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  • 1
    Online Resource
    Online Resource
    Using natural experimental studies to guide public health action: turning the evidence-based medicine paradigm on its head
    BMJ ; 2020
    In:  Journal of Epidemiology and Community Health Vol. 74, No. 2 ( 2020-02), p. 203-208
    Details
    In: Journal of Epidemiology and Community Health, BMJ, Vol. 74, No. 2 ( 2020-02), p. 203-208
    Abstract: Despite smaller effect sizes, interventions delivered at population level to prevent non-communicable diseases generally have greater reach, impact and equity than those delivered to high-risk groups. Nevertheless, how to shift population behaviour patterns in this way remains one of the greatest uncertainties for research and policy. Evidence about behaviour change interventions that are easier to evaluate tends to overshadow that for population-wide and system-wide approaches that generate and sustain healthier behaviours. Population health interventions are often implemented as natural experiments, which makes their evaluation more complex and unpredictable than a typical randomised controlled trial (RCT). We discuss the growing importance of evaluating natural experiments and their distinctive contribution to the evidence for public health policy. We contrast the established evidence-based practice pathway, in which RCTs generate ‘definitive’ evidence for particular interventions, with a practice-based evidence pathway in which evaluation can help adjust the compass bearing of existing policy. We propose that intervention studies should focus on reducing critical uncertainties, that non-randomised study designs should be embraced rather than tolerated and that a more nuanced approach to appraising the utility of diverse types of evidence is required. The complex evidence needed to guide public health action is not necessarily the same as that which is needed to provide an unbiased effect size estimate. The practice-based evidence pathway is neither inferior nor merely the best available when all else fails. It is often the only way to generate meaningful evidence to address critical questions about investing in population health interventions.
    Type of Medium: Online Resource
    ISSN: 0143-005X , 1470-2738
    URL: Article
    DOI: 10.1136/jech-2019-213085
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2015405-7
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  • 2
    Online Resource
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    Trends in incidence of total or type 2 diabetes: systematic review
    BMJ ; 2019
    In:  BMJ
    Details
    In: BMJ, BMJ
    Abstract: To assess what proportions of studies reported increasing, stable, or declining trends in the incidence of diagnosed diabetes. Design Systematic review of studies reporting trends of diabetes incidence in adults from 1980 to 2017 according to PRISMA guidelines. Data sources Medline, Embase, CINAHL, and reference lists of relevant publications. Eligibility criteria Studies of open population based cohorts, diabetes registries, and administrative and health insurance databases on secular trends in the incidence of total diabetes or type 2 diabetes in adults were included. Poisson regression was used to model data by age group and year. Results Among the 22 833 screened abstracts, 47 studies were included, providing data on 121 separate sex specific or ethnicity specific populations; 42 (89%) of the included studies reported on diagnosed diabetes. In 1960-89, 36% (8/22) of the populations studied had increasing trends in incidence of diabetes, 55% (12/22) had stable trends, and 9% (2/22) had decreasing trends. In 1990-2005, diabetes incidence increased in 66% (33/50) of populations, was stable in 32% (16/50), and decreased in 2% (1/50). In 2006-14, increasing trends were reported in only 33% (11/33) of populations, whereas 30% (10/33) and 36% (12/33) had stable or declining incidence, respectively. Conclusions The incidence of clinically diagnosed diabetes has continued to rise in only a minority of populations studied since 2006, with over a third of populations having a fall in incidence in this time period. Preventive strategies could have contributed to the fall in diabetes incidence in recent years. Data are limited in low and middle income countries, where trends in diabetes incidence could be different. Systematic review registration Prospero CRD42018092287.
    Type of Medium: Online Resource
    ISSN: 0959-8138 , 1756-1833
    URL: Article
    DOI: 10.1136/bmj.l5003
    Language: English
    Publisher: BMJ
    Publication Date: 2019
    detail.hit.zdb_id: 1479799-9
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  • 3
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    Prevalence of diagnosed diabetes in American Indian and Alaska Native adults, 2006–2017
    BMJ ; 2020
    In:  BMJ Open Diabetes Research & Care Vol. 8, No. 1 ( 2020-04), p. e001218-
    Details
    In: BMJ Open Diabetes Research & Care, BMJ, Vol. 8, No. 1 ( 2020-04), p. e001218-
    Abstract: The objective of this study was to examine recent trends in diagnosed diabetes prevalence for American Indian and Alaska Native (AI/AN) adults aged 18 years and older in the Indian Health Service (IHS) active clinical population. Research design and methods Data were extracted from the IHS National Data Warehouse for AI/AN adults for each fiscal year from 2006 (n=729 470) through 2017 (n=1 034 814). The prevalence of diagnosed diabetes for each year and the annual percentage change were estimated for adults overall, as well as by sex, age group, and geographic region. Results After increasing significantly from 2006 to 2013, diabetes prevalence for AI/AN adults in the IHS active clinical population decreased significantly from 2013 to 2017. Prevalence was 14.4% (95% CI 13.9% to 15.0%) in 2006; 15.4% (95% CI 14.8% to 16.0%) in 2013; and 14.6% (95% CI 14.1% to 15.2%) in 2017. Trends for men and women were similar to the overall population, as were those for all age groups. For all geographic regions, prevalence either decreased significantly or leveled off in recent years. Conclusions Diabetes prevalence in AI/AN adults in the IHS active clinical population has decreased significantly since 2013. While these results cannot be generalized to all AI/AN adults in the USA, this study documents the first known decrease in diabetes prevalence for AI/AN people.
