276 research outputs found
REFERENCES_FOR_TABLES – Supplemental material for Therapeutic inertia in type 2 diabetes: prevalence, causes, consequences and methods to overcome inertia
No full textSupplemental material, REFERENCES_FOR_TABLES for Therapeutic inertia in type 2 diabetes: prevalence, causes, consequences and methods to overcome inertia by Sachin Khunti, Kamlesh Khunti and Samuel Seidu in Therapeutic Advances in Endocrinology and Metabolism</p
sj-pdf-1-jrs-10.1177_01410768231156997 - Supplemental material for Intensive versus standard blood pressure control in older persons with or without diabetes: a systematic review and meta-analysis of randomised controlled trials
No full textSupplemental material, sj-pdf-1-jrs-10.1177_01410768231156997 for Intensive versus standard blood pressure control in older persons with or without diabetes: a systematic review and meta-analysis of randomised controlled trials by Samuel Seidu, Harini Willis, Setor K Kunutsor and Kamlesh Khunti in Journal of the Royal Society of Medicine</p
Secular trends in low birth weight and child undernutrition in West Africa : evidence from complex nationwide surveys, 1985–2019
No full textObjective:
We present prevalence estimates and secular trends of stunting, wasting, underweight, and anaemia among children under 5 years of age and low birth weight (LBW) over the period 1985–2019 in West Africa (WA).
Design:
Analysis of Demographic and Health Survey (DHS) and World Bank data. DerSimonian–Laird random effect model with the Knapp–Hartung adjustment to the standard error was used to derive overall prevalence estimates. We used fixed effect ordinary least square regression models with cluster robust standard error to conduct time trends analyses.
Setting:
West Africa.
Participants:
Children aged 0 to 59 months.
Results:
Three distinct periods (1986–1990, 1993–1996 and 1997–2000) of sharp increases in prevalence of all outcomes was observed. After the year 2000, prevalence of all outcomes except LBW started to decline with some fluctuations. LBW prevalence showed a steady increase after 2000. We observed a decline in prevalence of stunting (β = –0·20 %; 95 % CI –0·43 %, 0·03 %), log-wasting (β = –0·02 %; 95 % CI –0·02 %, –0·01 %), log-underweight (β = –0·02 %; 95 % CI –0·03 %, –0·01 %) anaemia (β = –0·44; 95 % CI –0·55 %, –0·34 %), and an increase in LBW (β = 0·06 %; 95 % CI –0·10 %, 0·22 %) in WA over the period. Pooled prevalence of stunting, wasting, underweight, anaemia and LBW in WA for the period 1985–2019 was 26·1 %, 16·4 %, 22·7 %, 76·2 % and 11·3 %, respectively.
Conclusions:
Child undernutrition prevalence varied greatly between countries and the year cohorts. We observed marginal reductions in prevalence of all outcomes except anaemia where the reductions were quite striking and LBW where an increase was noted. There is the need for more rigorous and sustained targeted interventions in WA
Human resource management and organizational performance:evidence from the retail banking sector
No full textUnderpinned by the resource-based view (RBV), social exchange theory (SET), and a theory of intrinsic motivation (empowerment), I proposed and tested a multi-level model that simultaneously examines the intermediate linkages or mechanisms through which HPWS impact individual and organizational performance. First and underpinned by RBV, I examined at the unit level, collective human capital and competitive advantage as path-ways through which the use of HPWS influences – branch market performance. Second and-, underpinned by social exchange (perceived organizational support) and intrinsic motivation (psychological empowerment) theories, I examined cross and individual level mechanisms through which experienced HPWS may influence employee performance. I tested the propositions of this study with multisource data obtained from junior and senior customer contact employees, and managers of 37 branches of two banks in Ghana. Results of the Structural Equation Modeling (SEM) analysis revealed that (i) collective human capital partially mediated the relationship between management-rated HPWS and competitive advantage, while competitive advantage completely mediated the influence of human capital on branch market performance. Consequently, management-rated HPWS influenced branch market performance indirectly through collective human capital and competitive advantage. Additionally, results of hierarchical linear modeling (HLM) tests of the cross-level influences on the motivational implications of HPWS revealed that (i) management-rated HPWS influenced experienced HPWS; (ii) perceived organizational support (POS) and psychological empowerment fully mediated the influence of experienced HPWS on service-oriented organizational citizenship behaviour (OCB), and; (iii) service-oriented OCB mediated the influence of psychological empowerment and POS on service quality and task performance. I discuss the theoretical and practical implications of these findings
