Osong Public Health and Research Perspectives

Original Articles

Estimation of the onset time of diabetic complications in type 2 diabetes patients in Thailand: a survival analysis: Natthanicha Sauenram, Jutatip Sillabutra, Chukiat Viwatwongkasem, Pratana Satitvipawee; Osong Public Health Res Perspect. 2023;14(6):508-519. Published online November 23, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0084

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Graphical Abstract Abstract PDF: Objectives
This study aimed to identify factors associated with the onset time of diabetic complications in patients with type 2 diabetes mellitus (T2DM) and determine the best-fitted survival model. Methods: A retrospective cohort study was conducted among T2DM patients enrolled from October 1, 2016 to July 15, 2020 at the National Health Security Office (NHSO). In total, 388 T2DM patients were included. Cox proportional-hazard and parametric models were used to identify factors related to the onset time of diabetic complications. The Akaike information criterion, Bayesian information criterion, and Cox-Snell residual were compared to determine the best-fitted survival model. Results: Thirty diabetic complication events were detected among the 388 patients (7.7%). A 90% survival rate for the onset time of diabetic complications was found at 33 months after the first T2DM diagnosis. According to multivariate analysis, a duration of T2DM ≥42 months (time ratio [TR], 0.56; 95% confidence interval [CI], 0.33–0.96; p=0.034), comorbid hypertension (TR, 0.30; 95% CI, 0.15–0.60; p=0.001), mildly to moderately reduced levels of the estimated glomerular filtration rate (eGFR) (TR, 0.43; 95% CI, 0.24–0.75; p=0.003) and an eGFR that was severely reduced or indicative of kidney failure (TR, 0.38; 95% CI, 0.16–0.88; p=0.025) were significantly associated with the onset time of diabetic complications (p<0.05). Conclusion: Patients with T2DM durations of more than 42 months, comorbid hypertension, and decreased eGFR were at risk of developing diabetic complications. The NHSO should be aware of these factors to establish a policy to prevent diabetic complications after the diagnosis of T2DM.

Educational Needs Associated with the Level of Complication and Comparative Risk Perceptions in People with Type 2 Diabetes: Youngji Hwang, Dongsuk Lee, Yeon Sook Kim; Osong Public Health Res Perspect. 2020;11(4):170-176. Published online August 31, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.4.05

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Abstract PDF: Objectives
This study aimed to identify the educational needs of people with type 2 diabetes according to risk perceptions and the level of severity of complications.
Methods
There were 177 study participants who were outpatients of the internal medicine department at a university hospital located in the Republic of Korea, who consented to participate in the survey from December 10, 2016 to February 10, 2017. The data were analyzed using descriptive statistics, Pearson correlation, ANOVA with post-hoc comparison, and multiple regression analysis. Type 2 diabetes complications were classified into 3 groups: no complications, common complications, and severe complications.
Results
There were statistically significant positive correlations between educational needs and comparative risk perceptions, and the level of complication and comparative risk perception. Multiple regression analysis revealed that the factor predicting educational needs of type 2 diabetes people was their comparative risk perceptions, rather than the severity of diabetes complications or sociodemographic variables.
Conclusion
Since risk perception is the factor that indicates the educational needs of people with type 2 diabetes, there is a need to explore factors which increase risk perception, in order to meet educational needs. The findings suggest that a more specific and individualized educational program, which focuses on each person's risk perceptions, should be developed.

Factors that Correlate with Poor Glycemic Control in Type 2 Diabetes Mellitus Patients with Complications: Mohammad Haghighatpanah, Amir Sasan Mozaffari Nejad, Maryam Haghighatpanah, Girish Thunga, Surulivelrajan Mallayasamy; Osong Public Health Res Perspect. 2018;9(4):167-174. Published online August 31, 2018; DOI: https://doi.org/10.24171/j.phrp.2018.9.4.05

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Abstract PDF

Objectives

Inadequate glycemic control amongst patients with Type 2 diabetes mellitus (T2DM) indicates a major public health problem and a significant risk factor for the progression and complications caused by diabetes. Glycemic control is the main therapeutic objective for the prevention of organ damage and other complications arising from diabetes.

Methods

This was a retrospective observational study of T2DM patients with complications, who were aged 40 years and older. The study was conducted retrospectively on medical records (in-patient and out-patient) obtained from a South Indian teaching hospital, Manipal, India. The patients included in the study had fasting blood sugar, postprandial blood sugar and HbA1c measured at least twice during follow-ups the previous year. Patients’ HbA1c levels were categorized into good control ≤7% (≤53mmol/mol), and poor control >7% (>53mmol/mol), and patients’ characteristics were analyzed.

Results

A total of 657 patients were included in the study. The mean age was 59.67 (SD = 9.617) years, with 152 (23.1%) females and 505 (76.9%) males, and 514 (78.2%) patients had poor glycemic control. Most of the patients were on insulin mono-therapy [n = 271 (42.1%)], about a third of the patients were on combination therapy that included an oral hypoglycemic agent and insulin [n = 236 (36.6%)]. Patients with a history of more than 10 years of diabetes [n = 293 (44.6%)], had a family history of diabetes [n = 256 (39%)] and obesity [n = 95 (14.5%)], all had poor glycemic control.

Conclusion

This present study indicated a significant association of gender (female), age, high-density lipoprotein level, duration of diabetes and type of medication, with poor glycemic control in T2DM patients that had secondary medical complications.

Citations

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Brief Report

Imported Melioidosis in South Korea: A Case Series with a Literature Review: Seung Woo Kim, Geun-Yong Kwon, Bongyoung Kim, Donghyok Kwon, Jaeseung Shin, Geun-Ryang Bae; Osong Public Health Res Perspect. 2015;6(6):363-368. Published online December 31, 2015; DOI: https://doi.org/10.1016/j.phrp.2015.10.014

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Abstract PDF

Objectives
Melioidosis is a potentially fatal infectious disease caused by the environmental anaerobic Gram-negative bacillus Burkholderia pseudomallei. Melioidosis is endemic to areas of northern Australia and Southeast Asia. With increasing international travel and migration, imported cases of melioidosis are being reported regularly. Here, we summarize the 11 cases of melioidosis reported in South Korea from 2003 to 2014.
Methods
Tracing epidemiological investigations were performed on every patient reported to the National Surveillance System since 2011. A systematic literature search was performed to identify melioidosis cases that occurred prior to 2011.
Results
The overall fatality rate was 36.4%. All the patients had visited Southeast Asia where melioidosis is endemic. The stay in the endemic region ranged from 4 days to 20 years. Of the seven patients who developed initial symptoms after returning to South Korea, the time interval between returning to South Korea and symptom onset ranged from 1 day to 3 years. The remaining four patients developed symptoms during their stay in the endemic region and were diagnosed with melioidosis in South Korea. Seven (63.6%) patients possessed at least one risk factor, all of whom were diabetic. Pneumonia was the most frequent clinical manifestation, but the patients showed a wide spectrum of clinical features, including internal organ abscesses, a mycotic aneurysm of the aorta, and coinfection with tuberculosis.
Conclusion
An early diagnosis and initiation of the appropriate antibiotics can reduce the mortality of melioidosis. Consequently, increased awareness of the risk factors and clinical features of melioidosis is required.

Citations

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