Article

# Global healthcare expenditure on diabetes for 2010 and 2030

Authors:
• Steno Diabetes Center Copenhagen, Denmark
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## Abstract

To estimate the global health expenditure on diabetes among people aged 20-79 years for the years 2010 and 2030. Country-by-country expenditures for 193 countries, expressed in United States Dollars (USD) and in International Dollars (ID), were estimated based on the country's age-sex specific diabetes prevalence and population estimates, per capita health expenditures, and health expenditure ratios per person with and without diabetes. Diabetes prevalence was estimated from studies in 91 countries. Population estimates and health expenditures were from the United Nations and the World Health Organization. The health expenditure ratios were estimated based on utilization and cost data of a large health plan in the U.S. Diabetes expenditures for the year 2030 were projected by considering future changes in demographics and urbanization. The global health expenditure on diabetes is expected to total at least USD 376 billion or ID 418 billion in 2010 and USD 490 billion or ID 561 billion in 2030. Globally, 12% of the health expenditures and USD 1330 (ID 1478) per person are anticipated to be spent on diabetes in 2010. The expenditure varies by region, age group, gender, and country's income level. Diabetes imposes an increasing economic burden on national health care systems worldwide. More prevention efforts are needed to reduce this burden. Meanwhile, the very low expenditures per capita in poor countries indicate that more resources are required to provide basic diabetes care in such settings.

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... The leading causes of this expenditure include avoidable and correctable system drawbacks, such as subpar vigilance delivery, overtreatment, and improper health care delivery. This is more serious than it seems [2][3][4]. ...
... According to a recent Newsweek article, AI has demonstrated 99% accuracy and is substantially faster than humans in evaluating and analyzing mammograms. This has made it possible to diagnose breast cancer more quickly, improving the cost of diagnosis [4,5]. ...
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Motivation: The price of medical treatment continues to rise due to (i) an increasing population; (ii) an aging human growth; (iii) disease prevalence; (iv) a rise in the frequency of patients that utilize health care services; and (v) increase in the price. Objective: Artificial Intelligence (AI) is already well-known for its superiority in various healthcare applications, including the segmentation of lesions in images, speech recognition, smartphone personal assistants, navigation, ride-sharing apps, and many more. Our study is based on two hypotheses: (i) AI offers more economic solutions compared to conventional methods; (ii) AI treatment offers stronger economics compared to AI diagnosis. This novel study aims to evaluate AI technology in the context of healthcare costs, namely in the areas of diagnosis and treatment, and then compare it to the traditional or non-AI-based approaches. Methodology: PRISMA was used to select the best 200 studies for AI in healthcare with a primary focus on cost reduction, especially towards diagnosis and treatment. We defined the diagnosis and treatment architectures, investigated their characteristics, and categorized the roles that AI plays in the diagnostic and therapeutic paradigms. We experimented with various combinations of different assumptions by integrating AI and then comparing it against conventional costs. Lastly, we dwell on three powerful future concepts of AI, namely, pruning, bias, explainability, and regulatory approvals of AI systems. Conclusions: The model shows tremendous cost savings using AI tools in diagnosis and treatment. The economics of AI can be improved by incorporating pruning, reduction in AI bias, explainability, and regulatory approvals.
... 1.9 million adults (> 20 years of age) were recently diagnosed in 2010, and an estimated 35% of American adults (and 50% of us older than 65) are pre-diabetics. [1][2] In the United States, type 2 diabetes accounts for around 95% of adult individuals with diabetes. ...
... Diabetes treatment is expensive, with each diabetic costing twice or triple the number of healthcare services as a non-diabetic. [2] Diabetes' asso- ciated costs (prescription drugs and hospital inpatient care) impose a significant financial burden on both patients and the healthcare system. A slew of indirect costs has also had a significant impact on patients and the economy. ...
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The study was to assess challenges associated with insulin therapy in people with type 2 diabetes and how these challenges can be resolved to increase patient safety and quality of life. Participants of both sexes between the ages of 20 and 59 years were enrolled across successive samples and assessed for the prevalence of type 2 diabetes, hypertension (whether hypertensive or not), dyslipidemia, and smoking status. Weight gain and hypoglycemia are the primary diagnostic and outcome criteria for type 2 diabetes when taking insulin therapy. According to the study, only 27.27% of type 2 diabetes patients were receiving oral antidiabetic drug monotherapy, while 72.72% were receiving antidiabetic drug combination therapy. Only 43.75% of the 72.72% of patients who received antidiabetic prescription combination medication received triple combination therapy, whereas 56.25% received dual combination therapy. It was concluded that participants undergoing conventional therapy are at a higher risk of hypoglycemia but a much lower risk of weight gain and other complications. Due to a lack of cultural understanding regarding these risk factors for weight gain and their modifiable risk factors, both individual and public health measures could be warranted.
... Diabetes patients make more outpatient visits, use more drugs, are more likely to be hospitalized, and need emergency and long-term care than persons without the illness. In the United States, diabetics spend 2.5 times as much on medical care than non-diabetics [10]. ...
... Processes 2022,10, 2050 ...
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Validating ethnobotanical data from underexplored traditional plant remedies provides an infinite source of new pharmaceutical chemicals. The purpose of this study was to determine the phytochemical composition and several biological activities (antioxidant, anti-lipase, anti-α-amylase, anti-α-glucosidase, and antimicrobial) of aqueous, ethanol, hexane, and acetone Artemisia scoparia leaf extracts. An exhaustive technique was employed to extract A. scoparia four extracts. At the same time, standard analytical and biochemical assays were utilized to determine preliminary phytochemical screening, anti-DPPH, anti-lipase, anti-α-glucosidase, and anti-α-amylase activities. Furthermore, the antimicrobial effects against seven microbial strains were evaluated using a broth micro-dilution assay. Acetone A. scoparia extract exhibited the highest DPPH scavenging and anti-α-glucosidase activities (IC50 = 21.87 ± 0.71, and 149.75 ± 1.33 µg/mL, respectively), as well as the ethanol extract, exhibited the highest anti-α-amylase activity (IC50 = 251 ± 1.34 µg/mL) while the aqueous extract had the best anti-lipase activity (IC50 = 102 ± 0.27 µg/mL) among other extracts. Moreover, A. scoparia hexane extract has more powerful activity against Methicillin-Resistant Staphylococcus aureus (MRSA), Staphylococcus aureus, Proteus vulgaris, Pseudomonas aeruginosa than Ciprofloxacin and Ampicillin antibiotics with MICs of 0.78 ± 0.01, 0.39 ± 0.01, 0.78 ± 0.01, and 1.56 ± 0.22 µg/mL, respectively. In addition, hexane and acetone extracts of A. scoparia have the same antifungal power as Fluconazole (1.56 ± 0.22 µg/mL). The outcomes of the current study indicated that the A. scoparia acetone, ethanol, and aqueous extracts had promising antioxidant, anti-lipase, and anti-α-amylase effects, while hexane and acetone extracts had interesting antimicrobial potential. A. scoparia four extracts of potentially bioactive compounds can be selected for further isolation and purification. Moreover, clinical investigations and in vivo approaches should be implemented to confirm the pharmaceutical benefits of these extracts against diabetes, obesity, oxidative stress, and microbial infections.
... Despite the advances in its treatment over the past few decades, DM continues to impose a significant clinical burden, while the economic consequences to the health care system are also substantial. DM-related healthcare spending in Greece was estimated at USD 3.9 billion in 2010, i.e., approximately 9% of the total healthcare expenditure, and it is projected to rise to USD 4.6 billion by 2030 [3]. ...
... Each dimension is measured on a five-level scale, with higher levels representing more health problems. Domain scores were also dichotomized to identify the presence of problems (level 1 vs. levels [2][3][4][5]. A single utility score is obtained by applying societal value sets, derived from population-based valuation studies, to the state of health vectors ranging between 11,111 (full health) and 55,555 (worst health). ...
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Purpose: The purpose was to evaluate the association between medication adherence and health-related quality of life (HRQoL) of patients with diabetes. Methods: In this cross-sectional study, a total of 518 patients were recruited from the outpatient departments of different general public and private hospitals in Greece during the COVID-19 pandemic using a consecutive sampling method. HRQoL was assessed with the EQ-5D-5L instrument and medication adherence with the corresponding subscale of the Adherence Starts with Knowledge 20 questionnaire. The relationship between HRQoL and adherence was explored by employing Spearman's correlations and multiple binary logistic and linear stepwise regressions using robust standard errors. Results: A total of 15.1 and 1.9% of the patients reported that they had taken a medicine either more or less often than prescribed in the last month and week, respectively. Statistically significant but modest correlations of medication non-adherence with the EQ-5D index (rho = - 0.223), EQ-VAS (rho = - 0.230), and all the HRQoL domains (rho ranging from 0.211, for pain/discomfort, to 0.136, for mobility issues) were found. These significant associations persisted even after controlling for several other known potential factors of HRQoL in the multivariable analyses, except for the mobility and anxiety/depression dimensions. Conclusion: Medication non-adherence appears to be independently associated with lower HRQoL and health levels in patients with diabetes. It is crucial to plan interventions to enhance medication adherence not only to obtain greater value from the available resources, but also to improve HRQoL of patients with diabetes.
... The two rst regulatory paths are within the controlled regulation area but identi ed and integrated regulation paths are within the autonomous regulation area (Figure 1) that generally lead to a change in behavior based on an internal motive (2,4,(8)(9)(10)(11)(12). ...
... Two headline sentences in the subscales were "I take my medications for diabetes and/or check my glucose because … " that correspond to 8 questions and "The reason I follow my diet and exercise regularly is that …" that coincide with 11 questions. To calculate the respondents' scores answers to questions 2, 3, 7, 10, 13, 16, 18, 19 were used to estimate the average AR score and the answers to questions 1, 4, 5, 6, 8, 9,11,12,14,15,17 to estimate the CR score relative to the overall target behavior. The response options to each of the scale's items were ranged from 1 to 7 (not at all true up to very true). ...
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Background: Autonomous self-regulation is a proxy for adapting long-term healthy behaviors with major impact on prevention of chronic illnesses. The psychometric properties of the Treatment Self-Regulation Questionnaire- Persian version (TSRQ-P) was assessed in this study for use in examination of autonomous regulation among the Iranian type 2 diabetes patients. Methods: The preliminary draft of the TSRQ-P was prepared based on a standard translation/back translation procedure and 15 allied health specialists assessed its face and content validities. The internal consistency measure of the Cronbach’s alpha and Intraclass Correlation Coefficient (ICC) were estimated to verify the TSRQ-P’s content validity and reliability. The exploratory (EFA) and confirmatory factor (CFA) analyses were performed to check the scale’s structural components. Results: The calculated Cronbach’s alpha= 0.893 and ICC= 0.982 deemed the scale as content valid and acceptable in terms of measurement invariance. The EFA and CFA outputs yielded two distinct factor structure for the TSRQ-P (RMSEA=0.078, NFI=0.849, RFI=0.806, IFI=0.913, TLI=0.886, CFI= 0.911). Conclusion: The TSRQ-P indicated robust psychometric features for application among Persian-speaking type 2 diabetes patients. Due to cross-borders cultural diversity of the subgroups of Persian speaking populations, further psychometric scrutiny is recommended to prevent bias and sociolinguistic inconsistencies.
... Por ello, resulta importante conocer las características de los pacientes que se realizan cribado en el Perú, así como los factores que se encuentran asociados a esta conducta, además de poder contrastar esta información con datos de países latinoamericanos, los cuales comparten realidades similares, más aún en el contexto de la atención primaria de salud. Con ello, se podrían elaborar mejores protocolos y lineamientos que estén encaminados a la prevención y disminución de la incidencia de esta enfermedad 23 . En este sentido, el objetivo de este trabajo de investigación fue determinar los factores asociados a la no realización del cribado de diabetes mellitus a través del análisis de la ENDES-2020. ...