Birth weight mediates the association of maternal undernutrition with child undernutrition prevalence in West Africa
No full textBackground: Maternal nutritional status before and during pregnancy is an important determinant of foetal health. In West Africa, maternal and child undernutrition remains a major public health problem and it is important to establish the mechanistic pathway linking the two disorders to help address the problem. We therefore assessed the mediating role of low birth weight (LBW) in the relationship of maternal undernutrition with child undernutrition in West Africa. Methods: We included recent (2010–2019) DHS data from thirteen West African countries. Poisson regression model with robust standard errors was used to assess the relationship between maternal undernutrition (body mass index and anaemia) and child undernutrition (stunting, wasting, underweight, and anaemia). Structural equation modelling was used to conduct the mediation analysis. Results: Prevalence of stunting, wasting, underweight, and anaemia among under-five children in West Africa was found to be 32.4%, 8.1%, 20.1%, and 71.5%, respectively. We found children of underweight mothers to be more likely to be undernourished (stunted, wasted, and underweight) and anaemic compared to children of normal-weight mothers. Also, children of anaemic mothers were more likely to be stunted and anaemic but not wasted compared with children of non-anaemic mothers. LBW mediated the observed relationships between maternal BMI and childhood stunting (22.6%), and maternal anaemia and childhood stunting (24.9%), wasting (11.7), and anaemia (6.6%). Conclusion: We found maternal undernutrition to be associated with child undernutrition in West Africa with LBW noted to be a mediator of the observed relationship. We recommend that, to address the child undernutrition problem in West Africa, governments and policymakers must integrate measures to address the burden of LBW
COVID-19 pandemic and risk factor measurement in individuals with cardio-renal-metabolic diseases: a retrospective study in the United Kingdom
No full textBackground: comprehensive research about changes in risk factor (RF) management of people with chronic conditions during the COVID-19 pandemic is sparse. We aimed to study the impact of the pandemic on RF assessment in people with type 2 diabetes (T2DM), cardiovascular disease (CVD), and chronic kidney disease (CKD). Method: using UK Clinical Practice Research Datalink GOLD, we identified adults with T2DM, CVD and CKD who were alive and registered two years before (March 2018 – February 2019; March 2019 – February 2020) and one year during (March 2020 – February 2021) the pandemic. We estimated the proportion of people whose RFs (systolic (SBP) and diastolic (DBP) blood pressure, total cholesterol (TC), body mass index, smoking, and HbA1c) were assessed, mean values, and the proportion of controlled at each period for each cohort, overall and by age, sex, ethnicity, and deprivation. Multivariable logistic regression was used to estimate the association of patient characteristics (age, sex, ethnicity, deprivation, and comorbidity) with the outcome of having all RFs assessed during a given period. Results: within the T2DM cohort, 66.4% and 65.2% had assessments of HbA1c in 2018 and 2019, which reduced to 43.4% in 2020. In CVD cohort, 76.9% and 72.6% had their BP measurements (54.5% and 51.3% for TC) in 2018 and 2019 respectively, which declined to 40.6% (30.7% for TC) in 2020. In CKD cohort, BP assessments declined from 77.9% and 72.3% in 2018 and 2019 respectively to 45.0% in 2020. These findings were consistent across patient demographics. In those with T2DM, SBP and DBP increased (+1.65 mmHg and +1.02 mmHg) in 2020. Elderly people were less likely to have all their RFs assessed in 2020 in all three cohorts compared to previous years. Conclusions: among people with major cardiometabolic conditions, there have been substantial reductions in the assessment and control of several key RFs during the pandemic. These patients will need regular monitoring in future for the prevention of complications. Our findings also highlight the need for resilient healthcare systems to ensure continuity of care and mitigate disparities in high-risk populations
Hospitalisation and mortality before and during the COVID-19 pandemic in individuals with cardiorenal–metabolic diseases in the UK: a retrospective cohort study
