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  Access statistics : Table of Contents
   2015| February-May  | Volume 6 | Issue 1  
    Online since January 13, 2017

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Cost-effectiveness of switching from biphasic human insulin (BHI) to biphasic insulin aspart 30 (BIAsp-30) in type 2 diabetes patients with suboptimal glycaemic control in Singapore
SY Goh, SC Tan, LC Lim, B Chua, B Hunt
February-May 2015, 6(1):2-2
The aim of the analysis was to assess the long-term cost-effectiveness of switching from BHI to BIAsp-30 in type 2 diabetes patients with suboptimal glycaemic control in Singapore. Lifetime cost-effectiveness analysis was performed from both societal and healthcare perspectives using the published and validated CORE Diabetes Model. Projected outcomes included quality-adjusted life expectancy, cumulative incidence of complications, direct and indirect costs. Baseline characteristics and treatment effects were derived from the ASEAN cohort analyses of the A1chieve study. Local cost data reported by the Singapore Ministry of Health was used, along with resource use inputs gathered through structured interviews with local key opinion leaders. A 3% discount rate was adopted. All costs were reported in 2013 S$. A series of sensitivity analyses were conducted to test the robustness of the cost-effectiveness results. The base case analysis showed that from both healthcare and societal perspectives, BIAsp-30 was dominant over BHI in poorly controlled diabetes patients. An Incremental benefit of 0.36 quality-adjusted life years was estimated with cost savings of S$14,180 from a healthcare perspective, and S$15,097 from a societal perspective. BIAsp-30 remained dominant over BHI in all the sensitivity analyses except when no difference in hypoglycaemia risk was assumed, where the incremental cost- effectiveness ratio was S$4,675. BIAsp-30 is both a clinically effective and cost-saving treatment for poorly controlled type 2 diabetes patients switching from BHI to BIAsp-30 in the public context of Singapore.
[ABSTRACT]   Full text not available  [PDF]
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Association of periodontal disease with lifestyle, diabetes mellitus and oral health care practices in an indigenous Bangladeshi population
K Zaman, M Naser, M.H.A. Khan, SH Habib
February-May 2015, 6(1):5-5
The present study evaluates the potential association of periodontal diseases among the indigenous "Garo" population in Bangladesh with their lifestyle, diabetes mellitus and routine oral health care practices. Adult males and females of the community were selected for the study. Data were recorded through one to one, face-to-face interview using a set of standard questionnaire. All teeth except the third molars were examined at 6 sites for gingival colour and swelling, bleeding on probing, probing pocket depths (PPD) and clinical attachment level (CAL). Gingival Index (GI) was recorded according to Loe and Silness. The greatest score for each of the 6 sites was used for assessing the PPD and CAL. Of 240 subjects, 64% were female. The mean number of teeth present was 26, and the mean number of affected teeth was 8.9 (PPD ≥3 mm). The mean ± standard deviations of GI, PPD and CAL of the community were 0.43±0.70, 2.34±0.47 and 2.70±0.77 respectively. Betel-leaf was chewed by 75%, 57.5% were tooth brush user and remaining 42.5% used traditional ways. A statistically significant difference in PPD and CAL was found between smokers and non-smokers; tooth-brush users and non-users; diabetics and non-diabetics. PPD and CAL were significantly high among frequent betel-leaf chewers and in older age-group. Without having an access to a professional dentist or part of any oral health care awareness programme, the relatively low prevalence of periodontal diseases can possibly be attributed, in part, to the traditional eating habits of the indigenous "Garo" population.
[ABSTRACT]   Full text not available  [PDF]
  692 217 -
Evaluation of protein oxidation and its association with total oxidants and antioxidants among type 2 diabetics in Asians
K Kar, S Sinha
February-May 2015, 6(1):4-4
Incidence and prevalence of type 2 diabetes and its complications are increasing worldwide but more in Asian countries. Oxidative stress is believed to be a common pathogenic factor for initiation for its grave consequences. Advanced oxidation protein product (AOPP) is a marker of protein damage whereas total oxidant status (TOS) reflects the severity of oxidative stress. Variation in results was found by different authors about association between these markers and antioxidant status in a limited number of studies. This cross sectional study was conducted among 50 patients who were clinically diagnosed type 2 diabetes, aged 47 and sex matched controls were selected for the study according to inclusion and exclusion criteria. We analyzed HbA1C, AOPP, TOS and Trolox Equivalent Antioxidant Capacity (TEAC) in diabetes patients and compared them with controls. (HbA1C was estimated by boronate affinity chromatography and others were estimated spectrophotometrically. Significant increase in mean HbA1C, AOPP (p<0.0001) and increase in mean TOS level (p<0.184) were found in diabetes patients in comparison to controls. We also observed significant decrease in mean TEAC levels (p<0.0001). Regression analysis showed the dependence of TEAC on AOPP (r= -0.99, p<0.0001, y=1.607-0.004x). AOPP accumulation is correlated with increased antioxidant consumption in type 2 diabetes. Estimation of AOPP is very much beneficial for prediction of chronic and grave complications of type 2 diabetes.