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... Coupled with the chronic nature of the disease, the impact of T2DM-related complications has made it one of the leading non-communicable disease mortalities in the world [1]. In Malaysia, the total diabetesrelated health expenditure was approximately USD 600 million in 2010 [2] rising to USD 3.5 billion in 2019, and expected to increase to USD 4.4 billion in 2030 and close to USD 5 billion by 2045 [3]. Approximately, 80% of diabetics seek care at health clinics (56%) and hospitals (24.6%) by the Ministry of Health which are heavily subsidized by the government. ...
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Purpose There is a knowledge gap of health utility values for Type 2 Diabetes Mellitus (T2DM) complications in Malaysia. This study aimed to estimate EQ-5D-5L utility values and evaluate health-related quality of life (HRQoL) for Malaysian T2DM associated with complications and clinical characteristics. Methods A cross-sectional study was conducted on T2DM patients at a tertiary hospital outpatient using the Malay and English version of the EQ-5D-5L questionnaire. Health utility values were derived using the Malaysian EQ-5D-5L value set. Ordinary least squares (OLS) multivariable regression model was used to estimate the health utility decrements associated with T2DM-related complications and clinical characteristics. Results A total of 513 T2DM patients were recruited. Overall, pain was the most affected of all five EQ-5D-5L dimensions. Patients with foot ulcer, amputation, severe heart failure and frequent hypoglycemia reported more problems collectively in all EQ-5D-5L dimensions. Older age, lower education level, longer duration of T2DM, urine protein creatine index (UPCI) > 0.02 g/mmol, and injection therapy were significantly associated with lower EQ-5D-5L utility values (p < 0.004, Bonferroni adjusted). The lowest unadjusted utility values were reported for severe heart failure 0.65 (interquartile range, IQR 0.50), frequent hypoglycemia 0.74 (0.22) and being amputated 0.78 (0.47). In the multivariable regression model after controlling for sociodemographic and clinical characteristics, the largest utility value decrement was observed for amputation (− 0.158, SE 0.087, p = 0.05), frequent hypoglycemia (− 0.101, SE 0.030, p = 0.001), myocardial infarction (-0.050, SE 0.022, p = 0.022) and obesity (-0.034, SE 0.016, p = 0.029). Conclusion Larger utility value decrements were found for severe stages of complications. These findings suggest the value of defining severity of complications in utility elicitation studies. The utility decrement quantified for different T2DM complication severity will be useful for economic evaluations within diabetic-related fields.
... Here, it is the pancreas that is responsible for producing insulin enzymes in the body. In economic terms, the global diabetes industry is worth 376 billion USD annually, predicted to rise to 490 billion USD by the year 2030, when the number of diabetes sufferers is estimated to reach approximately 642 million worldwide [4,5]. In addition, diabetes is a disease that weakens and impairs innate immunity, rendering patients susceptible to severe infections. ...
Article
Because of their mortality rate, diabetes and COVID-19 are serious diseases. Moreover, people with diabetes are at a higher risk of developing COVID-19 complications. This article therefore proposes a single, non-invasive system that can help people with diabetes and COVID-19 to monitor their health parameters by measuring oxygen saturation (SPO2), heart rate, and body temperature. This is in contrast to other pulse oximeters and previous work reported in the literature. A Max30102 sensor, consisting of two light-emitting diodes (LEDs), can serve as a transmission spectrum to enable three synchronous parameter measurements. Hence, the Max30102 sensor facilitates identification of the relationship between COVID-19 and diabetes in a cost-effective manner. Fifty subjects (20 healthy, 20 diabetic, and 10 with COVID-19), aged 18-61 years, were recruited to provide data on heart rate, body temperature, and oxygen saturation, measured in a variety of activities and scenarios. The results showed accuracy of ±97% for heart rate, ±98% for body temperature, and ±99% for oxygen saturation with an enhanced time efficiency of 5-7 seconds in contrast to a commercialized pulse oximeter, which took 10-12 seconds. The results were then compared with those of commercially available pulse oximetry (Oxitech Pulse Oximeter) and a thermometer (Medisana Infrared Thermometer). These results revealed that uncontrolled diabetes can be as dangerous as COVID-19 in terms of high resting heart rate and low oxygen saturation. Doi: 10.28991/esj-2022-SPER-04 Full Text: PDF
... These two hormones activate the hormone-sensitive enzyme lipase, which is found in fat cells, causing the rapid hydrolysis of triglycerides and the release of fatty acids, thus increasing the level of LDL-C [59]. The high concentration of VLDL-C may be credited to the increment in the concentration of free radicals in the body as a result of oxidative stress, as these radicals destroy pancreatic beta cells and fatty tissue and then increase the release of free fatty acids that the liver uses in large quantities in the production of VLDL-C [60]. Alternatively, the reason for this may be the increase in oxidative stress as a result of the high concentrations of free radicals generated, which leads to a decrease in activity of the enzyme lipoprotein lipase found in the tissues of the body; this, in turn, leads to an imbalance in fat concentrations and a high concentration of triglycerides in the serum. ...
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A saffron extract-based beverage (SEBB) was formulated and characterized based on its sensory attributes and health benefits. The main bioactive compounds of saffron extract (crocin and safranal) were quantified. Three formulations of SEBB were prepared based on the sucrose concentration: SEBB 1 contained 65 g of sucrose per 500 ml, SEBB 2 contained 17.5 g, and SEBB 3 contained 79.5 g. The SEBB most desired by consumers was then subjected to biochemical analysis to evaluate its antioxidative effects on the damage induced by food contaminated with carbon tetrachloride (CCl4). Fifteen albino rats were split into five groups and treated with different doses of CCl4 or SEBB according to the planned animal experiment for 62 days. Sensory evaluation illustrated that SEBB 1 had the highest acceptability scores. The content of crocin and safranal was 23.039 and 4.135 ppm, respectively. The SEBB ameliorated the increased activity of enzymes involved in liver and kidney function and improved the total antioxidant capacity, blood glucose, and lipid profile.
... [12] Globally, diabetes is a large economic burden on healthcare systems, equating to an average 11% of the total healthcare costs per annum. [13] In Saudi Arabia this figure is estimated to exceed US $0.87 billion. This estimate does not take into consideration the added cost to the economy from loss of attendance at work, the increased burden on carers, unemployment, as well as the increase in mortality. ... Article Full-text available Introduction The Kingdom of Saudi Arabia (KSA) is experiencing an increasing demand for healthcare due to a growing population and unhealthy changes in lifestyle, fostering the need for critical examination of the current status of primary healthcare in the KSA with analysis of health-related trends among its growing population. Methods A review of the literature was therefore undertaken, followed by a survey of primary healthcare centers at three facilities in Riyadh, to assess the current activities, understand challenges, compare existing practices with international best practices, and asses the level of patient satisfaction. The level of satisfaction with primary care services was examined by using observational surveys and retrospective reviews from the previous 20 years. Results The more rural areas with populations with lower education and income ranked factors such as cleanliness, competence of staff, and environment the highest (82–95%), whereas urban areas with populations with higher education and income rated their level of satisfaction lower (74–82%). The influence of population diversity and the country's unique cultural sensitivities on the awareness and uptake of cancer surveillance services available in the community was examined. The incidence of diabetes, asthma, obesity, along with breast and cervical cancer trends, has illustrated the importance of health education and disease prevention. Conclusion An investment in resources for primary healthcare staff and medical facilities is strongly recommended to support primary care providers in becoming the accepted and preferred community frontline for healthcare needs' assessment and care delivery. With its nursing staff comprised predominantly of expatriates, the emphasis needs to be on recruitment and training of a Saudi national workforce in line with succession planning strategy toward a sustainable Saudi workforce. ... At the same time, food systems are responsible for one-third (14-22 Gt CO 2 eq yr −1 in 2015) of global greenhouse gas (GHG) emissions, ~33% of which are direct non-CO 2 emissions (that is, CH 4 and N 2 O) occurring on-farm 3 . The critical role of food systems in limiting mean temperature increase to 1.5 °C is now well established 4,5 , while nations have pledged to end all forms of malnutrition by 2030 6 . ... Article Full-text available Sustainable food systems require malnutrition and climate change to be addressed in parallel. Here, we estimate the non-CO2 greenhouse gas emissions resulting from closing the world’s dietary nutrient gap—that between country-level nutrient supply and population requirements—for energy, protein, iron, zinc, vitamin A, vitamin B12 and folate under five climate-friendly intervention scenarios in 2030. We show that improving crop and livestock productivity and halving food loss and waste can close the nutrient gap with up to 42% lower emissions (3.03 Gt CO2eq yr−1) compared with business-as-usual supply patterns with a persistent nutrient gap (5.48 Gt CO2eq yr−1). Increased production and trade of vegetables, eggs, and roots and tubers can close the nutrient gap with the lowest emissions in most countries—with ≤23% increase in total caloric production required for 2030 relative to 2015. We conclude that the world’s nutrient gap could be closed without exceeding global climate targets and without drastic changes to national food baskets. Estimates of greenhouse gas emissions associated with feeding the world population rarely account for specific nutrient gaps. This study applies a composite indicator of emissions intensity of nutrient production to calculate non-CO2 emissions of closing the global dietary gaps for energy, protein, iron, zinc, vitamin A, vitamin B12 and folate in 2030 under five climate-friendly scenarios. ... Such an increase has significant implications on premature mortality rates and quality of life, coupled with the expanding economic burden. In 2019, financial burden due to DM is estimated to be about 9% of the total healthcare expenditure in the EU (5,6). This deteriorating trend is not inevitable. ... Article Full-text available Introduction: Surveillance of the European Union's (EU) legislations on the prevention of diabetes mellitus (DM) is needed, to more effectively tackle the rising prevalence of DM. Methods: This legal surveillance was carried out through a systematic search and screening, using EUR-Lex database to identify treaties, acts, and other legal documents for prevention of DM, non-communicable diseases (NCDs) and obesity, followed by their content analysis and assessment according to DM specific guidelines, target population and functional categories. Results and discussion: We found 22 legislations aimed at preventing DM, NCDs and obesity, but only 5 out of them specifically addressed preventing DM. The aims of legislations covered a broad spectrum of themes indicated by DM specific guidelines, mostly initiatives of life-course approach in preventing DM, NCDs and obesity from the area of energy intake. The target group of most legislations was the general population; high-risk subgroups such as pregnant women were hardly ever the primary target group. Our results prove that the EU has made cross-sectoral legislative efforts to reduce the disease burden and prevent DM but does not exhaust all possibilities. However, given its persistently rising DM prevalence, it is imperative to make sure that DM is a top health priority for various EU authorities and is incorporated into new initiatives, policies and laws. ... The (WHO) Organization declared it as a global epidemic and estimates the annual cost associated with diabetes management to the US$376 billion. It's also predicted that the number of diabetics to increase from 171 million in 2000 to 366 million by 2030 thus, the cost will increase to 490 billion US $in 2030 (Zhang, et al., 2010). The diagnostic criteria are i) oral glucose tolerance test -more than 200 mg/dl; ii) fast blood glucose level more than 126 mg/dl; iii) random blood sugar-more than 200 mg/dl; iv) hbA1c-more than 6.5%, it is the best parameter to know about diabetic