37 research outputs found
Real-world smartphone-based point-of-care diagnostics in primary health care to monitor HbA1c levels in people with diabetes
No full textBackgroundThe lack of accurate and affordable monitoring of glycated hemoglobin (HbA1c) is a common issue among patients with diabetes in low- and middle-income countries. We aimed to test a tablet- and smartphone-based point-of-care (TSB POC) device against a local laboratory-based measure of HbA1c for monitoring diabetes under real-world conditions.MethodsFor this cross-sectional clinical method applicability study, capillary and venous blood was collected in duplicate and analyzed at local primary health care centers. For a heterogeneity test, the tests were performed by an expert, and by a team of local nurses. The study was conducted in a multicenter design in rural and urban Aceh, Indonesia in 2019, and included a total of 533 adults. We mainly used Bland-Altman plots to assess the number of readings within the 95%-limits of agreement (LoA) and Deming regressions.ResultsThe results show a mean difference between capillary HbA1c on the test device and the reference method of −0.54 [CI0.95 = −1.6933; 0.6048] with 5.21% of measurements outside the LoA and a Pearson’s r = 0.91 in the Deming Regression. There is no significant difference in test concordance between local nurses and the expert (4.23% versus 5.13% results outside the LoA [CI0.95 = −0.0331; 0.0511]).ConclusionsTSB POC for analysis of HbA1c is an acceptable alternative for accessible monitoring of diabetes patients under these conditions. This method could provide access to high-quality diagnostic decisions through regular and cost-effective HbA1c monitoring directly in healthcare facilities, thus providing better access to essential health services.Plain language summary People with diabetes in low- and middle-income countries often lack access to reliable and affordable tests to monitor their long-term blood sugar levels, known as HbA1c. This study tested a simple tablet- or smartphone-based device to measure HbA1c directly at primary health centers. The study was conducted in urban and rural areas of Indonesia with 533 participants. The results showed that the device’s measurements were almost identical to laboratory tests. There was hardly any difference in the results, regardless of whether the tests were carried out by experienced experts or by nurses in the field. This method could provide a basis for regular and affordable HbA1c testing to improve diabetes care and access to basic health services for patients in these regions.Rhode et al. investigate the applicability of smartphone-based point-of-care diagnostics for monitoring HbA1c levels of diabetes patients under real-world conditions in a lower-middle income setting. They discover that the method offers an acceptable alternative for accessible monitoring under these conditions
The state of diabetes care and obstacles to better care in Aceh, Indonesia: a mixed-methods study
No full textAbstract
Background
Cardio-metabolic diseases are a major cause of death worldwide, including in Indonesia, where diabetes is one of the most critical diseases for the health system to manage.
Methods
We describe the characteristics, levels of control, health behavior, and diabetes-related complications of diabetes patients in Aceh, Indonesia. We use baseline data and blood testing from a randomized-controlled trial. We conducted semi-structured interviews with eight health providers from Posbindu and Prolanis programs that target diabetes and other non-communicable diseases (NCDs). We also conducted three focus group discussions with 24 diabetes patients about their experiences of living with diabetes and the existing support programs.
Results
The blood tests revealed average HbA1c levels indicative of poor glycemic control in 75.8 percent of patients and only 20.3 percent were free from any symptoms. Our qualitative findings suggest that patients are diagnosed after diabetes-related symptoms manifest, and that they find it hard to comply with treatment recommendations and lifestyle advice. The existing programs related to NCDs are not tailored to their needs.
Conclusion
We identify the need to improve diabetes screening to enable earlier treatment and achieve better control of the disease. Among diagnosed patients, there are widespread beliefs about diabetes medication and alternative forms of treatment that need to be addressed in a respectful dialogue between healthcare professionals and patients. Current diabetes screening, treatment and management programs should be revised to meet the needs of the affected population and to better respond to the increasing burden of this disease.Open-Access-Publikationsfonds 202
The economics of type 2 diabetes in middle-income countries
No full textThis thesis researches the economics of type 2 diabetes in middle-income countries
(MICs). Given the high prevalence of type 2 diabetes in MICs, in-depth
country specific analysis is key for understanding the economic consequences of
type 2 diabetes. The thesis consists of four studies with the unifying theme of
improving the understanding of the causal impact of diabetes on economic outcomes.