    Type of Medium: Online Resource
    ISSN: 2052-4897
    URL: Article
    DOI: 10.1136/bmjdrc-2020-001218
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2732918-5
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  • 4
    Online Resource
    Online Resource
    New directions in incidence and prevalence of diagnosed diabetes in the USA
    BMJ ; 2019
    In:  BMJ Open Diabetes Research & Care Vol. 7, No. 1 ( 2019-05), p. e000657-
    Details
    In: BMJ Open Diabetes Research & Care, BMJ, Vol. 7, No. 1 ( 2019-05), p. e000657-
    Abstract: To determine whether diabetes prevalence and incidence has remained flat or changed direction during the past 5 years. Research design and methods We calculated annual prevalence and incidence of diagnosed diabetes (type 1 and type 2 combined) for civilian, non-institutionalized adults aged 18–79 years using annual, nationally representative cross-sectional survey data from the National Health Interview Survey from 1980 to 2017. Trends in rates by age group, sex, race/ethnicity, and education were calculated using annual percentage change (APC). Results Overall, the prevalence of age-adjusted, diagnosed diabetes did not change significantly from 1980 to 1990, but increased significantly (APC 4.4%) from 1990 to 2009 to a peak of 8.2 per 100 adults (95% CI 7.8 to 8.6), and then plateaued through 2017. The incidence of age-adjusted, diagnosed diabetes did not change significantly from 1980 to 1990, but increased significantly (APC 4.8%) from 1990 to 2007 to 7.8 per 1000 adults (95% CI 6.7 to 9.0), and then decreased significantly (APC −3.1%) to 6.0 (95% CI 4.9 to 7.3) in 2017. The decrease in incidence appears to be driven by non-Hispanic whites with an APC of −5.1% (p=0.002) after 2008. Conclusions After an almost 20-year increase in the national prevalence and incidence of diagnosed diabetes, an 8-year period of stable prevalence and a decrease in incidence has occurred. Causes of the plateauing and decrease are unclear but the overall burden of diabetes remains high and deserves continued monitoring and intervention.
    Type of Medium: Online Resource
    ISSN: 2052-4897
    URL: Article
    DOI: 10.1136/bmjdrc-2019-000657
    Language: English
    Publisher: BMJ
    Publication Date: 2019
    detail.hit.zdb_id: 2732918-5
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  • 5
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    Online Resource
    Characteristics of undiagnosed diabetes in men and women under the age of 50 years in the Indian subcontinent: the National Family Health Survey (NFHS-4)/Demographic Health Survey 2015–2016
    BMJ ; 2020
    In:  BMJ Open Diabetes Research & Care Vol. 8, No. 1 ( 2020-02), p. e000965-
    Details
    In: BMJ Open Diabetes Research & Care, BMJ, Vol. 8, No. 1 ( 2020-02), p. e000965-
    Abstract: Prior studies examining diabetes prevalence in India have found that nearly 50% of the diabetes population remains undiagnosed; however, the specific populations at risk are unclear. Research design and methods First, we estimated the prevalence of undiagnosed diabetes in India for 750 924 persons between the ages of 15 years and 50 years who participated in the National Family Health Survey (NFHS-4)/Demographic Health Survey (2015–2016), a cross-sectional survey of all 29 states and 7 union territories of India. We defined ‘undiagnosed diabetes’ as individuals who did not know about their diabetes status but had high random (≥200 mg/dL) or fasting (≥126 mg/dL) blood glucose levels. Second, using Poisson regression, we associated 10 different factors, including the role of healthcare access, and undiagnosed diabetes. Third, we examined the association of undiagnosed diabetes with other potential comorbid conditions. Results The crude prevalence of diabetes for women and men aged 15–50 years was 2.9%, 95% CI 2.9% to 3.1%, with self-reported diabetes prevalence at 1.7%, 95% CI 1.6 to 1.8. The overall prevalence of undiagnosed diabetes for 15–50 year olds was at 1.2%, 95% CI 1.2% to 1.3%. Forty-two per cent, 95% CI 40.7% to 43.4% of the individuals with high glucose levels were unaware of their diabetes status. Approximately 45%, 95% CI 42.9% to 46.4% of undiagnosed diabetes population had access to healthcare. Men, younger individuals, and those with lower levels of education were most at risk of being undiagnosed. Geographically, the Southern states in India had a significantly higher prevalence of undiagnosed diabetes despite having nearly universal access to healthcare. Risk factors combined with random glucose could predict undiagnosed diabetes (area under the curve of 97.8%, 95% CI 97.7% to 97.8%), Nagelkerke R 2 of 66%). Conclusion Close to half (42%) of the people with diabetes in India are not aware of their disease status, and a large subset of these people are at risk of poor detection, despite having health insurance and/or having access to healthcare. Younger age groups and men are the most vulnerable.