No full textBackground: health-care access and use were considerably disrupted during the COVID-19 pandemic. This study assessed the sex-specific effect of the pandemic on hospitalisations and mortality among individuals in England with type 2 diabetes, cardiovascular disease, and chronic kidney disease.Methods: we conducted a retrospective cohort study using the UK Clinical Practice Research Datalink (CPRD) GOLD primary care database in individuals with data linkage available to the Hospital Episode Statistics Admitted Patient Care (HES APC), the Office for National Statistics (ONS) death registry, and the patient-level Index of Multiple Deprivation (IMD) 2019. Individuals were eligible for inclusion if they were registered in CPRD GOLD on the study start date (ie, March 1, 2017); were aged 18 years or older; had up-to-standard registration in CPRD GOLD for at least 1 year before the study start date; and had linkage available to HES APC, ONS, and IMD data. Adults with type 2 diabetes, cardiovascular disease, or chronic kidney disease were identified and followed up for 2 years before (March 1, 2018, to Feb 29, 2020) and 1 year during (March 1, 2020, to Feb 28, 2021) the COVID-19 pandemic. We estimated sex-specific crude incidence rates of all-cause hospitalisations and mortality in both periods. We also estimated sex-stratified, age-adjusted incidence rate ratios (IRRs) for all-cause hospitalisations and mortality during March 1, 2020, to Feb 28, 2021 versus March 1, 2018, to Feb 29, 2020 using Poisson models. Excess deaths were estimated by comparing observed and expected mortality rates.Findings: among 769 551 eligible individuals, 59 169 (7·7%) had type 2 diabetes, 49 754 (6·5%) had cardiovascular disease, and 39 803 (5·2%) had chronic kidney disease in 2018. From 2018–20 to 2020–21, all-cause hospitalisations declined across all disease cohorts, with the largest reduction observed in female participants with type 2 diabetes (from 568 [95% CI 561–575] to 394 [384–404] events per 1000 person-years; adjusted IRR [aIRR] 0·71 [95% CI 0·69–0·73]). From 2018–20 to 2020–21, all-cause mortality increased in all three cohorts and was highest among male participants (from 62 [95% CI 59–65] to 77 [71–83] events per 1000 person-years; aIRR 1·25 [95% CI 1·14–1·38]) and female participants (from 54 [95% CI 52–57] to 73 [67–79] events per 1000 person-years; aIRR 1·36 [95% CI 1·23–1·49]) with chronic kidney disease. In 2020 in England, there were approximately 24 500, 37 300, and 38 000 excess deaths in individuals with type 2 diabetes, cardiovascular disease, and chronic kidney disease, respectively.Interpretation: these findings show the effect of COVID-19 on male and female participants with three common chronic conditions in England. Prioritising care for groups at increased risk of severe outcomes and improving resilience are crucial for ensuring continuity of care during future public health crises.Funding: Health Data Research UK, ONS, and UK Research and Innovation.<br/
Percentage of age-predicted cardiorespiratory fitness may be a stronger risk indicator for incident type 2 diabetes than absolute levels of cardiorespiratory fitness
No full textPurpose: There are inverse and independent associations between cardiorespiratory fitness (CRF) and several adverse cardiometabolic outcomes. The percentage of age-predicted CRF (%age-predicted CRF) is comparable to absolute CRF as a risk indicator for some of these outcomes, but the association between %age-predicted CRF and risk of type 2 diabetes (T2D) has not been previously investigated. We aimed to assess the association between %age-predicted CRF and T2D in a prospective cohort study. Methods: Cardiorespiratory fitness, as measured directly by peak oxygen uptake, was assessed in 1901 men aged 42-60 yr who underwent cardiopulmonary exercise testing. The age-predicted CRF estimated from a regression equation for age was converted to %age-predicted CRF using (achieved CRF/age-predicted CRF) × 100. Hazard ratios (95% CI) were estimated for T2D. Results: During a median follow-up of 26.8 yr, 227 T2D cases were recorded. The risk of T2D decreased continuously with increasing %age-predicted CRF ( P value for nonlinearity = .30). A 1-SD increase in %age-predicted CRF was associated with a decreased risk of T2D in analysis adjusted for established risk factors (HR = 0.68: 95% CI, 0.59-0.79). The corresponding adjusted risk was (HR = 0.51: 95% CI, 0.35-0.75) comparing extreme tertiles of %age-predicted CRF. The respective estimates for the association between absolute CRF and T2D were-HR (95% CI)-0.71 (0.60-0.83) and 0.64 (0.44-0.95). Conclusions: Percentage of age-predicted CRF is linearly, inversely, and independently associated with the risk of incident T2D and may be a stronger risk indicator for T2D compared to absolute CRF in a general population of middle-aged and older men.https://journals.lww.com/jcrjournal/Abstract/2023/01000/Percentage_of_Age_Predicted_Cardiorespiratory.10.asp