control. ... Article Full-text available This paper presents an enhancement technique for tracking and regulating the blood glucose level for diabetic patients using an intelligent auto-tuning Proportional-Integral-Derivative PID controller. The proposed controller aims to generate the best insulin control action responsible for regulating the blood glucose level precisely, accurately, and quickly. The tuning control algorithm used the Dolphin Echolocation Optimization (DEO) algorithm for obtaining the near-optimal PID controller parameters with a proposed time domain specification performance index. The MATLAB simulation results for three different patients showed that the effectiveness and the robustness of the proposed control algorithm in terms of fast generating insulin control action and tracking the dynamics behavior of the blood glucose level of the diabetic patients through minimizing overshoot, rise time and settling time in the transient state as well as the steady-state blood glucose level error is reduced approximately to zero and keep it in the desired glucose level, especially when we added a meal as disturbance effect. ... Diabetes imposes costs to health care systems so that global cost of diabetes in Iran in the year 2010 was about 1.5 billion dollars [5]. Moreover, diabetes has no cure and it does not seem to be possible to cure it in the near future. ... Article Full-text available Keywords: Diabetes; Data Mining; Decision Tree; Sensitivity Analysis; Naïve Bayes Model; Quest Algorithm; Neural Networks; Support Vector Machine. The importance of predictor variables in every approach is obtained by sensitivity analysis. Accordingly, fasting blood sugar and 2-hour blood sugar (postprandial glucose) have been identified as two important variables in women. Glomerular filtration rate and mean arterial blood pressure in women are other variables having been identified in this research as predictors of the development of diabetes in women. In general, the results indicate that the variables of waist circumference and height are equally important in the incidence of diabetes, even ore than fasting glucose. In order to build predictive models, 6 main and conventional methods in data mining (decision trees with C5.0 algorithms, CART, QUEST, MLP algorithm neural network, support vector machine (SVM), Bayesian simple model (Naïve Bayes)) and a conventional model in epidemiological studies (logistic regression) have been used. The results showed that Naïve Bayes model is not sensitive to unbalanced data in both men and women so that its sensitivity in women with unbalanced data to total variables is 78%. Although other methods represented high characteristics of unbalanced data, they have very low sensitivity. Their average sensitivity to unbalanced data with total variables is 34.8% in women. The performance of all 6 methods of classification is comparable to balanced data; they are even better than logistic regression. In this combination, the best performance belongs to decision trees with QUEST algorithm (20 variables in women). Generally, data mining can be used in epidemiological studies for different purposes; the decision tree methods determine non-linear relationships among variables by creating a tree structure and they can help to identify risk factors in certain subgroups by creating a threshold or decision boundary. ... The evaluation metrics were selected based on their capacity to demonstrate the effects of the fall in oil prices in 2008 and 2014 on healthcare spending and whether the distribution of spending shifted from government to private spending. The analysis performed in this study used aggregate spending on healthcare as opposed to absolute values typically used for specific countries or diseases Zhang et al. (2010), Turner (2017). However, it is worth mentioning that aggregates are appropriate when undertaking comparisons across countries as they permit the investigation of different explanatory variables and institutional systems Gerdtham and Jönsson (2000). ... Article Full-text available The OPEC countries rely on oil to fund their budgets, similar to many countries worldwide. However, the fall in oil prices in 2008 and 2014 put significant strain on their public finances, including healthcare finances. This study examines the effect of the fall in oil prices on OPEC countries’ healthcare spending and whether the burden has shifted from government to private spending. The government and private healthcare spending after 2008 and after 2014 were compared to spending before 2008. Moreover, Welch’s t-test was used to assess the difference between healthcare spending in the stated periods. The study found that the majority of OPEC countries decreased government healthcare spending after 2008 and after 2014, indicating that the burden shifted from governments to private spending. The study suggests that countries should minimize reliance on oil, diversify their income, and avoid relying heavily on debt and foreign reserves, as these might negatively impact healthcare spending in the future. ... 2 The total national diabetes-related health expenditure soared to$294.6 billion in 2019, 3 a near $100 billion increase from that seen a decade prior. 4 Globally, health expenditures attributable to diabetes were estimated to be$966 billion in 2021. 5 Contributing to these expenses, costs of new pharmacologic agents used to manage diabetes have increased markedly over the past 2 decades, making it a top expenditure among therapeutic drug categories. ...
Article
BACKGROUND: Although metformin is generally universally recommended as a first-line pharmacologic therapy for most people living with type 2 diabetes, second-line and third-line choices can require a tailored approach to achieve optimal blood glucose and glycated hemoglobin levels. OBJECTIVE: To examine national trends in second- and third-line antihyperglycemic medications following metformin monotherapy, comparing 2015 and 2019. METHODS: This retrospective cohort analysis of deidentified pharmacy claims from a large national pharmacy benefits manager from January 1, 2015, to December 31, 2015, and again in January 1, 2019, to December 31, 2019, included adults (aged ≥ 18 years) continuously enrolled in commercial or Medicare insurance plans who filled an index metformin prescription in either year. Proportions of patients by second-line and third-line antihyperglycemic class were calculated. RESULTS: Second-line use of sulfonylureas (-10.1%; P < 0.001), combination drugs (-3.0%; P < 0.001), and dipeptidyl peptidase-4 inhibitors (-2.0%; P = 0.031) significantly declined, whereas second-line use of sodium-glucose cotransporter 2 inhibitors (SGLT2is) (+4.9%; P < 0.001) and glucagon-like peptide-1 receptor agonists (GLP-1Ras) (+10.0%; P < 0.001) significantly increased. Similarly, third-line use of sulfonylureas declined (-5.5%; P = 0.005), whereas third-line use of SGLT2is (+3.4%; P = 0.005) and GLP-1RAs (+8.3%; P < 0.001) increased. Similar trends between 2015 and 2019 were found in commercial and Medicare subgroups. Among all groups in 2015 compared with 2019, sulfonylureas were the most prescribed second-line class and insulins the most common third-line class. Although SGLT2i and GLP-1RA together represented more than one-third of second-line and third-line prescriptions for commercially insured patients in 2019 (34.3% and 35.0%, respectively), these classes were less frequently prescribed in the Medicare subgroup (18% and 25.6%, respectively). CONCLUSIONS: This report provides updated second-line and third-line antihyperglycemic medication prescribing trends in the United States, which suggests that evidence-based guidelines are being used in practice to prevent complications and individualize diabetes care. DISCLOSURES: Ms Swart and Drs Peasah and Good are employed by UPMC Health Plan. Dr Neilson was employed by UPMC Health Plan at the time of the study. Drs Munshi and Henderson were employed by Evernorth at the time of the study.
... Costs for treating CVD in the EU and the US were estimated at 8% and 17% of total health care expenditure respectively [48,49]. For diabetes, a major component of MetS risk, costs were estimated at 10% and 14% for the EU and the US respectively [50,51]. Minimization of health care costs is a pervasive aim of governments. ...
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Background Prolonged sitting is associated with increased risk of obesity, type 2 diabetes and cardiovascular disease. Occupational sitting accounts for up to 50 h/week for employees. This pilot study assessed the acceptability of stair climbing as an interruption to sitting throughout working hours, and provided preliminary data of the effects on glucose and lipid profiles. Methods A quasi-experimental design was conducted involving 16 sedentary office workers (five females and 11 males) for intervention (n = 8) and control groups (n = 8) with mean age of 36.38 (5.58). For the eight-week intervention, a continuous four-floor stair climb and descent was performed eight times/day spread evenly over the working day. A prompt to climb was presented on the participant’s computer eight times/day. Participants in the experimental group recorded daily floors climbed and steps (measured using pedometers) in a weekly log sheet. Blood samples were collected pre and post intervention to test effects on fasting glucose and 2 h plasma glucose, triglycerides, and total (TC), LDL and HDL cholesterol. Experimental participants were interviewed at the end of the study. The Wilcoxon signed rank test was used to compare the median changes (pre-post) of the dependent variables. Results On average, the experimental group climbed 121 floors/week when prompted. There were significant reductions in fasting blood glucose, TC and LDL, as well as the derived measures of ‘bad’ cholesterol and the TC/HDL ratio in the experimental group. Post-experimental interviews indicated that the interruption to sitting was well tolerated. Conclusion Prompted stair climbing activity had impacts on health outcomes and was found acceptable to employees at work. Trial registration Ethics for this study was approved by Science, Technology, Engineering and Mathematics Ethical Review Committee, University of Birmingham with ethics reference number ERN_15_0491.
... In 2020, approximately half a billion people had diabetes globally, with about 80% of these in LMICs [3]. The costs of managing diabetes are projected to rise to half a trillion US dollars (USD) world-wide by 2030 [4]. In addition to the economic pressures, LMICs continue to suffer the largest burden of extended humanitarian crises, necessitating the need for NCDs to be addressed [5]. ...
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Diabetes mellitus (DM) is increasing markedly in low- and middle-income countries where over three-quarters of global deaths occur due to non-communicable diseases. Unfortunately, these conditions are considered costly and often deprioritized in humanitarian settings with competing goals. Using a mixed methods approach, this study aimed to quantify the cost of outpatient treatment for uncomplicated type-1 (T1DM) and type-2 (T2DM) diabetes at a secondary care facility serving refugees in Kenya. A retrospective cost analysis combining micro- and gross-costings from a provider perspective was employed. The main outcomes included unit costs per health service activity to cover the total cost of labor, capital, medications and consumables, and overheads. A care pathway was mapped out for uncomplicated diabetes patients to identify direct and indirect medical costs. Interviews were conducted to determine inputs required for diabetes care and estimate staff time allocation. A total of 360 patients, predominantly Somali refugees, were treated for T2DM (92%, n = 331) and T1DM (8%, n = 29) in 2017. Of the 3,140 outpatient consultations identified in 2017; 48% (n = 1,522) were for males and 52% (n = 1,618) for females. A total of 56,144 tests were run in the setting, of which 9,512 (16.94%) were Random Blood Sugar (RBS) tests, and 90 (0.16%) HbA1c tests. Mean costs were estimated as: $2.58 per outpatient consultation,$1.37 per RBS test and $14.84 per HbA1c test. The annual pharmacotherapy regimens cost$91.93 for T1DM and $20.34 for T2DM. Investment in holistic and sustainable non-communicable disease management should be at the forefront of humanitarian response. It is expected to be beneficial with immediate implications on the COVID-19 response while also reducing the burden of care over time. Despite study limitations, essential services for the management of uncomplicated diabetes in a humanitarian setting can be modest and affordable. Therefore, integrating diabetes care into primary health care should be a fundamental pillar of long-term policy response by stakeholders. ... In New York State (NYS), an estimated 1.7 million adults have been diagnosed with diabetes (New York State Department of Health, Diabetes New York State Adults 2018, Shaw et al., 2010, Zimmet et al., 2014. Diabetes is not only common worldwide, it is also a very costly disease (Zhang et al., 2010). In 2017 in the U.S., the estimated direct and indirect costs of diagnosed diabetes was$327 billion, which reflects a 26% increase over the five-year period from 2012 to 2017 (American Diabetes Association 2018). ...
