.
METHODS: A questionnaire including data of 2016 and 2017 and consisting of eight general questions was prepared and sent to representatives in 18 Asia-Pacific countries by e-mail before the congress. After the congress, the data were analyzed and summarized.
RESULTS: Seventeen of 18 countries responded to the survey. The frequency of obesity (BMI ≥ 30) in the 4 Gulf countries was > 30%, much higher than that in the other countries. In total, 1640 surgeons and 869 institutions were engaging in bariatric/metabolic surgery. In many East and Southeast Asian countries, the indication for bariatric surgery was BMI ≥ 35 or ≥ 37, whereas in many Gulf countries and Australia, it was BMI ≥ 40 or ≥ 35 with obesity-related disease. Ten of the 17 countries (58.8%) but only one of the 5 Southeast Asian countries (20.0%) had public health insurance coverage for bariatric surgery. In 2017, 95,125 patients underwent bariatric/metabolic surgery, with sleeve gastrectomy accounting for 68.0%, bypass surgery for 19.5%, and others for 12.5%. Current problems included public insurance coverage, training system, national registry, and lack of awareness and comprehension.
CONCLUSION: This summary showed that bariatric/metabolic surgery is rapidly developing along with various problems in Asia-Pacific countries.
METHODS: Matching variables from the Towards Useful Aging and Malaysian Elders Longitudinal Research datasets related to falls, physical performance and determinants of falls were identified and pooled for analysis. The Timed Up and Go test and dominant handgrip strength tests were used as physical performance measures. Falls were self-reported, and functional status was assessed using activities of daily living.
RESULTS: Data of 3935 participants, mean age 68.9 ± 6.8 years, 2127 (54.0%) women and 1807 (46.0%) men were extracted for analyses. In an adjusted model, independent risk factors for falls from this cohort studies were diabetes (OR 1.258), arthritis (OR 1.366), urinary incontinence (OR 1.346), poor self-rated health (OR 1.293), higher body mass index (OR 1.029) and lower handgrip strength (OR 1.234).
CONCLUSIONS: Although the risk factors that emerged from our analyses were similar to available studies among older adults, the Timed Up and Go test did not appear as one of the risk factors in the present study that included middle-aged adults. Our findings will require confirmation in a prospective study. Geriatr Gerontol Int 2019; 19: 798-803.