Benefits and harms of sodium-glucose co-transporter-2 inhibitors (SGLT2-I) and renin-angiotensin-aldosterone system inhibitors (RAAS-I) versus SGLT2-Is alone in patients with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials
No full textIntroduction: It is uncertain if the combination of sodium-glucose co-transporter 2 inhibitors (SGLT2-Is) and renin-angiotensin-aldosterone system inhibitors (RAAS-Is) provides better cardio-renal clinical outcomes in people with type 2 diabetes mellitus (T2DM) compared with SGLT2-Is alone. Using a systematic review and meta-analysis of randomized controlled trials (RCTs), we evaluated the efficacy and safety with respect to cardio-renal outcomes of the combination of SGLT2 and RAAS inhibitors vs SGLT2-Is in patients with T2DM. Methods: Studies were identified from MEDLINE, Embase, the Cochrane Library and search of bibliographies to May 2021. The Cochrane risk of bias tool was used to assess the risk of bias of each study. Study-specific risk ratios (RRs) with 95% confidence intervals (CIs) were pooled. Quality of the evidence was assessed using GRADE. Results: Nine articles comprising 8 RCT evaluations (n = 34,551 participants) that compared SGLT2-Is with placebo in patients with T2DM against a background of standard care and reported subgroup results for those treated with or without RAAS-Is at baseline were included. No RCT specifically investigated the combination of SGLT2 and RAAS inhibitors compared with SGLT2-Is alone. The RRs (95% CIs) for composite cardiovascular outcome and composite CVD death/heart failure hospitalization comparing SGLT2-Is vs placebo in patients on RAAS-Is were 0.93 (0.85-1.01) and 0.88 (0.76-1.02), respectively. The corresponding estimates for patients not on RAAS-Is were 0.78 (0.65-0.93) and 0.73 (0.65-0.82), respectively. There was no evidence of interactions between RAAS-I status and the effects of SGLT2-Is for both outcomes. Single study results showed that SGLT2-Is vs placebo reduced the risk of composite kidney outcome and cardiovascular death in patients with RAAS inhibition. The effect of SGLT2 inhibition vs placebo on kidney parameters, genital infections, volume depletion, hyperkalaemia, hypokalaemia, hypoglycaemia and other adverse events was similar in patients with or without RAAS inhibition. The quality of the evidence ranged from very low to moderate. Conclusions: Aggregate published data suggest that the combination of SGLT2 and RAAS inhibitors in the treatment of patients with T2DM may be similar in efficacy and safety if not superior to SGLT2-Is alone. Head-to-head comparisons of the two interventions are warranted to inform T2DM management. The use of SGLT2 inhibition as a first-line therapy in T2DM or its early use in the prevention of renal deterioration and cardiovascular complications in addition to its glycaemic control deserves further study.https://onlinelibrary.wiley.com/doi/10.1002/edm2.30
Defining the role of SGLT2 inhibitors in primary care: Time to think differently
No full textDisease burden in people with diabetes is mainly driven by long-term complications such as cardiovascular disease, heart failure and chronic kidney disease. This is a consequence of the interconnection between the cardiovascular, renal and metabolic systems, through a continuous chain of events referred to as 'the cardiorenal metabolic continuum'. Increasing evidence suggests that sodium-glucose cotransporter 2 inhibitors (SGLT2is) have beneficial effects across all stages of the cardiorenal metabolic continuum, reducing morbidity and mortality in a wide range of individuals, from those with diabetes and multiple risk factors to those with established heart failure and chronic kidney disease, regardless of the presence of diabetes. Despite this robust evidence base, the complexity of label indications and misconceptions concerning potential side effects have resulted in a lack of clear understanding in primary care regarding the implementation of SGLT2is in clinical practice. With this in mind, we provide an overview of the clinical and economic benefits of SGLT2is across the cardiorenal metabolic continuum together with practical considerations in order to help address some of these concerns and clearly define the role of SGLT2is in primary care as a holistic outcomes-driven treatment with the potential to reduce disease burden across the cardiorenal metabolic spectrum.https://link.springer.com/article/10.1007/s13300-022-01242-
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