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... Type 2 diabetes mellitus (T2DM), a global serious condition with reduced quality of life and life expectancy, is expected to reach 550 million people by 2030 (1), and the estimated global health expenditure on T2DM will be $490 billion in 2030 (2). The mortality of cardiovascular disease (CVD) in patients with T2DM was 2-4 times higher compared with nondiabetic population (3,4). ... Article Full-text available Background Observational studies have shown inconsistent results of the associations between type 2 diabetes mellitus (T2DM) and blood lipid profiles, while there is also a lack of evidence from randomized controlled trials (RCTs) for the causal effects of T2DM on blood lipid profiles and lipoprotein subclasses. Objectives Our study aimed at investigating the causal effects of T2DM on blood lipid profiles and concentration of particle-size-determined lipoprotein subclasses by using the two-sample Mendelian randomization (MR) method. Methods We obtained genetic variants for T2DM and blood lipid profiles including high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglycerides (TG), and total cholesterol (TC) from international genome-wide association studies (GWASs). Two-sample MR method was applied to explore the potential causal effects of genetically predicted T2DM on blood lipid profiles based on different databases, respectively, and results from each MR analysis were further meta-analyzed to obtain the summary results. The causal effects of genetically predicted T2DM on the concentration of different subclasses of lipoproteins that are determined by particle size were also involved in MR analysis. Results Genetically predicted 1-unit higher log odds of T2DM had a significant causal effect on a higher level of TG (estimated β coefficient: 0.03, 95% confidence interval [CI]: 0.00 to 0.06) and lower level of HDL-C (estimated β coefficient: −0.09, 95% CI: −0.11 to −0.06). The causality of T2DM on the level of TC or LDL-C was not found (estimated β coefficient: −0.01, 95% CI: −0.02 to 0.01 for TC and estimated β coefficient: 0.01, 95% CI: −0.01 to 0.02 for LDL-C). For different sizes of lipoprotein particles, 1-unit higher log odds of T2DM was causally associated with higher level of small LDL particles, and lower level of medium HDL particles, large HDL particles, and very large HDL particles. Conclusion Evidence from our present study showed causal effects of T2DM on the level of TG, HDL-C, and concentration of different particle sizes of lipoprotein subclasses comprehensively, which might be particularly helpful in illustrating dyslipidemia experienced by patients with T2DM, and further indicate new treatment targets for these patients to prevent subsequent excessive cardiovascular events from a genetic point of view. ... The highest number of deaths due to diabetes is expected to occur in countries with large populations and low-and middle-income countries (almost 80% of diabetes deaths) and 12% increased deaths are reported in South East Asia from 2007 (International Diabetic Federation, 2009). In the absence of effective and affordable interventions for diabetes, the frequency of the disease will escalate worldwide, with a major impact on the population of developing countries (Zhang et al., 2010;Przeor, 2022). Several drugs have been used in the management of the disease. ... Article Full-text available Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The toxicity of oral antidiabetic drugs differs widely in clinical manifestations, severity, and treatment. Alternative medicines particularly herbal medicines are available for the treatment of diabetes. This study investigated the anti-diabetic, biochemical and histopathological changes of Carica papaya extract in alloxan induced diabetic rats. Rats were randomly grouped into negative control, positive control and experimented (100, 200 and 300 mg/kg body weight). Diabetes was induced by a single intraperitoneal injection of 160 mg/kg body weight of alloxan. Blood glucose levels were measured using blood glucose test strips with AccuCheck Advantage II glucometer at 1, 3, 6, and 24 h on the first day and 1 h after treatment on days 3, 5 and 7. Phytochemical and histopathological analysis of Carica papaya extract and pancreas tissues were also carried out respectively. Blood samples were collected and centrifuged to separate serum for estimation of biochemical parameters. The phytochemical screening revealed that alkaloids, reducing sugar, anthraquinones, flavonoids, saponins, cardiac glycosides, and steroids were present while only tarnins and phenols was absent. Histopathological study on pancreas in the treatment group indicates the presence of pancreatic islet cells and increased number of islet of Langerhans. Daily oral administration of Carica papaya extract (100, 200, and 300 mg/kg body weight) showed beneficial effects on blood glucose level at (p<0.05). Biochemical profile and hematological reductive effect was observed in the groups treated with the aqueous stem extract of Carica papaya. This study showed that Carica papaya extracts possess anti-diabetic activities as well as improve liver and renal profile and total lipids levels. ... The management of diabetes has gained international attention, and several countriesincluding Saudi Arabia (21%), Sri Lanka (16%), Malaysia (16%), Mexico (15%), and the US (16%)-spend a significant amount of their health expenditures on diabetes care [14]. The American Diabetes Association's cost estimates for the US population are notable instances of cost-of-illness research; the total burden for 2012 was projected to be USD 245 billion, taking into account higher health spending and productivity losses caused by diabetes. ... Article Full-text available Background: Diabetes is a major chronic illness that negatively influences individuals and society. Therefore, this research aimed to analyze and evaluate the cost associated with diabetes management, specific to the Pakistani Type 2 diabetes population. Research scheme and methods: A survey randomly collected information and data from diabetes patients throughout Pakistan out-patient clinics. Direct and indirect costs were evaluated, and data were analyzed with descriptive and inferential statistics. Results: An overall of 1839 diabetes patients participated in the study. The results have shown that direct and indirect costs are positively associated with the participants' socio-demographic characteristics, except for household income and educational status. The annual total cost of diabetes care was USD 740.1, amongst which the share of the direct cost was USD 646.7, and the indirect cost was USD 93.65. Most direct costs comprised medicine (USD 274.5) and hospitalization (USD 319.7). In contrast, the productivity loss of the patients had the highest contribution to the indirect cost (USD 81.36). Conclusion: This study showed that direct costs significantly contributed to diabetes's overall cost in Pakistan and overall diabetes management estimated to be 1.67% (USD 24.42 billion) of the country's total gross domestic product. The expense of medications and hospitalization mostly drove the direct cost. Additionally, patients' loss of productivity contributed significantly to the indirect cost. It is high time for healthcare policymakers to address this huge healthcare burden. It is time to develop a thorough diabetes management plan to be implemented nationwide. ... Diabetes is a leading cause of kidney failure and nontraumatic lower-limb amputations among adults in the world. In 2010, the USA was estimated to have spent$198 billion on diabetes treatment (Zhang et al. 2010). An estimated 285 million adults had Type II diabetes making up about 90% of diabetes cases in 2010 (Vijan 2010). ...
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Intramuscular implantation of cultured allogeneic myoblasts derived from pathogen-free muscle biopsies of genetically normal human volunteers demonstrated safety and efficacy in clinical studies of Duchenne muscular dystrophy (DMD), heart failure, ischemic cardiomyopathy, Type-II diabetes, cancer, and aging disfigurement. Through natural cell fusion, donor myoblasts inserted their normal nuclei that supplied the complete human genome to replenish the aberrant gene(s). The replacement gene(s) produced single or multiple gene transcripts, factors, and protein(s) in multiple pathways to effect complementary genetic repair. Donor myoblasts also fused among themselves to form normal myofibers. Applications included diagnostic screening, disease prevention, disease treatment, drug discovery, and selection of superior cell clones for therapies. Only 3-week cyclosporine immunosuppression was necessary to support engraftment, development, and functioning. Improvement in the host included production of repairing structural and regulatory proteins, increases in muscle cell number and function, increases in locomotive capacity, breathing capacity and life span in DMD boys, increases in blood ejection and vascularization in heart failure and ischemic patients, and transfer of biochemicals and ions across the muscle cell membrane in diabetic patients. Intra-tumor implantation of allogeneic human myoblasts induced cancer apoptosis, inhibiting metastasis and tumor growth with cancer patients. FDA currently listed 23 myoblast implantation projects, and EMA listed 6, mostly in Phase II with some in Phase III clinical trials. This unique platform technology, patented for its compositions, methods, and relatedmedical devices of cell/gene therapies, promised to be of great social and economic values in world health and human services.
... 9 Diabetes is among the most prevalent conditions globally and accounts for 11% of health care expenditures worldwide. 9,12 This number is supported by more recent studies in high median-income countries: 10% in Germany, 10 8.3% in Italy, 13 and 14% in the United States. 14 These estimates may even be conservative because some researchers have estimated that more than 40% of people with diabetes worldwide are undiagnosed. ...
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Background and aims: Diabetes is among the most prevalent noncommunicable chronic diseases globally and carries a substantial expense in worldwide health care. Pharmaceutical supplies related to diabetes management account for 20%-40% of the disease's management cos, and this percentage continues to increase. This study examines the pharmaceutical expenses associated with one of the most common chronic diseases: diabetes. Specifically, we measure the extent to which patient health and demographic factors drive the annual cost of pharmaceutical supplies for diabetes management. Second, the study applied a procurement-centric classification scheme to pharmaceutical items involved in diabetes treatment. Methods: Data on 98,648 pharmaceutical-dispensing transactions (related to 2828 patients) over 1 year were collected from a specialized diabetes health center. Pharmaceutical prices from the sample were compared internationally to ensure that the findings apply to other countries. The association between the item cost and the number of unique patients prescribed pharmaceutical products was estimated at the category and subcategory levels. Results: Approximately 80% of total pharmaceutical expenditures were attributed to 20% of patients. Two of 20 pharmaceutical categories-anti-diabetes drugs and insulin-accounted for 34% of products dispensed and 57% of total pharmaceutical expenditures. Age, body mass index, and diabetes type were essential factors in predicting supply cost per patient. Conclusion: Applying the portfolio purchasing model also suggested that some clinically similar items, like insulin types, are best procured through divergent procurement strategies or vendors for optimal cost efficiency. A better understanding of the diverse array of diabetes supplies can reveal opportunities for better strategic supply management. This supply classification approach can also be applied in other supply-intensive specialties, such as orthopedics.
... To accelerate the green transformation and upgrade of the economy, China promulgated the Green Credit Guidelines in February 2012, further strengthening the financial sector's role in environmental protection. Zhang et al. (2010) qualitatively analyzed the implementation of China's green credit policy at the national and provincial levels and pointed out that the implementation of the policy had an impact on high pollution and high energy consumption industries. However, due to the ambiguous details and inconsistent implementation standards of China's green credit policy at this step, the policy effect was not fully realized (Zhou et al., 2017). ...
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Green credit policy (GCP) can achieve economic growth and environmental conservation, notably by lowering air pollutants (PM2.5). Green credit is a significant component of China's green financing for environmental regulation and achieving carbon neutrality. In this paper, to understand the causal relationship between GCP and PM2.5, we apply a bootstrap full-sample Granger causality test, parameter stability test, and quantile-on-quantile test for the period between 2003:M01 to 2019:M12. The result shows a bidirectional relationship and reveals that GCP has varied environmental implications in its early and mature stages because of a low percentage of green credit and a lack of motivation for financial institutions. In the long run, GCP and PM2.5 interaction confirm the favorable effects of GCP on PM2.5 as the green credit system improves. For robustness, we used quantile-based granger causality to evaluate the causative link between GCP and PM2.5. In light of the findings, this research advises legislative reforms and stresses the relevance of green credit in improving air quality. This study adds additional evidence that air pollution affects green credit policies. Air quality being a leading indicator helps firms anticipate changes in bank credit preferences and alter financing techniques.
... In addition, it revealed that the prevalence of DM was higher for females, individuals aged over 30 years, with low education, overweight and obesity. 4 The costs of DM are high and are associated with morbidity, mortality and complications, and may account for 15% of a country's annual health budget, 5 considering direct expenses (medications, exams, procedures and supplies, professional visits and hospital expenses in emergency services, in addition to non-medical expenses) and indirect expenses (absenteeism from work, unproductivity, early retirement). 6 For people with DM, access to treatment is essential for their survival. ...
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... Physical impairment and cognitive development, organogenesis, and sexual differentiation are the results of BPA exposure during maternal and early childhood period (Kopras et al. 2014). Meanwhile, adult exposures to BPA have been linked with the incidence of breast cancer, prostate and testicular cancer, cardiovascular disease, diabetes, and various metabolic syndromes (Zhang et al. 2010). Environmental adverse effects include the negative impacts on growth and the sexual disruption of wild life such as abnormal sexual developments in animals (Dalrymple et al. 2007) and BPA negatively affect body systems that are critical for the health and survival of wildlife to the extent that there is a decline in numbers of wildlife populations (Hoffmann et al. 2011). ...
