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Sex differences and correlates of poor glycaemic control in type 2 diabetes: a cross-sectional study in Brazil and Venezuela.

ABSTRACT: OBJECTIVE:Examine whether glycaemic control varies according to sex and whether the latter plays a role in modifying factors associated with inadequate glycaemic control in patients with type 2 diabetes (T2D) in Brazil and Venezuela. DESIGN, SETTING AND PARTICIPANTS:This was a cross-sectional, nationwide survey conducted in Brazil and Venezuela from February 2006 to June 2007 to obtain information about glycaemic control and its determinants in patients with diabetes mellitus attending outpatient clinics. MAIN OUTCOME MEASURES:Haemoglobin A1c (HbA1c) level was measured by liquid chromatography, and patients with HbA1c ?7.0% (53 mmol/mol) were considered to have inadequate glycaemic control. The association of selected variables with glycaemic control was analysed by multivariate linear regression, using HbA1c as the dependent variable. RESULTS:A total of 9418 patients with T2D were enrolled in Brazil (n=5692) and in Venezuela (n=3726). They included 6214 (66%) women and 3204 (34%) men. On average, HbA1c levels in women were 0.13 (95% CI 0.03 to 0.24; p=0.015) higher than in men, after adjusting for age, marital status, education, race, country, body mass index, duration of disease, complications, type of healthcare, adherence to diet, adherence to treatment and previous measurement of HbA1c. Sex modified the effect of some factors associated with glycaemic control in patients with T2D in our study, but had no noteworthy effect in others. CONCLUSIONS:Women with T2D had worse glycaemic control than men. Possible causes for poorer glycaemic control in women compared with men include differences in glucose homeostasis, treatment response and psychological factors. In addition, sex modified factors associated with glycaemic control, suggesting the need to develop specific treatment guidelines for men and women.

SUBMITTER: G Duarte F

PROVIDER: S-EPMC6429715 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Sex differences and correlates of poor glycaemic control in type 2 diabetes: a cross-sectional study in Brazil and Venezuela.

G Duarte Fernanda F da Silva Moreira Sandra S Almeida Maria da Conceição C MDCC de Souza Teles Carlos A CA Andrade Carine S CS Reingold Art L AL Moreira Edson D ED

BMJ open 20190305 3

<h4>Objective</h4>Examine whether glycaemic control varies according to sex and whether the latter plays a role in modifying factors associated with inadequate glycaemic control in patients with type 2 diabetes (T2D) in Brazil and Venezuela.<h4>Design, setting and participants</h4>This was a cross-sectional, nationwide survey conducted in Brazil and Venezuela from February 2006 to June 2007 to obtain information about glycaemic control and its determinants in patients with diabetes mellitus atte ...[more]

PMID: 30842107

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Project description:Objectives: This study aimed to explore the relationship between glycaemic control and factors that may influence this among elderly type 2 diabetes mellitus (T2DM) patients in Lahore, Pakistan. Methods: This descriptive, cross-sectional study was conducted at the Jinnah and Sir Ganga Ram Hospitals, Lahore using convenience sampling techniques between 1 December 2015 and 28 February 2016. The sample consisted of elderly (>65 years) T2DM patients. Glycaemic values and patient characteristics were obtained from medical charts. Consenting patients were interviewed to complete the Barthel Index, Lawton Instrumental Activities of Daily Living Scale, Clinical Frailty Scale, Iowa Pain Thermometer Scale, Geriatric Depression Scale, Montreal Cognitive Assessment tool, Mini Nutritional Assessment Scale-Short Form and Self Care Inventory-Revised Version. Multiple logistic regression analysis was carried out to determine the predictors of poor glycaemic control. Results: A total of 490 patients were approached and 400 agreed to participate. Overall, nearly one-third (32.2%, n = 129) of patients had glycated haemoglobin (HbA1c) at the target level. Fasting and random plasma glucose levels were within the target range to much the same extent; (36.8%, n = 147) and (27%, n = 108), respectively. HbA1c levels were also higher in patients with co-morbidities (67.4%, n = 229) with diabetes-related complications (73.5%, n = 227). Significant predictors of impaired glycaemic control (HbA1c) included poor diabetes self-care (adjusted odds ratio (AOR) 0.96; 95% confidence interval (CI) 0.95, 0.98), not being prescribed oral hypoglycaemic agents (OHA) (AOR 6.22; 95% CI 2.09, 18.46), regular hypoglycaemic attacks (AOR 2.53; 95% CI 1.34, 4.81) and falling tendency (AOR 0.19; 95% CI 0.10, 0.36). Conclusions: Poor glycaemic control prevailed among the majority of elderly Pakistani diabetic patients in this study. Triggering factors of poor glycaemic control should be taken into consideration by the healthcare professionals in targeting multifaceted interventions to achieve good glycaemic control.