    Type of Medium: Online Resource
    ISSN: 2052-4897
    URL: Article
    DOI: 10.1136/bmjdrc-2019-000965
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2732918-5
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  • 6
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    Comparing different definitions of prediabetes with subsequent risk of diabetes: an individual participant data meta-analysis involving 76 513 individuals and 8208 cases of incident diabetes
    BMJ ; 2019
    In:  BMJ Open Diabetes Research & Care Vol. 7, No. 1 ( 2019-12), p. e000794-
    Details
    In: BMJ Open Diabetes Research & Care, BMJ, Vol. 7, No. 1 ( 2019-12), p. e000794-
    Abstract: There are currently five widely used definition of prediabetes. We compared the ability of these to predict 5-year conversion to diabetes and investigated whether there were other cut-points identifying risk of progression to diabetes that may be more useful. Research design and methods We conducted an individual participant meta-analysis using longitudinal data included in the Obesity, Diabetes and Cardiovascular Disease Collaboration. Cox regression models were used to obtain study-specific HRs for incident diabetes associated with each prediabetes definition. Harrell’s C-statistics were used to estimate how well each prediabetes definition discriminated 5-year risk of diabetes. Spline and receiver operating characteristic curve (ROC) analyses were used to identify alternative cut-points. Results Sixteen studies, with 76 513 participants and 8208 incident diabetes cases, were available. Compared with normoglycemia, current prediabetes definitions were associated with four to eight times higher diabetes risk (HRs (95% CIs): 3.78 (3.11 to 4.60) to 8.36 (4.88 to 14.33)) and all definitions discriminated 5-year diabetes risk with good accuracy (C-statistics 0.79–0.81). Cut-points identified through spline analysis were fasting plasma glucose (FPG) 5.1 mmol/L and glycated hemoglobin (HbA1c) 5.0% (31 mmol/mol) and cut-points identified through ROC analysis were FPG 5.6 mmol/L, 2-hour postload glucose 7.0 mmol/L and HbA1c 5.6% (38 mmol/mol). Conclusions In terms of identifying individuals at greatest risk of developing diabetes within 5 years, using prediabetes definitions that have lower values produced non-significant gain. Therefore, deciding which definition to use will ultimately depend on the goal for identifying individuals at risk of diabetes.