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Various treatments of choice are available to overcome contamination of bisphenol A (BPA) in the environment including membrane technologies; however, the treatment still releases contaminants that threaten the human being. Therefore, the present study is conducted to investigate the degradation of BPA by recently developed visible-light-driven photocatalytic nitrogen-doping titanium dioxide (N-doped TiO2) dual-layer hollow fibre (DLHF) membrane and its efficiency in reducing the level of BPA in contaminated water. Fabricated with suitable polymer/photocatalyst (15/7.5 wt.%) via co-extrusion spinning method, the DLHF was characterized morphologically, evaluated for BPA degradation by using submerged photocatalytic membrane reactor under visible light irradiations followed by the investigation of intermediates formed. BPA exposure effects were accessed by immunohistochemistry staining of gastrointestinal sample obtained from animal model. BPA has been successfully degraded up to 72.5% with 2 intermediate products, B1 and B2, being identified followed by total degradation of BPA. BPA exposure leads to the high-intensity IHC staining of Claudin family which indicated the disruption of small intestinal barrier (SIB) integrity. Low IHC staining intensity of Claudin family in treated BPA group demonstrated that reducing the level of BPA by N-doped TiO2 DLHF is capable of protecting the important component of SIB. Altogether, the fabricated photocatalytic DLHF membrane is expected to have an outstanding potential in removing BPA and its health effect for household water treatment to fulfil the public focus on the safety of their household water and their need to consume clean water.
... The high costs of type-2 diabetes (T2D) management has posed major challenges to healthcare systems of low-or middle-income countries in particular those with limited infrastructure for disease diagnosis and management. These countries spend 10% of all the costs of global diabetes; however, they are compelled to provide for the largest number of sufferers [6,7]. Therefore, developing and implementing economical and efficient strategies to control and combat type-2 diabetes is of vital importance [8]. ...
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Background: The most important factor in controlling diabetes is self-management behaviour and its development is the first step toward helping the patients to successfully control their disease. The current study was conducted so as to investigate self-management behaviour and its Impact on HbA1c. Methods: This study was carried out on 220 type-2 diabetic patients in 2020. The data was gathered through demographic and diabetes self-management questionnaire (DSMQ) and it included 16 items at four dimensions. The data analysed by independent t-test, One-way ANOVA, Multiple Linear Regression and Logistic Regression. Results: There was a significant relationship between gender and physical activity, diet, and diabetic self-management (P-value> 0/001). Also, there was a significant relationship between economic status and glycemic control, diet, and diabetic self-management (P-value>0/05). In addition, family history of the disease and glycemic control, diet, and diabetic self-management were found to be meaningfully related (P-value> 0/05). Smoking and glycemic control on the one hand and diabetic self-management and BMI, on the other, experienced meaningful relationship (P-value >0/05). The most adverse effects were among patients who had unfavourable or minimum self-management: 10.7% kidney complications and 17.9% visual impairment (P-value>0/05). Dietary control is the strongest predictor of HbA1c in all diabetics and people with borderline self-management and diabetics without complications (P-value> 0/000). Conclusion: Diabetes-related self-management predicted HbA1c levels and type-2 diabetic complications and intervention programmes crucial in increasing patients’ awareness, learning, and participation.
... This is imperative since diabetes is a major health problem that is growing at an accelerated rate in every corner of the world. So much so that global healthcare expenditure for diabetes is expected to reach $490 billion by 2030 [2]. Nowadays, medical blood testing can be done in the comforts of home. ... Article Various optical components employed in biomedical applications have been fabricated using spider silk because of its superior properties, such as elasticity, tensile strength, biodegradability, and biocompatibility. In this study, a highly sensitive fiber optic sugar sensor is fabricated using metal-nanolayer-coated spider silk. The spider silk, which is directly collected from Nephila pilipes , a giant wood spider, is naturally a protein-based biopolymer with great flexibility, low attenuation, and easy functionalization. The surface of the spider silk-based fiber is coated with a metal nano-layer by using the glancing angle deposition technique. This fiber optic sugar sensor is based on the principle of the change in the refractive indices of sugar solutions. The attained experimental results show that the proposed sugar sensor is highly sensitive in the detection of fructose, sucrose, and glucose concentrations. This work may provide a new way to realize precise and sensitive online sugar measurements for point-of-care diagnostics. ... Costs for treating CVD in the EU and the US were estimated at 8% and 17% of total health care expenditure respectively [48,49]. For diabetes, a major component of MetS risk, costs were estimated at 10% and 14% for the EU and the US respectively [50,51]. Minimization of health care costs is a pervasive aim of governments. ... Preprint Full-text available Prolonged sitting is associated with increased risk of obesity, type 2 diabetes and cardiovascular disease. Occupational sitting accounts for up to 50 hours per week for employees. This pilot study assessed 1) the acceptability of stair climbing as an interruption to sitting throughout working hours, 2) provide preliminary data of the effects on glucose and lipid profiles. Article Crude oil is one of the sources by which budgets are financed in OPEC countries. However, the fall in oil prices in 2014 put their governments’ finances under significant pressure. Healthcare was one of the sectors experiencing fiscal strain. This study examined the effect of a fall in oil prices on healthcare financing in eight OPEC countries and whether such financing has shifted away from the dependence on oil. Quantitative healthcare expenditure data from the WHO covering the period from 2003 to 2019 were evaluated using a comparison of means Welch’s t-test. The result showed that government healthcare expenditure in Iran, Venezuela, and Kuwait increased in the period post-2014 compared to the expenditure after 2008 and 2002, suggesting that these countries succeeded in shielding such spending against the fall in oil prices. By contrast, the United Arab Emirates, Saudi Arabia, Iraq, Nigeria, and Algeria did not, highlighting that they have not yet moved from dependence on oil. With the economic uncertainty caused by oil fluctuations, global political and economic developments, and the world transitioning to green energy, oil-dependent countries should free their governments’ healthcare expenditure from dependence on such sources of funding. Furthermore, they should not focus on temporary plans by shifting the burden to private spending at a time of falling oil prices, but to utilize different financing approaches. Article Full-text available O Diabetes Mellitus tipo 2 (DM2) é uma doença crônica causada por uma disfunção metabólica da insulina que gera grandes impactos na qualidade de vida dos pacientes. Seu tratamento consiste no controle sérico da glicose e envolve mudança nos hábitos de vida associados ou não ao uso de medicação. O presente estudo objetivou-se a identificar os motivos que levam a não adesão ao tratamento não farmacológico dos pacientes com DM2 em estudos brasileiros. A busca dos dados baseou-se nas diretrizes para Revisões Sistemáticas e Meta-Análise (PRISMA) e foram realizadas através das plataformas Scielo e Google Scholar, utilizando os critérios de elegibilidade: artigos somente em língua portuguesa, estudos envolvendo pacientes submetidos ao tratamento não farmacológico do DM 2 e resultados dos fatores que levaram ou não à adesão ao tratamento da doença. Após análise da literatura é possível apontar que os principais fatores da não adesão ao tratamento não farmacológico do DM2 encontrados nos estudos foram: variáveis sociodemográficas (baixa qualidade de vida e renda, menor escolaridade e idade), motivação pessoal, dificuldades quanto a mudança do estilo de vida e falta de conhecimento sobre a doença e suas complicações. É necessário a realização de estudos que relacionem outros fatores a não adesão ao tratamento não farmacológico contribuindo, assim, com intervenções mais efetivas na qualidade de vida dos pacientes. Article In type 2 diabetes mellitus (T2DM), elevated glucose level impairs the biochemistry of the skin which may result in alteration of its mechanical and structural properties. The several aspects of structural and mechanical changes in skin due to T2DM remain poorly understood. To fill these research gaps, we developed a non-obese T2DM rat (Sprague Dawley (SD)) model for investigating the effect of T2DM on the in vivo strain stress state, mechanical and structural properties of skin. In vivo strain and mechanical anisotropy of healthy and T2DM skin were measured using the digital imaging correlation (DIC) technique and DIC coupled bulge experiment, respectively. Fluorescence microscopy and histology were used to assess the collagen and elastin fibers microstructure whereas nanoscale structure was captured through atomic force microscopy (AFM). Based on the microstructural observations, skin was modeled as a multilayer membrane where in and out of plane distribution of collagen fibers and planar distribution of elastin fibers were cast in constitutive model. Further, the state of in vivo stresses of healthy and T2DM were measured using model parameters and in vivo strain in the constitutive model. The results showed that T2DM causes significant loss in in vivo stresses (p<0.01) and increase in anisotropy (p<0.001) of skin. These changes were found in good correlation with T2DM associated alteration in skin microstructure. Statistical analysis emphasized that increase in blood glucose concentration (HbA1c) was the main cause of impaired biomechanical properties of skin. The presented data in this study can help to understand the skin pathology and to simulate the skin related clinical procedures. STATEMENT OF SIGNIFICANCE: : Our study is significant as it presents findings related to the effect of T2DM on the physiologic stress strain, structural and mechanical response of SD rat skin. In this study, we developed a non-obese T2DM SD rat model which mimics the phenotype of Asian type 2 diabetics (non-obese). Several structural and mechanical characterization techniques were explored for multiscale characterization of healthy and T2DM skin. Further, based on microstructural information, we presented the constitutive models that incorporate the real microstructure of skin. The presented results can be helpful to simulate the realistic mechanical response of skin during various clinical trials. Article Full-text available GLP-1 (Glucagon-like peptide-1) is a peptide that stimulates insulin secretion from the β-cell for glycemic control of the plasma blood glucose level. Its mimetic exenatide (synthetic Exendin-4) with a longer half-life of approximately 3.3–4 h is widely used in clinical application to treat diabetes. Currently, exenatide is chemically synthesized. In this study, we report that the GLP-1 analogue recombinant Exendin-4 (Exdn-4) can be produced at a high level in Nicotiana benthamiana, with an estimated yield of 50.0 µg/g fresh biomass. For high-level expression, we generated a recombinant gene, B:GB1:ddCBD1m:8xHis : Exendin-4 (BGC : Exdn-4), for the production of Exendin-4 using various domains such as the BiP signal peptide, the GB1 domain (B1 domain of streptococcal G protein), a double cellulose binding domain 1 (CBD1), and 8 His residues (8xHis) to the N-terminus of Exendin-4. GB1 was used to increase the expression, whereas double CBD1 and 8xHis were included as affinity tags for easy purification using MCC beads and Ni2+-NTA resin, respectively. BGC : Exdn-4 was purified by single-step purification to near homogeneity using both Ni2+-NTA resin and microcrystalline cellulose (MCC) beads. Moreover, Exdn-4 without any extra residues was produced from BGC : Exdn-4 bound onto MCC beads by treating with enterokinase. Plant-produced Exdn-4 (Exendin-4) was as effective as chemically synthesized Exendin-4 in glucose-induced insulin secretion (GIIS) from mouse MIN6m9 cells a pancreatic beta cell line. Article Full-text available In contrast to traditional laboratory glucose monitoring, recent developments have focused on blood glucose self-monitoring and providing patients with a self-monitoring device. This paper proposes a system based on ultrasound principles for quantifying glucose levels in blood by conducting an in-vitro experiment with goat blood before human blood. The ultrasonic transceiver is powered by a frequency generator that operates at 40 kHz and 1.6 V, and variations in glucose level affect the ultrasonic transceiver readings. The RVM probabilistic model is used to determine the variation in glucose levels in a blood sample. Blood glucose levels are measured simultaneously using a commercial glucose metre for confirmation. The experimental data values proposed are highly correlated with commercial glucose metre readings. The proposed ultrasonic MEMS-based blood glucometer measures a glucose level of $$257\pm 21$$ 257 ± 21 mg/dl. In the near future, the miniature version of the experimental model may be useful to human society. Article Los determinantes sociales son condiciones del entorno en los que las personas nacen, viven, aprenden, trabajan, juegan y envejecen que afectan a los resultados en salud y calidad de vida y al manejo de las patologías, sobre todo crónicas. En este artículo repasamos cómo influyen las desigualdades sociales, las diferencias entre países, género, lugar de residencia, contexto social y comunitario, y, por supuesto, cómo ha influido la pandemia de la COVID-19 en el control de la diabetes mellitus tipo 2. Article Full-text available Objective: This study aimed to assess the economic burden of Diabetes mellitus and its associated factors among patients on follow up at public regional hospitals of Addis Ababa. Methods: an institution based cross-sectional study was employed among 385 diabetic patients who have a follow up on selected regional hospitals from May 1 to June 20, 2018. Data were analyzed using SPSS version 22. Linear regression was done to identify factors related with cost of DM. A p value of less than 0.05 was deemed statistically significant. Results: Among the 385 respondents (94.4% response rate) enrolled in the study, 197 (51.12%) of them were females. More than three-quarter (77.1%) of the study