47 research outputs found
Barriers to the delivery of diabetes care in the Middle East and South Africa: A survey of 1,082 practising physicians in five countries
No full textAims Developing countries face a high and growing burden of type 2 diabetes. We surveyed physicians in a diverse range of countries in the Middle East and Africa (Egypt, Kingdom of Saudi Arabia, United Arab Emirates, South Africa and Lebanon) with regard to their perceptions of barriers to type 2 diabetes care identified as potentially important in the literature and by the authors. Methods One thousand and eighty-two physicians completed a questionnaire developed by the authors. Results Most physicians enroled in the study employed guideline-driven care; 80-100percent of physicians prescribed metformin (with lifestyle intervention, where there are no contraindications) for newly diagnosed type 2 diabetes, with lifestyle intervention alone used where metformin was not prescribed. Sulfonylureas were prescribed widely, consistent with the poor economic status of many patients. About one quarter of physicians were not undertaking any form of continuing medical education, and relatively low proportions of practices had their own diabetes educators, dieticians or diabetic foot specialists. Physicians identified the deficiencies of their patients (unhealthy lifestyles, lack of education and poor diet) as the most important barriers to optimal diabetes care. Low-treatment compliance was not ranked highly. Access to physicians did not appear to be a problem, as most patients were seen multiple times per year. Conclusions Physicians in the Middle East and South Africa identified limitations relating to their patients as the main barrier to delivering care for diabetes, without giving high priority to issues relating to processes of care delivery. Further study would be needed to ascertain whether these findings reflect an unduly physician-centred view of their practice. More effective provision of services relating to the prevention of complications and improved lifestyles may be needed. Linked Comment: Flinders et al. Int J Clin Pract 2013; 67: 1074-5. © 2013 John Wiley and Sons Ltd.Abdoli S, 2011, INT J NURS PRACT, V17, P289, DOI 10.1111-j.1440-172X.2011.01937.x; Al-Maatouq M, 2010, INT J CLIN PRACT, V64, P149, DOI 10.1111-j.1742-1241.2009.02235.x; Al-Saeedi M, 2002, SAUDI MED J, V23, P1243; American Diabetes Association, 2013, DIABETES CARE S1, V36, pS11, DOI DOI 10.2337-DC13-S011; [Anonymous], 2006, HLTH SYST PROF; Asche C, 2011, CLIN THER, V33, P74, DOI 10.1016-j.clinthera.2011.01.019; Clinical Guidelines Task Force, 2005, GLOB GUID TYP 2 DIAB; Delamater AM, 2006, CLIN DIABETES, V24, P71, DOI DOI 10.2337-DIACLIN.24.2.71; Farsaei S, 2011, J RES MED SCI, V16, P43; Hammer JS, 2547 WORLD BANK DEV; International Diabetes Federation, E ATL DIAB; International Diabetes Federation, 2012, GLOB GUID TYP 2 DIAB; Inzucchi SE, 2012, DIABETES CARE, V35, P1364, DOI [10.2337-dc12-0413, 10.2337-dc12-041.3]; Lamchahab F. Z., 2011, Annals of Physical and Rehabilitation Medicine, V54, P359, DOI 10.1016-j.rehab.2011.07.004; Nam S, 2011, DIABETES RES CLIN PR, V93, P1, DOI 10.1016-j.diabres.2011.02.002; Nathan DM, 2009, DIABETES CARE, V32, P193, DOI 10.2337-dc08-9025; Reed R L, 2001, Arch Physiol Biochem, V109, P272, DOI 10.1076-apab.109.3.272.11591; Sharaf Fawzy, 2010, Int J Health Sci (Qassim), V4, P139; Society for Endocrinology, TYP 2 GUID; Soliman AR, 2012, RENAL FAILURE, V34, P425, DOI 10.3109-0886022X.2011.649671; Zgibor JC, 2001, DIABETES SPECTRUM, V14, P23, DOI 10.2337-diaspect.14.1.23; Zolfaghari M, 2012, J CLIN NURS, V21, P1922, DOI 10.1111-j.1365-2702.2011.03951.x0
Epidemiological evidence for the non-random clustering of the components of the metabolic syndrome: multicentre study of the Mediterranean Group for the Study of Diabetes.