Study (1) provides an updated overview, critically assesses and identifies
gaps in the current literature on the economic costs of type 2 diabetes using
a systematic review approach; study (2) investigates the effects of self-reported
diabetes on employment probabilities in Mexico, using cross-sectional data and
making use of a commonly used instrumental variable approach; study (3) revisits
and extends these results via the use of a fixed effects panel data analysis,
also considering a broader range of outcomes, including wages and working
hours. Further, it makes use of cross-sectional biomarker data that allow for the
investigation of undiagnosed diabetes. Study (4) researches the effect of a diabetes
diagnosis on employment as well as behavioural risk factors in China, using
longitudinal data and applying an alternative identification strategy, marginal
structural models estimation, while comparing these results with fixed effects estimation
results. The thesis identifies a considerable economic burden of diabetes
in middle-income countries and uncovers several inequities affecting women, the
poor and the uninsured. Biomarker results indicate that the adverse effects are
limited to those aware of their diabetes. Finally, women are also found to achieve
fewer positive changes of their behavioural risk factors after a diabetes diagnosis
than men, offering a potential explanation for their more adverse employment
outcomes compared to men. To reduce the economic burden, the groups most
affected by the identified inequities should be targeted. Further, the underlying
reasons for the found sex differences need to be identified
Replication Data for: Thou shalt be given…but how? A replication study of a randomized experiment on food assistance in northern Ecuador
No full textDataset contains the do-files and R code to replicate the tables and figures of the replication study.. Please read the Readme first before using the files. The data used for the replication are not included as they were provided to us by the authors of the original study
Replication Data for: Thou shalt be given…but how? A replication study of a randomized experiment on food assistance in northern Ecuador
No full textDataset contains the do-files and R code to replicate the tables and figures of the replication study.. Please read the Readme first before using the files. The data used for the replication are not included as they were provided to us by the authors of the original study
The Role of Stabilization and Savings Funds in the Sustainable Management of Natural Resource Revenues:
No full textTemporal trends in obesity defined by the relative fat mass (RFM) index among adults in the United States from 1999 to 2020: a population-based study
No full textObjectives The body mass index (BMI) largely underestimates excess body fat, suggesting that the prevalence of obesity could be underestimated. Biologically, women are known to have higher body fat than men. This study aimed to compare the temporal trends in general obesity by sex, ethnicity and age among adults in the USA using the relative fat mass (RFM), a validated surrogate for whole-body fat percentage and BMI.Design Population-based study.Setting US National Health and Nutrition Examination Survey, from 1999–2000 to 2017–March 2020.Participants A representative sample of adults 20–79 years in the USA.Main outcome measures Age-adjusted prevalence of general obesity. RFM-defined obesity was diagnosed using validated cut-offs to predict all-cause mortality: RFM≥40% for women and ≥30% for men. BMI-defined obesity was diagnosed using a cut-off of 30 kg/m2.Results Analysis included data from 47 667 adults. Among women, RFM-defined obesity prevalence was 64.7% (95% CI 62.1% to 67.3%) in 2017–2020, a linear increase of 13.9 percentage points (95% CI 9.0% to 18.9%; p<0.001) relative to 1999–2000. In contrast, the prevalence of BMI-defined obesity was 42.2% (95% CI 39.4% to 45.0%) in 2017–2020. Among men, the corresponding RFM-defined obesity prevalence was 45.8% (95% CI 42.0% to 49.7%), a linear increase of 12.0 percentage points (95% CI 6.6% to 17.3%; p<0.001). In contrast, the prevalence of BMI-defined obesity was 42.0 (95% CI 37.8% to 46.3%). The highest prevalence of RFM-defined obesity across years was observed in older adults (60–79 years) and Mexican Americans, in women and men. Conversely, the highest prevalence of BMI-defined obesity across years was observed in middle-age (40–59 years) and older adults, and in African American women.Conclusions The use of a surrogate for whole-body fat percentage revealed a much higher prevalence of general obesity in the USA from 1999 to 2020, particularly among women, than that estimated using BMI, and detected a disproportionate higher prevalence of general obesity in older adults and Mexican Americans