participants were diagnosed with Type 2 DM. Majority of the participants (291; 75.6%) were self-financing their expenses for the management of DM. Average total monthly cost of DM was found to be 1035.82 Birr per patient per month. Moreover, the mean cost of study participant for laboratory test and single purchasing of insulin, insulin syringe as well as oral antidiabetic agents were 56.34 (±90.68), 325.26 (±229.06), 86.90(±81.24) and 437.69 (±278.69) Birr per patient per month, respectively. Regression analysis study indicated that there is a significant (p < 0.05) association between cost of DM and variables such as education, income, admission, distance from the health facility, emergency visit as well as number of drugs prescribed. Conclusion: This study showed that DM imposes a high out of pocket cost expenditure on patients and their families. Article The prevalence of diabetes mellitus and hypertension is increasing yearly in many low- and middle-income countries such as Nigeria. The increasing burden of these noncommunicable diseases has led to an increase in the overall cost of health care. This study aimed at determining the direct and indirect health care costs of diabetes mellitus and hypertension occurring both singly and in co-morbidity. The study was undertaken in the Enugu State University Teaching Hospital (a tertiary hospital) in Enugu State, Southeast Nigeria. Data were collected using a pre-tested questionnaire. Out of 817 patients interviewed, 37% had only diabetes mellitus, 35% had hypertension, and 28% had both diabetes mellitus and hypertension in co-morbidity. Direct costs of treating diabetes mellitus and hypertension in the month before the survey were$28.40 and $19.35, respectively, while the indirect costs of treatment in the month before the study were$7.36 and $5.51, respectively. Direct and indirect costs for diabetes mellitus and hypertension in co-morbidity were$37.00 and $4.62, respectively. A concentration index showed that diabetes mellitus and hypertension were more evident among the poor than the rich. The economic cost when compared with patients’ income revealed that >25% of their income is spent monthly on health care. Article Background and Aims Although lower lean mass is associated with greater diabetes prevalence in cross-sectional studies, prospective data specifically in middle-aged Black and White adults are lacking. Relative appendicular lean mass (ALM), such as ALM adjusted for body mass index BMI, is important to consider since muscle mass is associated with overall body size. We investigated whether ALM/BMI is associated with incident type 2 diabetes in the Coronary Artery Risk Development in Young Adults study. Methods and Results 1,893 middle-aged adults (55% women) were included. ALM was measured by DXA in 2005-06. Incident type 2 diabetes was defined in 2010-11 or 2015-16 as fasting glucose ≥7 mmol/L(126 mg/dL), 2-hour glucose on OGTT ≥11.1 mmol/L(200 mg/dL)(2010-11 only), HbA1C ≥48 mmol/mol(6.5%)(2010-11 only), or glucose-lowering medications. Cox regression models with sex stratification were performed. In men and women, ALM/BMI was 1.07 ± 0.14(mean±SD) and 0.73±0.12, respectively. Seventy men(8.2%) and 71 women(6.8%) developed type 2 diabetes. Per sex-specific SD higher ALM/BMI, unadjusted diabetes risk was lower by 21% in men[HR 0.79 (0.62-0.99), p=0.04] and 29% in women[HR 0.71 (0.55-0.91), p=0.008]. After adjusting for age, race, smoking, education, physical activity, and waist circumference, the association was no longer significant. Adjustment for waist circumference accounted for the attenuation in men. Conclusion Although more appendicular lean mass relative to BMI is associated with lower incident type 2 diabetes in middle-aged men and women over 10 years, its effect may be through other metabolic risk factors such as waist circumference, which is a correlate of abdominal fat mass. Article Aim This study aimed to investigate the readmission pattern and risk factors for patients who experienced a hyperglycemic crisis. Methods Patients admitted to MacKay Memorial Hospital for diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS) between January 2016 and April 2019 were studied. The timing of the first readmission for hyperglycemia and other causes was recorded. Kaplan–Meier analysis was used to compare patients with hyperglycemia and all-cause readmissions. Cox regression was used to identify independent predictors for hyperglycemia and all-cause readmission post-discharge. Results The study cohort included 410 patients, and 15.3% and 46.3% of them had hyperglycemia and all-cause readmissions, respectively. The DKA and HHS group showed a similar incidence for hyperglycemia, with the latter group showing a higher incidence of all-cause readmissions. The significant predictors of hyperglycemia readmissions included young age, smoking, hypoglycemia, higher effective osmolality, and hyperthyroidism in the DKA group and higher glycated hemoglobin level in the HHS group. Conclusions Patients who experienced DKA and HHS had similar hyperglycemia readmission rates; however, predictors in the DKA group were not applicable to the HHS group. Designing different strategies for different types of hyperglycemic crisis is necessary for preventing readmission. Article Full-text available Loss of podocyte is a characteristic pathological change of diabetic nephropathy (DN) which is associated with increased proteinuria. Many studies have shown that novel inhibitors of sodium–glucose cotransporter 2 (SGLT2-is), such as dapagliflozin, exert nephroprotective effect on delaying DN progression. However, the mechanisms underlying SGLT2-associated podocyte injury are still not fully elucidated. Here, we generated streptozotocin-induced DN models and treated them with dapagliflozin to explore the possible mechanisms underlying SGLT2 regulation. Compared to mice with DN, dapagliflozin-treated mice exhibited remission of pathological lesions, including glomerular sclerosis, thickening of the glomerular basement membrane (GBM), podocyte injury in the glomeruli, and decreased nephrotoxin levels accompanied by decreased SGLT2 expression. The mRNA expression profiles of these treated mice revealed the significance of the insulin-like growth factor-1 receptor (IGF1R)/PI3K regulatory axis in glomerular injury. KEGG analysis confirmed that the phosphatidylinositol signaling system and insulin signaling pathway were enriched. Western blotting showed that SGLT2-is inhibited the increase of mesenchymal markers (α-SMA, SNAI-1, and ZEB2) and the loss of podocyte markers (nephrin and E-cad). Additionally, SGLT2, IGF1R, phosphorylated PI3K, α-SMA, SNAI-1, and ZEB2 protein levels were increased in high glucose-stimulated human podocytes (HPC) and significantly decreased in dapagliflozin-treated (50 nM and 100 nM) or OSI-906-treated (inhibitor of IGF1R, 60 nM) groups. However, the use of both inhibitors did not enhance this protective effect. Next, we analyzed urine and plasma samples from a cohort consisting of 13 healthy people and 19 DN patients who were administered with (n = 9) or without (n = 10) SGLT2 inhibitors. ELISA results showed decreased circulating levels of IGF1 and IGF2 in SGLT2-is-treated DN patients compared with DN patients. Taken together, our study reported the key role of SGLT2/IGF1R/PI3K signaling in regulating podocyte epithelial–mesenchymal transition (EMT). Modulating IGF1R expression may be a novel approach for DN therapy. Article This study estimates the effect of diabetes on labour market outcomes (employment, unemployment and labour force participation) in South Africa using data from the South African General Household Survey (2018). We first examine the possibility that diabetes status is endogenous through the application of heteroscedasticity-based instruments. Internal instruments meet the underlying diagnostic expectations, but do not consistently accept the endogeneity hypothesis. Thus we turn to multinomial logit models, ignoring endogeneity, to estimate the effect of diabetes. Our findings indicate that diabetes has differential effects for men and women, where the magnitude of the effect tends to be larger (in absolute value) for women. Article Background and aims: Diabetes mellitus (DM) is one of the most prevalent chronic non-communicable diseases globally, and the only way to reduce its complications is good glycemic control. Insulin remains the only approved treatment for type 1 DM (T1DM) and is used by many with Type 2 DM (T2DM). Carbohydrate counting is considered the ideal way to calculate meal-related insulin doses since it allows greater flexibility in diet and could, in some people, reduce the burden of the disease. This systematic review's primary objective was to assess carbohydrate counting efficacy in reducing glycated hemoglobin (HbA1c ) and safety by not increasing hypoglycemia risk, inducing an increase in body weight or blood lipids, and reducing the quality of life of people with T1DM. Methods: We included randomized controlled clinical trials with a parallel-group design comparing any carbohydrate counting forms with standard care or other forms of dietary advice or insulin dose calculation in people with T1DM with a follow up period of at least three months and with no restrictions in language, age, or settings. As a primary outcome, we consider the change of HbA1c within at least three months. Secondary outcomes were hypoglycemia events, body weight changes, blood lipids levels, and the total daily insulin dose. We also evaluated health-related quality of life changes and diabetes treatment satisfaction questionnaires. Results: Data from 11 studies with 899 patients were retrieved with a mean follow of 52 ± 35.5 weeks. Carbohydrate counting is not better in reducing HbA1c , SMD - 0.24% (95%CI -0.68 to 0.21) than all dietary advice forms. However, this finding was highly heterogeneous. We identified three studies that account for most of the heterogeneity using clustering algorithms. A second analysis excluding these studies shows a meaningful HbA1c reduction, SMD - 0.52% (95%CI -0.82 to -0.23) with low heterogeneity. In the subgroup analysis, carbohydrate counting significantly reduces HbA1c compared to usual diabetes education. Carbohydrate counting doesn't relate to any substantial change in blood lipids, body weight, hypoglycemia risk, or daily insulin dose. Finally, we analyzed the effect of trial duration with HbA1c reduction and found no significant change related to time. Conclusions: Carbohydrate counting is an efficacious technique to safely reduce HbA1c in adults and children compared to standard diabetes education. And its effect doesn't seem to change with prolonged time. Standardization in reporting important outcomes like hypoglycemia and quality of life is vital to produce comparable evidence in carbohydrate counting clinical trials. This SR was registered in PROSPERO under code: CRD42020218499. This article is protected by copyright. All rights reserved. Thesis Worldwide, people constantly embrace alternative and/or complementary therapies, which include traditional medicinal plants (TMPs), for management of their health conditions. Two non-communicable diseases, hypertension and diabetes, evoke growing concerns over the escalating health threat which they pose to humanity globally. Over the past decade these conditions have become two of the biggest healthcare issues in Africa, rivalling communicable diseases. This study focuses on the use of TMPs for the management of hypertension and diabetes in Nigeria, Africa’s most populous country. The aim is to determine using questionnaire, the extent of the usage of these TMPs. The high prevalence of hypertension and diabetes in Nigeria is a national health problem. The impact of poor management due mainly to unaffordable healthcare costs makes it more burdensome on the patients. These factors, combined with disease complications, exacerbate the financial plight of individual families. Hence the search for alternatives. This study considers the drive behind TMP use. A survey among HTN and DM patients in two South Eastern Nigeria hospitals was run based on a structured/semi-structured questionnaire administered over 600 patients. The results of this study show high prevalence in the use of TMPs for the management of hypertension and diabetes. Approximately, 75% of the participants use TMPs. All of them use TMPs concurrently with their prescription medicines, predisposing them to severe hypotension or hypoglycaemia, possibilities of drug interactions, direct toxicities, as well as adulteration with active pharmaceutical agents. Also, the poor quality of herbal medicines raises safety concerns. Directions for use of these TMPs are scanty or anecdotal. Consequently, fifty (50) plants commonly used by these patients were recorded with known pharmacokinetic parameters. Most of these TMPs have been proven to possess therapeutic properties and pharmacological effects, thus providing a baseline for investigation into their uses by patients. Vernonia amygdalina (bitter leaf), Ocimum gratissimum (sweet basil/scent leaf) and Gongronema latifolium (bush buck) were three of the most commonly used medicinal plants identified from this work. Quantitative statistical cross-analysis was used to make statistical inferences using data from this study. It was ascertained that there were some associations between the use of TMPs by patients, their conditions and demographics. This study is important as it forms the basis of a future study - survey to be conducted on Nigerian doctors – to ascertain their views on alternative medicine and its integration into the national healthcare system. Keywords: Hypertension; Diabetes mellitus; Traditional medicines; Medicinal plants; Nigeria; South Eastern Nigeria; CAM; ethnobotany; ethnopharmacology; Antihypertensive, herbs, herbal remedies; hypertension/diabetes and medicinal plant. Article Full-text available Alpha-amylase is widely exploited as a drug target for preventing postprandial hyperglycemia in diabetes and other metabolic diseases. Inhibition of this enzyme by plant-derived pregnanes is not fully understood. Herein, we used in vitro, in silico, and in vivo studies to provide further insights into the alpha-amylase inhibitory potential of selected pregnane-rich chromatographic fractions and four steroidal pregnane phytochemicals (SPPs), viz: marsectohexol (P1), 3-O-[6-deoxy-3-O-methyl-β-D-allopyranosyl-(1→14)-β-D-oleandropyranosyl]-11,12-di-O-tigloyl-17β-marsdenin (P2), 3-O-[6-deoxy-3-O-methyl-β-D-allopyranosyl-(1→4)-β-D-oleandropyranosyl]-17β-marsdenin (P3), and 3-O-[6-deoxy-3-O-methyl-β-D-allopyranosyl-(1→4)-β-D-canaropyranosyl]-17β-marsdenin (P4) derived from Gongronema latifolium Benth. The results revealed that the SPPs source pregnane-rich chromatographic fractions and the SPPs (P1–P4) exhibited inhibitory potential against porcine pancreatic alpha-amylase in vitro. Compounds P1 and P2 with IC50 values 10.01 and 12.10 µM, respectively, showed greater inhibitory potential than the reference acarbose (IC50 = 13.47 µM). Molecular docking analysis suggests that the SPPs had a strong binding affinity to porcine pancreatic alpha-amylase (PPA), human pancreatic alpha-amylase (HPA), and human salivary