No full textBarriers to the delivery of optimal antidiabetic therapy in the Middle East and Africa
No full textBackground The prevalence of type 2 diabetes is increasing worldwide, but developing nations will bear a disproportionate share of this burden. Countries in the Middle East and Africa are in a state of transition, where marked disparities of income and access to education and healthcare exist, and where the relatively young populations are being exposed increasingly to processes of urbanisation and adverse changes in diet that are fuelling the diabetes epidemic. Optimising diabetes care in these nations is crucial, to minimise the future burden of complications of diabetes. Methods We have reviewed the barriers to effective diabetes care with special relevance to countries in this region. Results The effects of antidiabetic treatments themselves are unlikely to differ importantly in the region compared with elsewhere, but economic inequalities within countries restrict access to newer treatments, in particular. Values relating to family life and religion are important modifiers of the physician-patient interaction. Also, a lack of understanding of diabetes and its treatments by both physicians and patients requires more and better diabetes education, delivered by suitably qualified health educators. Finally, sub-optimal processes for delivery of care have contributed to a lack of proper provision of testing and follow-up of patients in many countries. Conclusion Important barriers to the delivery of optimal diabetes care exist in the Middle East and Africa. © 2014 John Wiley and Sons Ltd.Abdelmoneim I, 2002, East Mediterr Health J, V8, P18; Abdoli S, 2011, INT J NURS PRACT, V17, P289, DOI 10.1111-j.1440-172X.2011.01937.x; Abou El-Enein N. 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Nutritional habits of subjects with Type 2 diabetes mellitus in the Mediterranean Basin: comparison with the non-diabetic population and the dietary recommendations. Multi-Centre Study of the Mediterranean Group for the Study of Diabetes (MGSD)
No full textAims/hypothesis. The aim of this study was to compare the nutritional habits of Type 2 diabetic patients among Mediterranean countries and also with those of their background population and with the nutritional recommendations of the Diabetes and Nutrition Study Group. Methods. We did a cross-sectional study of 1833 non-diabetic subjects and 1895 patients with Type 2 diabetes, in nine centres in six Mediterranean countries. A dietary questionnaire validated against the 3-Day Diet Diary was used. Results. In diabetic patients the contribution of proteins, carbohydrates and fat to the energy intake varied greatly among centres, ranging from 17.6% to 21.0% for protein, from 37.7% to 53.0% for carbohydrates and from 27.2% to 40.8% for fat, following in every centre the trends of the non-diabetic population. Furthermore, diabetic patients compared to the corresponding background population had: (i) lower energy intake, (ii) lower carbohydrate and higher protein contribution to the energy intake, (iii) higher prevalence of obesity, ranging from 9 to 50%. The adherence to the nutritional recommendations for proteins, carbohydrate and fat was very low ranging from 1.4 to 23.6%, and still decreased when fibre was also considered. Conclusion/interpretation. In diabetic patients of the Mediterranean area: (i) dietary habits vary greatly among countries, according to the same trends of the background population; (ii) the prevalence of obesity is much lower than the 80% reported for patients with diabetes in Western countries; (iii) Carbohydrate intake is decreased with a complementary increase of protein and fat consumption, resulting to a poor compliance with the nutritional recommendations
Human sex education in Lebanon : progress and challenges
No full textAprès avoir présenté la situation au Liban, les principaux concepts de didactique utilisés puis les différentes méthodologies mises en œuvre, une première série de résultats compare les conceptions d'enseignants libanais et français sur la sexualité et l'éducation à la sexualité (ES), à partir de leurs réponses au questionnaire du projet européen Biohead-Citizen. Les conceptions des enseignants libanais diffèrent très significativement de celles de leurs collègues français, montrant une certaine unité entre eux quelle que soit leur religion, mais corrélées à un grand degré de croyance et de pratique religieuse : moins favorables à l'avortement en toute situation, moins favorables au « safer sex », contre l'introduction de la plupart des thèmes de l'ES aux enfants du primaire et même aux adolescents. L'importance politique des confessions au Liban, y compris dans le système scolaire, nous a amené à recenser les positions des différentes religions sur l'ES : d'une part à partir d'une approche bibliographique sur leurs positions officielles, d'autre part à partir d'interviews de responsables socio-religieux impliqués dans le système éducatif au Liban. Cette seconde série de résultats montre des convergences quant au cadre et la finalité de l'exercice de la sexualité, et quant à la nécessité et la façon de contrôler le système éducatif libanais ; mais elle montre aussi de petites nuances avec des positions catholiques très strictes dans le refus de certains thèmes reliés à l'ES comme la contraception, l'avortement et l'insémination artificielle (les positions musulmanes concernant ces thèmes étant moins rigides). Ces nuances s'étendent à l'ES : l'Islam considère plus le texte religieux comme référence tandis que le Christianisme