Using peer education to improve diabetes management and outcomes in a low-income setting: a randomized controlled trial
No full textBACKGROUND: Diabetes is an important health burden in Indonesia. However, diabetes management and treatment remain poor, with most people with diabetes in Indonesia not achieving the recommended blood glucose levels. Peer education may have particular potential in low-income settings in complementing diabetes care without being a large additional strain on the health system. METHODS/DESIGN: This cluster randomized controlled trial aims to identify the effect of the implementation of peer education for patients with type 2 diabetes on diabetes-related outcomes in Aceh, Indonesia, which will complement the diabetes treatment provided at primary-care health posts (puskesmas). Altogether, 29 puskesmas were recruited in Banda Aceh and Aceh Besar, each of which was randomly assigned to either the control or the intervention group. Then, 534 people with diabetes were identified and recruited through their respective puskesmas. The intervention consists of up to two peer education groups per puskesmas, which are led by previously trained people with diabetes. Peer education sessions are held every month for 18 months, with follow-up data being collected 9 and 18 months after the first peer education session.
The main objective is to improve diabetes management and the health behavior of participants receiving peer education to reduce their average blood glucose levels as measured by glycated hemoglobin (HbA1c) levels. Secondary outcomes are the effects of peer education on lipid levels, waist circumference, blood pressure, quality of life, treatment adherence, diabetes knowledge, physical activity, and dietary diversity. Data sources for the measurement of outcomes include patient and health facility surveys and biomarker measurements. An economic evaluation will be conducted to assess the cost-effectiveness of the intervention. DISCUSSION: This trial will contribute to the evidence on the effectiveness and cost-effectiveness of peer education in improving diabetes management in a low-income setting in Indonesia and in other comparable contexts
The economic costs of type 2 diabetes: A global systematic review
No full textBackground: There has been a widely documented and recognized increase in diabetes prevalence, not only in high-income countries (HICs) but also in low- and middle-income countries (LMICs), over recent decades. The economic burden associated with diabetes, especially in LMICs, is less clear. Objective: We provide a systematic review of the global evidence on the costs of type 2 diabetes. Our review seeks to update and considerably expand the previous major review of the costs of diabetes by capturing the evidence on overall, direct and indirect costs of type 2 diabetes worldwide that has been published since 2001. In addition, we include a body of economic evidence that has hitherto been distinct from the cost-of-illness (COI) work, i.e. studies on the labour market impact of diabetes. Methods: We searched PubMed, EMBASE, EconLit and IBSS (without language restrictions) for studies assessing the economic burden of type 2 diabetes published from January 2001 to October 2014. Costs reported in the included studies were converted to international dollars (242 for a study on out-of-pocket expenditures in Mexico to 45 for Pakistan to $16,914 for the Bahamas. In LMICs—in stark contrast to HICs—a substantial part of the cost burden was attributed to patients via out-of-pocket treatment costs. Our regression analysis revealed that direct diabetes costs are closely and positively associated with a country’s gross domestic product (GDP) per capita, and that the USA stood out as having particularly high costs, even after controlling for GDP per capita. Studies on the labour market impact of diabetes were almost exclusively confined to HICs and found strong adverse effects, particularly for male employment chances. Many of these studies also took into account the possible endogeneity of diabetes, which was not the case for COI studies. Conclusions: The reviewed studies indicate a large economic burden of diabetes, most directly affecting patients in LMICs. The magnitude of the cost estimates differs considerably between and within countries, calling for the contextualization of the study results. Scope remains large for adding to the evidence base on labour market effects of diabetes in LMICs. Further, there is a need for future COI studies to incorporate more advanced statistical methods in their analysis to account for possible biases in the estimated costs