alpha-amylase (HSA), interacting with the key active site residues through an array of hydrophobic interactions and hydrogen bonds. The strong interactions of the SPPs with Glu233 and Asp300 residues may disrupt their roles in the acid-base catalytic mechanism and proper orientation of the polymeric substrates, respectively. The interactions with human pancreatic amylase were maintained in a dynamic environment as indicated by the root mean square deviation, radius of gyration, surface accessible surface area, and number of hydrogen bonds computed from the trajectories obtained from a 100-ns molecular dynamics simulation. Key loop regions of HPA that contribute to substrate binding exhibited flexibility and interaction potential toward the compounds as indicated by the root mean square fluctuation. Furthermore, P1 significantly reduced blood glucose levels and area under the curve in albino rats which were orally challenged with starch. Therefore, Gongronema latifolium and its constituent SPPs may be exploited as inhibitors of pancreatic alpha-amylase as an oral policy for impeding postprandial blood glucose rise. Article Currently, the reference method for diagnosing the pathology of diabetes is the measurement of glycated hemoglobin HbA1c. As a major public health problem, as categorized by the World Health Organization, the need to develop new techniques that are more accessible, especially for developing countries, is necessary. The objective of this work is to propose a new technique based on laser-induced breakdown spectroscopy (LIBS) using the essential minerals calcium, sodium, magnesium, and zinc in hair as biomarkers for the screening of type 2 diabetes. The study involved 130 women: 24 were classified as low-level diabetics with a glycated hemoglobin HbA1c <7% and 56 were classified as high-level diabetics with an HbA1c >7% after clinical tests were performed at the Habib Thameur Hospital in Tunis. The other 50 women were healthy and used as controls. The correlation of the mineral concentrations in the hair with the values of glycated hemoglobin allow an economical and rapid detection of the disease. The results showed a strong negative correlation between the levels of calcium, magnesium, and zinc with the HbA1c values and a strong positive correlation between the intensity of the sodium lines and HbA1c. These results allowed the discrimination of the three groups in the cohort, offering a new approach to quickly classify the patients involved in a screening campaign. In addition, the strong correlation between laser-induced breakdown spectroscopy (LIBS) and the front face fluorescence spectroscopy (FFFS), previously applied on the same samples, may help identify the source of the fluorescence spectra. All of these results support the use of LIBS upon hair to evaluate minerals as effective biomarkers for the detection of type II diabetes to be a promising approach. Article Full-text available Background Diabetes imposes a large burden on countries’ healthcare expenditures. In Kuwait, diabetes prevalence in adults is estimated at 22.0%%—double the worldwide prevalence (9.3%). There is little current data on pharmaceutical costs in Kuwait of managing diabetes and diabetes-related complications and comorbidities. Objectives Estimate the utilization and cost of drugs for diabetes and diabetes-related complications and comorbidities in Kuwait for year 2018, as well determinants of costs. Methods This cross-sectional study used a multi-stage stratified sampling method. Patients were Kuwaiti citizens with diabetes, aged 18–80, recruited from all six governorates. Physicians collected demographic data, clinical data, and current drug prescription for each patient which was extrapolated for the full year of 2018. A prevalence-based approach and bottom-up costing were used. Data were described according to facility type (primary care vs. hospital). A generalized linear model with log function and normal distribution compared drug costs for patients with and without comorbidities/complications after adjustments for demographic and health confounders (gender, age group, disease duration, and obesity). Results Of 1182 diabetes patients, 64.0% had dyslipidemia and 57.7% had hypertension. Additionally, 40.7% had diabetes-related complications, most commonly neuropathy (19.7%). Of all diabetes patients, 85.9% used oral antidiabetics (alone or in combinations), 49.5% used insulin alone or in combinations, and 29.3% used both oral antidiabetics and insulin. The most frequently used oral drug was metformin (75.7%), followed by DPP4 inhibitors (40.2%) and SGLT2 inhibitors (23.8%). The most frequently used injectables were insulin glargine (36.6%), followed by GLP-1 receptor agonists (15.4%). Total annual drug cost for Kuwait’s diabetic population for year 2018 was US$201 million (US$1,236.30 per patient for antidiabetics plus drugs for comorbidities/complications). Conclusions Drug costs for treating diabetes and comorbidities/complications accounted for an estimated 22.8% of Kuwait’s 2018 drug expenditures. Comorbidities and complications add 44.7% to the average drug cost per diabetes patient. Article Full-text available The aim of the study was to determine the annual healthcare expenditures of an individual with diabetes in Tehran, between March 2004 and March 2005. This prevalence-based 'cost-of-illness' study was conducted in two phases. In the first phase, 23,707 randomly selected individuals were interviewed to gather a cohort of participants with diabetes. In the second phase, 710 diabetic patients and 904 age- and sex-matched controls were followed up for 1 year at intervals of 3 months and the direct (physician services, medications and devices, hospitalisation, laboratory, paraclinical and transport) and indirect (loss of productivity) expenditures were recorded. The excess costs of a person with diabetes were estimated through comparison with matched controls. The estimates were also extrapolated to the total population of Tehran and Iran. The costs were converted from the Iranian rial to the US dollar (exchange rate September 2004). Total annual direct costs of diabetic and control participants were$152.3 +/- 14.5 and $52.0 +/- 5.8, respectively, which is indicative of 2.92 times higher costs in diabetic patients. The most expensive components of direct costs were medications and devices, and hospitalisation in diabetic patients (28.7% and 28.6%, respectively). Total indirect costs were$39.6 +/- 2.4 and $16.7 +/- 1.1 in diabetic and non-diabetic individuals. The aggregate annual direct costs of diabetes were estimated to be$112.424 +/- 10.732 million and $590.676 +/- 65.985 million in Tehran and Iran, respectively. Diabetes complications contributed 53% of the aggregate excess direct costs of diabetes. Diabetes is an expensive medical problem in Iran and planning of national programmes for its control and prevention is necessary. Article Full-text available Objective: Diabetes is the fifth leading cause of death by disease in the U.S. Diabetes also contributes to higher rates of morbidity-people with diabetes are at higher risk for heart disease, blindness, kidney failure, extremity amputations, and other chronic conditions. The objectives of this study were 1). to estimate the direct medical and indirect productivity-related costs attributable to diabetes and 2). to calculate and compare the total and per capita medical expenditures for people with and without diabetes. Research design and methods: Medical expenditures were estimated for the U.S. population with and without diabetes in 2002 by sex, age, race/ethnicity, type of medical condition, and health care setting. Health care use and total health care expenditures attributable to diabetes were estimated using etiological fractions, calculated based on national health care survey data. The value of lost productivity attributable to diabetes was also estimated based on estimates of lost workdays, restricted activity days, prevalence of permanent disability, and mortality attributable to diabetes. RESULTS-Direct medical and indirect expenditures attributable to diabetes in 2002 were estimated at 132 billion US dollars. Direct medical expenditures alone totaled 91.8 billion US dollars and comprised 23.2 billion US dollars for diabetes care, 24.6 billion US dollars for chronic complications attributable to diabetes, and 44.1 billion US dollars for excess prevalence of general medical conditions. Inpatient days (43.9%), nursing home care (15.1%), and office visits (10.9%) constituted the major expenditure groups by service settings. In addition, 51.8% of direct medical expenditures were incurred by people >65 years old. Attributable indirect expenditures resulting from lost workdays, restricted activity days, mortality, and permanent disability due to diabetes totaled 39.8 billion US dollars. U.S. health expenditures for the health care components included in the study totaled 865 billion US dollars, of which 160 billion US dollars was incurred by people with diabetes. Per capita medical expenditures totaled 13243 US dollars for people with diabetes and 2560 US dollars for people without diabetes. When adjusting for differences in age, sex, and race/ethnicity between the population with and without diabetes, people with diabetes had medical expenditures that were approximately 2.4 times higher than expenditures that would be incurred by the same group in the absence of diabetes. Conclusions: The estimated 132 billion US dollars cost likely underestimates the true burden of diabetes because it omits intangibles, such as pain and suffering, care provided by nonpaid caregivers, and several areas of health care spending where people with diabetes probably use services at higher rates than people without diabetes (e.g., dental care, optometry care, and the use of licensed dietitians). In addition, the cost estimate excludes undiagnosed cases of diabetes. Health care spending in 2002 for people with diabetes is more than double what spending would be without diabetes. Diabetes imposes a substantial cost burden to society and, in particular, to those individuals with diabetes and their families. Eliminating or reducing the health problems caused by diabetes through factors such as better access to preventive care, more widespread diagnosis, more intensive disease management, and the advent of new medical technologies could significantly improve the quality of life for people with diabetes and their families while at the same time potentially reducing national expenditures for health care services and increasing productivity in the U.S. economy. Article Full-text available The aim of this study was to identify the health care costs of diabetic patients in Germany in 2001, focusing on the influence of age, sex, and type of treatment. Annual direct costs of medical care and indirect costs of inability to work and early retirement in diabetic subjects were compared with costs of age- and sex-matched non-diabetic control subjects. The analysis was based on routine health care data from a random sample (18.75%) taken from a database of 1.9 million insured persons. Incremental differences in medical and national expenditure between subjects with and without diabetes were calculated. Annual direct mean costs per diabetic patient were 5,262 Euro, and indirect costs were 5,019 Euro. In the control group, mean direct and indirect costs were 2,755 Euro and 3,691 Euro, respectively. Analysis of cost components revealed that the high costs associated with the care of diabetic patients could be largely attributed to inpatient care and overall medication costs. Hypoglycaemic drugs amounted to only one-quarter of the medication costs. The total health care costs were correlated with the type of treatment. Direct excess costs increased with increasing age in insulin-treated patients, but were unaffected by age in patients receiving other types of treatment. The Costs of Diabetes Mellitus (CoDiM) study is the first comprehensive study to provide estimates of costs associated with diabetes care in Germany. Direct costs of diabetic patients account for 14.2% of total health care costs, which includes the proportion that specifically accounts for diabetes-related costs (6.8%). Article Full-text available Many socio-economic factors and health care system related issues impact the outcome of diabetes and consequently its costs and vice versa. Factors that influence delay in diagnosis also determine complication rates and thus costs. Presence and severity of complications as well as co-morbid conditions are the most important determinants of treatment and monitoring regimen as well as the need for hospitalization and are therefore important factors related to costs. The average annual direct costs of hospitalized patients are more than double to those not hospitalized. Complications are also responsible for indirect costs in terms of productivity loss and absenteeism. Our studies show that the cost of providing routine care is only a fraction of the overall costs and is perhaps still manageable; however when this is not available or its quality is poor the overall direct and indirect costs, escalate with disastrous health and economic consequences to the individual, his family and society. Effective intervention means prevention both primary (health promotion and awareness) as well as secondary prevention (reducing the burden of complications by early diagnosis and effective care). Everyone involved in diabetes care need to be aware of what drives cost: proper effective treatment of diabetes is not but not treating diabetes or treating it ineffectively is very costly. Article In assessing the economic impact of diabetes for a population, several factors should be considered, including the incidence and prevalence of the disease, the level of development of the health care system, and the population's overall level of economic development. Two different approaches have been used to address the economic impact of an increasing incidence of diabetes. The first approach uses disability-adjusted life-years (DALE's) to measure intangible costs associated with diabetes. It combines the number of healthy life-years lost as a result of early mortality with those lost because of disability The second approach, which has been used more frequently, is the cost-of-illness approach, which includes the concepts of direct, indirect, and intangible costs. A study conducted by the World Bank found that of the 1,362 million DALYs lost to all illnesses in 1990, 7.97 million DALYs were lost because of diabetes. In a 1992 study that assessed the direct costs of treating diabetes in the U.S., the American Diabetes Association used the cost-of-illness approach and found that the estimated total expenditure for 1 year was$45.2 billion. The 1994 epidemiological studies by Zimmet and the World Health Organization include estimates of increased prevalence of diabetes resulting from an increase in population. Estimates of the global cost of diabetes based on these studies reveal that diabetes accounts for 2-3% of the total health care budget in every country; therefore, an increase in diabetes incidence and prevalence translates into a significant economic impact.