Project description:OBJECTIVES:To investigate the relationship between functional health literacy and glycaemic control in a sample of older patients with type 2 diabetes. DESIGN:Cross-sectional study. SETTING:A government-financed outpatient geriatric clinic in São Paulo, Brazil. PARTICIPANTS:129 older patients with type 2 diabetes, a mean (SD) age of 75.9 (6.2) years, a mean glycosylated haemoglobin (HbA1c) of 7.2% (1.4), of which 14.7% had no formal education and 82.9% had less than a high-school diploma. MEASURES:HbA1c was used as a measure of glycaemic control. Functional health literacy was assessed with the 18-item Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA-18), a validated instrument to evaluate pronunciation and comprehension of commonly used medical terms. Regression models were controlled for demographic data, depressive symptoms, diabetes duration, treatment regimen, diabetes knowledge and assistance for taking medications. RESULTS:Functional health literacy below adequate was encountered in 56.6% of the sample. After controlling for potential confounding factors, patients with inadequate functional health literacy were more likely than patients with adequate functional health literacy to present poor glycaemic control (OR=4.76; 95% CI 1.36 to 16.63). In a fully adjusted linear regression model, lower functional health literacy (?=-0.42; p<0.001), longer diabetes duration (?=0.24; p=0.012) and lack of assistance for taking medications (?=0.23; p=0.014) were associated with higher levels of HbA1c. Contrary to our expectations, illiterate patients did not have poorer outcomes when compared with patients with adequate functional health literacy, raising the hypothesis that illiterate individuals are more likely to have their difficulties recognised and compensated. However, the small subsample of illiterate patients provided limited power to reject differences with small magnitude. CONCLUSIONS:Patients with inadequate functional health literacy presented with higher odds of poor glycaemic control. These findings reinforce the importance of addressing limited functional health literacy in clinical practice.

Project description:BackgroundClinicopathological studies are important in determining the brain lesions underlying dementia. Although almost 60% of individuals with dementia live in developing countries, few clinicopathological studies focus on these individuals. We investigated the frequency of neurodegenerative and vascular-related neuropathological lesions in 1,092 Brazilian admixed older adults, their correlation with cognitive and neuropsychiatric symptoms, and the accuracy of dementia subtype diagnosis.Methods and findingsIn this cross-sectional study, we describe clinical and neuropathological variables related to cognitive impairment in 1,092 participants (mean age = 74 y, 49% male, 69% white, and mean education = 4 y). Cognitive function was investigated using the Clinical Dementia Rating (CDR) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE); neuropsychiatric symptoms were evaluated using the Neuropsychiatric Inventory (NPI). Associations between neuropathological lesions and cognitive impairment were investigated using ordinal logistic regression. We developed a neuropathological comorbidity (NPC) score and compared it to CDR, IQCODE, and NPI scores. We also described and compared the frequency of neuropathological diagnosis to clinical diagnosis of dementia subtype. Forty-four percent of the sample met criteria for neuropathological diagnosis. Among these participants, 50% had neuropathological diagnoses of Alzheimer disease (AD), and 35% of vascular dementia (VaD). Neurofibrillary tangles (NFTs), hippocampal sclerosis, lacunar infarcts, hyaline atherosclerosis, siderocalcinosis, and Lewy body disease were independently associated with cognitive impairment. Higher NPC scores were associated with worse scores in the CDR sum of boxes (β = 1.33, 95% CI 1.20-1.46), IQCODE (β = 0.14, 95% CI 0.13-0.16), and NPI (β = 1.74, 95% CI = 1.33-2.16). Compared to neuropathological diagnoses, clinical diagnosis had high sensitivity to AD and high specificity to dementia with Lewy body/Parkinson dementia. The major limitation of our study is the lack of clinical follow-up of participants during life.ConclusionsNFT deposition, vascular lesions, and high NPC scorewere associated with cognitive impairment in a unique Brazilian sample with low education. Our results confirm the high prevalence of neuropathological diagnosis in older adults and the mismatch between clinical and neuropathological diagnoses.

Project description:BACKGROUND:Sleep problems are widespread among college students around the globe, especially in China. This study was designed to investigate the prevalence of poor sleep quality and identify associated factors among college students in Jilin Province, China. METHODS:A total of 6284 participants were completely collected by stratified cluster sampling in 2016. Information on basic demographics, lifestyles, social and family support, and subjective sleep quality was collected by questionnaire. The Pittsburgh Sleep Quality Index (PSQI) is a self-administered questionnaire used to assess sleep for one month. RESULTS:1951 (31.0%) participants were classified into poor sleep quality group, as defined by a PSQI score?>?5. Males scored significantly higher than females on sleep duration and use of sleep medication, while females scored significantly higher than males on PSQI total and sleep disturbances. The results of the multivariate logistic regression show the following factors to be significant predictors of poor sleep quality: freshman (OR?=?1.523, 95% CI: 1.168-1.987), alcohol use (OR?=?1.634, 1.425-1.874), gambling behaviors (OR?=?1.167, 95% CI: 1.005-1.356), exercised for more than 30?min a week on less than one day (OR?=?1.234, 95% CI: 1.016-1.498), the feelings of satisfied with parental love (OR?=?1.849, 95% CI: 1.244-2.749), and harmonious/neutral relationship with classmates (OR?=?2.206, 95% CI: 1.312-3.708; OR?=?1.700, 95% CI: 1.414-2.045),. No study pressure of this academic year (OR?=?0.210, 95% CI: 0.159-0.276), no truancy in the past month (OR?=?0.510, 95% CI: 0.354-0.735), never had self-injurious behaviors (OR?=?0.413, 95% CI: 0.245-0.698), very harmonious family relationship (OR?=?0.377, 95% CI: 0.219-0.650), frequent communication with parents (OR?=?0.524, 95% CI: 0.312-0.880), the feelings of satisfied with maternal love (OR?=?0.432, 95% CI: 0.257-0.725), and frequent excursions to gymnasium (OR?=?0.770, 95% CI: 0.659-0.899) were the protective factors. CONCLUSIONS:The implication of the present study may be that college students must be made aware of the consequences of inadequate sleep quality and risk factors could be improved if students tried to change their behavior and subjective consciousness.

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Sex differences and correlates of poor glycaemic control in type 2 diabetes: a cross-sectional study in Brazil and Venezuela.

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Sex differences and correlates of poor glycaemic control in type 2 diabetes: a cross-sectional study in Brazil and Venezuela.

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