établit une approche détaillée de l'ES impliquant les parents. Enfin, une troisième série de résultats amorce une analyse de l'état des lieux de la réalité actuelle de l'ES dans les établissements scolaires libanais à partir de trois approches. En conclusion, notre travail permet d'émettre des hypothèses sur plusieurs filtres, freins et obstacles qui s'opposent à l'implémentation de l'ES au Liban. Les résistances de nombreux acteurs du système éducatif libanais (directeurs d'école, corps enseignant, pouvoirs socio-religieux) semblent avoir pour origine la méconnaissance de la nature, de la visée et des conséquences d'une ESAfter presenting the situation in Lebanon, the main didactic concepts and the different methodologies implemented, a first set of results compares the conceptions on sexuality and sex education (SE) of Lebanese and French teachers, using their responses to the questionnaire of the European project Biohead-Citizen. Lebanese teachers' conceptions differ very significantly from those of their French colleagues, showing some unity between them regardless of their religion, but correlated to a large degree of belief and religious practice: less favorable to abortion in any situation, less supportive of "safer sex" and against introducing of most of the themes of the SE. The political importance of confessions in Lebanon, including in the school system, led us to identify the positions of different religions on the SE: firstly from a bibliographical approach to their official positions, then from interviews with socioreligious leaders involved in the Lebanese educational system. This second set of results shows convergence on the framework and purpose of teaching human sexuality, and about the need and the way to control the Lebanese education system, but it also shows little nuances with strict Catholic positions in the refusal of some topics related to human sexuality as contraception, abortion and artificial insemination (Muslim positions on these topics are more flexible). These nuances extend to the SE: Islam considers the religious text as the reference for SE while Christianity establishes a detailed approach involving the parents. Finally, a third set of results is revealed by an analysis of the status of the current reality of the SE in Lebanese schools, using three approaches. In conclusion, our work can speculate on several filters, brakes and obstacles to the implementation of the SE in Lebanon. Many actors in the Lebanese education system (school principals, teachers, social and religious authorities) seem to misunderstand the nature, aim and the consequences of S
Real-world effectiveness of amlodipine/valsartan and amlodipine/valsartan/hydrochlorothiazide in high-risk patients and other subgroups
No full textSamir Helmy Assaad-Khalil,1 Robert Najem,2 Jorge Sison,3 Asad Riaz Kitchlew,4 Belong Cho,5 Kwo-Chang Ueng,6 Shelley DiTommaso,7 Abhijit Shete7 1Department of Diabetology, Lipidology and Metabolism, Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt; 2Lebanese University Hospital, Beirut, Lebanon; 3Medical Center Manila, Manila, Philippines; 4Pakistan Institute of Medical Sciences, Islamabad, Pakistan; 5Seoul National University College of Medicine, Seoul, South Korea; 6Chung Shan Medical University Hospital, Taichung City, Taiwan; 7Novartis Pharma AG, Basel, SwitzerlandBackground: The clinical EXCITE (EXperienCe of amlodIpine and valsarTan in hypErtension) study reported clinically relevant blood pressure (BP) reductions across all doses of amlodipine/valsartan (Aml/Val) and Aml/Val/hydrochlorothiazide (HCT) single-pill combinations. The study prospectively observed a multiethnic population of hypertensive patients for 26 weeks who were treated according to routine clinical practice. Here, we present the results in high-risk subgroups including the elderly, obese patients, and patients with diabetes or isolated systolic hypertension. In addition, we present a post hoc analysis as per prior antihypertensive monotherapy and dual therapy.Methods: Patients prescribed Aml/Val or Aml/Val/HCT were assessed in this 26±8 week, noninterventional, multicenter study across 13 countries in the Middle East and Asia. Changes in mean sitting systolic BP, mean sitting diastolic BP, and overall safety were assessed.Results: Of a total of 9,794 patients analyzed, 8,603 and 1,191 patients were prescribed Aml/Val and Aml/Val/HCT, respectively. Among these, 15.5% were elderly, 32.5% were obese, 31.3% had diabetes, and 9.8% had isolated systolic hypertension. Both Aml/Val and Aml/Val/HCT single-pill combinations, respectively, were associated with clinically relevant and significant mean sitting systolic/diastolic BP reductions across all subgroups: elderly patients (−32.2/−14.3 mmHg and −38.5/−16.5 mmHg), obese patients (−32.2/−17.9 mmHg and −38.5/−18.4 mmHg), diabetic patients (−30.3/−16.1 mmHg and −34.4/−16.6 mmHg), and patients with isolated systolic hypertension (−25.5/−4.1 mmHg and −30.2/−5.9 mmHg). Incremental BP reductions with Aml/Val or Aml/Val/HCT single-pill combinations were also observed in patients receiving prior monotherapy or dual therapy for hypertension. Overall, both Aml/Val and Aml/Val/HCT were generally well tolerated.Conclusion: This large, multiethnic study supports the evidence that Aml/Val and Aml/Val/HCT single-pill combinations are effective in diverse and clinically important subgroups of patients with hypertension.Keywords: amlodipine, hydrochlorothiazide, single-pill combinations, real world, valsarta
Relation of the Mediterranean diet with the incidence of gestational diabetes.