Article
We estimated the number of people worldwide with diabetes for the years 2010 and 2030. Studies from 91 countries were used to calculate age- and sex-specific diabetes prevalences, which were applied to national population estimates, to determine national diabetes prevalences for all 216 countries for 2010 and 2030. Studies were identified using Medline, and contact with all national and regional International Diabetes Federation offices. Studies were included if diabetes prevalence was assessed using a population-based methodology, and was based on World Health Organization or American Diabetes Association diagnostic criteria for at least three separate age-groups within the 20-79 year range. Self-report or registry data were used if blood glucose assessment was not available. The world prevalence of diabetes among adults (aged 20-79 years) will be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7%, and 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries. These predictions, based on a larger number of studies than previous estimates, indicate a growing burden of diabetes, particularly in developing countries.
Article
The purpose of this study was to evaluate the direct medical costs of type 2 diabetes mellitus with or without complications, and to determine the economic impact of complications on type 2 diabetic patients. We performed a cross-sectional study of prevalent type 2 diabetes carried out in four major cities of China. The study populations were 1530 outpatients and 524 inpatients from clinics or wards of a total of 20 hospitals, using a two-phase subject enrollment process, by face-to-face interview with a unique questionnaire. The annual direct medical cost per patient was estimated to be 4800 Chinese Yuan (CNY) in median or 10,164 CNY in mean. There is a difference between annual direct medical costs for patients with or without complications (6056 vs. 3583 CNY; P < 0.001). It is also significantly different for the pay-out-of-pocket proportions (P = 0.015) between the patients with (44.6%) and without complications (40.4%). The direct medical cost varied significantly among the four cities (P < 0.001). Patients who simultaneously suffered microvascular and macrovascular diseases had higher direct medical cost (7600) than those with macrovascular (6000) (P = 0.012) and microvascular disease (5364) (P < 0.001), and those without both (3600) (P < 0.001). The correlation was statistically significant between the number of complications and direct medical costs (P < 0.001). The high economic burden raised by diabetes and its complications challenges the Chinese health-care system. It implicates an urgent need of intervention to prevent the development of long-term complications among the diabetic population, especially on the development of complications in high-cost body system.
Article
In assessing the economic impact of diabetes for a population, several factors should be considered, including the incidence and prevalence of the disease, the level of development of the health care system, and the population's overall level of economic development. Two different approaches have been used to address the economic impact of an increasing incidence of diabetes. The first approach uses disability-adjusted life-years (DALYs) to measure intangible costs associated with diabetes. It combines the number of healthy life-years lost as a result of early mortality with those lost because of disability. The second approach, which has been used more frequently, is the cost-of-illness approach, which includes the concepts of direct, indirect, and intangible costs. A study conducted by the World Bank found that of the 1,362 million DALYs lost to all illnesses in 1990, 7.97 million DALYs were lost because of diabetes. In a 1992 study that assessed the direct costs of treating diabetes in the U.S., the American Diabetes Association used the cost-of-illness approach and found that the estimated total expenditure for 1 year was $45.2 billion. The 1994 epidemiological studies by Zimmet and the World Health Organization include estimates of increased prevalence of diabetes resulting from an increase in population. Estimates of the global cost of diabetes based on these studies reveal that diabetes accounts for 2-3% of the total health care budget in every country; therefore, an increase in diabetes incidence and prevalence translates into a significant economic impact. Article The objective of the study was to estimate the direct costs of diabetes care to patients attending secondary care facilities in Madras, India. A total of 596 subjects were studied, at the Private Hospital for Diabetes Mellitus (PHD) (n = 422), and at the Government General Hospital (GGH) (n = 174). A simple interview schedule enabled a face to face interaction with the patients by the research investigator which elicited a frank and true response. The validity of the data collected was established by independent scrutiny of financial records in a sub sample. Payment bills for expenses of 140 subjects chosen on a random basis from the total sample of 422 PHD patients were compared with the costs reported by the subjects. There were no statistically significant differences both in the inpatient and the outpatient cases between the reported cost and actual cost. Median bill value (total costs)=Rs.1010 (range 195-16700) reported value=880 (110-20355) Z = -0.97, P = 0.33 and, for outpatients, median bill value=Rs.800 (195-4560) reported value=Rs. 740 (110-6320) Z = -1.56, P = 0.12. For inpatients, median bill value = Rs. 4235 (1289-16700) reported value=Rs.5459 (1285-20355), Z = -1.27, P5 years duration of diabetes spent more than those who had <5 years of duration; Rs.5570 (360-75200) and Rs.3220, (460-25600), respectively. All differences between these sub-groups were statistically significant. Within the ambit of economic aspects of the population in a developing country, the direct cost on diabetes health care is very high for many people. Article 'The Cost of Diabetes in Europe - Type II study' is the first coordinated attempt to measure total healthcare costs of Type II (non-insulin-dependent) diabetes mellitus in Europe. The study evaluated more than 7000 patients with Type II diabetes in eight countries -- Belgium, France, Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom. A bottom-up, prevalence-based design was used, which optimised the collection of data at the national level while maintaining maximum international comparability. Effort was made to ensure consistency in terms of data specification, data collection tools and methods, sampling design, and the analysis and reporting of results. Results are reported for individual countries and in aggregate for the total study population. The total direct medical costs of Type II diabetes in the eight European countries was estimated at EUR 29 billion a year (1999 values). The estimated average yearly cost per patient was EUR 2834 a year. Of these costs, hospitalisations accounted for the greatest proportion (55%, range 30-65%) totalling EUR 15.9 billion for the eight countries. During the 6-month evaluation period, 13% of the Type II diabetic patients were hospitalised, with an average of 23 days in hospital projected annually. In contrast, drug costs for managing Type II diabetes were relatively low, with antidiabetic drugs and insulin accounting for only 7% of the total healthcare costs for Type II diabetes. Type II diabetes mellitus is a common disease and the prevalence is expected to increase considerably in the future, especially in developing countries. Current comprehensive economic data on the costs of diabetes are required for policy decisions to optimise resource allocation and to evaluate different approaches for disease management. Article To determine the costs of health services and the financial consequences of changes in the epidemiological profile of chronic diseases in Latin America. We conducted longitudinal analyses of costs and of the economic impact of the epidemiological transition in healthcare services for diabetes and hypertension in the Mexican health system. The study population included both the insured and uninsured populations. The cost-evaluation method was based on the instrumentation and consensus techniques. To estimate the epidemiological changes and financial consequences for 2004-2006, six models were constructed according to the Box-Jenkins technique, using confidence intervals of 95% and the Box-Pierce test. Costs ranged from US$613 to US$887 for diabetes, and from US$485 to US\$622 for hypertension. Regarding epidemiological changes for 2004 compared with 2006, an increase is expected in both cases, although results predict a greater increase for diabetes, 10-15% in all three institutions (P<0.05). Comparing the financial consequences of health services required by insured and uninsured populations, the greater increase (17%) will be for the insured population (P<0.05). The financial requirements for both diseases will amount to 9.5% of the total budget for the uninsured population and 13.5% for the insured population. If the risk factors and the different healthcare models remain as they are at present, the economic impact of expected epidemiological changes on the social security system will be particularly strong. Another relevant financial factor is the appearance of internal competition in the use and allocation of financial resources among the main providers in the health services; this factor becomes even more complicated within each provider. In effect, within each institution, hypertension and diabetes programmes must compete for resources with other programmes for chronic and infectious diseases.
Global estimates of the prevalence of diabetes for 2110 and 2030 Economic costs of diabetes in the U
• J E Shaw
• R A Sicree
• P Z Zimment
J.E. Shaw, R.A. Sicree, P.Z. Zimment, Global estimates of the prevalence of diabetes for 2110 and 2030, Diabetes Res. Clin. Pract. 87 (1) (2010) 4–14. [2] American Diabetes Association, Economic costs of diabetes in the U.S. in 2007, Diabetes Care 31 (3) (2008) 596–615.
Global estimates of the prevalence of diabetes for 2110 and 2030
• J E Shaw
• R A Sicree
• P Z Zimment
J.E. Shaw, R.A. Sicree, P.Z. Zimment, Global estimates of the prevalence of diabetes for 2110 and 2030, Diabetes Res. Clin. Pract. 87 (1) (2010) 4–14.
Global estimates of the prevalence of diabetes for 2110 and 2030
• Shaw
• United Nations
Economic costs of diabetes in the U.S. in 2007
• American Diabetes Association