[ABSTRACT]   Full text not available  [PDF]
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Risk of coronary heart disease in type 2 diabetes: a follow-up study of Bangladeshi population
PA Khanam, MA Islam, MA Sayeed, T Begum, SH Habib, MG Rabbani, S Choudhury, H Mahtab, A.K.A Khan
February-May 2015, 6(1):3-3
The aim of this study was to determine the potential risk factors of CHD in Type 2 diabetic patients. We studied 2887 diabetic patients from the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) registry record books for the period from 1984 to 1997. We included socio- demographic information (age, sex, residence and education), anthropometry (height, weight) and blood pressure. Body mass index (BMI) and mean arterial blood pressure (MABP) were calculated. Also, the time from the diagnosis of type 2 diabetes mellitus (T2DM) to the occurrence of CHD was recorded. We used the logistic regression model and examined the potential risk factors. We have studied 2887 Type 2 diabetic patients. Among them male and female participants were 67.3% and 32.7% respectively. Their mean (SD) age was 52.69 (12.41) years, BMI was 22.92 (3.80) and MABP was 97.26 (11.53). The mean (SD) of 2-hBG was 12.39 (3.37) mmol/l. The subject with advanced age (1.7 vs. 5.7%; χ2=11.12, p= 0.001), increasing BMI (p=0.000) and MABP (p=0.000), and urban (p=0.000) participant had significantly higher prevalence of CHD than compared with the lower (age ≤ 40, BMI ≤ 21.46, MABP ≤ 93.33 ) groups and rural counterpart. The logistic regression analysis also showed that urban subjects, literate population, and increased age, BMI and MABP were the important risk factors of CHD with diabetes. We conclude that older age, obesity and high blood pressure were significant risk factors of CHD with diabetes. Compared with rural subjects, the urban subjects showed significantly greater risk for CHD. We couldn't find any correlation with the increasing 2-hBG as a significant risk factor of CHD.
[ABSTRACT]   Full text not available  [PDF]
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Increasing Diabetes Healthcare Capacity in Bangladesh through a Distance Learning Project
A.K.A. Khan, H Mahtab, T Ahmed, SM Ashrafuzzaman, B Bhowmik, T Ahmed, F Afsana, MM Ilondo, DE Stevens
February-May 2015, 6(1):1-1
The purpose of this study was to evaluate the impact of the Distance Learning Program (DLP) on provider capacity to provide comprehensive diabetes care and improvement on patient outcomes in Bangladesh. Study was conducted among 1974 DLP trained physicians, 1876 Non-DLP physicians and 2617 diabetic patients. In addition, quality of patient care and clinical outcomes before and after the implementation of DLP were also studied. Historical documents including patient case records from registered patient guidebooks and biochemical profiles from laboratory database were documented and analyzed. DLP physicians had more knowledge in each clinical practice guideline of diabetes care than Non-DLP physicians (odds ratio [OR] range: 2.2 to 11.7). DLP-trained physicians performed more diabetes-related examinations including blood pressure (OR=3.0), waist and hip circumference (OR= 2.6), BMI (OR= 2.6), foot (OR= 2.2), eye (OR= 2.0) and investigated blood glucose (OR= 2.2), hemoglobin A1c (A1C) (OR= 2.1), lipids (OR=1.9), creatinine (OR=1.9), micro albumin (OR=1.8) and ECG (OR=1.6) more than non-DLP physicians. DLP physicians felt more confident to give advice on key areas of diabetes care including diet (OR=2.9), physical activity (OR=3.0), smoking cessation (OR=2.5), foot care (OR=2.9) and complications related to diabetes (OR=2.8) than non-DLP doctors. Significant improvement of patients care including dietary advice (91 to 96%), frequency of clinic visits (3 to 3.6 time), foot care referral (3 to 8%), measurement of blood pressure (73.1 to 89.2%) and blood glucose (58 to 75%) were observed from pre to post DLP period. Average values of fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) significantly decreased in post DLP period. Patient satisfaction also improved between pre to post DLP period. DLP is feasible and acceptable to physicians in Bangladesh. It has made highly positive impact on patients care. We recommend that other resource-poor settings should consider the adoption of a DLP.
[ABSTRACT]   Full text not available  [PDF]
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