No full textBACKGROUND/OBJECTIVES:
Some studies document relationships of the incidence of gestational diabetes mellitus (GDM) with individual components of the diet, but studies exploring relationships with patterns of eating are lacking. This observational study aimed to explore a possible relationship between the incidence of GDM and the Mediterranean diet (MedDiet) pattern of eating.
SUBJECTS/METHODS:
In 10 Mediterranean countries, 1076 consecutive pregnant women underwent a 75-g OGTT at the 24th-32nd week of gestation, interpreted both by the ADA_2010 and the International Association of the Diabetes and Pregnancy Study Groups (IADPSG)_2012 criteria. The dietary habits were assessed by a previously validated questionnaire and a Mediterranean Diet Index (MDI) was computed, reflecting the degree of adherence to the MedDiet pattern of eating: a higher MDI denoting better adherence.
RESULTS:
After adjustment for age, BMI, diabetes in the family, weight gain and energy intake, subjects with GDM, by either criterion, had lower MDI (ADA_2010, 5.8 vs 6.3, P=0.028; IADPSG_2012, 5.9 vs 6.4, P<0.001). Moreover, the incidence of GDM was lower in subjects with better adherence to the MedDiet (higher tertile of MDI distribution), 8.0% vs 12.3%, OR=0.618, P=0.030 by ADA_2010 and 24.3% vs 32.8%, OR=0.655, P=0.004 by IADPSG_2012 criteria. In subjects without GDM, MDI was negatively correlated with both fasting plasma glucose and AUC glucose, P<0.001 for both.
CONCLUSIONS:
Adherence to a MedDiet pattern of eating is associated with lower incidence of GDM and better degree of glucose tolerance, even in women without GDM. The possibility to use MedDiet for the prevention of GDM deserves further testing with intervention studies
Nutritional habits in the Mediterranean Basin. The macronutrient composition of diet and its relation with the traditional Mediterranean diet. Multi-centre study of the Mediterranean Group for the Study of Diabetes(MGSD)
No full textDIETARY FAT INTAKE AS RISK FACTOR FOR THE DEVELOPMENT OF DIABETES: MULTINATIONAL MULTICENTER STUDY OF THE MEDITERRANEAN GROUP FOR THE STUDY OF DIABETES IF:7.912
No full textNutritional habits of subjects with Type 2 diabetes mellitus in the Mediterranean basin: comparison with the non-diabetic population and the dietary recommendations. Multi-centre study of the Mediterranean group for the study of Diabetes (MGSD)
No full textAims/hypothesis. The aim of this study was to compare
the nutritional habits of Type 2 diabetic patients
among Mediterranean countries and also with those of
their background population and with the nutritional
recommendations of the Diabetes and Nutrition Study
Group.
Methods. We did a cross-sectional study of 1833 nondiabetic
subjects and 1895 patients with Type 2 diabetes, in nine centres in six Mediterranean countries. A dietary questionnaire validated against the 3-Day Diet Diary was used.
Results. In diabetic patients the contribution of proteins,
carbohydrates and fat to the energy intake varied
greatly among centres, ranging from 17.6% to 21.0%
for protein, from 37.7% to 53.0% for carbohydrates
and from 27.2% to 40.8% for fat, following in every
centre the trends of the non-diabetic population. Furthermore, diabetic patients compared to the corresponding
background population had: (i) lower energy intake, (ii) lower carbohydrate and higher protein contribution to the energy intake, (iii) higher prevalence of obesity, ranging from 9 to 50%. The adherence to the nutritional recommendations for proteins, carbohydrate and fat was very low ranging from 1.4 to 23.6%, and still decreased when fibre was also considered.
Conclusion/interpretation. In diabetic patients of the
Mediterranean area: (i) dietary habits vary greatly
among countries, according to the same trends of the
background population; (ii) the prevalence of obesity
is much lower than the 80% reported for patients with
diabetes in Western countries; (iii) Carbohydrate intake
is decreased with a complementary increase of protein and fat consumption, resulting to a poor compliance with the nutritional recommendations