    Type of Medium: Online Resource
    ISSN: 2052-4897
    URL: Article
    DOI: 10.1136/bmjdrc-2019-000794
    Language: English
    Publisher: BMJ
    Publication Date: 2019
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  • 7
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    Online Resource
    Disruption of diabetes and hypertension care during the COVID-19 pandemic and recovery approaches in the Latin America and Caribbean region: a scoping review protocol
    BMJ ; 2024
    In:  BMJ Open Vol. 14, No. 1 ( 2024-01), p. e074443-
    Details
    In: BMJ Open, BMJ, Vol. 14, No. 1 ( 2024-01), p. e074443-
    Abstract: The COVID-19 pandemic significantly disrupted primary healthcare globally, with particular impacts on diabetes and hypertension care. This review will examine the impact of pandemic disruptions of diabetes and hypertension care services and the evidence for interventions to mitigate or reverse pandemic disruptions in the Latin America and Caribbean (LAC) region. Methods and analyses This scoping review will examine care delivery disruption and approaches for recovery of primary healthcare in the LAC region during the COVID-19 pandemic, focusing on diabetes and hypertension awareness, detection, treatment and control. Guided by Arksey and O’Malley’s scoping review methodology framework, this protocol adheres to the Joanna Briggs Institute guidelines for scoping review protocols and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance for protocol development and scoping reviews. We searched MEDLINE, CINAHL, Global Health, Embase, Cochrane, Scopus, Web of Science and LILACS for peer-reviewed literature published from 2020 to 12 December 2022 in English, Spanish or Portuguese. Studies will be considered eligible if reporting data on pandemic disruptions to primary care services within LAC, or interventions implemented to mitigate or reverse pandemic disruptions globally. Studies on COVID-19 or acute care will be excluded. Two reviewers will independently screen each title/abstract for eligibility, screen full texts of titles/abstracts deemed relevant and extract data from eligible full-text publications. Conflicts will be resolved through discussion and with the help of a third reviewer. Appropriate analytical techniques will be employed to synthesise the data, for example, frequency counts and descriptive statistics. Quality will be assessed using the Newcastle Ottawa Quality Assessment Scale. Ethics and dissemination No ethics approval was needed as this is a scoping review of published literature. Results will be disseminated in a report to the World Bank and the Pan American Health Organization, in peer-reviewed scientific journals, and at national and international conferences.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2023-074443
    DOI: 10.1136/bmjopen-2023-074443.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2024
    detail.hit.zdb_id: 2599832-8
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  • 8
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    Trends in type 2 diabetes detection among adults in the USA, 1999–2014
    BMJ ; 2018
    In:  BMJ Open Diabetes Research & Care Vol. 6, No. 1 ( 2018-01), p. e000487-
    Details
    In: BMJ Open Diabetes Research & Care, BMJ, Vol. 6, No. 1 ( 2018-01), p. e000487-
    Abstract: To examine recent trends in type 2 diabetes detection among adults in the USA. Research design and methods We used data from the 1999–2014 National Health and Nutrition Examination Surveys on non-pregnant adults (aged ≥18 years) not reporting a diagnosis of diabetes (n=16 644 participants, averaging about 2000 for each 2-year cycle). We defined undiagnosed diabetes as a fasting plasma glucose ≥126 mg/dL or a hemoglobin A1c ≥6.5% (48 mmol/mol). We measured case detection as the probability of finding undiagnosed type 2 diabetes among the population without diagnosed diabetes. Linear regression models were used to examine trends overall and by sociodemographic characteristics (ie, age, gender, race/ethnicity, education, poverty-income ratio (PIR)). Results Age-standardized probability of finding undiagnosed type 2 diabetes was 3.0% (95% CI 2.1% to 4.2%) during 1999–2000 and 2.8% (2.2%–3.6%) during 2013–2014 ( P for trend=0.52). Probability increased among Mexican-Americans ( P for trend=0.01) but decreased among adults aged 65 years or older ( P for trend=0.04), non-Hispanic (NH) white ( P for trend=0.02), and adults in the highest PIR tertile ( P for trend=0.047). For all other sociodemographic groups, no significant trends were detected. Conclusions We found little evidence of increased detection of undiagnosed type 2 diabetes among adults in the USA during the past 15 years. Although improvements were seen among NH white, older, and wealthy adults, these improvements were not large. As the scope of primary prevention efforts increases, case detection may improve.
    Type of Medium: Online Resource
    ISSN: 2052-4897
    URL: Article
    DOI: 10.1136/bmjdrc-2017-000487
    Language: English
    Publisher: BMJ
    Publication Date: 2018
    detail.hit.zdb_id: 2732918-5
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  • 9
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    Time to start addressing (and not just describing) the social determinants of diabetes: results from the NEXT-D 2.0 network
    BMJ ; 2021
    In:  BMJ Open Diabetes Research & Care Vol. 9, No. Suppl 1 ( 2021-12), p. e002524-
    Details
    In: BMJ Open Diabetes Research & Care, BMJ, Vol. 9, No. Suppl 1 ( 2021-12), p. e002524-
    Type of Medium: Online Resource
    ISSN: 2052-4897
    URL: Article
    DOI: 10.1136/bmjdrc-2021-002524
    Language: English
    Publisher: BMJ
    Publication Date: 2021
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  • 10
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    Identifying risk for type 2 diabetes in different age cohorts: does one size fit all?
    BMJ ; 2017
    In:  BMJ Open Diabetes Research & Care Vol. 5, No. 1 ( 2017-10), p. e000447-
    Details
    In: BMJ Open Diabetes Research & Care, BMJ, Vol. 5, No. 1 ( 2017-10), p. e000447-
    Type of Medium: Online Resource
    ISSN: 2052-4897
    URL: Article
    DOI: 10.1136/bmjdrc-2017-000447
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 2732918-5
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